Necrosis intestinal asociada a la nutrición enteral por yeyunostomía / Intestinal necrosis associated with enteral nutrition by jejunostomy

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Implication of gestational diabetes treatment on maternal weight gain and low neonatal weight: a large retrospective cohort study / Implicación del tratamiento de la diabetes gestacional en el aumento de peso materno y bajo peso neonatal: gran estudio de cohorte retrospectivo

Objective: the treatment for gestational diabetes is based on diet, and this may modify maternal weight gain. The limited maternal weight gain is related to newborns with small weight for their gestational age (SGA), and many studies have found an increase of SGA in women with gestational diabetes (GD), but the reason for this is not clear. The objective of this study is to evaluate the effects of gestational diabetes treatment on maternal weight gain and neonatal weight. Methods: a retrospective cohort study of 1,765 patients with GD, according to the National Diabetes Data Group (NDDG) criteria. We assessed: pre-pregnancy BMI, total maternal weight gain (MWG), weight gain during the third trimester, gestational week of starting the treatment, and treatment modality (diet or diet plus insulin). Birth weight was adjusted by gestational age and gender: SGA (= 10th) and large for gestational age (LGA) ( > 90th). Results: the percentage of newborns with weight percentile = 10 was 14.8%. The diet and the time of initiation of the treatment were related to maternal weight gain (MWG) in the third trimester. For every 1 kcal/kg of variation in the diet (increase or decrease), a MWG variation of 0.03 (0.001-0.06) kg occurred (p < 0.01). For each week before the beginning of treatment, the mother did not gain 0.13 ± [(-0.15) - (-0.11)] kg in the third trimester (p < 0.01). The SGA was related to the lowest MWG in total gestation: 7.0 (IQR 3.0-10.4) kg vs. 8.4 (IQR 5.0-11.6) kg (p < 0.01), and in the third trimester: 0.3 (IQR -0.9-1.5) kg vs. 0.9 (IQR -0.3-2.2) kg (p < 0.01). Conclusion: the dietary treatment for gestational diabetes leads to a lower maternal weight gain and induces an impact on neonatal weight

Objetivo: el tratamiento para la diabetes gestacional se basa en la dieta y esto puede modificar el aumento de peso materno. Un aumento de peso materno limitado está relacionado con recién nacidos con bajo peso para su edad gestacional (SGA). Muchos estudios han encontrado un aumento de niños con bajo peso en mujeres con diabetes gestacional, pero la razón de esto no está clara. El objetivo de este estudio es evaluar los efectos del tratamiento de la diabetes gestacional sobre el aumento de peso materno y el peso neonatal. Métodos: estudio de cohortes retrospectivo en 1765 pacientes con diabetes gestacional, según los criterios de los National Diabetes Data Groups (NDDG). Evaluamos: IMC antes del embarazo, aumento de peso materno total (MWG), aumento de peso durante el tercer trimestre, semana gestacional de inicio del tratamiento y modalidad de tratamiento (dieta o dieta más insulina). El peso al nacer se ajustó por edad gestacional y género: SGA (percentil de = 10) y grande para la edad gestacional (LGA) (percentil de > 90). Resultados: el porcentaje de recién nacidos con peso percentil de = 10 fue del 14,8%. La dieta y el momento de inicio del tratamiento se relacionaron con el aumento de peso materno en el tercer trimestre. Por cada 1 kcal/kg de variación en la dieta (aumento o disminución) se produjo una variación de aumento del peso materno de 0,03 (0,001-0.06) kg (p < 0,01). Por cada semana antes de inicio del tratamiento, la madre dejó de ganar 0,13 ± [(- 0,15) - (- 0,11)] kg en el tercer trimestre (p < 0,01). El SGA se relacionó con un aumento de peso materno más bajo en el total de la gestación: 7,0 (IQR 3,0-10,4) kg vs. 8,4 (IQR 5,0-11,6) kg (p < 0,01), y en el tercer trimestre: 0,3 (IQR -0,9-1,5) kg vs. 0,9 (IQR -0,3-2,2) kg (p < 0,01). Conclusión: el tratamiento dietético para la diabetes gestacional puede conducir a un menor aumento de peso materno y a su vez inducir un impacto en el peso neonatal

Implication of gestational diabetes treatment on maternal weight gain and low neonatal weight: a large retrospective cohort study.

