Radiculopatía L5 por quiste óseo aneurismático de localización vertebral. A propósito de un caso / L5 radiculopathy due to vertebral aneurysmal bone cyst. A case report

El quiste óseo aneurismático es una lesión osteolítica expansiva, con cavidades rellenas de sangre, localizado con mayor frecuencia en la metáfisis de los huesos largos. Representa el 1-2% de los tumores óseos primarios. El diagnóstico de sospecha se realiza mediante estudios de imagen, siendo el definitivo anatomopatológico. El tratamiento de elección es la extirpación quirúrgica si su localización lo permite. Presentamos el caso de un varón de 13 años que acudió a urgencias por cuadro de dolor lumbar irradiado por miembro inferior izquierdo con parestesias en el mismo. Fue diagnosticado de quiste óseo aneurismático vertebral que condicionó una radiculopatía L5 y fue tratado mediante varias embolizaciones con inyección de etanol y posterior tratamiento rehabilitador. Destacamos la importancia de este caso por la baja frecuencia de aparición en nuestras consultas de esta lesión en localización vertebral, comenzando y dejando como secuela una radiculopatía L5 (AU)

Aneurysmal bone cyst is an osteolytic expansive lesion with blood-filled cavities, that is more frequently located in the metaphysis of long bones. It represents 1-2 percent of primary bone tumors. Suspected diagnosis is made by imaging studies, the definitive one being histological. Treatment of choice is surgical extirpation if it is possible according to its localization. We report a case of a 13-year-old boy who came to the emergency department with low back pain radiating down his left leg and paresthesia. He was diagnosed with vertebral aneurysmal bone cyst that caused L5 radiculopathy. He was treated with several embolizations using ethanol injections and subsequent rehabilitation treatment. We stress the importance of this case because of the low incidence of this lesion seen in Rehabilitation -Departments and the unusual vertebral location, causing L5 radiculopathy (AU)

Análisis de la alimentación en el ámbito escolar / Child feeding analysis in the school setting

INTRODUCCIÓN El diseño de las políticas de alimentación escolar incide en el perfil epidemiológico nutricional, OBJETIVOS Caracterizar el entorno alimentario y evaluar la calidad nutricional de las prestaciones alimentarias ofrecidas y la ingesta total (hogar y escuela) de energía y nutrientes críticos (grasas saturadas, sodio y azúcares agregados), MÉTODOS Se realizaron entrevistas y mediciones de las prestaciones alimentarias en una muestra de 50 escuelas pertenecientes a 5 jurisdicciones urbanas de Argentina. El estudio incluyó observación y registro de la oferta de alimentos en 24 kioscos escolares, encuestas sobre ingesta de energía y nutrientes críticos (recordatorios de 24 horas) y autorregistro de alimentos adquiridos en kioscos en una muestra de 811 escolares. RESULTADOS En el conjunto de la muestra, se observó una ingesta energética (mediana) de 1954 kcal. Un 28% del aporte promedio de energía y nutrientes críticos se origina en el comedor escolar, 12% en el kiosco y 69% en la dieta hogareña. Las mayores inadecuaciones de la dieta se concentran en las ingestas altas de kcal dispensables (97% de los escolares), azúcares agregados (79%) y grasas saturadas (74%). La dieta tiende a ser monótona, y las prestaciones escolares refuerzan (en lugar de atenuar) esa monotonía. El perfil de los alimentos adquiridos en los kioscos escolares es de una alta carga en azúcares agregados. No hay diferencias significativas entre las características del entorno alimentario escolar y los resultados de la calidad de la dieta. DISCUSIÓN Se identifican tres áreas de recomendaciones intervenciones de educación alimentaria con foco en las principales inadecuaciones de la dieta; rediseño de metas y contenidos de las prestaciones alimentarias; y regulación de la oferta de kioscos escolares para fomentar un mejor perfil nutricional, en especial por disminución de vehículos de azúcares agregados.

Progression of Doppler abnormalities in intrauterine growth restriction.

