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R Simó

Publications and source records attributed to R Simó.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Differentiated thyroid carcinoma, 1972-1992. Follow-up, detection of recurrences and prognostic factors].

BACKGROUND: There is no consensus about the treatment and the follow-up of differentiated thyroid carcinoma (DTC), because in some patients, currently known prognostic factors cannot predict the course of the disease. The aim of this work has been to review the results of the treatment of our patients with DTC and to assess the prognostic factors. PATIENTS AND METHODS: We include, retrospectively, 204 patients with DTC (54 males and 150 women) with a men (SD) age of 38 (23) years, attending to a terciary university hospital. The follow-up is 9.2 (6) years (range, 2-22 years). They all underwent near total thyroidectomy, ablative doses of radioactive iodine (131INa) and L-thyroxine to suppress thyroid stimulating hormone (TSH) levels. At least once a year, a clinical examination, a whole-body scan (WBS) with 131INa and serum thyroglobulin (Tg) measurements were performed in hypothyroid state. In the statistics, chi 2 test, univariate analysis, Student's t test, Kaplan-Meier method, Mantel-Cox test and multiple regression analysis were employed. RESULTS: The survival rate was 89.05%. Twenty patients died of DTC (9.8%) (papillary 8 [6%], follicular 12[17%]). Surgical complications (recurrent nerve palsy or permanent hypoparathyroidism) were seen in 5% of the patients. The sensitivity of WBS to detect distant metastases or local (neck) involvement was 71% (initial 100%, late 71%). Tg sensitivity was 85% (initial 95%, late 73%). Factors associated to a poor prognosis were age > 40 years (p < 0.0001), follicular carcinoma (p < 0.02) and initial stages III and IV (p < 0.0001). CONCLUSIONS: The mortality and complications rates in our patients with differentiated thyroid carcinoma validate our management schedule. Tg measurements are more sensitive than WBS to detect distant or local metastases; however, sensitivity of both techniques was lower in the detection of late metastases. Age below 40 years, papillary carcinoma and initial stages I and II are factors of better prognosis.

Adenocarcinoma, Follicular↗
PubMed1997

Vitreous levels of vascular endothelial growth factor are not influenced by its serum concentrations in diabetic retinopathy.

Vascular endothelial growth factor (VEGF) plays a major role in the development of neovascularization in proliferative diabetic retinopathy (PDR). The source of intravitreous VEGF is presumably ischaemic retina, but increased levels derived from serum cannot be excluded. The aim of the study is to determine the intravitreous concentrations of VEGF in diabetic patients with PDR and to investigate whether serum VEGF could contribute to the intravitreous concentration. For this purpose, we studied 20 diabetic patients (5 IDDM and 15 NIDDM) with PDR in whom a vitrectomy was performed (group A). Non-diabetic patients (n = 13) with other conditions requiring vitrectomy served as a control group (group B). In both groups, VEGF was determined in serum and undiluted vitreous samples obtained simultaneously. Furthermore, serum VEGF was determined in 69 healthy control subjects (group C) and 39 diabetic patients without microvascular complications (group D). Vitreous and serum VEGF was determined by ELISA (R & D Systems, Abingdon, UK); intra-assay CV 3.8%, interassay CV 5.1%. Intravitreous concentrations of VEGF were strikingly higher in group A (median 1.75 ng/ ml, range 0.33-6.66) in comparison with group B (median 0.009 ng/ml, range 0.009-0.038); p < 0.0001. This difference remained significant after adjusting for intravitreous protein concentration (p < 0.05). Differences in serum VEGF among the groups included in the study were not found. We conclude that the high vitreous levels of VEGF observed in diabetic patients with PDR cannot be attributed to serum diffusion across the blood-retinal barrier. Therefore, intraocular synthesis is the main contributing factor for the high vitreous VEGF concentrations observed in PDR.