INTRODUCTION: Objective: the treatment for gestational diabetes is based on diet, and this may modify maternal weight gain. The limited maternal weight gain is related to newborns with small weight for their gestational age (SGA), and many studies have found an increase of SGA in women with gestational diabetes (GD), but the reason for this is not clear. The objective of this study is to evaluate the effects of gestational diabetes treatment on maternal weight gain and neonatal weight. Methods: a retrospective cohort study of 1,765 patients with GD, according to the National Diabetes Data Group (NDDG) criteria. We assessed: pre-pregnancy BMI, total maternal weight gain (MWG), weight gain during the third trimester, gestational week of starting the treatment, and treatment modality (diet or diet plus insulin). Birth weight was adjusted by gestational age and gender: SGA (≤ 10th) and large for gestational age (LGA) (> 90th). Results: the percentage of newborns with weight ≤ 10 was 14.8 %. The diet and the time of initiation of the treatment were related to maternal weight gain (MWG) in the third trimester. For every 1 kcal/kg of variation in the diet (increase or decrease), a MWG variation of 0.03 (0.001-0.06) kg occurred (p < 0.01). For each week before the beginning of treatment, the mother did not gain 0.13 ± [(-0.15) - (-0.11)] kg in the third trimester (p < 0.01). The SGA was related to the lowest MWG in total gestation: 7.0 (IQR 3.0-10.4) kg vs 8.4 (IQR 5.0-11.6) kg (p < 0.01), and in the third trimester: 0.3 (IQR -0.9-1.5) kg vs. 0.9 (IQR -0.3-2.2) kg (p < 0.01). Conclusion: the dietary treatment for gestational diabetes leads to a lower maternal weight gain and induces an impact on neonatal weight.

INTRODUCCIÓN: Objetivo: el tratamiento para la diabetes gestacional se basa en la dieta y esto puede modificar el aumento de peso materno. Un aumento de peso materno limitado está relacionado con recién nacidos con bajo peso para su edad gestacional (SGA). Muchos estudios han encontrado un aumento de niños con bajo peso en mujeres con diabetes gestacional, pero la razón no está clara. El objetivo es evaluar los efectos del tratamiento de la diabetes gestacional sobre el aumento de peso materno y el peso neonatal. Métodos: estudio de cohortes retrospectivo en 1765 pacientes con diabetes gestacional. Evaluamos: IMC antes del embarazo, aumento de peso materno total, aumento de peso durante tercer trimestre, semana gestacional de inicio y modalidad de tratamiento (dieta o dieta más insulina). El peso al nacer se ajustó por edad gestacional y género: SGA (≤ 10) y grande para la edad gestacional (> 90). Resultados: el porcentaje de recién nacidos con peso ≤ 10 fue 14,8%. La dieta y el momento de inicio del tratamiento se relacionaron con aumento de peso materno en el tercer trimestre. Por cada 1 kcal/kg de variación en dieta (aumento o disminución) se produjo una variación de aumento del peso materno de 0,03 (0,001-0,06) kg (p < 0,01). Por cada semana antes de inicio del tratamiento la madre dejó de ganar 0,13 ± [(- 0,15)-(- 0,11)] kg en el tercer trimestre (p < 0,01). El SGA se relacionó con un aumento de peso materno más bajo en el total de la gestación: 7,0 (IQR 3,0-10,4) kg versus 8,4 (IQR 5,0-11,6) kg (p < 0,01), y en el tercer trimestre: 0,3 (IQR -0,9-1,5) kg vs. 0,9 (IQR -0,3-2,2) kg (p < 0,01). Conclusión: el tratamiento dietético para la diabetes gestacional puede conducir a un menor aumento de peso materno y a su influir en el peso neonatal.

Efectos agudos y a largo plazo del tratamiento con zolendronato en pacientes adultos con osteogénesis imperfecta. Estudio español observacional con 5 años de seguimiento / Acute and long-term effects of zoledronate in adult patients with osteogenesis imperfecta. An observational Spanish study with five years of follow-up

