Menopausia y terapia hormonal de la menopausia. Las recomendaciones 2018 de la Unidad de Endocrinología Ginecológica de Clínica Alemana de Santiago -Sociedad Italiana de la Menopausia y la Sociedad Chilena de Endocrinología Ginecológica / Menopause and menopausal hormone therapy. The 2018 recommendations of the Gynecological Endocrinology Unit of Clínica Alemana de Santiago -Italian Society of Menopause and the Chilean Society of Gynecological Endocrinology

ABSTRACT In the last decade, the risk benefits ratio of MHT has been evaluated mainly in terms of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these Recommendations is to provide a simple and updated reference on postmenopausal MHT. The term MHT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential (Seq) when progestogen is added to ERT for 10-14 days a month, or continuous combined (CC) when progestogen is administered continuously every day along with a fixed amount of estrogen. MHT also includes Tibolone and the Tissue Selective Estrogen Complex (TSEC).

Transmission study of Andes hantavirus infection in wild sigmodontine rodents.

Our study was designed to contribute to an understanding of the timing and conditions under which transmission of Andes hantavirus in Oligoryzomys longicaudatus reservoir populations takes place. Mice were caged in test habitats consisting of steel drums containing holding cages, where seronegative rodents were exposed to wild seropositive individuals by freely sharing the same cage or being separated by a wire mesh. Tests were also performed for potential viral transmission to mice from excrement-tainted bedding in the cages. Andes virus transmitted efficiently; from 130 attempts with direct contact, 12.3% resulted in virus transmission. However, if we consider only those rodents that proved to be infectious, from 93 attempts we obtained 16 infected animals (17.2%). Twelve of them resulted from intraspecies O. longicaudatus encounters where male mice were differentially affected and 4 resulted from O. longicaudatus to Abrothrix olivaceus. Experiments using Abrothrix longipilis as receptors were not successful. Transmission was not observed between wire mesh-separated animals, and mice were not infected from excrement-tainted bedding. Bites seemed not to be a requisite for oral transmission. Genomic viral RNA was amplified in two out of three saliva samples from seropositive rodents, but it was not detected in urine samples obtained by vesicle puncture from two other infected rodents. Immunohistochemistry, using antibodies against Andes (AND) hantavirus proteins, revealed strong reactions in the lung and salivary glands, supporting the possibility of oral transmission. Our study suggests that AND hantavirus may be principally transmitted via saliva or saliva aerosols rather than via feces and urine.

Sperm binding to the human zona pellucida and calcium influx in response to GnRH and progesterone.

In this study the effect of the sequential exposure of spermatozoa to progesterone and gonadotrophin-releasing hormone (GnRH) upon zona binding and the intracellular free Ca2+ concentration was evaluated. Sperm aliquots were treated as follows: (a) 0.7 micro mol l(-1) progesterone or 0.1% DMSO (progesterone solvent) followed by 50 nmol l(-1) of GnRH; (b) 50 nmol l(-1) of GnRH or distilled water (GnRH solvent) followed by 0.7 micro mol l(-1) of progesterone. Additional aliquots were incubated with DMSO or distilled water (controls) and with 0.7 micro mol l(-1) of progesterone or 50 nmol l(-1) of GnRH. All treatments were for 5 min. Motile spermatozoa were incubated in modified Tyrode's medium, at 37 degrees C, 5% CO2, 10 x 10(6) spermatozoa ml(-1), for 4.5 h. Intracellular Ca2+ concentration and sperm-zona binding was evaluated using fura 2 and the hemizona assay, respectively. GnRH and progesterone increased sperm-zona binding and the Ca2+ concentration. Regarding zona binding, the effect of GnRH was significantly greater when the spermatozoa had been previously treated with progesterone (progesterone-->GnRH=185 +/- 116 zona-bound spermatozoa versus DMSO-->GnRH=99 +/- 15, P < 0.001). On the other hand, previous treatment with GnRH did not modify their subsequent response to progesterone (GnRH-->progesterone= 114 +/- 19 zona-bound spermatozoa versus distilled water-->progesterone=108 +/- 22, NS). The results regarding intracellular Ca2+ showed a similar pattern. These findings suggest a priming effect of progesterone upon a GnRH-induced increase in sperm-zona binding and intracellular Ca2+.

