Better Together: Volatile-Mediated Intraguild Effects on the Preference of Tuta absoluta and Trialeurodes vaporariorum for Tomato Plants.

Plant-herbivore interactions have been extensively studied in tomato plants and their most common pests. Tomato plant chemical defenses, both constitutive and inducible, play a role in mediating these interactions. Damaged tomato plants alter their volatile profiles, affecting herbivore preferences between undamaged and damaged plants. However, previous studies on tomato volatiles and herbivore preferences have yielded conflicting results, both in the volatile chemistry itself as well as in the attraction/repellent herbivore response. This study revisits the volatile-mediated interactions between tomato plants and two of their main herbivores: the leafminer Tuta absoluta and the whitefly Trialeurodes vaporariorum. Tomato plant volatiles were analyzed before and after damage by each of these herbivores, and the preference for oviposition (T. absoluta) and settling (T. vaporariorum) on undamaged and damaged plants was assessed both after conspecific and heterospecific damage. We found that both insects consistently preferred damaged plants over undamaged plants. The emission of herbivore-induced plant volatiles (HIPVs) increased after T. absoluta damage but decreased after T. vaporariorum damage. While some of our findings are in line with previous reports, T. absoluta preferred to oviposit on plants damaged by conspecifics, which differs from earlier studies. A comparison of HIPVs emitted after damage by T. absoluta and T. vaporariorum revealed differences in up- or down-regulation, as well as significant variations in specific compounds (12 for T. absoluta and 26 for T. vaporariorum damaged-plants). Only two compounds, ß-caryophyllene and tetradecane, significantly varied because of damage by either herbivore, in line with the overall variation of the HIPV blend. Differences in HIPVs and herbivore preferences may be attributed to the distinct feeding habits of both herbivores, which activate different defensive pathways in plants. The plant's challenge in simultaneously activating both defensive pathways may explain the preference for heterospecific damaged plants found in this study, which are also in line with our own observations in greenhouses.

The influence of common gene variants of the xenobiotic receptor (PXR) in genetic susceptibility to intrahepatic cholestasis of pregnancy.

BACKGROUND: The xenobiotic nuclear pregnane X receptor is implicated in many physiological pathways and diseases, including bile acid detoxification and cholestasis. Aim To estimate the contribution of common gene variants of the xenobiotic receptor (pregnane X receptor, PXR) to genetic susceptibility to intrahepatic cholestasis of pregnancy. METHODS: A total of 101 intrahepatic cholestasis of pregnancy patients and 171 healthy pregnant women in the third trimester of their pregnancies were included. Four tag single nucleotide polymorphisms (SNPs) (rs12488820 C/T, rs2472671 C/T, rs2461823 A/G, and rs1054191 A/G) encompassing 36 kb in chromosome 3, with a minor allele frequency > or =0.10 and representing 33 polymorphic sites were genotyped. Besides these, three additional SNPs (rs3814057, rs6785049, and rs7643645) were included because they showed previous evidence of functionality. RESULTS: Genotypic test for single SNPs showed that rs2461823 genotypes were significantly associated with intrahepatic cholestasis of pregnancy (P < 0.0069), OR per G allele: 1.44, 95% CI: 1.01-2.05, P < 0.042. The Cochran-Armitage test for trend and the allelic test showed a significant association with disease status (P < 0.04 and 0.03 respectively), G being the risk allele. A positive association between rs2461823 and ALT, AST, and bilirubin concentrations was observed. Neonate birth weight adjusted by the Capurro index was significantly associated with rs2461823 (P < 0.05); the proportion of the total variation attributed to rs2461823 genotypes was 7.8%. CONCLUSION: Common PXR polymorphisms may contribute to the genetic susceptibility to intrahepatic cholestasis of pregnancy.

Effects of rotating shift work on biomarkers of metabolic syndrome and inflammation.