La osteogénesis imperfecta (OI) es una enfermedad genética que cursa con baja densidad mineral y fragilidad ósea. Varios trabajos han demostrado la eficacia de los bisfosfonatos para mejorar la densidad mineral ósea (DMO). El objetivo de este estudio es evaluar la evolución de la DMO y parámetros bioquímicos de metabolismo óseo, en pacientes adultos con OI tratados con ácido zoledrónico intravenoso (iv) durante un periodo medio de 5 años, así como valorar la seguridad de dicho tratamiento. Pacientes y métodos: Estudio prospectivo, observacional en pacientes adultos con OI con osteoporosis u osteopenia, con T-score<-2, a los que se administró ácido zoledrónico (4mg iv) cada 6 meses durante 3 años y posteriormente de forma anual. Se registraron a las 24 y 48 h los cambios agudos en calcio, fósforo, creatinina y hemograma así como los efectos secundarios tras la infusión. Se realizó densitometría basal y cada año. Se determinaron basal y anualmente calcio, fósforo, paratohormona (PTHi), 25OH-vitamina D y marcadores de remodelado óseo (fosfatasa alcalina ósea, ß-cross-lap y deoxipiridolina en orina). Se registraron las nuevas fracturas. Resultados: Se trataron 20 pacientes, 6 hombres y 14 mujeres con una mediana de seguimiento de 5 años. Los niveles de calcio y las plaquetas disminuyeron significativamente a las 24 y 48 h tras la primera infusión. El recuento de hematíes disminuyó a las 24h. Estos cambios no fueron clínicamente relevantes. Siete pacientes presentaron un cuadro pseudogripal tras la primera dosis. La DMO medida en columna lumbar mostró un aumento significativo (6,7%) a los 12 meses de seguimiento (0,741±0,178 vs. 0,791±0,140g/cm2; p=0,003) así como a los tres (5,7%) y 5 años (9%) de seguimento. En cuello femoral se evidenció incremento significativo de la DMO a los 3 años (11,1%): 0,648±0,148 vs. 0,720±0,138g/cm2; p=0,01. En cadera total el incremento (10,1%) resultó significativo a los 3 años de tratamiento (0,706±0,118 vs. 0,720±0,138; p=0,01). No se evidenciaron diferencias significativas en los niveles de calcio y 25OH-vitamina D largo del seguimiento, el fósforo disminuyó significativamente al año y PTHi aumentó a los 3 años. ß-cross-lap disminuyó al año de tratamiento. Solo un paciente ha presentado nuevas fracturas. Conclusiones: El ácido zoledrónico es un tratamiento cómodo, seguro y eficaz para mejorar la DMO en pacientes adultos con OI

Osteogenesis imperfecta (OI) is an inherited disorder that causes low mineral density and bone fragility. Previous studies have shown the efficacy of bisphosphonates to increase bone mineral density (BMD). This study assessed changes over time in BMD and biochemical markers of bone metabolism in adult patients with osteogenesis imperfecta treated with intravenous zoledronic acid and the safety of this treatment. Patients and methods: A prospective, observational study in patients with OI, osteoporosis or osteopenia (T score <-2) who were administered zoledronic acid infusions (4mg IV) every 6 months for three years and annually thereafter. Densitometry was performed annually. Acute changes in complete blood count and calcium, phosphate, and creatinine levels, as well as side effects of the infusion, were recorded 24 and 48h after treatment. Calcium, phosphate, parathyroid hormone (iPTH), 25OH-vitamin D and bone turnover markers (bone alkaline phosphatase, ß-crosslaps and urinary deoxypyridinoline) were measured at baseline and every 12 months. Adverse events and new fractures were recorded. Results: Twenty patients (6 men and 14 women) were treated. Median follow-up time was five years. Calcium levels and platelet counts significantly decreased 24 and 48hours after the first infusion, and the red blood cell count decreased at 24hours. These changes were not clinically relevant. Seven patients experienced a flu-like episode after the first dose. Treatment induced significant increases in BMD in the lumbar spine (6.7%) after 12 months of follow-up (0.791±0.178 vs. 0.791±0.140g/cm2, p=.003) and at three (5.7%) and five years (9%) of follow-up. Femoral neck BMD significantly increased after 3 years (11.1%): 0.648±0.148 vs. 0.720±0.138g/cm2; p=.01. In total hip, increase in BMD (10.1%) was significant after three years of treatment (0.706±0.118 vs. 0.720±0.138, p=.01). There were no significant differences in calcium and 25OH-vitamin D levels during follow-up, phosphorus significantly decreased after one year, and iPTH increased at three years. ß-crosslaps decreased after one year of treatment. Only one patient sustained new fractures. Conclusions: Zoledronic acid is a convenient, safe, and effective treatment that increases BMD in adult patients with OI

Acute and long-term effects of zoledronate in adult patients with osteogenesis imperfecta. An observational Spanish study with five years of follow-up. / Efectos agudos y a largo plazo del tratamiento con zolendronato en pacientes adultos con osteogénesis imperfecta. Estudio español observacional con 5 años de seguimiento.