Postpartum thyroid dysfunction and postpartum depression: are they two linked disorders?

OBJECTIVE: Postpartum has been considered as a period of risk for developing postpartum depression (PD) by some but not all authors, and this PD has been linked with postpartum thyroid dysfunction (PPTD). The major aim of this study was to evaluate the relation between the presence of PPTD and PD. DESIGN AND PATIENTS: Six hundred and forty-one healthy Caucasian women recruited between their 36th week of pregnancy and fourth day postpartum underwent clinical and laboratory evaluation and were checked again at 1 (n = 605), 3 (n = 552), 6 (n = 574), 9 (n = 431), and 12 (n = 444) months postpartum. MEASUREMENTS: At baseline and at each clinical evaluation, Beck Depression Inventory (BDI) was administered to screen PD. The definitive diagnoses of PD was performed by a psychiatrist according to the DSM-III-R criteria. At each visit, we determined serum free T4 and TSH concentrations. Thyroperoxidase and thyroglobulin antibodies were determined only in patients with abnormal hormone concentrations. Postpartum thyroiditis (PPT) was considered to be present in women with overt or subclinical transient hyperthyroidism between 1 and 3 months postpartum and/or overt or subclinical hypothyroidism between 3 and 6 months postpartum. RESULTS: Fifty-six women developed postpartum thyroid dysfunction (PPTD), corresponding to an incidence rate of 11%: 45 with PPT [incidence rate 7.8%; confidence interval (CI) 5.6-10%], eight with Graves' disease (incidence rate 1.5%; CI 0.5-2.5%) and three with nonpalpable toxic thyroid adenoma (incidence rate 0.5%; CI 0-1.5%). Five hundred and eighty of the evaluated women (incidence rate 90.5%; CI 95% 88.2-92.8) presented BDI scores below 21 and therefore the PD diagnoses was excluded. In 50 cases (incidence rate 7.8%; Cl 95% 5.7-9.8), we detected a BDI score over 21 in some evaluations, but the PD diagnosis was not confirmed. Another 11 (incidence rate 1.7%; CI 95% 0.7-2.7) were diagnosed as having PD and required psychiatric treatment. None of the PPTD was diagnosed as having PD. The BDI scores frequency over 21 was similar between healthy women and those with PPTD. Patients with a previous history of depression developed PD more often (P < 0.0001). One hundred and ninety women breast fed their babies for more than 2 months, without observing a higher PD rate or BDI scores over 21 (P = 0.5). CONCLUSIONS: We found a general PD incidence rate of 1.7% in our group of patients. This figure is not higher in women with hormone abnormalities caused by PPTD. Women with a past history of depression present a higher risk of PD while those who breast fed did not have an increased risk.

Gonadotropin-releasing hormone-stimulated sperm binding to the human zona is mediated by a calcium influx.

The mechanism by which GnRH increases sperm-zona pellucida binding in humans was investigated in this study. We tested whether GnRH increases sperm-zona binding in Ca(2+)-free medium and in the presence of Ca(2+) channel antagonists. We also examined the GnRH effect on the intracellular free Ca(2+) concentration ([Ca(2+)](i)). Sperm treatment with GnRH increased sperm-zona binding 300% but only when Ca(2+) was present in the medium. In Ca(2+)-free medium or in the presence of 400 nM nifedipine, 80 microM diltiazem, or 50 microM verapamil, GnRH did not influence sperm-zona binding. GnRH increased the [Ca(2+)](i) in the sperm in a dose-dependent manner. The maximum effect was reached with 75 nM GnRH. The GnRH-induced increase in [Ca(2+)](i) was fast and transient, from a basal [Ca(2+)](i) of 413 +/- 22 nM to a peak value of 797 +/- 24 nM. The GnRH-induced increase in [Ca(2+)](i) was entirely due to a Ca(2+) influx from the extracellular medium because the increase in [Ca(2+)](i) was blocked by the Ca(2+) chelator EGTA and by the Ca(2+) channel antagonists nifedipine and diltiazem. These antagonists, however, were not able to inhibit the progesterone-activated Ca(2+) influx. On the contrary, T-type calcium channel antagonists pimozide and mibefradil did not affect GnRH-activated Ca(2+) influx but inhibited the progesterone-activated Ca(2+) influx. Finally, the GnRH-induced Ca(2+) influx was blocked by two specific GnRH antagonists, Ac-D-Nal(1)-Cl-D-Phe(2)-3-Pyr-D-Ala(3)-Arg(5)-D-Glu(AA)(6)-GnRH and Ac-(3,4)-dehydro-Pro(1),-p-fluoro-D-Phe(2), D-Trp(3,6)-GnRH. These results suggest that GnRH increases sperm-zona binding via an elevation of [Ca(2+)](i) through T-type, voltage-operated calcium channels.

