Màrius Foz

Suppressive therapy with levothyroxine for solitary thyroid nodules

objective To evaluate the effect of treatment with TSH suppressive dose of levothyroxine In patients with benig nthyroid nodules.

Pharmacological Approaches for the Treatment of Obesity

AbstractThe high incidence of obesity, its multifactorial nature, the complexity and lack of knowledge of the bodyweight control system, and the scarcity of adequate therapeutics have fuelled anti-obesity drug development during a considerable number of years. Irrespective of the efforts invested by researchers and companies, few products have reached a minimum level of effectiveness, and even fewer are available in medical practice. As a consequence of anti-obesity research, our knowledge of the bodyweight control system increased but, despite this, the pharmacological approaches to the treatment of obesity have not resulted yet in effective drugs.This review provides a panoramic of the multiple different approaches developed to obtain workable drugs. These approaches, however, rely in only four main lines of action: i) control of energy intake, mainly through modification of appetite; ii) control of energy expenditure, essentially through the increase of thermogenesis; iii) control of the availability of substrates to cells and tissues through hormonal and other metabolic factors controlling the fate of the available energy substrates; and iv) control of fat reserves through modulation of lipogenesis and lipolysis in white adipose tissue. A large proportion of current research is centred on neuropeptidic control of appetite, followed by the development of drugs controlling thermogenic mechanisms and analysis of the factors controlling adipocyte growth and fat storage. The adipocyte is also a fundamental source of metabolic signals, signals that can be intercepted, modulated and used to force the brain to adjust the mass of fat with the physiological means available.The large variety of different approaches used in the search for effective antiobesity drugs show both the deep involvement of researchers on this field and the large amount of resources devoted to this problem by pharmaceutical companies. Future trends in anti-obesity drug research follow closely the approaches outlined; however, the increasing mass of information on the molecular basis of bodyweight control and obesity will in the end prevail in our search for effective and harmless anti-obesity drugs.

Influence of sociodemographic factors in the prevalence of obesity in Spain. The SEEDO'97 Study.

Objective: To analyse the influence of social and cultural factors in the prevalence of obesity in the Spanish adult population aged 25–60 y based on available population data.Design: Pooled analysis of four cross-sectional nutrition surveys.Subjects: A total of 5388 free-living subjects aged 25–60 y, respondents of the Nutritional Surveys carried out in four Spanish regions (Catalunya, Basque Country, Madrid and Valencia) from 1990 to 1994. The samples were pooled together and weighted to build a national random sample.Measurements: Weight and height were measured on each individual by trained observers. Age, gender, educational level, occupation, habitat (rural/urban) and region were considered. Obesity was defined as body mass index ≥30 kg/m2. The protocol used in each survey was in accordance with the recommendations of the Spanish Society for the Study of Obesity (SEEDO). Logisitic regression models were designed to analyse the influence of sociodemographic factors in the prevalence of obesity in men and women.Results: The prevalence of obesity was higher in older age groups in men and women, odds ratio (OR) for every 10 y OR=1.40 (95% CI 1.39–1.41) for men and OR=1.86 (95% CI 1.85–1.87) for women. Logisitic regression analysis adjusted for age showed higher obesity rates among low educated people, OR=1.80 (95% CI 1.78–1.81) in men and OR=2.36 (95% CI 2.29–2.42) in women (P<0.001). Among men the odds ratio for the prevalence of obesity in rural areas was OR=1.87 (95% CI 1.86–1.89), compared to cities. The geographical distribution showed higher obesity rates in the southeast.Conclusion: This study supports that obesity is a multifactorial problem. Older women with low educational level and low income seem to be the most susceptible group to weight gain. Therefore, Public Health Programs should consider this type of environmental factor when planning strategies aimed at preventing or reducing the problem of obesity in western societies.European Journal of Clinical Nutrition (2001) 55, 430–435

Assay-dependent results of immunoassayable spontaneous 24-hour growth hormone secretion in short children.