OBJECTIVE: The major function of the circadian system is the internal cycling of physiological and metabolic events. The present study sought to explore the effect of rotating shift work schedule on leucocyte count and its relationship with risk factors of metabolic syndrome (MS). DESIGN AND PARTICIPANTS: From a population-based design, 1351 men of self-reported European ancestry were included in a cross-sectional study: 877 day workers were compared with 474 rotating shift workers. Medical history, health examination including anthropometric and arterial blood pressure measurements, a questionnaire on health-related behaviours and biochemical determinations was given to all participants. RESULTS: In comparison with day workers, rotating shift workers had elevated (mean +/- SE) body mass index (27.1 +/- 0.3 vs. 26.3 +/- 0.2, P < 0.0154), waist-hip ratio (0.95 +/- 0.01 vs. 0.93 +/- 0.01, P < 0.00024), diastolic arterial blood pressure (78 +/- 1 vs. 76 +/- 1, P < 0.033), fasting insulin (65.5 +/- 2.9 vs. 55.9 +/- 1.9 pmol L(-1), P < 0.017), Homeostasis Model Assessment index (2.12 +/- 0.11 vs. 1.77 +/- 0.07, P < 0.0027), triglycerides (1.71 +/- 0.1 vs. 1.5 +/- 0.1 mmol L(-1), P < 0.002), uric acid (292.7 +/- 2.8 vs. 282 +/- 3.4 micromol L(-1), P < 0.01) and leucocyte count (7030 +/- 84 vs. 6730 +/- 58, P < 0.0094). In multiple regression analysis, leucocyte count was correlated with rotating shift work independently of age, smoking, education and components of MS. CONCLUSION: The odds ratio for MS in rotating shift workers compared with day workers was 1.51 (95% CI 1.01-2.25), independently of age and physical activity. Increased leucocyte count, a biological marker of systemic inflammation, was associated with rotating shift work.

Sensibilidad insulínica en niños de 6 a 15 años: asociación con estado nutricional y pubertad / Insulin sensitivity in children aged 6 to 16 years: Association with nutritional status and pubertal development

Backgrounds: There is a high prevalence of obesity and hyperinsulinism among Chilean prepuberal children. Aim: To evaluate insulin sensitivity (IS) using fasting insulin, the Homeostasis Model Assessment (HOMA) and quantitative insulin-sensitivity check index (QUICKI) in Chilean children. Material and Methods: Body mass index (BMI), total body fat percentage ( percentTBF) using the sum of 4 skin folds, abdominal obesity determined through waist circumference (WC), pubertal maturation using five Tanner stages, fasting glucose (Glu) and insulin (Ins), were measured in 354 children aged 6 to 15 years (173 males). IS was evaluated using HOMA and QUICKI. Results: IS was strongly associated with percentTBF and WC. Ins, HOMA and QUICKI were significantly correlated with BMI (r =0.412; 0.405 y -0.442, respectively), percentTBF (r =0.370; 0.367 y -0.394, respectively), and WC (r =0.452; 0.446 y -0.481, respectively). Ins and HOMA increased and QUICKI decreased significantly (p <0.0001) with age. Children in a similar Tanner stage did not have differences in Ins, HOMA and QUICKI. No differences in Ins, HOMA and QUICKI were observed between children in Tanner stages 1 and 2. However, children in Tanner stages 1 and 2, had significantly lower Ins and HOMA and higher QUICKI than those in Tanner 3 to 5 stages. The highest Ins quartile for Tanner stages 1 and 2 was 10.0 æUI/dl; for Tanner stages 3 to five, the figure was 15.6 æUI/dl. Conclusions: These results confirm the relationship of IS with BMI, percentTBF, WC and pubertal maturation. IS decreases significantly and fasting Ins levels increase approximately 50 percent with puberty. This fact must be considered for the diagnosis of hyperinsulinism and insulin resistance in children.

[Insulin sensitivity in children aged 6 to 16 years: association with nutritional status and pubertal development]. / Sensibilidad insulínica en niños de 6 a 15 años: asociación con estado nutricional y pubertad.