Adult↗
PubMed1997

Relationship between lipoprotein(a) phenotypes and albumin excretion rate in non-insulin-dependent diabetes mellitus: protective effect of 'null' phenotype?

The possible association between lipoprotein(a) [Lp(a)] and albumin excretion rate (AER) is a topic that generates conflicting views. In addition, Lp(a) phenotypes have not previously been considered as factors influencing AER. In order to clarify this issue, we studied 70 non-insulin-dependent diabetes mellitus (NIDDM) patients without clinically detectable macroangiopathy, 27 with microalbuminuria and 43 without it. Both groups were matched for the known variables that could influence AER and serum Lp(a) levels. Lp(a) was determined by enzyme-linked immunosorbent assay (ELISA), and Lp(a) phenotypes were assessed by electrophoresis followed by immunoblotting. Lp(a) phenotypes were grouped as follows: 'small' (F, S1 and S2), 'big' (S3 and S4) and 'null'. The NIDDM patients with microalbuminuria presented higher serum Lp(a) concentrations than the patients without it [15.7 mg dL-1 (95% CI 0.5-36.5) vs. 4.5 mg dL-1 (95% CI 0.1-18.5); P < 0.001] and a direct correlation between Lp(a) and AER was observed (r = 0.34; P < 0.01). AER was significantly different when Lp(a) phenotypes were considered ['small': median 19 micrograms min-1 (range 1-195); 'big': median 9.5 micrograms min-1 (range 1-186); 'null': 4 micrograms min-1 (range 1-9); P = 0.04]. None of the NIDDM patients with a 'null' phenotype showed an AER of > 10 micrograms min-1. In conclusion, this case-control study provides evidence that microalbuminuria is associated with high serum Lp(a) in NIDDM without clinically detectable macroangiopathy. Furthermore, NIDDM patients with a 'null' phenotype could be considered at low risk for the development of microalbuminuria.

Aged↗
PubMed1997

False-positive results of basal and pentagastrin-stimulated calcitonin in non-gene carriers of multiple endocrine neoplasia type 2A.

Direct DNA analysis permits accurate identification of gene carriers in kindred members with multiple endocrine neoplasia type 2A (MEN 2A). The aim of this study was to assess the specificity of basal and pentagastrin stimulated calcitonin levels in 3 family members with MEN 2A. For this purpose 53 members of 3 consecutive families with MEN 2A were evaluated in a university medical center. Serum calcitonin, basal and stimulated, was determined by a commercial RIA. RET protooncogene analysis was carried out by automatic DNA sequencing and adequate digestion of PCR amplified products for exons 10 and 11. Two distinct mutations in the RET protooncogene were identified. A T-->A transition at position 1783 (codon 618) in exon 10 was detected in one family, and a G-->A replacement at position 1832 (codon 634) in exon 11 in the others. In non-gene carriers we obtained 6.6% of false-positive results for basal calcitonin and 15.4% for the pentagastrin provocative test. We conclude that the specificity of basal and pentagastrin-stimulated calcitonin is rather limited and RET protooncogene analysis must be the first line screening procedure in order to identify gene carriers.

Adolescent↗
PubMed1997

Leu-M1 immunoreactivity and phaeochromocytoma.

The aim was to evaluate Leu-M1 immunoreactivity as a prognostic factor in phaeochromocytoma. Anti-Leu-M1 monoclonal antibodies were used to determine the Leu-M1 immunoreactivity in 17 histologically confirmed phaeochromocytomas from 15 patients, using an avidin-biotin technique. Ten patients had a sporadic phaeochromocytoma, and five had multiple endocrine neoplasia type 2A (MEN 2A). Malignancy was diagnosed in three patients by the presence of metastases. Leu-M1 immunoreactivity was shown in 12 (70.5%) phaeochromocytomas. Three patterns of arrangement were observed: isolated (scattered positive cells) (n = 3); focal (aggregates of positive cells) (n = 5), and diffuse patterns (dispersed positive cells) (n = 4). Two cases of malignant phaeochromocytoma were positive (one focal and one isolated pattern). All cases of MEN 2A showed immunoreactivity, although no characteristic pattern was prevalent. A diffuse pattern was observed in all phaeochromocytomas longer than 7 cm. In conclusion, Leu-M1 expression is frequent in phaeochromocytoma. However, Leu-M1 immunoreactivity seems to be useless in predicting malignant behaviour and to be influenced mainly by tumour size.