OBJECTIVE: To identify the sequence of progression of arterial and venous Doppler abnormalities from the onset of placental insufficiency in intrauterine growth restriction (IUGR). METHODS: Prospective observational study of singletons with IUGR (abdominal circumference < 5(th) percentile) who underwent serial standardized umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV) and umbilical vein (UV) Doppler surveillance. Time intervals between progressive Doppler abnormalities and patterns of deterioration were related to UA Doppler status and gestational age. RESULTS: Six hundred and sixty-eight longitudinal examinations were performed in 104 fetuses, identifying three patterns of progression: (1) Mild placental dysfunction (n = 34) that remained confined to the UA/MCA. The UA became abnormal at a median of 32 weeks' gestation but the pulsatility index never exceeded 3 SD above normal. Progression took a median of 33 days, requiring delivery at a median of 35 weeks. (2) Progressive placental dysfunction (n = 49). Initially normal UA Doppler PI at 29 weeks' gestation increased beyond 3 SD, progressing to abnormal MCA, absent/reversed UA diastolic flow, abnormal DV, UV pulsations in 9-day intervals requiring delivery by 33 weeks. (3) Severe early-onset placental dysfunction (n = 21). Markedly elevated UA PI established by 27 weeks' gestation was associated with rapid (7-day intervals) progression to abnormal venous Doppler with median delivery at 30.6 weeks. Gestational age at onset, time to delivery and progression intervals were different between patterns (all P < 0.05). CONCLUSION: The characteristics of cardiovascular manifestations in IUGR are determined by the gestational age at onset and the severity of placental disease. Recognition of these factors is critical for planning fetal surveillance in IUGR.

[Prevalence of cardiovascular risk factors in adult from Talca, Chile]. / Prevalencia de factores de riesgo cardiovascular clásicos en población adulta de Talca, Chile, 2005.

BACKGROUND: Cardiovascular disease (CVD) has several traditional risk factors (RF), and some of them are potentially modifiable. AIM: To determine the prevalence of most common risk factors in adult population in Talca in Central Chile. SUBJECTS AND METHODS: We studied 1007 subjects aged 18 to 74 years (66% women), living in Talca, selected by a probability sampling. They answered a questionnaire and anthropometry, blood pressure, lipid profile and blood glucose were measured. RESULTS: Thirty seven percent of subjects smoked, 70.1% had a body mass index over 25 kg/m(2) and 41% had an abnormally high circumference. High blood pressure was found in 37% (36% of these subjects were unaware of this condition), 44.5% had hypercholesterolemia, 21.5% had low HDL cholesterol, 40.1% had hypertriglyceridemia and 26.3% had high blood glucose levels. CONCLUSIONS: There is a high prevalence of risk factors for CVD in adult population from Talca. The prevalence of risk factors is higher than that reported by the 2003 National Health Survery.

Computerized fetal heart rate analysis, Doppler ultrasound and biophysical profile score in the prediction of acid-base status of growth-restricted fetuses.

OBJECTIVE: To investigate the performance of non-stress test (NST), computerized fetal heart rate analysis (cCTG), biophysical profile scoring (BPS) and arterial and venous Doppler ultrasound investigation in the prediction of acid-base status in fetal growth restriction. METHODS: Growth-restricted fetuses, defined by abdominal circumference < 5(th) percentile and umbilical artery (UA) pulsatility index > 95(th) percentile, were tested by NST, cCTG, BPS, and UA, middle cerebral artery (MCA), ductus venosus (DV) and umbilical vein (UV) Doppler investigation. The short-term variation (STV) of the fetal heart rate was calculated using the Oxford Sonicaid 8002 cCTG system. Relationships between antenatal test results and cord artery pH < 7.20 were investigated, using correlation, parametric and non-parametric tests. RESULTS: Fifty-six of 58 patients (96.6%) received complete assessment of all variables. All were delivered by pre-labor Cesarean section at a median gestational age of 30 + 6 weeks. The UA pulsatility index (PI) was negatively correlated with the cCTG STV (Pearson correlation - 0.29, P < 0.05). The DV PI was negatively correlated with the pH (Pearson correlation - 0.30, P < 0.02). The cCTG mean minute variation and pH were not significantly correlated (Pearson correlation 0.13, P = 0.34). UV pulsations identified the highest proportion of neonates with a low birth pH (9/17, 53%), the highest number of false positives among patients with an abnormal BPS, abnormal DV Doppler and a STV < 3.5 ms, and also stratified false negatives among patients with an equivocal or normal BPS. Abnormal DV Doppler correctly identified false positives among patients with an abnormal BPS. cCTG reduced the rate of an equivocal BPS from 16% to 7.1% when substituted for the traditional NST. Elevated DV Doppler index and umbilical venous pulsations predicted a low pH with 73% sensitivity and 90% specificity (P = 0.008). CONCLUSION: In fetal growth restriction with placental insufficiency, venous Doppler investigation provides the best prediction of acid-base status. The cCTG performs best when combined with venous Doppler or as a substitute for the traditional NST in the BPS.

