[Short bowel syndrome cause of hypomagnesaemia importance of its diagnosis and treatment]. / Síndrome de intestino corto causa de hipomagnesemia, importancia de su diagnostico y tratamiento.

The short bowel syndrome (SIC) is a complex entity characterized by a malabsorptive state usually secondary to extensive intestinal resection originating a clinical, metabolic and/or nutritional disorder due to the reduction of the effective intestinal absorptive surface. The diagnosis is essentially clinical and, due to the patients malabsorptive process, it requires nutritional support to maintain their basic requirements, as the case reported. The clinical features of SIC patients depend on the grade of the alteration of function of the the small intestine or the impairment secondary to the surgical resection. We know that electrolytes are absorbed predominantly in the proximal gut. The regulation of ion/mineral levels depend on both the intestinal absorption and the renal excretion. We present an unusual case of SIC with only low absorption of magnesium. We discuss the most outstanding aspects of the case and review the literature.

El síndrome de intestino corto (SIC) es una entidad compleja caracterizada, por un estado malabsortivo secundario normalmente a una resección intestinal extensa que ocasiona alteraciones clínico, metabólicas y/o nutricionales debidas a la reducción de la superficie absortiva intestinal efectiva. El diagnóstico es fundamentalmente clínico y el paciente, por el proceso malabsortivo, requiere un soporte nutricional para mantener sus requerimientos básicos, como en el caso que presentamos. La clínica asociada al SIC también está en función de la zona de intestino delgado afectada por la resección o la alteración funcional. Sabemos que los electrolitos son absorbidos predominantemente en el intestino delgado. La regulación de los niveles de iones/minerales se basa tanto en la absorción intestinal como en la excreción renal. Consideramos de interés la publicación del caso, dado lo excepcional de la pérdida aislada de magnesio secundaria al SIC. Comentamos los aspectos más destacables del mismo y revisamos la literatura.

Síndrome de intestino corto causa de hipomagnesemia; importância de su diagnostico y tratamiento / Short bowel syndrome cause of hypomagnesaemia importance of its diagnosis and treatment

El síndrome de intestino corto (SIC) es una entidad compleja caracterizada, por un estado malabsortivo secundario normalmente a una resección intestinal extensa que ocasiona alteraciones clínico, metabólicas y/o nutricionales debidas a la reducción de la superficie absortiva intestinal efectiva. El diagnóstico es fundamentalmente clínico y el paciente, por el proceso malabsortivo, requiere un soporte nutricional para mantener sus requerimientos básicos, como en el caso que presentamos. La clínica asociada al SIC también está en función de la zona de intestino delgado afectada por la resección o la alteración funcional. Sabemos que los electrolitos son absorbidos predominantemente en el intestino delgado. La regulación de los niveles de iones/minerales se basa tanto en la absorción intestinal como en la excreción renal. Consideramos de interés la publicación del caso, dado lo excepcional de la pérdida aislada de magnesio secundaria al SIC. Comentamos los aspectos más destacables del mismo y revisamos la literatura (AU)

The short bowel syndrome (SIC) is a complex entity characterized by a malabsorptive state usually secondary to extensive intestinal resection originating a clinical, metabolic and/or nutritional disorder due to the reduction of the effective intestinal absorptive surface. The diagnosis is essentially clinical and, due to the patients malabsorptive process, it requires nutritional support to maintain their basic requirements, as the case reported. The clinical features of SIC patients depend on the grade of the alteration of function of the the small intestine or the impairment secondary to the surgical resection. We know that electrolytes are absorbed predominantly in the proximal gut. The regulation of ion/mineral levels depend on both the intestinal absorption and the renal excretion. We present an unusual case of SIC with only low absortion of magnesium. We discuss the most outstanding aspects of the case and review the literatura (AU)

Circulating free testosterone in obese men after bariatric surgery increases in parallel with insulin sensitivity.

