Effect of two forms of alendronate administration upon bone mass after two years of treatment.

The efficacy of alendronate in slowing the loss of bone mass, or even in increasing it, in osteoporotic patients and thus reducing the risk of new fractures has been described. Nevertheless, the way of taking this drug, together with its side effects, sometimes produces withdrawals. In this study, we analyzed if an alternative way of taking the alendronate improves the follow-up of the treatment and if it had the same effect on bone mineral metabolism than the traditional way of prescription. An open, intention-to-treat study, with follow-up of 2 yr was conducted. Eighty women suffering from postmenopausal osteoporosis were included in the study. They were classified in a random manner into two groups, each one of them received 10 mg/d alendronate, together with 1.2 g of calcium and 800 IU of Vitamin D3. Group I received the drug fasting, before breakfast, as usually prescribed and group II received the alendronate fasting, at noon, before lunch. Biochemical markers of bone remodeling were determined. Total alkaline phosphatase, osteocalcin, tartrate-resistant acid phosphatase, urine calcium/creatinine ratio, crosslinked N-telopeptides of type I collagen/creatinine ratio, serum calcium, and parathyroid hormone were also determined, and a lateral dorsolumbar radiography of the spine was performed. Bone mineral density was determined in the lumbar spine by dual-energy X-ray absorptiometry and quantitative computed tomography and by dual-energy X-ray absorptiometry in the proximal femur. Both groups showed an increase in bone mineral density in the lumbar spine and in the proximal femur, which was statistically significant after 1 yr of treatment in the range between 1.5% and 4.3%, depending on the anatomical localization where bone mineral density was measured. There was also an important decrease in the biochemical markers of bone remodeling, between 5.6% and 42.5%, depending on the biochemical marker; the decrease of amino-terminal telopetide during the first year was more important. The group that received alendronate in the morning reported a significantly higher number of withdrawals than the group that received the drug at noon. The alternative administration of 10 mg alendronate at noon had the same effect on bone mineral metabolism than its traditional administration in the morning, but the rate of withdrawals was significantly lower.

La paratiroidectomía aumenta la densidad mineral ósea en el hiperparatiroidismo primario. Un estudio preliminar / Parathyroidectomy increases bone mineral density in primary hyperparathyroidism a preliminary study

Fundamento. Aunque en general se acepta que la cirugía del hiperparatiroidismo primario (HPT) produce una mejoría de la densidad mineral ósea (DMO), algunos estudios han mostrado recuperaciones incompletas de ésta. Presentamos en este trabajo los cambios en la DMO en un grupo de mujeres afectas de HPT un año después de la extirpación del adenoma, comparando los mismos con un grupo control formado por pacientes con HPT que no fueron intervenidas. Diseño. Estudio abierto, prospectivo, con seguimiento durante un año. Pacientes. Setenta y ocho mujeres diagnosticadas de HPT fueron clasificadas en 2 grupos: grupo quirúrgico, compuesto por 55 pacientes que recibieron tratamiento quirúrgico y grupo conservador, formado por 23 pacientes que no fueron intervenidas. Método. Se determinó el calcio sérico y la parathormona intacta (PTH). Se realizó una radiografía lateral de la columna dorsolumbar. La DMO se estimó por absorciometría radiológica dual (DEXA), en la columna lumbar y en la extremidad proximal del fémur. Resultados. La DMO basal de ambos grupos fue similar, pero tras un año de seguimiento, la DMO aumentó en el grupo quirúrgico en cada una de las localizaciones anatómicas donde se midió, mientras que las pacientes del grupo conservador mostraron un incremento en la DMO en algunos lugares y pérdida en otros. En su conjunto, el incremento en la DMO fue mayor en las pacientes que recibieron cirugía. Conclusiones. En mujeres postmenopáusicas afectas de HPT, la paratiroidectomía produce una mejoría estadísticamente significativa de la DMO tanto en la columna lumbar como en la extremidad proximal del fémur tras un año de seguimiento, en comparación con aquellas que no fueron intervenidas quirúrgicamente (AU)

Diagnostic usefulness of carbohydrate-deficient transferrin for detecting alcohol-related problems in hospitalized patients.