BACKGROUND: There is a high prevalence of obesity and hyperinsulinism among Chilean prepuberal children. AIM: To evaluate insulin sensitivity (IS) using fasting insulin, the Homeostasis Model Assessment (HOMA) and quantitative insulin-sensitivity check index (QUICKI) in Chilean children. MATERIAL AND METHODS: Body mass index (BMI), total body fat percentage (%TBF) using the sum of 4 skin folds, abdominal obesity determined through waist circumference (WC), pubertal maturation using five Tanner stages, fasting glucose (Glu) and insulin (Ins), were measured in 354 children aged 6 to 15 years (173 males). IS was evaluated using HOMA and QUICKI. RESULTS: IS was strongly associated with %TBF and WC. Ins, HOMA and QUICKI were significantly correlated with BMI (r =0.412; 0.405 y -0.442, respectively), %TBF (r =0.370; 0.367 y -0.394, respectively), and WC (r =0.452; 0.446 y -0.481, respectively). Ins and HOMA increased and QUICKI decreased significantly (p <0.0001) with age. Children in a similar Tanner stage did not have differences in Ins, HOMA and QUICKI. No differences in Ins, HOMA and QUICKI were observed between children in Tanner stages 1 and 2. However, children in Tanner stages 1 and 2, had significantly lower Ins and HOMA and higher QUICKI than those in Tanner 3 to 5 stages. The highest Ins quartile for Tanner stages 1 and 2 was 10.0 micro UI/dl; for Tanner stages 3 to five, the figure was 15.6 microUI/dl. CONCLUSIONS: These results confirm the relationship of IS with BMI, %TBF, WC and pubertal maturation. IS decreases significantly and fasting Ins levels increase approximately 50% with puberty. This fact must be considered for the diagnosis of hyperinsulinism and insulin resistance in children.

Perfil metabólico de riesgo cardiovascular en niños y adolescentes obesos con menor sensibilidad insulínica / Cardiovascular risk and metabolic profile in obese children and adolescents with low insulin sensitivity

Background:Infantile obesity is associated with metabolic disturbances (hiperinsulinism, impaired glucose, dislypidemia) that determine a higher risk of type 2 diabetes, high blood pressure and atherosclerotic vascular disease in adulthood. Insulin resistance is a central mechanism of complications of obesity and is associated to body fat mass. Aim: To investigate insulin sensitivity and its association with anthropometric and metabolic variables in obese children. Patients and methods: We studied 314 children aged 6 to 15 years. Of these, 235 had a body mass index (BMI) over the 95 percentile for age and sex (classified as obese) and 79 had a normal body mass index; 161 were pre-pubescent and 153 were pubescent. Weight, height, percentage of total body fat (% TBF) using the sum of 4 skinfolds, blood pressure (BP), waist circumference (WC), basal glucose (Glu) and insulin (Ins) were measured. Insulin sensitivity (IS) was calculated with the homeostasis model assessment (HOMA) and QUICKI index. Serum lipids, postprandial Glu and Ins were measured only in obese children. Results: BMI, WC and % TBF had an inverse and significant correlation with basal IS (p <0.001). Obese children had higher BP, basal Ins, and HOMA and a lower QUICKI index, compared to normal weight children. A low basal IS was present in 58% of obese children. Obese children with low IS had higher WC, % TBF, triglycerides, total/HDL-cholesterol ratio, basal and 2-h post glucose Gli and Ins and lower HDL-cholesterol than obese children with normal IS. In prepubescent children, the risk of a low IS was 2.43 times higher with a TBF over 33%. In pubescent children, it was 2.92 times higher with a TBF over 37%. Conclusions: Low IS in prepubescent and pubescent obese children is associated with central obesity and a higher cardiovascular risk.

Comparison of the effects of 3,5,3'-triiodothyroacetic Acid and triiodothyronine on goiter prevention and involution and on hepatic and skeletal parameters in rats.