Postpartum thyroiditis: epidemiology and clinical evolution in a nonselected population.

Postpartum thyroiditis (PPT) presents in approximately 5% of women. Its incidence, clinical characteristics, and evolution were studied in a nonselected population of Mediterranean women. Six hundred five healthy women, recruited between the 36th week of pregnancy and the 4th postpartum day, underwent initial clinical and biological evaluation and postpartum at 1 (n = 605), 3 (n = 552), 6 (n = 574), 9 (n = 431), and 12 (n = 444) months. PPT was diagnosed in women with transient hyperthyroidism between 1 and 3 months postpartum and/or hypothyroidism between 3 and 6 months postpartum. Permanent hypothyroidism was considered if it was overt and persisted one year after diagnosis. The incidence rate of PPT was 7.8%. Eighty-two percent of PPT patients had hormone abnormalities at the 6th month postpartum, 8.8% showed depression and 51% goiter. PPT was manifest as hyperthyroidism plus hypothyroidism in 35.5% of patients, because only transient hyperthyroidism in 22.2% and as hypothyroidism alone in 42.3%. Five patients with hypothyroidism during PPT (0.82% of the initial population, 11.1% of PPT patients, and 15.6% of hypothyroidism PPT patients) presented permanent hypothyroidism after a follow-up of 39.8 (4.2) months. PPT was found in 7.8% of general Mediterranean population. We recommend evaluation at the 6th postpartum month to diagnose the majority of PPT women and indefinite follow-up of hypothyroid PPT patients to detect permanent hypothyroidism.

Gonadotrophin-releasing hormone antagonists inhibit sperm binding to the human zona pellucida.

Previous work from our laboratory indicated that gonadotrophin-releasing hormone (GnRH) increases human sperm-zona pellucida binding. Here we present evidence that GnRH antagonists inhibit sperm-zona pellucida binding in humans. Motile spermatozoa (10(7) cells/ml) were incubated in modified Tyrode's medium at 37 degrees C, in 5% CO(2) in air. After 4.5 h, aliquots of spermatozoa were treated with saline (control) or with different concentrations of GnRH antagonists (test). Each sperm aliquot was then tested in the hemizona binding assay. In this assay, the control aliquot was incubated with half a human zona pellucida (hemizona) and the test aliquot was incubated with the matching half. After 20 min, the hemizonae were withdrawn and the number of zona-bound spermatozoa counted using phase-contrast microscopy. In addition, the effect of GnRH antagonists upon the pattern of sperm movement, frequency of sperm-zona pellucida collisions, and percentage of living and acrosome-reacted spermatozoa was determined. The results indicated that treatment with GnRH antagonists decreased the number of zona-bound spermatozoa and did not change the pattern of sperm movement, frequency of sperm-zona collisions, and percentage of acrosome-reacted spermatozoa. We suggest that this action of GnRH antagonists may be due to an effect on zona receptors on the sperm plasma membrane.