BACKGROUND AND AIM: Male hypogonadism has been linked to obesity and diabetes. We aimed to study the association of changes in insulin sensitivity and testosterone levels in severe obese patients submitted to bariatric surgery. SUBJECTS AND METHODS: Prospective intervention study with twenty consecutive patients who underwent bariatric surgery studied before and after significant weight loss. Serum testosterone, SHBG, fasting glucose, and insulin were measured among others. Free testosterone was calculated with the Vermeulen formula and insulin sensitivity with the homeostatic model assessment (HOMA). RESULTS: At baseline, thirteen patients had low total testosterone levels, whereas eight of these patients also had free testosterone levels below the reference range obtained from the control group. After bariatric surgery total testosterone, SHBG, and free testosterone significantly increased and achieved normal values in all evaluated patients. Insulin sensitivity improved in all of them. Multivariate linear regression showed that changes in fasting glucose (ß=-1.868, p=0.001), insulin (ß=-3.782, p=0.001), weight (ß=-0.622, p=0.002), and SHBG (ß=-0.635, p=0.022) were associated with changes in free testosterone (adjusted R2=0.936, F=26.613, p=0.001). When insulin resistance calculated by HOMA was in the model instead of insulin and glucose, it also was associated (ß=-3.488, p=0.008) with free testosterone (adjusted R2=0.821, F=11.111, p=0.005). CONCLUSIONS: Circulating tes tos terone in obese men increases after bariatric surgery in parallel with an improvement in insulin sensitivity.

[Percutaneous gastrostomy complicated with abdominal wall hematoma; severe anemia secondary to percutaneous endoscopic gastrostomy]. / Gastrostomía percutánea complicada con hematoma de pared abdominal; anemización severa secundaria a gastrostomía endoscópica percutánea.

Endoscopic percutaneous gastrostomy (PEG) is a safe and effective procedure that offers clear advantages over nasogastric tube feeding to ensure adequate nutrition in patients with swallowing problems who have an intact digestive tract. With proper placement and monitoring methodology there are few complications in both the peritrack procedure as in the long run. However, despite being considered a safe technique it is not devoided of serious complications. We report a patient with dysphagia, requiring percutaneous endoscopic gastrostomy placement developing a severe anemia with severe subcutaneous hematoma, given the exceptional case and literature review.

Influencia de la pérdida de peso en la evolución clínica, metabólica y psicológica de los pacientes con sobrepeso u obesidad / Influence of weight loss in the clinical evolution, metabolic and psychological of the patients with overweight or obesity

Fundamento y objetivo: La evolución clínica y psicológica de los pacientes con sobrepeso u obesidad sigue generando controversias. El objetivo del estudio es conocer el impacto de la pérdida de peso sobre la evolución de las alteraciones tanto clínicas, metabólicas como psicológicas en los pacientes con sobrepeso u obesidad. Pacientes y método: Estudiamos una cohorte de 192 pacientes elegidos aleatoriamente. Todos ellos fueron caracterizados clínica y bioquímicamente. Para el estudio psicopatológico se emplearon cuestionarios auto-administrados y validados en población española: el cuestionario de Goldberg (GHQ-28) y la escala de bulimia y atracones del cuestionario Eating Disorder Inventary (EDI). Para el análisis estadístico se utilizó el programa estadístico SPSS 15.0. Los datos son expresados como medias (desviación estándar). Resultados: La pérdida de peso fue de 3,77 (4,85)kilogramos, equivalente a un 3,8 (4,86)% del peso total, el diámetro de la cintura se redujo en 3,78 (5,89) centímetros, la tensión arterial sistólica se redujo en 3,36 (15,61) mmHg y la diastólica en 2.15 (11,26) mmHg. Disminuyeron de forma significativa los niveles de glucosa 7,37 (21,23) mg/dl, la insulinemia 2,773 (8,749) UI/ml, el índice HOMA-IR 0,925 (2,728), los triglicéridos 12,59 (82,95) mg/dl y el ácido úrico 0,172 (1,13) mg/dl. También disminuyeron significativamente las transaminasas GOT y GPT [2,39(9,38) U/L y 4,95 (16,40) U/L, respectivamente]. El GHQ-28 inicial fue patológico en el 44,8% de los pacientes estudiados, y a los seis meses de tratamiento, la puntuación del GHQ-28 mejoró en el 20,8% (p < 0,001). La puntuación global de la subescala de bulimia del EDI al inicio fue 1,02 (1,91), disminuyendo significativamente a los seis meses a 0,65 (1,49); p < 0,002. Conclusión: La disminución de peso mejora no sólo los parámetros clínicos y bioquímicos de riesgo cardiovascular y la resistencia insulínica, sino que también mejora la puntuación en la escala Goldberg, con un mayor impacto en aquellos con el cuestionario GHQ-28 más patológico al inicio de la intervención (AU)