Prevalencia de factores de riesgo cardiovascular clásicos en población adulta de Talca, Chile, 2005 / Prevalence of cardiovascular risk factors in adult from Talca, Chile

Background: Cardiovascular disease (CVD) has several traditional risk factors (RF), and some of them are potentially modifiable. Aim: To determine the prevalence of most common risk factors in adult population in Talca in Central Chile. Subjects and methods: We studied 1007 subjects aged 18 to 74 years (66 percent women), living in Talca, selected by a probability sampling. They answered a questionnaire and anthropometry, blood pressure, lipid profile and blood glucose were measured. Results: Thirty seven percent of subjects smoked, 70.1 percent had a body mass index over 25 kg/m² and 41 percent had an abnormally high circumference. High blood pressure was found in 37 percent (36 percent of these subjects were unaware of this condition), 44.5 percent had hypercholesterolemia, 21.5 percent had low HDL cholesterol, 40.1 percent had hypertriglyceridemia and 26.3 percent had high blood glucose levels. Conclusions: There is a high prevalence of risk factors for CVD in adult population from Talca. The prevalence of risk factors is higher than that reported by the 2003 National Health Survery.

Fetal echocardiography in trisomy 18.

BACKGROUND: Previously reported pathological series suggest that cardiac malformations are universal in trisomy 18. We examined our experience of fetal echocardiography in trisomy 18 for comparison. METHODS: Of 255 fetuses with trisomy 18 detected in our centre between January 1999 and June 2004, 174 were evaluated using fetal echocardiography. Our results were compared to four previous echocardiographic and four autopsy series, comprising 89 and 110 patients, respectively. RESULTS: Of these 174 fetuses, 114 were examined between 10 and 14 weeks gestation and the remainder between 15 and 33 weeks. An increased nuchal translucency measurement was the reason for referral in most of the early cases and extracardiac anomalies in the remainder. Images were non-diagnostic in 12 cases (7%), all examined at <15 weeks gestation. Abnormal cardiac findings were detected in 118 of the remaining 162 fetuses (73%), including 15 with functional anomalies. The various heart malformations included ventricular septal defects, tetralogy of Fallot, left heart disease, and atrioventricular septal defects. In all series used for comparison, a similar diversity of disease was seen. In pathological series of trisomy 18, structural heart malformations were found in all cases, but some had lesions which would not be detectable echocardiographically in the fetus. CONCLUSION: Abnormal cardiac findings are detectable echocardiographically in the majority of cases of trisomy 18 examined during fetal life, but not in all. A wide spectrum of heart defects is seen. Diagnosis of heart malformations can be made reliably, even in the first trimester at the time of nuchal translucency measurement.

Antioxidant status in anorexia nervosa.

OBJECTIVE: The study of the antioxidant status in female adolescents (N = 82) with anorexia nervosa, by the measurement of erythrocyte tocopherol concentration, and the determination of activities of the main antioxidant enzymes: superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase. METHOD: Tocopherol was measured by high-performance liquid chromatography (HPLC) with ultraviolet (UV) detection, and antioxidant enzyme activities by spectrometric methods using a Cobas Fara automated centrifugal analyzer. RESULTS: Tocopherol was significantly decreased in the anorexic patients compared to reference values (p < .02). In 21% of patients, tocopherol levels were below the reference interval. Superoxide dismutase activity was significantly decreased (p < .0001), while catalase activity was increased (p < .0001). The activity of the glutathione system enzymes did not show significant differences between patients and controls. DISCUSSION: The deficient concentration of erythrocyte tocopherol together with the altered antioxidant enzyme activities suggest a certain degree of oxidative damage in anorexia nervosa owing to both factors deficient micronutrient intake and oxidative stress.

