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El quiste paratiroideo es una enfermedad muy rara que puede llevar a un diagnóstico y tratamiento inadecuado. Se presenta un caso clínico junto a una revisión de la literatura disponible sobre patogénesis y proceso diagnóstico terapéutico de esta entidad. Nuestro paciente fue remitido por hipercalcemia siendo diagnosticado de hiperparatiroidismo primario. Las pruebas de localización mostraron una lesión quística con niveles elevados de PTHi (Paratohormona intacta) en la citología, lo que permitió el correcto diagnóstico y tratamiento con paratiroidectomía inferior derecha con resolución del cuadro bioquímico.

Aims: The aim of the study was to evaluate the effect of a Mediterranean diet (MedDiet), enhanced with extra virgin olive oil (EVOO) and nuts, on a composite of adverse maternofoetal outcomes of women with normoglycemia during pregnancy. Methods: This was a sub-analysis of the St Carlos gestational diabetes mellitus Prevention Study. Only normoglycemic women were analysed (697). They were randomized (at 8–12th gestational weeks) to: standard-care control group (337), where fat consumption was limited to 30% of total caloric intake; or intervention group (360), where a MedDiet, enhanced with EVOO and pistachios (40–42% fats of total caloric intake) was recommended. The primary outcome was a composite of maternofoetal outcomes (CMFOs): at least having 1 event of emergency C-section, perineal trauma, pregnancy-induced hypertension and preeclampsia, prematurity, large-for-gestational-age and small-for gestational-age. Results: Crude relative risk showed that the intervention was associated with a significant reduction in the risk of CMFOs (0.48 [0.37–0.63]; p = 0.0001), with a number-needed-to-treat = 5. Risk of urinary tract infections, emergency C-sections, perineal trauma, large-for-gestational-age and small-for gestational age new-borns were also significantly reduced. Conclusion: A MedDiet, enhanced with EVOO and nuts, was associated with a risk reduction of CMFOs in over 50% in normoglycemic pregnant women. Therefore, it might be a potentially adequate diet for pregnant women. Trial registration: Identifier ISRCTN84389045. The study was registered on September 27, 2013. Last edited on September 26, 2018

Resumen Antecedentes y objetivo La tiroglobulina del lavado de aguja (Tg-PAAF) junto con la citologia de la puncion-aspiracion con aguja fina (cito-PAAF) son procedimientos recomendados para el diagnostico de metastasis ganglionares cervicales y recurrencias del cancer diferenciado de tiroides. El objetivo de este estudio fue valorar la utilidad de estas tecnicas en 16 lesiones cervicales de pacientes con cancer de tiroides del epitelio folicular (CT). Pacientes y metodo Se incluyeron 6 pacientes con CT y adenopatias laterocervicales evaluadas antes de la cirugia tiroidea inicial y 10 pacientes en seguimiento por CT ya operado y lesiones cervicales ecograficamente sospechosas y/o persistentes. Las 16 lesiones fueron sometidas a PAAF. Los resultados de la Tg-PAAF, cito-PAAF y de la combinacion de ambas se compararon con el diagnostico definitivo asignado a cada lesion. Resultados En 10 lesiones comprobadamente malignas tras extirpacion quirurgica (9 metastasis ganglionares y una recurrencia en lecho), la cito-PAAF, la Tg-PAAF y la combinacion de ambas tecnicas permitieron llegar al diagnostico correcto en 7, 9 y 10 casos respectivamente. En 6 lesiones consideradas benignas, la cito-PAAF pudo confirmar la benignidad de la lesion en 4, resulto no diagnostica en una y falsamente positiva en otra, mientras que la Tg-PAAF se hallo por debajo del valor de corte establecido (para considerar malignidad) en todos los casos. Conclusiones En pacientes con CT y lesiones cervicales sospechosas, la Tg-PAAF mejora la rentabilidad diagnostica de la cito-PAAF aislada justificandose asi su recomendacion sistematica al realizar la PAAF. Quedan sin embargo por definir una estandarizacion universal de la tecnica y unos valores de corte validos de Tg-PAAF (de acuerdo al inmunoanalisis empleado) por encima de los cuales considerar la lesion maligna.