Osteogenesis imperfecta (OI) is an inherited disorder that causes low mineral density and bone fragility. Previous studies have shown the efficacy of bisphosphonates to increase bone mineral density (BMD). This study assessed changes over time in BMD and biochemical markers of bone metabolism in adult patients with osteogenesis imperfecta treated with intravenous zoledronic acid and the safety of this treatment. PATIENTS AND METHODS: A prospective, observational study in patients with OI, osteoporosis or osteopenia (T score <-2) who were administered zoledronic acid infusions (4mg IV) every 6 months for three years and annually thereafter. Densitometry was performed annually. Acute changes in complete blood count and calcium, phosphate, and creatinine levels, as well as side effects of the infusion, were recorded 24 and 48h after treatment. Calcium, phosphate, parathyroid hormone (iPTH), 25OH-vitamin D and bone turnover markers (bone alkaline phosphatase, ß-crosslaps and urinary deoxypyridinoline) were measured at baseline and every 12 months. Adverse events and new fractures were recorded. RESULTS: Twenty patients (6 men and 14 women) were treated. Median follow-up time was five years. Calcium levels and platelet counts significantly decreased 24 and 48hours after the first infusion, and the red blood cell count decreased at 24hours. These changes were not clinically relevant. Seven patients experienced a flu-like episode after the first dose. Treatment induced significant increases in BMD in the lumbar spine (6.7%) after 12 months of follow-up (0.791±0.178 vs. 0.791±0.140g/cm2, p=.003) and at three (5.7%) and five years (9%) of follow-up. Femoral neck BMD significantly increased after 3 years (11.1%): 0.648±0.148 vs. 0.720±0.138g/cm2; p=.01. In total hip, increase in BMD (10.1%) was significant after three years of treatment (0.706±0.118 vs. 0.720±0.138, p=.01). There were no significant differences in calcium and 25OH-vitamin D levels during follow-up, phosphorus significantly decreased after one year, and iPTH increased at three years. ß-crosslaps decreased after one year of treatment. Only one patient sustained new fractures. CONCLUSIONS: Zoledronic acid is a convenient, safe, and effective treatment that increases BMD in adult patients with OI.

Adenocarcinoma de tipo glándula salivar y adenoma paratiroideo intratiroideos en paciente con bocio multinodular / Intrathyroid salivary adenocarcinoma not otherwise specified and parathyroid adenoma in multinodular goiter

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Complicated osteoporosis in progeroid syndrome: treatment with teriparatide.

Human progeroid syndromes (PSs) include a group of genetic "premature aging" diseases that affect a variety of organ systems. Bone diseases are common sequelae of patients diagnosed with PSs. Teriparatide therapy is recommended for elderly men with low bone mineral density (BMD; T-score <-2.5) and at least 1 fragility fracture who are unable to tolerate bisphosphonates. We describe a 20-yr-old patient affected by PS and severe osteoporosis complicated with femoral fracture. The patient experienced a significant improvement in lumbar spine BMD after treatment with teriparatide.

Revisión casuística en el hospital universitario de Getafe de pacientes con patología hipofisaria adenomatosa intervenidos quirúrgicamente / Casuistry review of patients undergoing surgery for pituitary adenomas in Getafe University Hospital (Spain)