Adrenal Gland Neoplasms↗
PubMed1996

Serum concentrations of laminin-P1 in diabetes mellitus: usefulness as an index of diabetic microangiopathy.

OBJECTIVE: To assess the influence of several variables on serum laminin-P1 (Lam-P1) and to evaluate its usefulness as a serum marker of diabetic microangiopathy. MATERIAL AND METHODS: We determined Lam-P1 by serum radioimmunoassay in 121 controls and 176 diabetic patients, 58 type 1 (insulin dependent) and 118 type (non-insulin dependent), grouped according to retinal status and urinary albumin excretion. The variables evaluated were: age, gender, body mass index, blood pressure, consumption of tobacco and alcohol, type of diabetes, duration of disease, fasting blood glucose, HbA1, cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and apolipoproteins (A1, B). Imprecision for laminin determination was: 3.6% intrassay; 5.8% interassay. STATISTICS: Student's t-test, ANOVA, ANCOVA, and multiple regression analysis. RESULTS: In diabetic patients Lam-P1 was higher than in controls (X = 1.63 +/- S.D. 0.36 vs. X = 1.40 +/- S.D. 0.18 U ml-1; P < 0.001) and only correlated with age (P = 0.002). Lam-P1 was higher in diabetics with proliferative retinopathy than in patients with non-proliferative retinopathy and without retinopathy (X = 2.17 +/- S.D. 0.49 U ml-1 vs. X = 1.71 +/- S.D. 0.22 U ml-1 vs. X = 1.47 +/- S.D. 0.26 U ml-1; P < 0.001). Patients with macroalbuminuria presented higher serum Lam-P1 than patients with micro or normoalbuminuria (X = 2.39 +/- S.D. 0.53 U ml-1 vs. X = 1.78 +/- S.D. 0.23 U ml-1 vs. X = 1.51 +/- S.D. 0.29 U ml-1; P < 0.001). These differences remained significative when patients were age-adjusted. CONCLUSIONS: Lam-P1 could be useful as an index of diabetic microangiopathy but patient's age should be considered.

Adult↗
PubMed1996

High prevalence of hepatitis C virus infection in diabetic patients.

OBJECTIVE: To evaluate the prevalence of hepatitis C virus (HCV) infection in diabetic patients and to investigate the influence of several epidemiological and clinical factors on HCV infection. RESEARCH DESIGN AND METHODS: A total of 176 consecutive diabetic patients were compared with 6,172 blood donors, matched by recognized risk factors to acquire HCV infection. Serologic testing for anti-HCV was done using a second-generation commercial enzyme-linked immunosorbent assay (ELISA) and an immunoblot assay was performed in anti-HCV positive samples to confirm HCV specificity. Diabetic patients were divided in two groups according to their HCV antibody status and analyzed for the following variables: age, sex, type of diabetes, duration of disease, mode of therapy, late diabetic complications, previous blood transfusions, intravenous drug addiction, hospital admissions, major surgical procedures, and liver function tests (LFTs). RESULTS: A higher prevalence of HCV infection was observed in diabetic patients in comparison with blood donors (11.5 vs. 2.5%; P < 0.001; odds ratio 4.39; 95% Cl2.61-7.24). We did not detect any particular epidemiological factor for HCV infection in anti-HCV positive diabetic patients. In these patients, abnormal LFTs were observed in 72.3%, compared with only 24.7% of anti-HCV negative diabetic patients (P < 0.001). CONCLUSIONS: A high prevalence of HCV infection was detected in diabetic patients, and most of anti-HCV positive patients presented with abnormal LFTs. Therefore, testing for HCV infection of diabetic patients with an abnormal LFT is mandatory. The lack of any particular epidemiological factor for HCV infection in our diabetic population suggests that HCV may have a direct role in the development of diabetes.