3,5,3'-triiodothyroacetic acid (TRIAC) has been used to suppress pituitary TSH secretion with reported attenuation of extrapituitary effects. We investigated whether equivalent doses of T (3) and TRIAC preventing the induction of goiter by methimazole (MMI) had a different or similar impact on peripheral tissues, such as liver and bone. In particular, we compared the effects of both compounds on the activity of the hepatic thyroid hormone-responsive enzymes, malic enzyme and L-glicerol-3-P dehydrogenase; bone mineral density and biochemical parameters of bone turnover, such as bone alkaline phosphatase (b-ALP) and the carboxy-terminal telopeptide region of type I collagen (beta-CTX); and the activity of thyroid ornithine decarboxylase (ODC). We also compared the effects of T (3) and TRIAC on the involution of MMI-induced goiter. Our results showed that TRIAC was more effective than T (3) to reduce MMI-induced goiter in a short-term goiter involution assay. TRIAC increased hepatic enzymes activity and beta-CTX levels, a parameter of bone resorption, more than T (3). However, bone mineral density was not altered by either treatment. Both compounds even reduced ODC activity at doses that were not effective at the pituitary level. These results demonstrate increased TRIAC hepatic and antigoitrogenic activity compared to T (3). TRIAC induces an imbalance in bone remodeling without affecting bone mineral density. Further studies are required to clarify this point.

Niveles plasmáticos de vitamina D e ingesta de calcio en niños celiacos: factores de riesgo para su salud futura / Calcium intake and vitamin D plasmatic levels in celiac children: risk factors for their future life

Objetivo: Evaluar los niveles plasmáticos de vitamina D y la ingesta de calcio en pacientes celíacos. Material y Método: 25 pacientes celíacos (20 mujeres y 5 hombres, de 5 a 15 años de edad) con una buena adhesión al régimen libre de gluten de al menos los dos últimos años. La ingesta de calcio se evaluó mediante tres encuestas de recordatorio de 24 horas. La 25 OH vitamina D se determinó mediante RIA (INCSTAR). Resultados: Un 80 por ciento de los pacientes presentó una ingesta de calcio insuficiente de acuerdo al consenso del NIH; en los menores de 10 años la ingesta promedio fue de 866 ( 423 y en los mayores de 11 años 605 ( 237 mg/día. Se encontró déficit de vitamina D (<37.5 nmol/L ó 15 ng/mL) en 5 de los casos (20 por ciento), de los cuales 4 corresponden a muestras tomadas en invierno y una en verano. En dos casos el déficit fue severo <20 nmoles/L (<8 ng/ml). Conclusión: En pacientes celíacos evaluados la hipovitaminosis D y la ingesta insuficiente de calcio fueron situaciones frecuentes, lo que puede producir el déficit de masa ósea detectado en estos pacientes y facilitar el desarrollo futuro de osteoporosis y diabetes. Se recomienda evaluar los niveles de vitamina D y la ingesta de calcio como parte del control de estos pacientes y en caso necesario efectuar una suplementación con calcio y vitamina D.

Sensibilidad de diferentes estándares para detectar los trastornos metabólicos en niños con exceso de peso / Sensivity of various standards for detection of metabolic distrubance in overweight children