We evaluated the diagnostic usefulness of carbohydrate-deficient transferrin (CDT) for detecting alcohol-related problems (ARP) in hospitalized patients, assessed potential differences according to gender and age, and compared this value to the other screening measures conventionally used, namely the CAGE questionnaire and standard biological markers MCV (mean corpuscular volume) and GGT (gamma-glutamyltransferase). CDT sensitivity for detecting ARP was 70%, specificity 75% and area under the receiver operating characteristic curve 0.76%. Its sensitivity was shown to be lower both in the female group (65 vs 71%) as well as in the younger-age group whereas its specificity was lower in the liver-damaged group (55%). CDT diagnostic value did not exceed that of CAGE (sensitivity 78% and specificity 99%), MCV (sensitivity and specificity 74%) or GGT (sensitivity 82% and specificity 53%) but was better than those of other biochemical measures. We conclude that CDT is an effective biological marker for the detection of ARP among hospitalized patients, but that its diagnostic usefulness does not exceed that of some other alternative measures commonly used.

Prevalence and determinants of diabetes mellitus and glucose intolerance in a Canarian Caucasian population - comparison of the 1997 ADA and the 1985 WHO criteria. The Guía Study.

AIMS: To estimate the prevalence of diabetes mellitus, impaired fasting glucose and impaired glucose tolerance in a Canarian population according to the 1997 ADA and the 1985 WHO criteria; and to study the cardiovascular risk factors associated with these categories. METHODS: A total of 691 subjects over 30 years old were chosen in a random sampling of the population (stratified by age and sex). An oral glucose tolerance test was performed (excluding known diabetic patients) and lipids were determined in the fasting state. Anthropometric and blood pressure measurements were performed, and history of smoking habits and medications was recorded. RESULTS: The prevalence of diabetes was 15.9% (1997 ADA) and 18.7% (1985 WHO); the prevalence of impaired fasting glucose and impaired glucose tolerance was 8.8 and 17.1%, respectively. The age-adjusted prevalence of diabetes (Segi's standard world population) for the population aged 30-64 years was 12.4% (1985 WHO). The risk factors significantly associated with diabetes (1997 ADA and 1985 WHO) were age, body mass index; waist-to-hip ratio, systolic and mean blood pressure, triglycerides, total cholesterol and low HDL-cholesterol. Age, body mass index and systolic blood pressure were associated with impaired fasting glucose and impaired glucose tolerance; triglycerides were also associated with impaired fasting glucose. CONCLUSIONS: The prevalence of diabetes mellitus and glucose intolerance in Guía is one of the highest among studied Caucasian populations. The new 1997 ADA criteria estimate a lower prevalence of diabetes. Impaired fasting glucose also had a lower prevalence than impaired glucose intolerance and the overlap of these categories was modest.

Implantation of a composite bifurcated cryopreserved aorto-iliac-femoral homograft in a patient with Candida albicans endocarditis.

A 35 year old woman, cocaine addict, suffered Candida albicans aortic valve endocarditis complicated with embolisation of infected vegetations in the distal abdominal aorta. She underwent successful staged aortic valve replacement followed by transaortic and transfemoral thrombectomy. One month later an arteriogram disclosed partial occlusion of the left iliac artery, bilateral aneurysmal degeneration of both iliac arteries and right iliac artery-right iliac vein fistula. She was operated again, performing re-laparotomy and re-exploration. A composite bifurcated cryopreserved homograft was implanted end-to-side between the infrarenal abdominal aorta, right external iliac artery and left common femoral artery. The right iliac artery-iliac vein fistula was obliterated with suture. The patient had an uneventful recovery but a relapsing arterio-venous fistula was diagnosed by arteriography. Three months later she underwent percutaneous transluminal closure of the reopened fistula. At present, 17 months after the implantation of the homograft, the patient is symptom-free, on antifungal agents and with arteriographic and clinical evidence of a well-functioning arterial homograft.