Adult↗
PubMed1995

Differentiated thyroid carcinoma as a cause of cervical spinal injury.

Cervical cord compression due to local extension of differentiated thyroid carcinoma (DTC) is an extremely rare condition and, to our knowledge, only one case has been reported in the literature. Among 256 patients with DTC treated at our hospital, we have observed 3 cases of spinal injury due to local extension of DTC. A Brown-Séquard syndrome was detected at physical examination in 2 cases. In both patients, cervical cord compression precipitated a fatal event. In the remaining patient, a radiculopathy C5-C7 was observed. Magnetic resonance imaging was very successful in outlining the mass, clearly differentiating the extrinsic invasion from a metastasis, and allowing the surgical possibilities to be evaluated. Poor cervical uptake of 131I was observed on scans performed in two cases, suggesting a certain degree of cell dedifferentiation. We suggest that cervical spinal injury due to local extension of DTC may be an underreported complication of DTC that seems to condition the patient's outcome. Careful neurological examination is warranted in patients with DTC at stages III-IV and magnetic resonance imaging must be performed when spinal injury is suspected.

Adenocarcinoma, Follicular↗
PubMed1994

Pre-clinical Cushing's syndrome: report of three cases and literature review.

Pre-Cushing's syndrome (PCS) is defined as an overproduction of cortisol by an adrenal adenoma, without physical changes on clinical examination. Three patients with PCS were recently diagnosed among 21 consecutive patients suffering from adrenal 'incidentaloma'. All patients showed nonsuppression of serum and urinary cortisol following 2 and 8 mg of dexamethasone (DXM), and suppressed or normal baseline plasma ACTH. Unilateral uptake of radiolabelled iodocholesterol, which persisted after DXM, was uniformly present. The authors review 36 patients with PCS previously reported. This entity probably constitutes a transition from classic 'nonfunctional' adrenal adenoma to cortisol-producing adenoma. Uniform guidelines in the management of PCS cannot yet be given, but surgical intervention is usually required to prevent the development of long-term complications of subtle corticoid excess.

Adenoma↗
PubMed1993

[Clinical usefulness of adrenal gland computed tomography in the etiologic diagnosis of Addison's disease].

BACKGROUND: The aim of this study was to evaluate adrenal gland morphology by computerized tomography (CT) in the etiologic diagnosis of Addison's disease. METHODS: Twenty-two patients were grouped according to their etiology based on the study of antiadrenal antibodies at diagnosis of the disease: 7 were positive (autoimmune etiology or EAA), 11 were negative (tuberculous etiology or EAT) and in four serologic study was not available (undetermined etiology or EAI). Adrenal gland CT was performed with contiguous sections every 5 mm. In eight cases the examination was carried out upon diagnosis of the disease (initial stage) and in 14 between 2 and 17 years following diagnosis (evolutive stage). RESULTS: In all the patients of the EAA group, examined in either the initial or evolutive stages, the adrenal glands appeared atrophic without calcifications. In the patients of the EAT group adrenal masses of proven tuberculous origin were found in five who were studied in the initial stage and with atrophic glands with calcifications in the remaining patients examined in the evolutive stage, with the exception of two cases with atrophic adrenal glands without calcifications which could serologically be considered as false negatives having autoimmune etiology. The patients in the EAI groups were studied in the evolutive stage with three having atrophic glands with calcifications and one atrophic adrenal glands without calcifications. CONCLUSIONS: Adrenal gland computerized tomography is an useful examination to differentiate between autoimmune or tuberculous origin in Addison's disease. Clinical application may be justified in all patients of recent diagnosis when the study of the antiadrenal antibodies is negative or not possible.

Addison Disease↗