La obesidad infantil se asocia a una alta prevalencia de trastornos metabólicos (TM) que preceden a la Diabetes Mellitus tipo 2 y a la cardiopatía isquémica. Detectarlos y corregirlos tempranamente permitiría disminuir la morbimortalidad por estas enfermedades. La dislipidemia y la resistencia insulínica se relacionan con la cantidad de grasa corporal total (GCT), describiéndose un mayor riesgo biológico cuando es igual o mayor al 30 por ciento. Para calificar el sobrepeso en el menor de 18 años la OMS recomienda el Indice de Masa Corporal (IMC). Los referentes más utilizados son los del CDC-NCHS (USA) que califica como obesidad al IMC _> p95 y el del International Obesity Task Force (IOTF), cuya calificación de obesidad se basa en los IMC calculados regresivamente a partir de una población que a los 18 ańos tenía un IMC 30; ambos estándares se apoyan en un criterio estadístico. El propósito de este estudio fue comparar la sensibilidad de los puntos de cortes que califican obesidad de estos 2 estándares y del 30 por ciento GCT, para pesquizar los trastornos metabólicos asociados a la obesidad, con el objeto de aportar antecedentes que permitan realizar un diagnóstico más biológico que estadístico. En 259 niños con sobrepeso de ambos sexos entre 5 y 17 años, se midió el colesterol total (CT), el colesterol LDL (Col-LDL), la insulinemia basal (Ins bas ) y 2 horas post sobrecarga de glucosa (Ins 2 hrs). Se calificó el exceso de peso utilizando los estándares CDC/NCHS e IOTF y el por ciento GCT. Por tablas de contingencia simple, Chi2 y Odds Ratio (OR) R se evaluó la validez, la sensibilidad y la especificidad para pesquisar los trastornos metabólicos de estos tres criterios. Hubo un 25 por ciento de hiper CT, un 24,2 por ciento de hipercol- LDL, un 20,5 por ciento de hiper Ins b y 39,5 por ciento de hiper Ins 2h. La prevalencia de obesidad y/o sobrepeso se asoció significativamente (p < 0.000) al criterio utilizado para calificarlos. No se encontró asociación entre la calidad del exceso ponderal y el riesgo de dislipidemia, ni hipersinsulinismo post sobrecarga al utilizar los estandares CDC-NCHS e IOTF. En los obesos el riesgo de hipersinsulinismo basal fue 4.8 y 4.5 veces mayor respectivamente. El punto de corte _> 30 por ciento GCT mostró la mayor sensibilidad y validez estadística para la pesquiza del hiperinsulinismo tanto basal como postsobrecarga de glucosa.

Características biológicas, familiares y metabólicas de la obesidad infantil y juvenil / Familial and metabolic characteristics of infantile and juvenile obesity

Background: Obesity is the most prevalent nutritional disease in people of less than 20 years old. Aim: To report biological, familial and metabolic characteristics in obese children. Patients and methods: A retrospective review of 187 children seen at obesity clinics and that had a complete metabolic study. Results: Ninety five prepuberal and 92 puberal children, aged 8.7ñ2.2 and 12.6ñ2.2 years old respectively, were studied. Body mass index was over 4 standard deviations in 48.4 per cent of prepuberal children and in 39.1 per cent of puberal children. Paternal obesity was twice more prevalent (30.2 per cent) than in the general population. The daily caloric intake and basal metabolic rate (BMR) were within the normal range; nevertheless there was a positive caloric balance due to minimal physical activity. The mean daily fat intake was normal (26.4ñ8.5 and 25.3ñ9.1 per cent of total calories in prepuberal and puberal children respectively). The daily fiber intake was under 70 per cent of recommendation. The total cholesterol was over 200 mg/dl in 26.6 and 23.9 per cent of prepuberal and puberal children. LDL cholesterol was over 130 mg/dl in 27.3 and 26.6 per cent and triacylglycerol was over 150 mg/dl in 16.9 and 25 per cent of prepuberal and puberal children respectively. Basal serum insulin was over 20 uIU/ml in 27.7 and 42.2 per cent of prepuberal and puberal children, respectively. Post glucose serum insulin was over 60 uIU/ml in 40 and 63 per cent of prepuberal and puberal children, respectively. Conclusions: Infantile and juvenile obesity is a chronic disease with a high incidence of metabolic alterations

Características del crecimiento en pacientes con síndrome de Turner y sus posibilidades terapéuticas actuales / Growth characteristics in patients with Turner's syndrome and therapeutic possibilities