Rentabilidad de la información de la alfa fetoproteí na (AFP). Utilización de bases de datos relacionales / Profitabldity of the information of alpha fetoprotein (AFP). Utilization of data base related with

El carcinoma hepatocelular (CHC) es el más frecuente de los cánceres primitivos de hígado y desde su descubrimiento, la alfa fetoproteína (AFP) ha sido el marcador de elección para su diagnóstico y seguimiento. En base a obtener información valiosa sobre la rentabilidad diagnóstica del marcador, en cuanto a sus niveles y circunstancias de comorbilidad, se realizó un estudio de tipo retrospectivo en el área de referencia del Hospital Nuestra Señora del Pino de Las Palmas de Gran Canaria. Para ello se utilizaron los datos del laboratorio, exportados en un fichero en código ASCII, e implementados con datos demográficos y clínicos obtenidos del fichero maestro de pacientes del Hospital.Se realizaron 346 determinaciones a 159 pacientes. De ellos, 11 presentaban CHC (6 asociados con cirrosis y 4 con hepatitis), 75 cirrosis hepática (4 asociados con hepatitis), 64 presentaban otros procesos tumorales, 2 cáncer secundario de hígado y 7 otros diagnósticos. El 45 por ciento de los casos de CHC tenían niveles de AFP > 50 ng/ml y el 36.5 por ciento AFP > 500 ng/ml, frente al 5.2 por ciento y 1.3 por ciento respectivamente para los casos de cirrosis hepática. La utilización de bases de datos relacionales constituye un método eficaz, rápido y rentable en términos económicos para obtener información sobre problemas clínicos seleccionados. Abreviaturas: CHC, carcinoma hepatocelular; AFP, alfa fetoproteína; VHB, virus de la hepatitis B; VHC, virus de la hepatitis C; CH, cirrosis hepática; CEA, antígeno carcinoembrionario. (AU)

The distribution of two different vitamin D receptor polymorphisms (BsmI and start codon) in primary hyperparathyroidism.

INTRODUCTION: The bb genotype of the BsmI polymorphism of the vitamin D receptor (VDR) is more common in primary hyperparathyroidism (HPT) than in the general population in Swedish and German women. However, little is known about the association of HPT with the start codon polymorphism of the VDR (defined by FokI). OBJECTIVE: To study the distribution of the VDR genotypes in a group of women with HPT compared with a control group. The bone mineral density (BMD) of different genotypes was also investigated. METHODS: VDR alleles were typed by polymerase chain reaction (PCR) assay around the polymorphic BsmI or FokI restriction sites in 67 control women (48.5 +/- 10 years) and 53 women with HPT (61.4 +/- 11 years). They were all Caucasian and born in the Canary Islands. Lumbar and proximal femur BMDs were measured by dual X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). RESULTS: The 'bb' genotype was equally frequent in controls and HPT subjects (46.3 and 45.3%, respectively). There was a trend towards a lower prevalence of the FF genotype amongst women with HPT as compared with controls (41.5 vs. 57.1%; P = 0.09). BMD was lower in patients with HPT compared with controls in the lumbar spine and the proximal femur. CONCLUSIONS: The association of the BsmI polymorphism of the VDR gene with HPT is not applicable to all geographical areas. In Canarian postmenopausal women suffering from HPT, VDR genotype distribution is similar to that found in controls. A possible association of HPT with the FokI polymorphism deserves further investigation.

Cardiac surgery in patients infected with human immunodeficiency virus.