Objetivo Revisión casuística de pacientes diagnosticados de adenomas hipofisarios (AH) que han sido intervenidos en nuestro centro desde el año 1995 por el mismo neurocirujano. Material y métodos Estudio retrospectivo descriptivo de 98 pacientes intervenidos por AH entre 1995–2008. Se analizó tamaño tumoral, datos de funcionalidad, anatomía patológica y complicaciones posquirúrgicas. La distribución de los datos se hizo atendiendo a la fecha de cirugía en 2 grupos: 1995–2002 (1.er periodo) y 2003–2008 (2.° periodo).Resultados Se realizaron 110 intervenciones quirúrgicas. En el 1.er periodo tuvieron lugar 59 intervenciones y en el 2.° se realizaron 51. De estas, 49 fueron AH no funcionantes y 61 funcionantes. Se hallaron 85 macroadenomas y 25 microadenomas. Resultados Del total de macroadenomas, la curación se obtuvo en 31 pacientes (36%) frente a 21 (84%) en de los microadenomas. P<0,05. El número de complicaciones fue significativamente mayor en el 1.er periodo; 32 pacientes (54%) frente a 16 pacientes en el 2.° periodo (31,3%). P<0,05. En el 1.er periodo se curaron 28 pacientes (47,4%) y en el segundo 31 (52,1%). P=0,1. Tasa de mortalidad: 0,9%.ConclusionesLa tasa de curación de microadenomas es significativamente superior a la de macroadenomas como ya se describe en trabajos previos. Se evidencia de manera significativa una menor incidencia de complicaciones quirúrgicas y una tendencia al aumento del porcentaje de curación global en el 2.° periodo del estudio. Estos resultados probablemente estén en relación con el aumento de la experiencia del neurocirujano debido a la adquisición de destreza quirúrgica (AU)

Objective To perform a casuistry review of patients diagnosed with pituitary adenomas (PA) who underwent surgery performed by the same neurosurgeon after 1995.Material and methods A descriptive and retrospective study was performed in 98 patients with PA undergoing surgery from 1995–2008. Tumor size and data on functionality, pathology and postprocedural complications were analyzed. The study was divided into two periods: 1995–2002 (first period) and 2003–2008 (second period).Results A total of 110 surgical interventions (59 in the first period and 51 in the second) were performed for 49 non-hormone-producing PA and 61 hormone-producing PA. There were 85 macroadenomas and 25 microadenomas. Cure was achieved in 31 patients (36%) with macroadenomas and in 21 patients (84%) with microadenomas (P=0.05).The number of complications was significantly higher in the first period [32 patients (54 %)] than in the second period [16 patients (31.3%)] (P<0.05). Cure was achieved in 28 patients (47.4%) in the first period compared with 31 (52.1%) in the second (P=0.1). The mortality rate was 0.9%.ConclusionsAs described in previous studies, the cure rate was significantly higher for microadenomas than for macroadenomas. There was a significant reduction in the incidence of surgical complications and a trend toward an increase in the percentage of overall healing in the second period of the study. These results are probably related to the neurosurgeon's greater experience and surgical skill (AU)

Efectos del tratamiento con ácido zoledrónico en pacientes adultos con osteogénesis imperfecta / Effects of zoledronic acid in adults with osteogenesis imperfecta

Antecedentes y objetivo La osteogénesis imperfecta (OI) es una enfermedad genética que cursa con fragilidad ósea. Varios trabajos han demostrado la eficacia de los bisfosfonatos. El objetivo de este estudio es evaluar la evolución de la densidad mineral ósea (DMO) y parámetros bioquímicos de metabolismo óseo, en pacientes adultos con OI tratados con ácido zoledrónico iv. Material y métodos Estudio prospectivo no aleatorizado con pacientes adultos con OI con osteoporosis u osteopenia, con T-score <2, e intolerancia o contraindicación de bisfosfonatos orales, a los que se administró ácido zoledrónico iv cada 6 meses. Material y metodosSe realizó densitometría basal y cada año. Se determinaron basal y anualmente calcio total (Ca), fósforo (P), paratirina intacta (PTHi), 25 hidroxivitamina D (Vit D) y marcadores de remodelado óseo: fosfatasa alcalina ósea (FAO), telopéptido carboxiterminal del colágeno tipo I (ß cross-laps [CTX] y deoxipiridolina urinaria (DOP). Se registraron los efectos secundarios y la aparición de nuevas fracturas.ResultadosSe trataron 10 pacientes, 2 hombres y 8 mujeres. Resultados La DMO medida en columna lumbar mostró un aumento significativo a los 24 (0,738±0,141 vs 0,788±0,144g/cm2; p=0,048) y a los 36 meses (0,720±0,139 vs 0,820±0,128) con respecto a la basal. En cuello femoral se evidenció un incremento significativo de la DMO a los 24 meses: 0,677±0,121 vs 0,703±0,122g/cm2; p<0,016.ResultadosNo se evidenciaron cambios significativos en las concentraciones de Ca, P, FAO y CTX a lo largo de seguimiento. La concentración de PTHi aumentó y la de Vit D descendió a los 36 meses. La excreción de DOP disminuyó significativamente a los 24 meses. Siete pacientes presentaron un cuadro pseudogripal leve en las primeras 24h tras la primera infusión. No se evidenciaron efectos secundarios graves.(..) (AU)

