Prevalencia de osteoporosis en la población española por ultrasonografía de calcáneo en función del criterio diagnóstico utilizado. Datos del estudio GIUMO / Calcaneous ultasonography es measurement of osteoporosis prevalence in the general population in relation to the diagnostic criterion utilized. Data of the study GIUMO

Fundamento. En los últimos años se han desarrollado un gran número de técnicas para estimar la densidad mineral ósea y con ello poder realizar el diagnóstico de osteoporosis. Sin embargo, invariablemente se aplican los criterios diagnósticos que fueron establecidos por la OMS para su utilización con la densitometría radiológica dual (DEXA), lo cual podría no ser correcto en el caso de los ultrasonidos. Método. Se estudió a una población escogida aleatoriamente de 2.589 personas de ambos sexos, 1.138 varones y 1.451 mujeres de entre 10 y 99 años de edad procedente de 11 provincias españolas. Se efectuó una medición de los parámetros que estima el ultrasonógrafo de calcáneo Sahara®, Hologic®: velocidad del sonido, (SOS), coeficiente de atenuación de banda ancha (BUA), índice de consistencia (QUI) y densidad mineral ósea estimada (est. DMO). Se calculó la prevalencia de osteopenia y osteoporosis aplicando los criterios de la OMS (osteopenia: Tscore 1 y osteoporosis Tscore 2,5) y la prevalencia de osteoporosis efectuando el corte en un Tscore de -1,8.Resultados. Empleando los criterios de la OMS, existe osteoporosis (Tscore 2,5) en el 1,5 por ciento de los varones y el 5,9 por ciento de las mujeres de entre 51 y 70 años y en el 2,6 por ciento de los varones y el 22,1 por ciento de las mujeres de más de 70 años. Si efectuamos el corte en un Tscore de -1,8, la prevalencia asciende al 8,2 por ciento de los varones y 21,9 por ciento de las mujeres de entre 51 y 70 años y al 8,4 por ciento de los varones y 40,9 por ciento de las mujeres de más de 70 años. Conclusión. La prevalencia de osteoporosis en la población española de ambos sexos difiere notablemente aplicando el punto de corte en un Tscore de -2,5 como indica la OMS o en -1,8 sugerido por otros autores. Es necesario la realización de un consenso para establecer cuál es el punto de corte apropiado para el diagnóstico de osteoporosis por ultrasonografía cuantitativa de calcáneo (AU)

[Calcaneous ultrasonography as measurement of osteoporosis prevalence in the general population in relation to the diagnostic criterion utilized. Data of the study GIUMO]. / Prevalencia de osteoporosis en la población española por ultrasonografía de calcáneo en función del criterio diagnóstico utilizado. Datos del estudio GIUMO.

CONTEXT: In recent years, a large number of techniques have been developed to estimate the bone mineral density for the diagnosis of osteoporosis. However, diagnostic criteria established by WHO are invariably applied for the interpretation of dual radiological densitometry (DEXA), which could not be correct in the case of the interpretation of ultrasound. METHOD: We studied 2,589 randomly chosen people of both sexes, 1,138 males and 1,451 women from 10 to 99 years, in 11 spanish provinces. We carried out a measurement of the following calcaneous ultrasound parameters with the Sahara and Hologic devices: speed of the sound (SOS), coefficient of attenuation of wide band (BUA), index of consistency (QUI) and estimated bone mineral density (est. BMD). The prevalence of osteopenia and osteoporosis was calculated by applying the WHO criteria (osteopenia Tscore < or = 1 and osteoporosis Tscore < or = 2.5) and the prevalence of osteoporosis by applying a Tscore 1.8 as threshold. RESULTS: According to the WHO criteria, osteoporosis (Tscore < or = 2.5) is seen in 1.5 % males and 5.9 % females from 51 to 70 years, and in 2.6% males and 22.1% females over 70 years. Using a Tscore 1.8 as threshold, osteoporosis prevalence increases to 8.2% males and 21.9% females from 51 to 70 years, and to 8.4% males and 40.9% females over 70 years. CONCLUSION: Osteoporosis prevalence in spanish people of both sexes differs notably when applying the cut off point in a Tscore of 2.5, as WHO recommends, or in a Tscore of 1.8 as is suggested by other authors. Consensus is necessary to establish the appropriate cut off point or threshold for the diagnosis of osteoporosis with quantitative ultrasonography of calcaneum.

Diferencias regionales en los valores ultrasonográficos. Datos del estudio GIUMO / Regional differences in the ultrasonographic values. Data of GIUMO study

Toda nueva técnica utilizada para estimar la densidad mineral ósea precisa unos valores de referencia, tanto de normalidad como de precisión y exactitud, hasta el punto de que la Organización Mundial de la Salud recomienda que estos estudios sean realizados localmente. En el grupo de investigación sobre ultrasonidos y metabolismo óseo (GIUMO) hemos realizado este trabajo en la población española, pero tratándose de un estudio cooperativo multicéntrico, hemos observado marcadas diferencias entre los distintos centros participantes. Presentamos en este artículo las variaciones encontradas al analizar los parámetros del ultrasonográfo Sahara ©Hologic ©: (velocidad del sonido, SOS, coeficiente de atenuación de banda ancha, BUA, índice de Consistencia , QUI y densidad mineral ósea estimada , BMD), así como la precisión in vivo, in vitro y la exactitud de estas estimaciones (AU)

Acceptance of the different denominations for reflex sympathetic dystrophy.