Plasma amino acids in anorexia nervosa.

OBJECTIVE: To evaluate the amino acid profile in a group of adolescents with anorexia nervosa, and to apply alternative ways of presenting and assessing results, so as to increase the information available for understanding the metabolic abnormalities developed in these patients. DESIGN: Plasma amino acid concentrations of a random group of patients with anorexia nervosa compared with values obtained from a 'healthy' adolescent population. SETTING: The study was performed at the tertiary children's Hospital Sant Joan de Deu. SUBJECTS: Female adolescents (n = 92, age: 15+/-1.8 y) at diagnosis of anorexia nervosa. Reference values for amino acids were obtained from apparently healthy adolescents (by history and analytical data) who underwent presurgical analysis for minor operations. INTERVENTIONS: Plasma amino acid concentrations were measured by ion exchange chromatography. Basic laboratory analysis, carnitine and IGF-I were also determined. RESULTS: In anorexic patients plasma concentrations of taurine, asparagine, glutamine, glycine, methionine, phenylalanine, ornithine, and histidine were significantly higher than reference values (Mann-Whitney, P < 0.01-0.0001), whereas arginine and cystine were lower than our reference values (P < 0.0001). Relative amino acid values (the molar fraction of the patient medians relative to control medians) were plotted. The ratios of some amino acids were significantly greater than those obtained from the reference population: Phe/Tyr (P < 0.001), Met/Cys (P < 0.0001), and Gly/Val (P < 0.01). CONCLUSIONS: A trend to hyperaminoacidemia is a common feature in anorexia nervosa. Although absolute amino acid values cannot play a significant role in the assessment of nutritional status in this condition, the calculation of some ratios (Phe/Tyr, Met/Cys and Gly/Val) and the graphical representation of relative values may be useful. The plasma amino acid profile in anorexia nervosa is different from those of other severe malnutrition states, showing a marasmic pattern of balanced protein-energy undernutrition. Cystine and arginine may be considered limiting amino acids in this disease, and the consequences of their deficient concentrations for oxidative damage should be further evaluated.

Antioxidant status in hyperphenylalaninemia.

Abnormal oxidative stress was observed in some inborn errors of metabolism owing to the accumulation of toxic metabolites leading to excessive free radical production and to the influence of restricted diets on the antioxidant status. Erythrocyte antioxidant enzymes activities and tocopherol concentrations were measured in a group of phenylketonuric (n = 42) and mild-hyperphenylalaninemic (n = 28) patients compared with 45 age-matched controls. We also determined plasma selenium levels in these groups. We also evaluated the possible relationship between antioxidant status and neuropsychological disorders. Erythrocyte glutathione peroxidase (GSH-Px) activity was significantly lower (P < 0.001) in both phenylketonuric and mild-hyperphenylalaninemic patients compared with the control group, but no differences were observed between the two groups of patients. Neuropsychological disturbances were more frequent in the group of PKU patients with low GSH-Px activity than in PKU patients with normal GSH-Px. Low GSH-Px activity might be explained in phenylketonuria as a result of a selenium deficiency caused by a poor selenium intake or absorption, but not in mild hyperphenylalaninemic patients with free diet. Selenium levels were normal in both groups of patients, so low glutathione peroxidase activity in both phenylketonuric and hyperphenylalaninemic groups might be influenced by other factors, such as the consequences of an unbalanced amino acid profile, common to both conditions.

Plasma total-homocysteine in anorexia nervosa.