ABSTRACT. Forty‐eight children, referred for evaluation of short stature, underwent 24‐hour spontaneous growth hormone (GH) secretion studies. The GH level in pooled sera was assessed for each child, using up to 11 commercial immunoassays. In a group of 15 children, the mean GH values obtained by nine of the assays were compared with the mean value given by a polyclonal radioimmunoassay (RIA) from Sorin: four gave higher results (p < 0.0001), three gave comparable results and two gave lower results (p < 0.001). The assay yielding the highest results (Nichols: 5.9 ± 2.3 ng/ml, mean ± SD) gave values that were approximately triple those obtained by the assay yielding the lowest results (Hybritech: 1.8 ± 0.8 ng/ml; p < 0.0001); both of these are monoclonal immunoradiometric assays (IRMAs). The GH concentrations measured in 24‐hour pools from 32 children using a monoclonal IRMA from Biomerieux were similar to those obtained using a polyclonal RIA from Farmos (2.8 ± 1.1 ng/ml and 2.9 ± 1.4 ng/ml, respectively) but significantly lower than those measured by another polyclonal RIA from Sorin (3.5 ±1.5 ng/ml). Two polyclonal assays (Biomérieux and Sorin) were then used to measure the GH levels in all of the 30‐minute samples and in the day, night and 24‐hour pools from the secretion studies of 22 children. The ratio of the results of the two assays remained fairly constant for a given child (although the GH levels in different 30‐minute samples differed considerably). However, the ratios between different children showed quite wide variation (from 2.03 to 1.04). It was concluded that the GH assay must be taken into account when evaluating data from GH secretion studies, and the disparity in the GH level measured by two or more assays may differ from child to child.

Obesity and overweight trends in Catalonia, Spain (1992-2003): gender and socio-economic determinants

OBJECTIVE To evaluate the trends of overweight and obesity prevalences in the population of Catalonia, Spain, aged 18-75 years, and the influence of socio-economic determinants on these prevalence trends. DESIGN Analysis based on data from two representative population-based cross-sectional surveys. SETTING Data from the two Evaluations of Nutritional Status in Catalonia (ENCAT 1992-93 and ENCAT 2002-03), Spain. Weights and heights were obtained by direct measurement in standardised conditions by trained interviewers. Overweight and obesity were defined using body mass index (BMI) and waist circumference (WC), categorised according to WHO criteria. SUBJECTS In total, 1015 men and 1233 women from ENCAT 1992-93, and 791 men and 924 women from ENCAT 2002-03. RESULTS Mean BMI and mean WC were higher in males in 2002-03 as compared to 1992-93, while for females mean BMI was lower except for the youngest group, and mean WC was higher. In men, overall BMI overweight prevalence remained stable (from 44.1% to 43.7%), while obesity increased (from 9.9% to 16.6%); total WC overweight remained stable (from 21.7 to 23.8%), while WC obesity increased (from 13.1% to 24.4%). In women, overall BMI overweight increased (from 29.1% to 30.1%), whereas BMI obesity remained stable (from 15.0% to 15.2%); total WC overweight decreased (from 21.8% to 17.7%), while WC obesity increased (from 24.5% to 31.1%). The socio-economic and education variables had an influence on BMI and WC overweight and obesity rates mainly on females in both surveys and on the youngest men only in the 1992-93 survey. CONCLUSIONS Ten-year trends indicate that Catalan males are getting bigger overall (BMI) and around the waistline (WC), while Catalan females only have bigger waistlines (WC). BMI male obesity prevalence has overtaken that of females. WC obesity continues to be more prevalent among females than males.

Real-Time Ultrasound for Diagnosis of Symptomatic Venous Thrombosis and for Screening of Patients at Risk: Correlation with Ascending Conventional Venography

This is a prospective study of 108 patients in two distinct groups undergoing real-time ultrasonography (US) and ascending conventional venography within the same day. The two patient groups consisted of the following: Those patients evaluated because of suspicion of deep venous thrombosis of lower limbs (69 patients) and those at high risk for venous thrombosis (19 patients with a recent hip fracture, 20 with a suspected pulmonary embolism). In the diagnosis group 48 patients had venographic evidence of thrombosis. The predictive value of abnormal findings from real-time US was 97%, and that of a negative study was 75%. Thus, real-time US may have a role as a diagnostic procedure, to be fol lowed by x-ray venography in patients with negative US results. By contrast, real-time US is far less sensitive as a screening test in patients without clinical evidence of thrombosis. Only 3 of 9 patients with thrombosis were detected, with a 50% sensitivity for proximal vein thrombosis. Therefore, the use of real-time US for screening high-risk patients must be limited to very high risk patients in whom other tests are ineffective (as in hip surgery).