OBJECTIVE: To elucidate the real impact in the medical literature of the different denominations for reflex sympathetic dystrophy (RSD). METHODS: A search was performed through the Medline database (WinSPIRS, SilverPlatter International, NS), from 1995 to 1999, including the following descriptors: RSD, complex regional pain syndrome (CRPS), CRPS type I, algodystrophy, Sudeck, shoulder-hand syndrome, transient osteoporosis, causalgia, and CRPS type II. RESULTS: The descriptor RSD was detected in 576 references, algodystrophy in 54, transient osteoporosis in 42, CRPS type I in 24, Sudeck in 16, and shoulder-hand syndrome in 11. One hundred records were obtained for the descriptor causalgia and five for CRPS type II. The descriptor RSD was detected in the title of 262 references, algodystrophy in 29, transient osteoporosis in 29, CRPS type I in 15, Sudeck in 3, shoulder-hand syndrome in 5, causalgia in 17, and CRPS type II in 3 references. CONCLUSIONS: The new CRPS terminology has not effectively replaced the old one. RSD and causalgia are the most used denominations.

Fibromyalgia syndrome: overnight falls in arterial oxygen saturation.

PURPOSE: Sleep alterations and muscular changes suggesting hypoxia have been reported in fibromyalgia syndrome (FS) pathophysiology. We tested the hypothesis that patients with FS show falls in the oxygen saturation of hemoglobin in arterial blood (SaO2%) during sleep. PATIENTS AND METHODS: Overnight SaO2% was measured by digital pulse oximetry in 28 randomly selected women who met 1990 American College of Rheumatology criteria for the diagnosis of FS and 15 similar controls. Considering the results of pulse oximetry and in order to evaluate the possible presence of a sleep apnea syndrome (SAS) as the reason for the nocturnal desaturations, the Epworth Sleepiness Scale (ESS) was mailed to the patients and controls. Patients and controls who had a score higher than 10 on the ESS underwent a polysomnographic study. RESULTS: Patients with FS showed lower overnight minimum SaO2% (86.8 +/- 1.3 versus 90.7 +/- 0.9 in controls, P < 0.05), greater number of desaturations (8.3 +/- 1.8 versus 2.7 +/- 0.8 in controls, P < 0.05) and more desaturations/hour (1.3 +/- versus 0.4 +/- 0.1 in controls, P < 0.05), more night minutes in SaO2% < 92% (56.3 +/- 12.9 versus 9.1 +/- 3.8 in controls, P < 0.01) and more minutes in SaO2% < 90% (14.7 +/- 3.7 versus 2.4 +/- 1.0 in controls, P < 0.05). There were no differences between patients with FS and controls in ESS scores. Five patients (19.2%) in the FS group and 2 (15.4%) in the control group had ESS scores higher than 10. One patient had 1 control subject showed on apnea-plus-hypopnea index higher than 5 (13 and 9, respectively) in polysomnographic study. CONCLUSIONS: Patients with FS showed small overnight falls in SaO2% and spent more time during the night in SaO2% below 92% and 90% than did the control group. These alterations that, as a whole, are not due to the presence of an associated SAS could be important in FS musculoskeletal pathophysiology.

Acquired Brown's syndrome in a patient with systemic lupus erythematosus.

A 27 year old woman with systemic lupus erythematosus (SLE) developed vertical diplopia with an apparent bilateral inferior oblique muscle palsy, resulting in a limitation of elevation of the globe in adduction. It resolved with systemic steroid treatment. A transient tenosynovitis affecting the superior oblique tendons was the probable underlying pathological mechanism. This is the first described case of Brown's syndrome associated with SLE.

[A psoas abscess in a patient with Crohn's disease]. / Absceso del psoas en un paciente con enfermedad de Crohn.

We report a case of Crohn's disease diagnosed 13 years ago, complicated by a psoas abscess. The main symptoms were flexion deformity of the hip, pain and fever. Diagnosis was made by CT-scan. Surgical and CT-guided percutaneous drainage was ineffective and the abscess relapsed. Surgical resection of the affected bowel with abscess drainage, provided patient's healing.

[Relapsing polychondritis: apropos a case with significant tracheal involvement]. / Policondritis recidivante: a propósito de un caso con importante afectación traqueal.

Relapsing polychondritis is an infrequently recognized disease. Its etiology is unknown. It is characterized by recurrent and potentially destructive inflammatory lesions involving cartilaginous structures, the cardiovascular system and some sensory organs. We report a patient with important tracheal stenosis, vestibulo cochlear dysfunction and polyarthritis. We present a literature review.