Valor nutritivo da silagem de milho adicionada de uréia e carbonato de cálcio e do roläo de milho. I - Consumo de digestibilidade aparente da matéria seca e da proteína bruta e balanço de nitrogênio / Nutritive value of maize silage or maize silage with urea and calcium carbonate, and dried whole maize plant. I - Dry matter and crude protein intake and aparent digestibility, and nitrogen balance

Estudou-se o uso de aditivo em silagem de milho e sua comparaçäo com o roläo de milho sobre o consumo, a digestibilidade aparente de matéria seca e da proteína bruta e o balanço de nitrogênio, usando planta integral de milho, em três silos subterrâneos , revestidos de cimento, com capacidade média de 24t, vedados com plástico. Os tratamentos constituíram-se de: I- Silagem de milho com 0,5 por cento de uréia e 0,5 por cento de carbonato de cálcio; II-Silagem de milho com 0,5 por cento de uréia; III- Silagem de milho pura; IV - Roläo de milho. Os aditivos foram adicionados secos, em porcentagem do material verde, no momento da ensilagem. Utilizaram-se oito carneiros castrados, com aproximadamente três anos de idade, distribuídos em um delineamento de quadrado latino quatro por quatro, com uma repetiçäo. A adiçäo de uréia dobrou o teor de proteína bruta e aumentou o pH das silagens. A silagem tratada com uréia apresentou menor conteúdo de matéria seca que a tratada com uréia e carbonato de cálcio, mas ambas foram semelhantes à silagem pura. Houve melhora nos consumos de matéria seca e proteína digestível das silagens com o uso da uréia, mas esses valores foram ainda maiores com adiçäo conjunta de carbonato de cálcio. Os consumos de matéria seca e proteína digestível da silagem sem aditivos foram iguais aos do roläo. As digestibilidades da proteína e da matéria seca do roläo foram iguais às da silagem sem aditivos. A retençäo de nitrogênio no caso desta última mostrou-se igual à do roläo, sendo melhorada com a adiçäo de uréia e de carbonato de cálcio. O roläo de milho, de forma geral, apresentou características comparáveis às da silagem de milho sem aditivos

Valor nutritivo de silagem de milho, adicionada de uréia e carbonato de cálcio, e do roläo de milho. II - Consumo de digestibilidade de energia / Nutritive value of maize silage with urea and calcium carbonate, and dried whole maize plant. II - Energy intake and digestibility

Estudou-se o uso de aditivos em silagens de milho e sua comparaçäo com o roläo de milho sobre o consumo e a digestibilidade aparente da energia, usando planta integral de milho, em três silos subterrâneos, revestidos de cimento. Os tratamentos foram: I- Silagem de milho com 0,5 por cento de uréia e 0,5 por cento de carbonato de cálcio; II - Silagem de milho com 0,5 por cento de uréia; III - Silagem de milho pura; IV - Roläo de milho. Os aditivos foram adicionados secos, em porcentagem do material verde, no momento da ensilagem. Utilizaram-se oito carneiros castrados, com aproximadamente três anos de idade, distribuídos em um delineamento de quadrado latino quatro por quatro, com uma repetiçäo. A adiçäo de uréia melhorou os consumos de matéria seca e energia digestíveis da silagem, mas a adiçäo de uréia mais carbonato de cálcio tornaram esses valores ainda melhores. O uso de uréia pura ou junto com carbonato de cálcio também aumentou a digestibilidade da energia bruta da silagem. Os consumos de matéria seca e de energia digestíveis da silagem sem aditivos foram semelhantes aos do roläo. A digestibilidade da energia do roläo foi maior que a da silagem sem aditivos. O uso de uréia sozinha ou com carbonato de cálcio teve efeito positivo sobre o consumo de matéria seca e de energia

Medical therapy of Graves' disease: does thyroxine prevent recurrence of hyperthyroidism?

