[Hungry bone syndrome: clinical experience in its diagnosis and treatment]. / Síndrome de "huesos hambrientos": experiencia clínica en su diagnóstico y tratamiento.

Hungry bone syndrome is a unusual complication of the postoperative period of primary hyperparathyroidism. This syndrome is characterized by hypocalcemia, hypophosphatemia and hypomagnesemia, due to an excessive bone remineralization. We report the clinical features, laboratory and therapy in four females (aged 39 to 73 years old) with a long standing hyperparathyroidism, elevated alkaline phosphatases and decreased bone mineralization in two. The mean size of the adenoma was 2.9 +/- 1.1 cm. Hypocalcemia appeared between days 1 and 6 of the postoperative period. All were treated with calcium, calcitriol and magnesium at different timing and dosages. The mean hospitalization period was 19.8 +/- 2.1 days. As reported previously, low bone mineralization and a large adenoma are risk factors for the syndrome. Serial monitoring of serum calcium and magnesium and an early supplementation of these minerals could prevent hypocalcemia and decrease the hospitalization time.

An institutional experience with cervical vagus nerve trunk stimulation for medically refractory epilepsy: rationale, technique, and outcome.

OBJECTIVE: Intermittent stimulation of the left cervical vagus nerve trunk is emerging as a novel adjunct in the treatment of medically refractory seizures. We sought to evaluate theoretical and practical issues attendant to this concept. We review the anatomic and physiological background arguing for clinical application of vagus nerve stimulation, discuss salient aspects of patient selection and the nuances of surgical technique, and present our observations of and results from application of the method. METHODS: Each of 18 patients with medically refractory epilepsy and at least six complex partial or secondarily generalized seizures per month underwent placement of a NeuroCybernetic Prosthesis pulse generator (Cyberonics, Webster, TX) in the chest, connected to helical platinum leads applied to the left cervical vagus nerve trunk. The patients were then randomized in a double-blinded fashion to receive either high (presumably therapeutic) or low (presumably less therapeutic) levels of vagus nerve stimulation. Reduction in seizure frequency, global assessments of quality of life, physiological measurements, and adverse events were recorded during a 3-month period. Patients in the low group were then crossed over to high-stimulation paradigms during a 15-month extension trial. RESULTS: All operations were successful, uneventful, and without adverse postoperative sequelae. One patient was excluded from analysis because of inadequate seizure calendars. Of the seven patients initially assigned to high stimulation, the mean reduction in seizure frequency was 71% at 3 months and 81% at 18 months. Five (72%) of these patients had a greater than 75% reduction in seizure frequency, and one (14%) remained seizure-free after more than 1.5 years of follow-up. The mean reduction in seizure frequency among the low-stimulation group was only 6% at 3 months. No serious complications, device failures, or physiological perturbations occurred. CONCLUSION: In our experience, vagus nerve stimulation has proven to be a safe, feasible, and potentially effective method of reducing seizures in select patient populations. However, the elements of strict definition for the application of the method require further study.

[Nutritional study of alcoholics with specific reference to calcium and phosphorus]. / Estudio nutricional en alcohólicos con particular referencia a calcio y fósforo.

We performed a nutritional study of 80 alcoholic males at least 15 days after an acute episode of alcoholic intake. 43 patients were intermittent drinkers with mean age 37.9 years and 37 patients were continuous drinkers with mean age 440.30 healthy subjects were studied as controls. Body mass index was 23.7 (range 19.2-37.9) in intermittent drinkers compared to 23.1 (range 18.1-29.8) in continuous drinkers (NS). Wine was the main alcoholic beverage in 70% and 89%, respectively. Mean daily alcohol intake was 170 g for 17 years and 358 g for 23 years, respectively. Mean caloric intake and % of calories from alcohol were 3387 and 42% for intermittent compared to 4271 and 66% for continuous drinkers, respectively. Daily calcium intake was 757 g and 774 g in each group. Alcoholic beverages supplied 16% and 34% of calcium intake, respectively. The intake of phosphorus was adequate. Alcoholic subjects did not manifest anemia or hypoalbuminemia, compared to controls. The present study fails to disclose significant caloric and protein undernutrition in alcoholic subjects. However, the intake of calcium is inadequate and a high percentage of it is provided by alcoholic beverages. This deficiency in conjunction with alcoholic damage to intestinal mucosa may lead to osteopenia in alcoholic patients.