OBJECTIVE: The measurement of plasma total-homocysteine (tHcy) as a marker of folate and cobalamin status in patients with anorexia nervosa. DESIGN: Plasma tHcy, folate, cobalamin and other determinants of tHcy of a random group of patients with anorexia nervosa were compared with our own reference values. SETTING: The study was performed at the tertiary children's Hospital Sant Joan de Déu. SUBJECTS: All the female adolescents (n=43) coming to the Hospital during a one-year period, who were diagnosed with anorexia nervosa. Reference values for tHcy were simultaneously performed with apparently healthy adolescents (by history and analytical data) who underwent presurgical analysis for minor interventions, and other magnitudes we used our own reference values. INTERVENTIONS: Plasma tHcy was measured by reverse phase HPLC with fluorescence detection of the SBDF derivatives. Folate and cobalamin concentrations were determined by radioimmunoassay. RESULTS: tHcy was significantly increased in anorexic patients compared to reference values (Mann-Whitney, P < 0.0001-0.001). Values were above reference range in 34% of patients, and high-normal range in 53% of patients. tHcy concentrations lowered in 8 and 11 patients after nutritional rehabilitation. Cobalamin and folate were in the reference range except for one case. No significant correlation was found among tHcy, vitamins and other determinants of tHcy concentration. CONCLUSIONS: tHcy concentrations appear significantly increased in adolescents with anorexia nervosa, most probably owing to subclinical folate deficiency. This might be caused by both, intracellular folate deficiency and impaired availability. Abnormal plasma tHcy values were completely corrected after nutritional rehabilitation.

Tocopherol in inborn errors of intermediary metabolism.

Red blood cell tocopherol was measured in a group of 92 children with inborn errors of intermediary metabolism to evaluate the peroxidative damage in different mitochondrial and cytosolic defects, and to consider the need for treatment or vitamin supplementation. Tocopherol was determined by HPLC with UV detection. Results were expressed in nanomoles red blood cell tocopherol per gram protein. Significant differences (Mann-Whitney; P < 0.001) were found between tocopherol levels in untreated patients: 19 with mitochondrial defects versus 23 with cytosolic enzyme or transport defects, and versus 58 age-matched reference values. In conclusion, mitochondrial enzyme deficiencies, either amino and organic acidurias or defects of energy metabolism, seem to produce an excess of free radicals with the consequent utilization of tocopherol as antioxidant. This is not apparent in the cytosolic enzyme defects studied, whose tocopherol levels are in the normal range. Treatment with tocopherol completely corrects the deficient antioxidant status.

[Lipoprotein(a): its concentrations in children with insulin-dependent diabetes mellitus]. / Lipoproteína(a): concentraciones en niños con diabetes mellitus dependiente de la insulina.

BACKGROUND: Insulin-dependent diabetes mellitus (IDDM) is characterized by an increased risk of having cardiovascular diseases which have been associated to, among other factors, an increase in lipoprotein (a) [Lp(a)] levels. METHODS: With the aim of analyzing the relationship between Lp(a) plasma levels and the degree of metabolic control in infantile diabetes mellitus their levels have been evaluated in children with IDDM and correlated with the degree of metabolic control and the length of disease evolution. The study was performed in a sample of 41 children diagnosed with IDDM and ages ranging from 2 to 9 years, and 82 normolipemic healthy children corresponding to the same ages and an equal proportion by sex. Cholesterol and total triglycerides, HDL, LDL and VLDL cholesterol, apolipoproteins AI and B were determined in all. Fasting glycemia, glycohemoglobin, serum fructosamine and creatinine clearance were used as markers of metabolic disease control. RESULTS: No significant differences were observed in the Lp(a) values among sexes or age in the control group. Upon comparison of the Lp(a) values of the diabetic patients with the control group, no significant differences were observed. In the diabetic children, no differences were found between the Lp(a) values according to the glycohemoglobin values (X +/- SD g/l) (< 8% 0.16 +/- 0.13); (> or = 8% 0.21 +/- 0.26). The Lp(a) values were only increased in diabetic children with more than 5 years of evolution (control: 0.12 +/- 0.14, IDDM < or = 5 years; 0.16 +/- 0.16 and IDDM > 5 years: 0.34 +/- 0.31 [p < 0.01]). CONCLUSIONS: The plasma levels of Lp(a) in diabetic children are significantly related to the length of disease evolution and are independent of the degree of metabolic control.

[Splenic rupture in the course of pancreatitis]. / Ruptura esplénica en el curso de una pancreatitis.

We present the case of a young patient with a history of alcoholism and chronic relapsing pancreatitis, who developed an associated pseudocyst. During the course of the disease he presented an acute abdomen due to splenic rupture and splenic thrombosis, disclosed by laparotomy. Following splenectomy and drainage the evolution was satisfactory. In the present paper we discuss the presentation of splenic vein thrombosis and splenic rupture as a rare complication of pancreatic pseudocyst.