Introduction and objective: The clinical evolution and psychological well-being of patients with overweight or obesity is still a matter of controversy. The aim of this study is to know the impact of the loss of weight on the evolution of the alterations both clinical and metabolic as psychological in patients with overweight or obesity. Patients and method: We studied a cohort of 192 patients randomly chosen. All of them were characterized clinically and biochemically. Autoadministered questionnaires were used which were already validated in the Spanish population:the General Health Questionnaire (GHQ-28), and bulimia subescale, the Eating Disorder Inventary (EDI). For the statistical analysis using the statistical program SPSS 15.0. Data are expressed as mean (standard deviation). Results: The weight loss was 3.77 (4.85) kilograms, equivalent to a 3.8 (4.86)% of the total weight, the diameter of the waist was reduced by 3.78 (5.89) centimeters, systolic blood pressure was reduced by 3.36 (15.61) mmHg and diastolic in 2.15 (11.26) mmHg. We also found a decreased significantly of glucose levels 7.37(21.23) mg/dl, insulin levels 2.773 (8.749) IU/ml, HOMA-IR index 0.925 (2.728), triglycerides 12.59 (82.95) mg/dl and uric acid 0.172 (1.13) mg/dl. The basal score of the GHQ-28 was pathological in 44,8% of the studied patients, and after six months of treatment, it improved in 20,8% of the patients (p < 0,001). The EDI bulimia subscale score at the beginning of the treatment was 1,02 (SD 1,91), improving after six months of treatment to 0,65 (SD 1,49) p < 0,002. Conclusion: The decrease in weight improves not only clinical parameters and biochemical cardiovascular risk and insulin resistance, but also improves the scale score Goldberg, with higher impact on those with worse baseline GHQ-28 scores (AU)

Gastrostomía percutánea complicada con hematoma de pared abdominal; anemización severa secundaria a gastrostomía endoscópica percutánea / Percutaneous gastrostomy complicated with abdominal wall hematoma; severe anemia secondary to percutaneous endoscopic gastrostomy

Introducción: La Gastrostomía Percutánea Endoscópica (PEG), es un método seguro y efectivo que ofrece claras ventajas respecto a la alimentación por sonda naso-gástrica para conseguir una nutrición adecuada en pacientes con problemas de deglución, pero que mantienen intacto el sistema digestivo. Sin embargo, a pesar de ser considerada una técnica segura no está exenta de complicaciones graves. Presentamos una paciente con disfagia que tras la práctica de la gastrostomía endoscópica percutánea desarrolla una anemización severa con gran hematoma subcutáneo, dado lo excepcional del caso y revisamos la literatura (AU)

Endoscopic percutaneous gastrostomy (PEG) is a safe and effective procedure that offers clear advantages over nasogastric tube feeding to ensure adequate nutrition in patients with swallowing problems who have an intact digestive tract. With proper placement and monitoring methodology there are few complications in both the peritrack procedure as in the long run. However, despite being considered a safe technique it is not devoided of serious complications. We report a patient with dysphagia, requiring percutaneous endoscopic gastrostomy placement developing a severe anemia with severe subcutaneous hematoma, given the exceptional case and literature review (AU)

Chylous ascytes secondary to acute pancreatitis: a case report and review of literature.

Chylous ascites is an uncommon finding which is due to the presence of thoracic or intestinal lymph in the abdominal cavity. It is usually caused by a chronic disruption of the lymphatic system. The present report is one of the rare cases in the literature of chylous ascites secondary to idiopathic acute pancreatitis, which showed a complete resolution with a combination of low fat enteral nutrition with MCT and somatostatin analogs.