Background and objective Thyroglobulin in the needle washout (Tg-FNA) and cytology of fine needle aspiration (cyto-FNA) are recommended for diagnosis of metastatic lymphadenopathies and recurrence of differentiated thyroid cancer. The objective of this study was to assess the value of these procedures in 16 cervical masses from patients with thyroid cancer of the follicular epithelium (TC). Patients and methods The study included six patients with TC and cervical lymphadenopathies evaluated before initial thyroid surgery and 10 patients followed up after TC surgery with cervical lumps discovered. FNA was performed in all 16 masses. Results of cyto-FNA, Tg-FNA and of the combined tests were compared to the final diagnosis of each lesion. Results Among 10 lesions proven to be malignant at surgery, cyto-FNA, Tg-FNA and the combination of both allowed for adequate diagnosis in 7, 9, and 10 cases respectively. Among 6 lesions considered to be benign, cyto-FNA was able to confirm diagnosis in 4, was non-diagnostic in one, and was falsely negative in the remaining case, while Tg-FNA was below the established cut-off value (to consider malignancy) in all cases. Conclusions In patients with TC and suspect cervical masses, Tg-FNA improved the diagnostic yield of cyto-FNA alone, thus warranting its routine recommendation when FNA is performed. However, universal standardization of the technique and definition of valid cut-off thyroglobulin values (depending on the immunoassay used) above which the lesion should be considered to be malignant are still pending.

ObjectivesTo assess whether Mediterranean Diet (MedDiet)-based medical nutrition therapy facilitates near-normoglycemia in women with gestational diabetes mellitus (GDMw) and observe the effects on adverse pregnancy outcomes.Research design and methodsThis is a secondary analysis of the St Carlos GDM Prevention Study, conducted between January and December 2015 in Hospital Clínico San Carlos (Madrid, Spain). One thousand consecutive women with normoglycemia were included before 12 gestational weeks (GWs), with 874 included in the final analysis. Of these, 177 women were diagnosed with gestational diabetes mellitus (GDM) and 697 had normal glucose tolerance. All GDMw received MedDiet-based medical nutrition therapy with a recommended daily extra virgin olive oil intake ≥40 mL and a daily handful of nuts. The primary goal was comparison of hemoglobin A1c (HbA1c) levels at 36–38 GWs in GDMw and women with normal glucose tolerance (NGTw).ResultsGDMw as compared with NGTw had higher HbA1c levels at 24–28 GWs (5.1%±0.3% (32±0.9 mmol/mol) vs 4.9%±0.3% (30±0.9 mmol/mol), p=0.001). At 36–38 GWs values were similar between the groups. Similarly, fasting serum insulin and homeostatic model assessment insulin resitance (HOMA-IR) were higher in GDMw at 24–28 GWs (p=0.001) but became similar at 36–38 GWs. 26.6% of GDMw required insulin for glycemic control. GDMw compared with NGTw had higher rates of insufficient weight gain (39.5% vs 22.0%, p=0.001), small for gestational age (6.8% vs 2.6%, p=0.009), and neonatal intensive care unit admission (5.6% vs 1.7%, p=0.006). The rates of macrosomia, large for gestational age, pregnancy-induced hypertensive disorders, prematurity and cesarean sections were comparable with NGTw.ConclusionsUsing a MedDiet-based medical nutrition therapy as part of GDM management is associated with achievement of near-normoglycemia, subsequently making most pregnancy outcomes similar to those of NGTw.

Resumen La neoplasia endocrina multiple de tipo 1 (MEN1) es un sindrome hereditario raro conocido por la predisposicion a la aparicion de neoplasias endocrinas en distintos tejidos como paratiroides, hipofisis y tracto gastrointestinal. Se presenta el caso de un varon en el que ademas de manifestaciones tradicionalmente descritas (hipeparatiroidismo y gastrinoma) se objetivan otras lesiones tumorales procedentes de celulas de estirpe endocrinologica (insulinoma, carcinoide gastrico, adenoma suprarrenal, tumores neuroendocrino no funcionantes del pancreas) y no endocrinologica (lipoma y colagenoma). La frecuente recurrencia de las lesiones sobre los tejidos susceptibles no resecados en su totalidad (como en el caso del hiperparatiroidismo y del gastrinoma duodenal) y las dudas sobre su significado clinico en el MEN1 suscitan cierta controversia en la actualidad sobre las recomendaciones en el manejo terapeutico de dichas lesiones que se revisa brevemente.