Se describen las características del crecimiento estatural de pacientes con síndrome de Turner, señalando las variaciones en la velocidad de crecimiento que se producen a diferentes edades y las alteraciones hormonales que podrían estar condicionando el retraso estatural. Se analizan los resultados de estudios que han probado diferentes combinaciones de hormonas, entre ellas la hormona de crecimiento, oxandrolona y estrógenos con la finalidad de mejorar la talla final de estos pacientes

Nutrición de yodo en escolares de cuatro zonas censorias de Chile / Iodine nutrition in school age children of four censorial areas of Chile

Background: although endemic goiter is an easily controlled chronic disease, it continues to be a serious global public health problem. Aim: To study iodine nutrition in school age children from different areas of Chile. Subjects and methods: Thyroid gland was palpated in 4181 school age children from Calama, Santiago, Temuco and Punta Arenas. Urinariy iodine excretion was measured to 9 percent of these children and iodine concentration in salt for human consumption obtained in each of these areas was determined. Results: A 9 percent goiter prevalence in boys and 11 percent prevalence in girls was detected. The prevalence of goiter Ia was 6.5 percent and the figure in different geographic areas was similar. Iodine concentration in salt for human consumption was adequate according to Chilean legislation (82.6, 95.7, 96.8 and 93.2 ug ugI/g salt in Calama, Santiago, Temuco and Punta Arenas respectively). Urinary iodine excretion in boys and girls was 1695 and 1802 ug l/g creatinine in Calama, 680 and 732 in Santiago, 574 and 690 in Temuco, 570 and 528 in Punta Arenas. These values are well above recommendations. Conclusions: Endemic goiter is no longer a problem in Chile, the importance of a continuous surveillance of iodine nutrition in Chile and the reduction of salt iodine concentration required by Chilean legislation is underscored

Bocio endémico / Endemic goiter

El bocio endémico es el aumento de volumen de la glándula tiroides debido principalmente a la escasez de yodo en los alimentos. En el mundo hay aproximadamente un mil millones de personas expuestas a déficit de yodo en la dieta. Sesenta millones de las cuales viven en Iberoamérica, entre ellos los pobladores de las zonas precordilleranas y cordilleranas de Chile, incluyendo Santiago, donde una muestra de escolares mostraba, en el año 1982, prevalencias de 18 por ciento de bocio endémico, que se redujeron a menos de 8 por ciento siete años después de iniciado un programa de yodación de sal de mesa. La prevención del bocio y el cretinismo endémicos se basa en el suministro de yodo a la población, preferentemente en el pan, la sal de cocina, la administración de tabletas de yoduro de potasio o sódico y la administracion intramuscular u oral de aceite yodado, siendo lo mas corriente la incorporación de yodato potásico una parte por 10.000 o 20.000 partes de sal

[Meaning of mosaic color area in mitral regurgitation. Echocardiographic transesophageal study]. / Significado da área de mosaico cor na regurgitação mitral. Estudo ecocardiográfico transesofágico.