Chylous ascytes secondary to acute pancreatitis: a case report and review of literature / Ascitis quilosa secundaria a pancreatitis: caso clínico y revisión de la bibliografía

Chylous ascites is an uncommon finding which is due to the presence of thoracic or intestinal lymph in the abdominal cavity. It is usually caused by a chronic disruption of the lymphatic system. The present report is one of the rare cases in the literature of chylous ascites secondary to idiopathic acute pancreatitis, which showed a complete resolution with a combination of low fat enteral nutrition with MCT and somatostatin analogs (AU)

La ascitis quilosa es un hallazgo infrecuente producido por la presencia de linfa de origen torácico o intestinal en la cavidad abdominal. Normalmente es producido por la disfunción crónica del sistema linfático. El caso que presentamos es uno de los pocos casos descritos en la literatura de ascitis quilosa secundaria a una pancreatitis aguda idiopática, que se resolvió completamente con una combinación de dieta enteral baja en grasas con triglicéridos de cadena media y análogos de somatostatina (AU)

[Influence of weight loss in the clinical evolution, metabolic and psychological of the patients with overweight or obesity]. / Influencia de la pérdida de peso en la evolución clínica, metabólica y psicológica de los pacientes con sobrepeso u obesidad.

INTRODUCTION AND OBJECTIVE: The clinical evolution and psychological well-being of patients with overweight or obesity is still a matter of controversy. The aim of this study is to know the impact of the loss of weight on the evolution of the alterations both clinical and metabolic as psychological in patients with overweight or obesity. PATIENTS AND METHOD: We studied a cohort of 192 patients randomly chosen. All of them were characterized clinically and biochemically. Autoadministered questionnaires were used which were already validated in the Spanish population:the General Health Questionnaire (GHQ-28), and bulimia subescale, the Eating Disorder Inventary (EDI). For the statistical analysis using the statistical program SPSS 15.0. Data are expressed as mean (standard deviation). RESULTS: The weight loss was 3.77 (4.85) kilograms, equivalent to a 3.8 (4.86)% of the total weight, the diameter of the waist was reduced by 3.78 (5.89) centimeters, systolic blood pressure was reduced by 3.36 (15.61) mmHg and diastolic in 2.15 (11.26) mmHg. We also found a decreased significantly of glucose levels 7.37(21.23) mg/dl, insulin levels 2.773 (8.749) IU/ml, HOMA-IR index 0.925 (2.728), triglycerides 12.59 (82.95) mg/dl and uric acid 0.172 (1.13) mg/dl. The basal score of the GHQ-28 was pathological in 44,8% of the studied patients, and after six months of treatment, it improved in 20,8% of the patients (p < 0,001). The EDI bulimia subscale score at the beginning of the treatment was 1,02 (SD 1,91), improving after six months of treatment to 0,65 (SD 1,49) p < 0,002. CONCLUSION: The decrease in weight improves not only clinical parameters and biochemical cardiovascular risk and insulin resistance, but also improves the scale score Goldberg, with higher impact on those with worse baseline GHQ-28 scores.

Serum concentrations of osteocalcin, procollagen type 1 N-terminal propeptide and beta-CrossLaps in obese subjects with varying degrees of glucose tolerance.

AIMS: To evaluate serum levels of osteocalcin (OC), procollagen type 1 N-terminal propeptide (P1PN) and beta-CrossLaps (beta-CTx) in obese subjects and their relationship with glucose metabolism parameters. SUBJECTS: Sixty-four obese patients classified according to their glucose tolerance. DESIGN: Case-control study. MEASUREMENTS: A 75-g oral glucose tolerance test was performed with determinations of glucose and insulin between 0 and 120 min. Serum concentrations of OC, P1PN and beta-CTx were quantified in baseline samples. RESULTS: Patients with type 2 diabetes (T2D, n = 24) exhibited OC serum levels (2·6 ± 1·0 nm) significantly lower than those found in subjects with normal glucose tolerance (NGT, n = 20, 3·9 ± 1·5 nm, P < 0·01). We found no significant differences in P1NP and beta-CTX levels among patients with NGT, prediabetes and T2D. Multiple regression analysis showed that serum OC concentration, but not P1NP or beta-CTx levels, was independently related to 2-h plasma glucose. CONCLUSION: Obese patients with T2D showed significantly reduced levels of OC in comparison with patients with lower degrees of glucose tolerance derangement. Our results also suggest that OC was the only bone marker independently related to the degree of glucose metabolism derangement in these patients.

