[Factors associated with amputation in diabetic patients with foot ulcer]. / Estudio de factores asociados con amputación, en pacientes diabéticos con ulceración en pie.

OBJECTIVE: To analyse risk factors for amputation in diabetic foot ulcers. METHOD: We have studied 152 diabetic patients (in 14 food ulcers treatment was amputation) who were attendance between January 1996 and June 1998 in the diabetic foot Unit. Subjects with gangrene were excluded. RESULTS: Risk factors for amputation were: previous history of amputation (odds ratio 3.7; 1.0113.7), proliferative retinopathy, osteomielitis, and independently clinical signs of peripheral vasculopathy (7.1; 1.88-27.2) and severe infection (14.4; 2.92-71.2). CONCLUSION: Diabetic subjects with foot ulcers and previous history of amputation, proliferative retinopathy, osteomielitis, clinical signs of peripheral vasculopathy and/or severe infection were a high risk group for amputation and in this group aggressive therapeutical and preventive approaches should be done in order to prevent amputation.

Estudio de factores asociados con amputación en pacientes diabéticos con ulceración en pie / Study of factors associated with amputation in diabetic patients with foot ulceration

Objetivo: Analizar factores asociados con amputación en pacientes diabéticos que presentan úlceras en sus pies, con el fin de identificar sujetos con alto riesgo para amputación.Método: Hemos estudiado 152 diabéticos que acudieron a la Unidad del pie diabético desde enero de 1996 hasta junio de 1998 con úlceraciones en sus pies. En 14 de ellos fue necesaria la amputación. Se excluyeron sujetos con gangrena.Resultados: Los factores asociados con amputación fueron: antecedentes personales de amputación previa (odds ratio 3,7; 1,01-13,7), retinopatía proliferativa, osteomielitis y, de forma independiente, la presencia de vasculopatía (7,1; 1,88-27,2) e infección grave (14,4; 2,92-71,2).Conclusión: Los pacientes diabéticos con úlceras en pie que presenten antecedentes de amputación, signos clínicos de vasculopatía periférica, infección grave, osteomielitis o retinopatía avanzada son de alto riesgo para la amputación y en ellos se deben instaurar precozmente medidas terapéuticas y preventivas intensas. (AU)

Embolización terapéutica selectiva en el insulinoma maligno / Selective therapeutic embolization in malignant insulinoma

Se presenta el caso de una paciente con episodios de hipoglucemia secundarios a un insulinoma maligno de gran tamaño con metástasis hepáticas.Para el control sintomático de las crisis hipoglucémicas se utilizaron inicialmente dieta fraccionada y octreótido por vía subcutánea sin obtener respuesta. Posteriormente se usó diazóxido por vía oral con buena respuesta inicial, pero fue suspendido por la gravedad de sus efectos secundarios. Para conseguir una reducción de la masa tumoral se administraron adriamicina y estreptozotocina sin resultados. Finalmente se decidió la embolización de la arteria hepática derecha, que supuso la desaparición de las crisis hipoglucémicas, permaneciendo la paciente asintomática durante 14 meses de seguimiento.Se concluye que la embolización hepática selectiva representa una buena opción terapéutica en casos seleccionados de insulinoma maligno, con hipoglucemias de difícil control (AU)

No disponible

[Selective therapeutic embolization in malignant insulinoma]. / Embolización terapéutica selectiva en el insulinoma maligno.

A case is reported of a patient with hypoglycemia episodes secondary to a large sized malignant insulinoma with metastases to the liver. For the control of hypoglycemic episodes, both diet and octreotide were initially used but the response obtained was poor. Later, oral diazoxide was used and a good initial response was obtained but treatment was stopped due to severe adverse effects. To obtain a decrease in the tumoral size both adrimaycin and streptozotocin were administered but results were unsuccessful. Finally, embolization of the right hepatic artery was performed and no further hypoglycemic episodes occurred during the following 14 months. We conclude that selective hepatic embolization is a good therapeutic option to control hypoglycemic episodes in malignant insulinoma with metastases to the liver when other therapeutic options have proved unsuccessful.

[Gynecomastia and Leydig cell tumor]. / Ginecomastia y tumor de células de Leydig.

INTRODUCTION: Leydig cell tumors may generate estrogen production and gynecomastia. CASE PRESENTED: A 32-year man asked for medical advice due to gynecomastia. He had raised estrogen levels and diminished testosterone/estradiol index. A testicular echogram showed a nodular image in the right testis. Orchidectomy was performed and the diagnosis of a Leydig cell tumor was confirmed. The gynecomastia diminished, and estradiol remained lightly elevated, with little response to HCG. DISCUSSION: The more frequent hormonal manifestations of these tumors are high plasmatic and urinary estrogen levels, low serum testosterone, low testosterone/estradiol index, and FSH or LH low levels as well. The low response to HCG, the absence of metastasis and the good clinical evolution suggested the tumor was benign. Testicular echography is useful in the diagnosis of these tumors.

[Effect of enalapril on microalbuminuria and lipid profile of normotensive type I diabetes mellitus patients]. / Influencia de enalapril sobre la microalbuminuria y el perfil lipídico en pacientes con diabetes mellitus tipo I normotensos.

A longitudinal study for six months was conducted to demonstrate the influence of enalapril therapy on microalbuminuria in a group of patients with IDDM without arterial hypertension. An evaluation was also considered of its possible activity on other biochemical parameters, particularly plasma lipid levels. Thirty-four patients with IDDM were selected, with a mean age of 26.1 +/- 7.2 years and a mean clinical course of 11.8 +/- 5.6 years. Arterial blood pressure (ABP) was confirmed lower than 140/85 mmHg in all cases. Patients were administered 5 mg/day of enalapril and if a decrease in microalbuminuria higher than 25% was not achieved at the end of the first month of therapy, the dose was doubled (10 mg/day). No significant differences were found in ABP and in HbA1c throughout the study period. Albumin excretion in the initial period was 125.1 +/- 79.28 mg/24 h, at one month in the follow-up 47.6 +/- 44.1 mg/24 h, at three months 23.8 +/- 18.1 mg/24 h, and at the end of the 6th month 15.33 +/- 6.9 mg/24 h, all differences being significant. Renal function parameters and Na+ and K+ measurements remained unchanged for the follow-up period. No significant changes were detected for lipid and lipoprotein values for the length of the study. We conclude that therapy with enalapril in insulin-dependent diabetic patients without hypertension has an important effect on microalbuminuria during the first month of therapy; a stabilization in the normal range was reached in the third and sixth months of follow-up. No changes in arterial blood pressure nor in renal function were observed. Plasma lipid values were in the normal range throughout the study. Therefore, treatment for microalbuminuria with the ACEI assayed was efficient, in absence of arterial hypertension and irrespective of the metabolic control obtained. Future long-term studies are needed to evaluate the possible delay in the emergence of renal insufficiency.