Sixty patients with Graves' disease (GD) hyperthyroidism were distributed in two randomized groups. Patients in group A (n = 30) received carbimazole by a titration regimen, and patients in group B (n = 30) were treated with higher doses of carbimazole plus T4. Clinical and analytical evaluations were done at baseline, during treatment (18.4 +/- 2.6 months), and after, until the relapse of hyperthyroidism, or for 4.98 +/- 1.6 yr in patients who did not relapse. There were no differences in clinical parameters, thyroid hormones, or TSH binding inhibitory immunoglobulins (TBII) levels between the two groups, either at baseline or at the end of treatment. Serum TSH persisted undetectable in 16 out of 60 patients (group A: 9; group B: 7), after treatment. Relapse occurred in 38 patients (63.3%), (group A: 18 (60%) vs. group B: 20 (66.7%)). Patients who relapsed had bigger goiters at baseline (P = 0.02) and at the end of treatment (P = 0.03). Eighty-seven percent (14/16) of patients with undetectable TSH after therapy relapsed, vs. 54.5% (24/44) of those with normal TSH (P = 0.01). Undetectable TSH at the end of treatment was the only independent variable in the logistic analysis to predict relapse. Treatment modality did not influence the relapse rate. This study has found that, in Spanish patients, the use of high doses of carbimazole with T4 offers no advantages in the treatment of GD hyperthyroidism.

The GyneFix implant systems for interval, postabortal and postpartum contraception: a significant advance in long-term reversible contraception. International Study Group on Intrauterine Drug Delivery.

Intrauterine contraception has a number of important advantages over other forms of contraception and remains, therefore, an important method of birth control. However, side-effects and other drawbacks have reduced its overall acceptance. Also misconceptions and lack of updated scientific knowledge among the potential users and providers are major obstacles to the widespread use of intrauterine contraception. Ideally, an intrauterine device (IUD) should prevent pregnancy effectively, be well tolerated, not become displaced or expelled over time, cause a minimum of side-effects, be long-lasting, have a strictly local effect, and be easy to insert and remove. A group at the University of Ghent, Belgium, the International Study Group on Intrauterine Drug Delivery, has developed, since 1985, a totally new concept in order to improve current intrauterine contraceptive efficacy and enhance tolerance, by creating a harmonious relationship between the uterine cavity and the contraceptive 'foreign body'. The new concept (GyneFix) consists of a non-biodegradable suture thread made of surgical 00 monofilament polypropylene on which six copper tubes are threaded, providing a total surface area of 330 mm2. The upper and lower tubes are crimped onto the thread to keep the tubes in place. The upper extremity of the thread is provided with a knot which serves as an anchor. The knot is implanted in the myometrium of the uterine fundus with a specially designed insertion instrument, thereby permanently securing the device in the uterine cavity. Since the initial clinical investigations, over 10,000 woman years of experience and up to 10 years' follow-up in international multicenter, non-comparative and comparative clinical trials have been collected. The clinical material also included a large number of nulligravid and nulliparous women. Due to the design characteristics of the GyneFix and its anchoring in the uterine fundus, an optimal tolerance and almost complete absence of expulsion were obtained. The constant release of copper ions in the upper part of the uterine cavity results in the high effectiveness of the anchored device. The effectiveness is higher than in the high-load conventional copper IUDs which have a risk of becoming displaced, partially or totally expelled in 10% or more (nulliparous women), resulting in a significant number of accidental pregnancies. The absence of frame and, as a consequence, its flexibility, explain the low incidence of side-effects and the very low incidence of complications, such as pelvic inflammatory disease and ectopic pregnancies. This new concept could be a major step forward in the acceptance of intrauterine contraception worldwide and increase its popularity. This article reviews the experience with the new concept for interval, postabortal and postpartum contraception.

[Chlamydia trachomatis infection in asymptomatic Chilean men and with urethritis. Usefulness of first catch urine samples]. / Infección por Chlamydia trachomatis en hombres chilenos asintomátícos y con uretritis. Utilidad de la orina de primer chorro.