Objetivo: Identificar en el cancer diferenciado de tiroides (CDT) factores asociados a la persistencia de enfermedad a los 5 anos de la tiroidectomia total o casi total. Pacientes y metodo: Estudio retrospectivo en 63 pacientes con CDT, de los que se considero libres de enfermedad a los 5 anos a 46 (grupo L) y 17 presentaban enfermedad persistente al quinto ano o habian fallecido por CDT (grupo P). Se compararon las siguientes variables entre estos grupos: a) al diagnostico, relacionadas con el paciente (edad, sexo) y con el tumor (tipo histologico, tamano, extension extratiroidea, invasion vascular, multifocalidad, metastasis ganglionares y a distancia), y b) recogidas durante el seguimiento: proporcion de pacientes con tiroglobulina (Tg) serica estimulada = 10 ng/ml tras la cirugia (Tg0) y entre los 6 y los 12 meses (Tg1). Resultados: Al diagnostico, el sexo masculino, la extension extratiroidea y las metastasis ganglionares resultaron mas frecuentes en el grupo P (el 41 frente al 11%, el 60 frente al 18% y el 50 frente al 5,5% respectivamente; p < 0,05). Durante el seguimiento, el porcentaje de sujetos con Tg = 10 ng/ml fue mayor en el grupo P (Tg0, el 75 frente al 13%; Tg1, el 69% frente a 0; p < 0,05). Conclusiones: En nuestro medio, el sexo masculino, la extension extratiroidea y las metastasis ganglionares son factores asociados a la enfermedad persistente. El elevado valor predictivo de la Tg estimulada tras la cirugia y a los 6-12 meses ayuda a identificar a los pacientes que precisan de un seguimiento mas estrecho.

Diabetes remains the main cause of lower-extremity amputations (LEAs) (1,2,3). Recently (3), the number of LEAs carried out worldwide has been estimated to be >162 × 106 each year, with a high economic and social cost. More than 50% of these LEAs are performed in subjects with diabetes. Differences in the incidence of LEAs could reflect variations in risk factors, diabetes prevalence, health care systems, and lifestyle, as well as differences in population age-structure, the sources from which the case was identified, the levels of ascertainment, and the definitions of LEAs and the distinctions between major and minor LEAs. Recently, a standard approach to data collection has been described (4,5), and the first article (3) about the epidemiology of LEAs in several countries has been published. In this study, area 7 from Madrid presents the lowest LEA rates. The purpose of this article is to compare the incidence of LEAs in diabetic and nondiabetic subjects—in relation to the provision of improved foot-care after the St. Vincent Declaration—by use of a standardized approach, in the area 7 of Madrid between 1989 and 1993, between 1994 and 1996, and between 1997 and 1999. The National Health Service has divided Madrid into 13 health care areas. The public health care system is serving >99% of the total population from the area 7 and is provided by a single hospital (Hospital Clinico San Carlos) with a single specialized service for vascular patients. According to the census in 1991, the total population for the catchment area was 569,307 (261,529 men and 307,778 women). The population with diabetes was calculated according to the Lejona study (6). In this study, the prevalence of diabetes was estimated by a randomized sample stratified by 5-year age-groups and sex. The data of this …

Multiple endocrine neoplasia type 1 (MEN1) is a rare hereditary syndrome known to predispose subjects to endocrine neoplasms in a variety of tissues such as the parathyroid glands, the pituitary gland, and the gastrointestinal tract. We report the case of a male patient who, in addition to the traditionally described conditions (hyperparathyroidism and gastrinoma), was found to have other tumor lesions arising from both endocrine cells (insulinoma, gastric carcinoid, adrenal adenoma, and non-functional pancreatic neuroendocrine tumors), and non-endocrine cells (lipoma and collagenoma). The frequent recurrence of lesions in not completely resected susceptible tissues (as occurs in hyperparathyroidism and duodenal gastrinoma) as well as doubts concerning their clinical significance in MEN1 has raised some questions regarding the therapeutic management of such lesions, and this controversy is briefly reviewed.

To identify possible risk factors associated with persistent disease 5 years after total or near-total thyroidectomy in patients with differentiated thyroid cancer (DTC).Retrospective study evaluating data from 63 patients 5 years after they were first diagnosed of DTC. At this time of the study, 46 subjects were considered disease-free (F group) whereas 17 had evidence of persistent disease or had died from DTC (P group). We compared both groups of patients regarding the following variables: a) variables at diagnosis related to the patient (age, gender) and the tumor (histological type, size, extrathyroidal involvement, vascular invasion, multifocality, lymph node and distant metastases), and b) variables recorded during follow-up: percentage of subjects showing serum stimulated thyroglobulinor = 10 ng/ml few weeks postoperatively (Tg0) and 6 to 12 months later (Tg1).Male gender, extrathyroidal involvement and lymph node metastases were more frequent in P group than in F group (41 vs. 11%, 60 vs. 18% and 50 vs. 5.5%; p0.05). During the follow-up the percentage of patients showing Tgor = 10 ng/ml was higher in P group compared to F group, both at a few weeks postoperatively and 6 to 12 months later (Tg0, 75 vs. 13%; Tg1, 69% vs. 0; p0,05).In our patients, male gender, extrathyroidal involvement, and lymph node metastases at diagnosis were associated with persistent disease 5 years later. Serum stimulated thyroglobulin had a very high predictive value both just after surgery and in the next 6 to 12 months and could help identifying subjects who need a closer follow-up.