Taurine and glucose metabolism: a review / Taurina y metabolismo de la glucosa: una revisión

Introduction: Taurine has probed to be involved in a wide range of biological processes and to provide several different important health benefits. Its effects have been revealed to be exerted mainly through its antioxidant and anti-inflammatory effects, among other mechanisms. Objectives and methods: The present review is aimed to provide a solid body of evidence regarding the beneficial effects of taurine in the context of diabetes and its complications, with an special focus on the cardiovascular health impairments so frequently associated to this disease, so that data from this updated systematic review of the literature, may constitute a base to back up future clinical and epidemiological studies, on the possibilities of taurine supplementation as a useful tool for both prevention and treatment of diabetes complications. Conclusions: We consider results from the different experimental, in vitro studies as well as some clinical ones reviewed, to provide sufficient evidence as to constitute a solid base to back up future clinical and epidemiological studies on the usefulness of taurine supplementation both in the prevention and treatment of diabetes and its complications (AU)

Introducción: El aminoácido taurina ha demostrado estar involucrado en una amplia gama de procesos biológicos, así como proporcionar distintos e importantes beneficios para la salud. Los principales efectos de la taurina que han sido puestos de manifiesto a través de distinto estudios, residen principalmente en su acción antioxidante y en su capacidad antiinflamatoria, entre otros que también señalaremos. Objetivos y métodos: La presente revisión tiene como objetivo proporcionar una sólida evidencia en relación a estos y otros efectos de la taurina en el contexto de la diabetes y sus complicaciones, con especial énfasis en las alteraciones de la salud cardiovascular, tan frecuentemente asociadas a esta enfermedad, de manera que los datos de esta revisión sistemática de la literatura que hemos realizado, puedan constituir un base con la que respaldar futuros estudios clínicos y epidemiológicos, sobre las posibilidades que tiene la suplementación con taurina de convertirse en herramienta útil, tanto en la prevención como en el tratamiento de la diabetes y sus complicaciones. Conclusiones: Consideramos que los resultados de los distintos estudios experimentales, in vitro y algunos clínicos, proporcionan evidencia suficiente como para servir de base científica a futuros estudios clínicos y epidemiológicos sobre la utilidad de la suplementación con taurina en la enfermedad de diabetes y en sus complicaciones (AU)

Severe ketoacidosis secondary to starvation in a frutarian patient / Cetoacidosis severa secundaria a frugitarismo

The present paper presents the firts clinical case of a patient suffering from Frutarianism a new ‘Eating disorder’ and severe Ketoacidosis. The life-style feed strictly only on fruits (not even other vegetables, since plant death is necessary previous consumption).This behavioural alteration frequently leads to starvation and the subsequent Ketoacidosis due to starvation (AU)

El presente trabajo es el primer caso descrito de un paciente que sufre de Frugitarismo ‘Trastorno de conducta alimentaria de reciente aparición’ que ingresa en la UVI por cetoacidosis grave. La alimentación es estrictamente sólo de frutas. Esta alteración del comportamiento alimentario nos lleva a desarrollar una ketoacidosis severa con secundaria a la desnutrición (AU)

Taurine and glucose metabolism: a review.

INTRODUCTION: Taurine has probed to be involved in a wide range of biological processes and to provide several different important health benefits. Its effects have been revealed to be exerted mainly through its antioxidant and anti-inflammatory effects, among other mechanisms. OBJECTIVES AND METHODS: The present review is aimed to provide a solid body of evidence regarding the beneficial effects of taurine in the context of diabetes and its complications, with an special focus on the cardiovascular health impairments so frequently associated to this disease, so that data from this updated systematic review of the literature, may constitute a base to back up future clinical and epidemiological studies, on the possibilities of taurine supplementation as a useful tool for both prevention and treatment of diabetes complications. CONCLUSIONS: We consider results from the different experimental, in vitro studies as well as some clinical ones reviewed, to provide sufficient evidence as to constitute a solid base to back up future clinical and epidemiological studies on the usefulness of taurine supplementation both in the prevention and treatment of diabetes and its complications.

Severe ketoacidosis secondary to starvation in a frutarian patient.