BACKGROUND: Chlamydia trachomatis is responsible for 30 to 50% of genital tract infections and is present, without symptoms, in 20% of men and 60% of women. We have little information in Chile about the prevalence of this infection. AIM: To assess the prevalence of Chlamydia trachomatis in men, using first catch urine samples. SUBJECTS AND METHODS: Three hundred and fifty one first catch urine samples of asymptomatic men and 50 samples coming from men with a primary urethritis, were analyzed. Urethral discharge samples from the latter were simultaneously studied. Analysis was performed using an enzyme immuno analysis (MicroTrak Chlamydia EIA, Syva Co.) and a nested polymerase chain reaction towards the gene that codifies MOMP (PCR/OMP). RESULTS: Among asymptomatic men, two of 154 teenagers aged 18 to 19 years old (1.3%), 10 of 100 university students (10%) and eight of 97 adults over 30 years old (8.2%), were infected. The global prevalence of infection in these men was 5.7%. The prevalence of infection in men with urethritis was 12%. Urine EIA had a higher detection frequency than PCR/OMP, but according to another PCR assay, these results were false positives. EIA in first catch urine, had a sensitivity, specificity, positive and negative predictive value of 83.3, 75, 31.3 and 97% respectively, for the detection of Chlamydia trachomatis. The figures for PCR/OMP were 100% for all these parameters. CONCLUSIONS: The prevalence of Chlamydia trachomatis infection in Chilean men is similar to that reported in developed countries. Enzyme immuno assay in first catch urine had a good diagnostic accuracy and could be used in epidemiological studies in asymptomatic men.

[Ultrasonography: a complement to sialography in recurrent chronic childhood parotitis]. / L'échographie: un complément à la sialographie dans les parotidites récurrentes chroniques infantiles.

The objective of this research is to compare the ultrasonographic (USG) and sialographic contributions for the diagnosis of Recurrent Parotitis in Childhood (RPC). Bilateral USG of the parotid gland was performed among 16 children with RPC and 16 healthy children. The image of the normal parotid glands was compared with the image of the parotid gland with RPC. A pathologic USG pattern for RPC was obtained which consisted in a homogeneous, micronodular parenchyme with a diffuse increase density, sometimes with multiples hypoechogenous areas, that were considered solid hypoechogenous nodules suggesting inflammatory nodes. A glandular contour finely granulated was described with normal peri-parotidareas and with aponeurotic-muscular planes. Then 16 USG of the parotid gland of the children with RPC were compared with 16 Sialography previous obtained. The possibilities of diagnosis of the disease with both techniques was not different (p > 0.05). When the clinic was correlated with the USG it was possible to obtain parameters of severity of the glandular damage and to visualise the degree of changes of the parenchyma of each child with RPC. In some cases, bilateral damage was observed in children with clinical unilateral symptoms. The USG was performed in children in the acute phase of disease, visualising the microabscess in the gland and confirming the previous diagnosis. Finally, it was possible to conclude the utility of USG in the study of the disease. Being a not invasive exam, harmless, unpainfully echography, was easily accepted by the child. Also, we obtain information not only about the diagnosis of the disease, but also about the severity, prognosis, treatment and follow-up of the infant patients.

Renal function changes in hypertensive patients with non-insulin- dependent diabetes mellitus.

A group of 146 patients with non-insulin- dependent diabetes mellitus (NIDDM) was studied. They were divided into two groups of 73 age and sex matched patients, according to the presence or absence of hypertension. We recorded the presence of macrovascular and microvascular complications of NIDDM, family history, body mass index (BMI), glycemic control and lipidic profile. Renal parameters included plasma creatinine, urinary albumin excretion rate (UAER), glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and filtration fraction. Hypertensive patients had a higher BMI (30 +/- 4.8 kg/m2 vs. 27.6 +/- 4.4 kg/m2, P < 0.005), total cholesterol (6.34 +/- 1.47 mmol/l vs. 5.72 +/- 1.14 mmol/liter, P < 0.01), creatinine (91.1 +/- 25.6 mumol/liter vs. 81.3 +/- 20.3 mumol/liter, P < 0.05) and UAER [63.7 (range 1 to 5160) mg/24 hr vs. 27.3 (3 to 5500) mg/24 hr, P < 0.001]. GFR was lower in the group with hypertension (113 +/- 35 ml.min-1.1.73 m-2 vs. 127 +/- 29 ml.min-1.1.73 m-2, P < 0.05), but there were no differences in ERPF. The difference in GFR was only apparent in patients without established diabetic nephropathy. Hypertensive patients had higher frequency of ischemic heart disease (18% vs. 6%, P < 0.05) and diabetic nephropathy (62% vs. 38%, P < 0.005). We conclude hypertensive NIDDM patients, when compared with normotensive NIDDM patients, are more obese, hypercholesterolemic and have a higher frequency of ischemic heart disease and diabetic nephropathy. Hypertensive NIDDM patients have a worse renal function than normotensives before clinical proteinuria appears. The deterioration of GFR in hypertensive NIDDM patients possibly has an important influence on the progression of diabetic nephropathy.