OBJECTIVE: The purpose of our study was to analyse the meaning of total and mosaic color Doppler area of the mitral regurgitation jet, in terms of the degree of mitral regurgitation severity. PATIENTS: In and out patients referred to the Echocardiographic Laboratory of Gregorio Marañon General Hospital, Madrid. SETTING: Transesophageal echocardiographic prospective study MATERIAL AND METHODS: By pulsed and color Doppler transesophageal approach we studied 94 consecutive patients with mitral regurgitation diagnosis. We divided the entire population in three groups according to the degree of transthoracic mitral regurgitation severity and mitral regurgitation color area index (Groups I, II and III). In each patient we systematically measured the regurgitant maximal area (AT) and of the aliasing color area, as well as maximal peak velocity (VIS) and area (AIS) of the reversed pulmonary venous pulsed Doppler flow obtained at the level of the left upper pulmonary vein. RESULTS: For the group I, color Doppler AT was 411 +/- 315 mm2 and AN was 204 +/- 123 mm2 (R = 0.25), pulmonary venous pulsed Doppler VIS was 4 +/- 8 cm/sec (R = NS for AT and 0.79 for AN) and AIS was 9 +/- 6 mm2 (R = NS for AT and 0.82 for AN). In the group II, color Doppler AT was 802 +/- 447 mm2, AN was 671 +/- 307 mm2 (R = 0.42). the pulmonary venous pulsed Doppler VIS was 22 +/- 12 cm/sec (R = NS for AT and 0.66 for AN). In the group III we obtained an AT value of 1174 +/- 462 mm2 and an AN value of 1092 +/- 417 mm2 (R = 0.62). In this group the pulmonary venous pulsed Doppler VIS was 50 +/- 13 cm/sec (R = 0.57 for AT and 0.76 for AN) and the correspondent AIS was 671 +/- 570 mm2 (R = 0.38 for AT and 0.91 for AN). CONCLUSIONS: Mosaic transesophageal echocardiographic color Doppler area of mitral regurgitant jets has a direct relationship with the reversal criteria of pulsed Doppler pulmonary venous flow. This relationship is greater than the total color Doppler area of the same regurgitant jet. The mosaic color Doppler area of mitral regurgitant jets is a more correct estimation of the systolic variation of left atrial pressure, when compared with the total color area of mitral regurgitation.

Respuesta al factor liberador en niños con deficiencia de hormona de crecimiento / Growth hormone response to releasing factor in growth hormone deficient children

El factor liberador de hormona de crecimiento (GRF) es un péptido de 44 aminoácidos producido en el hipotálamo, que estimula la secreción de hormona de crecimiento (GH) por la hipófisis. Este factor fue administrado a 21 niños prepuberales (12 varones y 9 mujeres) portadores de deficiencia de hormona de crecimiento. La edad cronológica promedio fue de 8,9 ñ 3,5 años, y su edad ósea de 5,6 ñ 2,6 años. El diagnóstico de deficiencia de GH se basó en una talla 2 DE bajo la media, velocidad de crecimiento inferior a 4,5 cm/año, respuesta inferior a 7 ng/ml a 2 diferentes pruebas de estímulo para GH, y ausencia de otras afecciones. La respuesta al estímulo con GRF fue definida como positiva cuando los niveles de GH aumentaron por sobre 4 veces al coeficiente de variación del radioinmunoensayo utilizado, lo que se registró en 13 de los 21 pacientes (62%). La respuesta máxima al GRF fue 17,2 ñ 10,8 ng/ml y se observó entre 5 y 30 min después de su administración. Los resultados positivos en 62% de los pacientes estudiados sugieren que sus defectos residen en el hipotálmo más que en la hipófisis. Estos niños se podrían beneficiar de un tratamiento a largo plazo con GRF

Síndrome de Turner por mosaico 45,X/46,XXr / Turner's syndrome by 45,X/46,XXr mosaic

El síndrome de Turner es una entidad clínica de origen genético que afecta a pacientes con fenotipo femenino. Se caracteriza por una talla baja, infantilismo sexual, hipogonadismo y un fenotipo característico de expresión variable, siendo menos notorio en los mosaicos. Se describe una paciente de 6 2/12 años de edad, que sufría de importante retraso estatural y tenía un fenotipo poco característico. El cariotipo correspondía al de un mosaico 45,X/46,XXr. Se trató con microdosis de etinil-estradiol, obteniéndose aumento de su velocidad de crecimiento, pero asociado a aceleración de la maduración esquelética, por lo que se reemplazó la terapia por hormona de crecimiento recombinante, sintética, 2 U subcutáneas cada día durante dos años, consiguiéndose hacerla crecer a una velocidad de 6 cm/año, sin que se acelerase la edad ósea

[Transesophageal echocardiography study of mitral valve prosthesis]. / Estudo ecocardiográfico transesofágico de próteses valvulares em posição mitral.