From January 1991 through December 1999, 5 consecutive patients who were infected with human immunodeficiency virus presented in need of cardiac surgery. All were men; the median age was 44 years. Two of them presented with mitral and aortic infectious valve endocarditis, 1 with tricuspid endocarditis, 1 with prosthetic valve endocarditis, and 1 with pericarditis and pericardial tamponade. Under cardiopulmonary bypass, the 4 patients with endocarditis underwent these procedures: mitral and aortic valve replacement (2), tricuspid valve replacement (1), and aortic valve replacement (reoperation) and concomitant repair of a mycotic ascending aortic aneurysm (1). In the patient who had pericardial effusion, subxifoid pericardiostomy and drainage were performed, and a pericardial window was created. There was no intraoperative mortality. The patient with pericardial effusion died 8 days after surgery; he was in septic shock and had multiple organ failure. Two deaths occurred at 2 and 63 months, due to hemoptysis and sudden death, respectively. The 2 patients who underwent double valve replacement are alive and in good condition after a median follow-up of 71 months. Cardiac surgery is indicated in selected patients infected by the human immunodeficiency virus. These patients are frequently drug abusers or homosexual. Valvular endocarditis is the most common finding. Hospital morbidity and mortality rates are higher than usual in this group of patients.

The range of bone mineral density in healthy Canarian women by dual X-ray absorptiometry radiography and quantitative computer tomography.

Bone mass measurements play a crucial role in the diagnosis of osteoporosis. According to a World Health Organization (WHO) Working Group, osteoporosis in women can be diagnosed if the value for bone mineral density (BMD) is 2.5 or more standard deviations below the mean value of a young reference population. This definition obviously requires the availability of normal data, which should ideally be obtained locally. The objective was establish normal values of BMD in the female Canarian population, by dual X-ray absorptiometry (DXA) in the lumbar spine and the proximal femur, and by quantitative computed tomography (QCT) in the lumbar spine, and to study the correlation between the results of both techniques and the changes with age. Seven hundred forty-four Healthy Canarian women, from 20-80 yr old were examined. Measurement of bone density was performed by an Hologic QDR 1000 densitometer (DXA) in the lumbar spine and proximal femur, and by a Toshiba scanner model 600 HQ in the lumbar spine. Both methods show that the peak bone mass is achieved in the fourth decade (30-39 yr). Bone density decreases thereafter with age in the lumbar spine (r = -0.3364 DXA and r = -0.6988 for QCT) and in the femoral neck (r = -0.3988). Bone density mean values obtained by DXA are very similar to those described in Spain and in other European female populations, using the same densitometer. The correlations between both techniques (DXA and QCT) were high and statistically significant (p < 0.001 in every case). Normal values in the normal Canarian women for DXA and QCT are provided. Our results are very similar to those previously described. These two techniques have a close correlation.

Bone mineral metabolism is normal in non-insulin-dependent diabetes mellitus.

Because of the previous controversial findings in non-insulin-dependent diabetes mellitus (NIDDM), we measured bone-mineral density (BMD) by two different methods, studied biochemical markers of bone remodeling and calciotropic hormones (parathyroid hormone and calcitonin) in women with NIDDM, and compared the results with age-matched controls. Forty-seven women with NIDDM and 252 healthy nondiabetic women as controls were recruited for this study. BMD was measured by dual X-ray absorptiometry (DEXA) and by quantitative computed tomography (QCT). Biochemical markers of bone remodeling included plasma alkaline phosphatase (AP), osteocalcin (BGP), tartrate-resistant acid phosphatase (TRAP), parathyroid hormone (PTH), calcitonin (CT), and 24-h urine calcium, hydroxyproline. Diabetic patients were more obese with a higher body-mass index (BMI) than controls. Bone mass was normal in NIDDM, both by DEXA and by QCT. Biochemical markers of bone remodeling, PTH and CT were also normal. There was no statistical correlation between bone mass and any of the other measurements studied. There is no evidence that NIDDM produces any change in bone metabolism or mass.

Effects of tamoxifen on serum lipid and apolipoprotein levels in postmenopausal patients with breast cancer.

Serum lipids and apolipoprotein levels were measured in twenty postmenopausal women with primary breast cancer, before and three months after tamoxifen therapy (10 mg twice a day). Tamoxifen caused a significant reduction in total serum cholesterol (10%; P < 0.02), and in low-density lipoprotein cholesterol (17%; P < 0.01), and a significant 47% increase in the subclass 2 of the high density lipoprotein cholesterol (P < 0.01). In addition, tamoxifen caused a 16% increase in apolipoprotein A-I, a 12% decrease in apolipoprotein B (P < 0.05), and a 37% reduction in the serum concentration of lipoprotein (a) (P < 0.01). These results show that tamoxifen brings about an important improvement in serum lipid profile.