Fine-needle aspiration cytology of benign nodular thyroid disease. Value of re-aspiration.

Fine-needle aspiration cytology (FNAC) has become a widespread procedure for the study of thyroid nodules (TN). Some authors recommend the practice of repeated punctures for their follow-up. This study was done to determine the usefulness of repeated FNAC in patients with benign nodular thyroid disease. We have studied 251 fine-needle re-aspirations performed on 116 females aged 45.6 +/- 14 years with benign nodular thyroid disease. The time elapsed between each consecutive FNAC was 1 year. No patients presented any changes in the size or consistency of their nodular goiters during this period; all FNACs were carried out by the same physician in the same thyroid area according to the Löwhagen technique, with a minimum of two or three aspirations of each nodule, and processed in the same way and valued by the same cytologist without any knowledge of previous cytological diagnoses. These were done using strictly classical criteria (Löwhagen). One hundred and five out of 116 patients (90.51%) with two consecutive FNACs (210) showed identical cytological diagnoses in the two specimens studied. The remaining 11 patients (9.48%) with two FNACs were diagnosed with colloid goiter and cyst alternately. Fifteen out of 19 patients (78.94%) with three FNACs showed identical cytological diagnoses in the three samples and the rest (21%) also demonstrated alternate diagnoses of colloid goiter and cyst. Our results show that the routine performance of repeated FNAC in the follow-up of females with benign nodular thyroid disease, without any clinical changes, is of limited usefulness.

Relationship between lipoprotein profile and urinary albumin excretion in type II diabetic patients with stable metabolic control.

OBJECTIVE: To assess lipids and lipoprotein composition and the relationship between lipoprotein abnormalities and urinary albumin excretion (UAE) in select type II diabetic patients with stable metabolic control. RESEARCH DESIGN AND METHODS: Fifty-five type II diabetic patients and 55 healthy control subjects both with a body mass index < 30 kg/m2 were studied. Patients were classified according to their level of UAE as normoalbuminuric (n = 37), microalbuminuric (n = 11), and macroalbuminuric (n = 7). In all cases, serum creatinine and albumin concentrations were in the normal range. RESULTS: Normoalbuminuric patients showed increased triglyceride (TG) contents in intermediate-density lipoprotein (IDL) (P < 0.01), low-density lipoprotein (LDL) (P < 0.001), and high-density lipoprotein (HDL) (P < 0.001) compared with control subjects. Lipoprotein concentration in microalbuminuric patients did not differ from that of normoalbuminuric patients. On the other hand, patients with macroalbuminuria showed a significant increase in IDL cholesterol (P < 0.01) and IDL (P < 0.01), LDL (P < 0.05), and HDL TGs (P < 0.01) compared with the other groups. Diabetic patients with nephropathy, both microalbuminuric and macroalbuminuric, tended to have higher mean lipoprotein(a) (Lp[a]) concentrations than normoalbuminuric patients and control subjects. A strongly positive correlation was observed between UAE and serum TGs (r = 0.56) and very-low-density lipoprotein (r = 0.55), IDL (r = 0.52), LDL (r = 0.54), and HDL TGs (r = 0.52). CONCLUSIONS: Lipoprotein alterations observed in diabetic patients, specifically IDL abnormalities and a tendency toward high Lp(a) levels, which are more marked in those with increased UAE, may contribute to the excess of cardiovascular disease in type II diabetic patients, particularly those with nephropathy.