Pérdida de peso en un paciente con obesidad mórbida en tratamiento con oleoil-estrona

Fundamento Y Objetivo La administracion de oleoil-estrona a las ratas induce la perdida de grasa, sin afectar la proteina, mediante la disminucion de la ingesta y el mantenimiento del gasto energetico. La oleoil-estrona ademas reduce la resistencia a la insulina y la hiperlipemia, y carece de efectos estrogenicos. El objetivo fue determinar si la oleoil-estrona oral es efectiva en el tratamiento de la obesidad morbida en un paciente obeso voluntario. Pacientes Y Metodo Se administro oleoil-estrona (150–300 μmol/dia) a un varon obeso morbido (indice de masa corporal de 51,9 kg/m2) en 10 periodos consecutivos de 21 dias, seguidos en cada caso de al menos dos meses de descanso. El tratamiento se siguio sin restricciones dieteticas adicionales. Se midieron las concentraciones de algunos metabolitos plasmaticos y hormonas antes y durante el tratamiento y los periodos de descanso. Resultados El tratamiento con oleoil-estrona hizo disminuir el peso corporal (38,5 kg en 27 meses, hasta un indice de masa corporal de 40,5 kg/m2). No se observaron tendencias al rebote en el peso durante los periodos de descanso. Tampoco se observaron cambios negativos significativos en los parametros sanguineos, hormonas, metabolitos y enzimas plasmaticas como consecuencia del tratamiento. Conclusiones La oleoil-estrona disminuyo el peso corporal en el sujeto sin afectar las cifras de metabolitos y hormonas, de modo similar a lo observado en modelos animales. Estos resultados estan de acuerdo con un claro potencial de la oleoil-estrona como farmaco antiobesidad.

Different patterns of nicotinic acetylcholine receptor subunit transcription in human thymus

Clinical observations suggest that the thymus is strongly implicated in the pathogenesis of myasthenia gravis (MG), but questions such as the level and location of nicotinic acetylcholine receptor (AChR) subunit expression that are fundamental to postulate any pathogenic mechanism, remain controversial. We have re-examined this question by combining calibrated RT-PCR and real-time PCR to study nicotinic AChR subunit mRNA expression in a panel of normal and myasthenic thymi. The results suggest that the expression of the different AChR subunits follows three distinct patterns: constitutive for, neonatal for gamma and individually variable for alpha1, beta1 and delta. Experiments using confocal laser microdissection suggest that AChR is mainly expressed in the medullary compartment of the thymus but there is not a clear compartmentalization of subunit expression. The different patterns of subunit expression may influence decisively the level of central tolerance to the subunits and explain the focusing of the T cell response to the alpha and gamma subunits.

Occult Thyrotoxicosis in Patients with Atrial Fibrillation and an Acute Arterial Embolism

Serum total thyroxine, triiodothyronine, and thyrotropin response to thyro tropin-releasing hormone (TRH-TSH test) were measured in 126 consecutive patients admitted with atrial fibrillation: 33 patients with an acute arterial limb embolism (Group I), 31 patients with an acute embolic stroke (Group II), and 62 patients without any arterial occlusion (Group III). A blunted TRH-TSH test, suggestive of thyrotoxicosis, was found in 5 patients in Group I, 8 patients in Group II, and 2 patients in Group III. The diagnosis of hyperthyroidism was confirmed in 8 patients (by repeated TRH-TSH test and scintigraphy): 4 pa tients in Group I (12.1%) and 4 patients in Group II (12.9%). All of them had a nonvalvular atrial fibrillation. Thyrotoxicosis should not be recognized in 6 of them if TRH-TSH test was not performed, because peripheral hormone levels were normal. Five of these 8 patients with thyrotoxicosis had reversion to sinus rhythm after treatment with carbimazole, either spontaneously or after car dioversion. This outcome prevented prolongation of anticoagulant therapy for an indefinite time.

Amyloid goiter. Diagnosis by fine-needle aspiration biopsy of the thyroid

Amyloid goiter is a rare condition. We could not find more than 90 cases from an extensive review of the world literature. We report here two patients in whom that diagnosis was made, prior to surgery, by fine-needle aspiration biopsy of the thyroid. We review the major clinic and histopathologic characteristics of amyloid goiter and we stand out the usefulness of the fine-needle aspiration biopsy of the thyroid to diagnose the amyloid goiter and amyloidosis, in general.