Effects of zoledronic acid in adults with osteogenesis imperfectajueves, 01 jul 2010Background and objective Osteogenesis imperfecta (OI) is a genetic disorder that results in bone fragility. Several studies have demonstrated the effectiveness of bisphosphonate therapy. The aim of this study was to evaluate the effects of intravenous zoledronic acid on bone mineral density (BMD) and biochemical markers of bone turnover in adults with OI.Material and methodsWe carried out a prospective non-randomized study in patients with osteoporosis or severe osteopenia (T score (..) (AU)

[Casuistry review of patients undergoing surgery for pituitary adenomas in Getafe University Hospital (Spain)]. / Revisión casuística en el hospital universitario de Getafe de pacientes con patología hipofisaria adenomatosa intervenidos quirúrgicamente.

OBJECTIVE: To perform a casuistry review of patients diagnosed with pituitary adenomas (PA) who underwent surgery performed by the same neurosurgeon after 1995. MATERIAL AND METHODS: A descriptive and retrospective study was performed in 98 patients with PA undergoing surgery from 1995-2008. Tumor size and data on functionality, pathology and postprocedural complications were analyzed. The study was divided into two periods: 1995-2002 (first period) and 2003-2008 (second period). RESULTS: A total of 110 surgical interventions (59 in the first period and 51 in the second) were performed for 49 non-hormone-producing PA and 61 hormone-producing PA. There were 85 macroadenomas and 25 microadenomas. Cure was achieved in 31 patients (36%) with macroadenomas and in 21 patients (84%) with microadenomas (P=0.05).The number of complications was significantly higher in the first period [32 patients (54 %)] than in the second period [16 patients (31.3%)] (P<0.05). Cure was achieved in 28 patients (47.4%) in the first period compared with 31 (52.1%) in the second (P=0.1). The mortality rate was 0.9%. CONCLUSIONS: As described in previous studies, the cure rate was significantly higher for microadenomas than for macroadenomas. There was a significant reduction in the incidence of surgical complications and a trend toward an increase in the percentage of overall healing in the second period of the study. These results are probably related to the neurosurgeon's greater experience and surgical skill.

[Effects of zoledronic acid in adults with osteogenesis imperfecta]. / Efectos del tratamiento con ácido zoledrónico en pacientes adultos con osteogénesis imperfecta.

BACKGROUND AND OBJECTIVE: Osteogenesis imperfecta (OI) is a genetic disorder that results in bone fragility. Several studies have demonstrated the effectiveness of bisphosphonate therapy. The aim of this study was to evaluate the effects of intravenous zoledronic acid on bone mineral density (BMD) and biochemical markers of bone turnover in adults with OI. MATERIAL AND METHODS: We carried out a prospective non-randomized study in patients with osteoporosis or severe osteopenia (T score < -2) related to OI and intolerance or contraindication to oral bisphosphonates. The patients were treated with a zoledronic acid infusion every 6 months. Densitometry was carried out annually. Calcium (Ca), phosphate (P), intact parathormone (PTH), 25 hydroxyvitamin D and biochemical markers of bone turnover [bone alkaline phosphatase (BAP), beta-cross-laps (CTX) and urinary deoxypyridoxine (DOP)] were measured every year. Adverse events and new fractures were registered. RESULTS: Ten patients (2 men and 8 women) were treated. Treatment increased BMD measured in the lumbar spine after 24 (0.738+/-0.141 vs 0.788+/-0.144 g/cm(2); p=0.048) and 36 months (0.720+/-0.139 vs 0.820+/-0.128; p=0.01). Significant increases in BMD were also observed after 24 months in the femoral neck (0.677+/-0.121 vs 0.703+/-0.122 g/cm(2); p<0.016). Serum Ca, P, BAP and CTX concentrations remained unchanged. PTH concentrations increased and vitamin D concentrations decreased after 36 months of treatment. DOP excretion decreased significantly after 24 months. Seven patients had mild influenza-like symptoms occurring within the first 24 h after the first infusion. No severe adverse events were observed. None of the patients had new fractures. CONCLUSION: Zoledronic acid seems to be a safe and effective treatment option in adults with osteoporosis related to OI.