[The role of multiparameter indices in preoperative nutritional assessment]. / Papel de los índices multiparamétricos en la valoración nutricional preoperatoria.

The consequence of malnutrition in surgical patients is an increase in post-operative complications. Detection of alteration in the nutritional state is a target in surgery theatres, using a variety of methods, notably anthropometry, analytic protein calculation, and delayed hypersensitivity cutaneous trials, which provide and objective assessment of the different body behaviors. A drawback is the large number of calculations required per patient, so that there is a limited number of patients with all the normal tests. To improve results in predicting complications in surgical patients based on nutritional parameters, the use is proposed of Multiparametric Nutritional Indices, obtained from the joint valuation of those parameters, by using multivariable statistical calculation techniques. The main indices in the literature are described. Multiparametric Indices are useful and easily calculated for the nutritional screening of surgical populations.

[The prediction of postoperative septic complications by means of nutritional parameters. II. The verification of the predictive formula]. / Predicción de las complicaciones sépticas posoperatorias mediante parámetros nutricionales: II. Comprobación de la fórmula predictiva.

An assessment was made of the predictive capacity of the following predictive formulation named Nutritional Sepsis Risk: NSR = 14.26 - 1.76 (albumin) - 1.47 (risk area) This was done in a sample of 65 surgery patients with digestive pathology who were candidates for selective surgery. All had undergone a pre-operative nutritional evaluation program, based on anthropometric and analytical data and Retarded Hypersensitivity Cutaneous Tests (RHCT). NSR was calculated pre-operatively. Infections were assessed qualitatively and quantitatively using Elebeute and Stoner's sepsis index. There were a total of five post-operative infections (7.69%). The NSR intersection point was calculated with an ROC curve, situated in a score of 3. The NSR detected the five infections, so is 100% sensitive, with 70% specificity and, in the detection of the septic risk population, surpassed the other nutritional parameters, whether anthropometric or analytical, and the RHCTs, when they were studied individually.

[The prediction of postoperative septic complications via nutritional parameters. I. The prognostic formulation]. / Predicción de las complicaciones sépticas postoperatorias mediante parámetros nutricionales: I. Formulación pronóstica.

A study has been made of the influence of the nutritional situation on post-operative infections in a sample of 217 patients. A nutritional evaluation file was prepared for each of them, based on anthropometric and analytical tests and delayed hypersensitivity skin tests (PCHR) during the first 24 hours of hospital admission. The criteria whereby a post-operative infection was considered to be present were surgical wound infection, intra-abdominal infection, pneumonia and post-operative fever of 38.5 degrees C or more without a demonstrable septic focus. They were also evaluated quantitatively using Elebeute and Stoner's sepsis index. In the study of the anthropometric parameters, the relation was noted between the body mass index (BMI) and usual weight Percentage (HW%), and septic risk areas (RA) were defined, as a new anthropometric data. A total of 33 patients (15.2%) showed some type of post-surgical infection, manifested in this group by an alteration of the nutritional state revealed by a lower BMI, increased weight loss, a lower albumin rate than in the control group. The septic prognostic value of the RAS is confirmed: no relation was found between septic complications and the PCHR. Finally a multiple regression procedure was prepared between the Elebeute and Stoner sepsis index and all the nutritional parameters studied, to give the following nutritional sepsis risk prognosis index (RSN): NSR = 14,265 - 1,764 x Albumin - 1,427 x Risk Area.

Epidemiology of proximal femoral fracture in Gran Canaria (Canary Islands).

An epidemiological survey of proximal femoral fracture (PFF) was carried out in Gran Canaria (Canary Islands) in 1990. We identified 211 cases of PFF affecting residents, which gave an incidence of 161 per 100,000 per year (92 per 100,000 per year for men and 176 for women). Three quarters of all fractures occurred to residents of urban areas and nearly all fractures were caused by falls indoors. There was a higher incidence in winter than in summer months.