The present paper presents the first clinical case of a patient suffering from Frutarianism a new "Eating disorder" and severe Ketoacidosis. The life-style feed strictly only on fruits (not even other vegetables, since plant death is necessary previous consumption).This behavioural alteration frequently leads to starvation and the subsequent Ketoacidosis due to starvation.

Complicaciones de la nutrición enteral a través de gastrostomía: a propósito de un caso / Complications of enteral nutrition in a patient with gastrostomy

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Meal replacement with a low-calorie diet formula in weight loss maintenance after weight loss induction with diet alone.

BACKGROUND/OBJECTIVES: Weight loss in obesity can reduce morbidity and mortality and benefits persist as long as weight loss is maintained. Weight maintenance is difficult in the long term and new strategies need to be developed to achieve this goal. We aimed to evaluate the efficacy of substituting a low-calorie diet formula for a meal in a weight loss program during the maintenance phase. METHODS: Randomized paralleled clinical trial including 62 adult patients with at least a 5% weight loss with diet alone for 6 months, randomized to two groups: daily replacement of one meal with a low-calorie diet formula, or dieting alone for another 6 months (weight maintenance phase). RESULTS: Weight maintenance or further weight loss occurred in 83.9% of patients in the intervention group, whereas only in 58.1% in the control group (P=0.025). As a whole, patients in the intervention group lost a further 3.2+/-3.7% of initial weight compared with a 1.3+/-3.6% in the control group (P=0.030). Body fat mass diminished in both groups, with no differences between them (1.6+/-3.5 vs 1.0+/-9.3 kg, respectively, P=0.239), and the same happened with free fat mass (0.9+/-3.3 vs 0.4+/-6.7 kg, respectively, P=0.471). A multivariate logistic regression analysis (R (2)=0.114, P=0.023) retained only the intervention as a predictor of the achievement of weight maintenance with an odds ratio (95% confidence interval) of 3.756 (1.138-12.391). CONCLUSIONS: Substitution of a low-calorie diet formula for a meal is an effective measure for weight loss maintenance compared with dieting alone.

Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion.

Secondary hyperparathyroidism (SH) is a frequent metabolic complication of bariatric surgery. Around 70%of patients who undergo biliopancreatic diversion (BPD) have this complication in the long term. The aim of this study was to evaluate the relative influence of vitamin D deficiency and calcium malabsorption in the development of SH in patients who underwent BPD. We reviewed the mean values of PTH throughout the post-operative follow-up and of related biochemical data (25-hydroxyvitamin D, calcium, magnesium) of 121 patients who underwent BPD at our institute from November 1996 to November 2004 (mean follow-up 66 months). Mean PTH correlated negatively with mean 25-hydroxyvitamin D (r=-0.27, p=0.003) and with urinary calcium(r=-0.19, p=0.047), and positively with age (r=0.22, p=0.018). However, a high mean PTH was found in 48.7% patients with mean 25-hydroxyvitamin D >or=30 ng/ml and in 80.0% patients with mean 25-hydroxyvitamin D between 20 and 30 ng/ml. The mean PTH was normal in 5 patients without calcium supplements at present, and progressively increased in parallel to the calcium dose in the rest of patients, although mean 25-hydroxyvitamin D levels were not related to the calcium dose. Our data suggest that individual differences in active and/or passive calcium absorption determine intractable SH after BPD in around half of the patients who have normal levels of 25-hydroxyvitamin D and in 80% of patients with 25-hydroxyvitamin D levels between 20 and 30 ng/ml after BPD, worsening with age.

Importancia de la nutrición artificial en la resolución y diagnóstico etiológico de diarrea crónica severa: a propósito de un caso / Importante of artificial nutrition in the resolution and etiologic diagnosis of severe chronic diarrhea: A propos of a case

Presentamos un caso de diarrea crónica severa, que precisa soporte nutricional parenteral, no sólo para cubrir las necesidades nutricionales sino para permitir un reposo intestinal, que permita su posterior adaptación a la nutrición enteral, permitiendo todo ello el diagnóstico etiológico de la diarrea y curación del proceso

We present a case of severe chronic diarrhea requiring parenteral nutritional support to both cover the nutritional needs and allow for intestinal rest for later adaptation to enteral nutrition, altogether allowing for the etiologic diagnosis and disease healing