OBJECTIVE: Transesophageal (TEE) and Transthoracic (TTE) comparative echocardiographic analysis of patients with mitral valve prosthesis. DESIGN: Prospective study. SETTING: In hospital and out patients with mitral prosthesis in a follow-up study by the Cardiology Department and referred to the echocardiographic laboratory of Gregorio Marañon General Hospital, Madrid. PATIENTS: We studied 90 consecutive patients with mitral prosthesis diagnosis. INTERVENTIONS: Comparative and prospective echocardiographic study of transthoracic and transesophageal techniques in mitral prosthesis pathology. RESULTS: TTE diagnosed 18% of dysfunctioning mitral prosthesis patients compared to 56% of cases identified by TEE. TTE observed 1% of mitral prosthesis vegetation compared to 8.8% by TEE. TEE diagnosed left atrial thrombosis in 2.2% and TEE in 10%. Left atrial spontaneous dynamic contrast was identified exclusively by TEE in 55% of all cases. Paravalvular mitral prosthesis leak was correctly identified exclusively by TEE in 20% of cases. CONCLUSIONS: TEE has a greater diagnostic capacity compared to TTE in mitral prosthesis patients. This technique can give a greater security in evaluating mitral prosthesis thrombi, vegetations and leak, establishing a more precise diagnosis of mitral prosthesis dysfunction. The authors concluded that TEE is the technique of choice in noninvasive evaluation of patients admitted with the suspicion of mitral prosthesis dysfunction.

[Changes in the physiologic pattern of mitral prosthesis regurgitation in the presence of a prosthetic dysfunction]. / Alteração do padrão fisiológico de regurgitação protésica mitral em presença de disfunção.

AIM OF STUDY: Evaluation by transesophageal echocardiography of the effect on the characteristics of physiological regurgitant jets (JF) resulting from prosthetic disfunction due to pathologic regurgitation (JF). PATIENTS AND METHODS: We studied 69 consecutive patients with the diagnosis of prosthesis in mitral position using transesophageal echocardiography and color doppler codification. The patients were divided in two groups (N and D groups) according to the presence of prosthesis disfunction by pathologic regurgitation. In each patient we determined planimetric areas and atrial peak depth of each JF and also the sum of JF planimetric areas of each mitral prosthesis. When pathological regurgitation was present we calculated the highest planimetric area, severity degree and atrial peak depth in each JP. RESULTS: The planimetric area in each JF of group N was 330 +/- 167 mm2 and in group D 117 +/- 116 mm2 (p less than 0.001). The sum of the areas of JF in group N was 474 +/- 204 mm2 and in group D 254 +/- 176 mm2 (p less than 0.01). The atrial depth of JF in group was 32 +/- 15 mm and in group D 26 +/- 18 mm (p less than 0.01). In group D 29% of the patients had mild pathological regurgitation, 10% moderate and 61% severe. The maximum planimetric area of JP in group D was 1078 +/- 1007 mm2 with atrial depth of 37 +/- 28 mm. CONCLUSION: The pathological regurgitation in disfunction prosthesis in mitral position has a significant reduction effect in the dimension of prosthesis physiologic regurgitation jets. This transesophageal echocardiographic observation makes it possible to characterize and clarify more precisely the different types of mitral prosthesis jets.

Hipogonadismo hipogonadotrófico y anosmia: síndrome de Kallman / Hypogonadotrophic hypogonadism and anosmia: Kallmann's syndrome

Se presentan 3 varones con HH y anosmia, en los cuales se diagnosticó síndrome de Kallman y se inició tratamiento con enantato de testosterona para inducir desarrollo sexual. Se discute el modelo de herencia, la importancia de signos y síntomas clínicos agregados en la sospecha temprana del diagnóstico, la variabilidad de las respuestas de las gonadotrofinas hipofisiarias y prolactina frente a estímulos con LHRH y clorpromazina respectivamente. La dosis de enantato de testosterona óptima para producir una adecuada virilización parece ser de 200 mg im cada 2 semanas, ya que frecuencias mensuales de administración de la hormona si bien inducen virilización producen un progreso demasiado lento del desarrollo puberal