[Primary hyperparathyroidism. An alternative to the surgery]. / Hiperparatiroidismo primario. Una alternativa a la cirugía.

Primary hyperparathyroidism is caused by an adenoma/hyperplasia in the parathyroid glands in which hypercalcemia is mainly due to an increased secretion of parathormone (PTH). The only definitive treatment is surgery. There are some patients at high surgical risk or who refuse surgery, and whose hypercalcemia cannot be controlled with conventional medical therapy such as hydration, diuretics and/or oral biphosphonates. We suggest the use of two drugs indicated for the treatment of hypercalcemia of other etiologies: zoledronic acid, a parenteral bisphosphonate, and cinacalcet, a calcimimetic agent that reduces PTH secretion. We present the case of a woman with hypercalcemia due to primary hyperparathyroidism caused by an adenoma, who was treated with both drugs.

Hiperparatiroidismo primario. Una alternativa a la cirugía / Primary hyperparathyroidism. An alternative to the surgery

El hiperparatiroidismo primario es una enfermedad causada por un adenoma/hiperplasia en las glándulas paratiroides, en la que la hipercalcemia debida a una excesiva secreción de parathormona (PTH) es el rasgo principal, y cuyo único tratamiento definitivo es la cirugía. Hay pacientes en los que la cirugía supone un gran riesgo, o que la rechazan, y en los cuales la hipercalcemia no puede ser controlada mediante el tratamiento médico convencional con hidratación, diuréticos y/o bisfosfonatos. Proponemos el uso de dos fármacos indicados en el tratamiento de la hipercalcemia de otras etiologías: el ácido zoledrónico, bisfosfonato de uso parenteral, y el cinacalcet, calcimimético que disminuye la secreción de PTH. Presentamos el caso de una mujer con hipercalcemia por un hiperparatiroidismo primario causado por un adenoma, tratado con ambos fármacos (AU)

Primary hyperparathyroidism is caused by an adenoma/hyperplasia in the parathyroid glands in which hypercalcemia is mainly due to an increased secretion of parathormone (PTH). The only definitive treatment is surgery. There are some patients at high surgical risk or who refuse surgery, and whose hypercalcemia cannot be controlled with conventional medical therapy such as hydration, diuretics and/or oral biphosphonates. We suggest the use of two drugs indicated for the treatment of hypercalcemia of other etiologies: zoledronic acid, a parenteral bisphosphonate, and cinacalcet, a calcimimetic agent that reduces PTH secretion. We present the case of a woman with hypercalcemia due to primary hyperparathyroidism caused by an adenoma, who was treated with both drugs (AU)

Tratamiento del bocio multinodular con radioyodo / Radioiodine therapy for multinodular goiter

Actualmente, las opciones terapéuticas del bocio compresivo se limitan a la cirugía o a la administración de radioyodo. Clásicamente, la cirugía suele plantearse como primera opción, y se reserva el radioyodo para lospacientes de elevado riesgo quirúrgico. Comentamos el caso de una paciente de 81 años, con bocio multinodular (BMN) hiperfuncionante, extensión intratorácica y sintomatología compresiva, en quien la cirugíaestaba contraindicada por enfermedades concomitantes. Revisamos las evidencias de eficacia de las alternativas de tratamiento del BMN compresivo y las posibles complicaciones secundarias (AU)

Treatment options for large, compressive goiters are currently limited to surgery and radioiodine administration. Classically, the first-line option has been surgery, with radioiodine therapy being reserved as an lternative treatment in patients with highsurgical risk. We describe the case of an 81-year-old woman with a large, compressive multinodular goiter and hyperthyroidism, substernal extension and associated co-morbidity, contraindicating surgery. We review the efficacy of different treatment options for compressive multinodular goiter, as well as the potential secondary complication (AU)

Radioiodine therapy for multinodular goiter.

Treatment options for large, compressive goiters are currently limited to surgery and radioiodine administration. Classically, the first-line option has been surgery, with radioiodine therapy being reserved as an alternative treatment in patients with high surgical risk. We describe the case of an 81-year-old woman with a large, compressive multinodular goiter and hyperthyroidism, substernal extension and associated co-morbidity, contraindicating surgery. We review the efficacy of different treatment options for compressive multinodular goiter, as well as the potential secondary complications.