Riesgo de fractura osteoporótica y de cadera en pacientes con enfermedad pulmonar obstructiva crónica / Risk of osteoporotic fracture and hip fracture in patients with chronic obstructive pulmonary disease

Antecedentes y objetivos. La osteoporosis es una comorbilidad frecuente en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Hemos examinado el riesgo de fractura osteoporótica mayor y el riesgo de fractura de cadera en pacientes con EPOC. Pacientes y métodos. Se trata de un estudio observacional, multicéntrico, realizado en 26 hospitales de 16 comunidades autónomas de España. Se incluyeron pacientes diagnosticados de EPOC que requirieron ingreso y que fueron admitidos en un Servicio de Medicina Interna por exacerbación de su enfermedad respiratoria. La EPOC se confirmó mediante una espirometría posbroncodilatadora en fase estable: volumen espiratorio máximo en el primer segundo (FEV1) < 80% del valor teórico y cociente (FEV1)/capacidad vital forzada < 0,7 tras la administración de un broncodilatador. La disnea se evaluó con la escala modificada del Medical Research Council (mMRC). La variable principal fue la probabilidad de fractura con la herramienta FRAX® para la población española. Resultados. Se incluyeron 392 pacientes, 347 (88%) varones, con una edad (media y desviación estándar) de 73,7 (8,9) años y un FEV1 de 1,23 l (43,3% del predicho). Sólo 37 pacientes (9,4%; 27 varones y 10 mujeres) habían sido diagnosticados previamente de osteoporosis. Un riesgo >= 20% de sufrir en los siguientes 10 años una fractura osteoporótica mayor lo presentó un 1,8% (intervalo de convianza [IC] 95%: 0,9-3,6) y un riesgo ≥ 3% de padecer una fractura de cadera lo presentó un 49,7% (IC 95%: 44,8-54,7) de los enfermos con EPOC. No se observó relación entre la probabilidad de fractura y el estadio GOLD o la escala de disnea evaluada con la escala mMRC. Conclusiones. En nuestro medio, el diagnóstico de osteoporosis en los pacientes con EPOC es poco frecuente. Sin embargo, la mitad de ellos tiene un riesgo elevado de padecer una fractura de cadera en los próximos 10 años(AU)

Aim. Osteoporosis is a frequent comorbidity in patients with chronic obstructive pulmonary disease (COPD). We have studied the risk of major osteoporotic fracture and hip fracture in patients with COPD. Patients and methods. A multicenter cross-sectional study was performed in Spain in 26 hospitals of 16 regional communities. Patients diagnosed with COPD who required admission to the Internal Medicine Service due to exacerbation of their respiratory disease were enrolled. COPD was confirmed by post-bronchodilator spirometry in stable state: maximum expiratory volume in the first second (FEV1) < 80% of the theoretical value and quotient FEV1/FVC < 0.70 and percent predicted after the administration of a bronchodilator. Dyspnea was evaluated with the modified Medical Research Council (mMRC) dyspnea scale. The principal variable was the likelihood of fracture evaluated with the FRAX® tool for the Spanish population. Results. Three hundred and ninety two patients, 347 (88%) men, with a mean (SD) age of 73.7 (8.9) years and a mean FEV1 of 1.23 liters (43.3% of predicted) were enrolled. Only 37 patients (9.4%), 27 men and 10 women had been diagnosed previously of osteoporosis. Overall, 1.8% (95% CI: 0.9-3.6) had a 10-year probability of major osteoporotic fracture >= 20% and 49.7% (95% CI: 44.8-54.7) had a probability of hip fracture ≥ 3%. No relationship was observed between the probability of fracture and GOLD stage or mMRC dyspnea scale. Conclusions. The diagnosis of osteoporosis is uncommon in our COPD patients. However, half of them have a high probability of a hip fracture in the next 10 years(AU)

[Risk of osteoporotic fracture and hip fracture in patients with chronic obstructive pulmonary disease]. / Riesgo de fractura osteoporótica y de cadera en pacientes con enfermedad pulmonar obstructiva crónica.

AIM: Osteoporosis is a frequent comorbidity in patients with chronic obstructive pulmonary disease (COPD). We have studied the risk of major osteoporotic fracture and hip fracture in patients with COPD. PATIENTS AND METHODS: A multicenter cross-sectional study was performed in Spain in 26 hospitals of 16 regional communities. Patients diagnosed with COPD who required admission to the Internal Medicine Service due to exacerbation of their respiratory disease were enrolled. COPD was confirmed by post-bronchodilator spirometry in stable state: maximum expiratory volume in the first second (FEV1) < 80% of the theoretical value and quotient FEV(1)/FVC < 0.70 and percent predicted after the administration of a bronchodilator. Dyspnea was evaluated with the modified Medical Research Council (mMRC) dyspnea scale. The principal variable was the likelihood of fracture evaluated with the FRAX® tool for the Spanish population. RESULTS: Three hundred and ninety two patients, 347 (88%) men, with a mean (SD) age of 73.7 (8.9) years and a mean FEV1 of 1.23 liters (43.3% of predicted) were enrolled. Only 37 patients (9.4%), 27 men and 10 women had been diagnosed previously of osteoporosis. Overall, 1.8% (95% CI: 0.9-3.6) had a 10-year probability of major osteoporotic fracture ≥ 20% and 49.7% (95% CI: 44.8-54.7) had a probability of hip fracture ≥ 3%. No relationship was observed between the probability of fracture and GOLD stage or mMRC dyspnea scale. CONCLUSIONS: The diagnosis of osteoporosis is uncommon in our COPD patients. However, half of them have a high probability of a hip fracture in the next 10 years.

Manifestaciones oculares como presentación de un síndrome de vena cava superior / Severe ocular symptoms as an initial manifestation of superior vena cava syndrome

El síndrome de vena cava superior es una complicación grave de una amplia variedad de procesos (el más frecuente es el cáncer de pulmón) que obstruyen el flujo de la vena cava superior y provocan la aparición de manifestaciones clínicas características, por el aumento de presión en el territorio venoso de la cabeza, los miembros superiores y la parte superior del tórax. Dentro de estas manifestaciones las referidas al ojo son poco frecuentes, y cuando aparecen raramente son el síntoma de presentación y tienen la expresividad del caso de este varón fumador al que diagnosticamos un síndrome de vena cava superior tras consultar por acusada sintomatología ocular

Superior vena cava syndrome is obstruction of blood flow through the superior vena cava (SVC). It is most commonly caused by neoplasm, especially lung cancer. An obstructed SVC initiates collateral venous return to the heart from the upper half of the body and the classic symptoms and signs become obvious. Superior vena cava síndrome is a rare cause of ocular manifestations. We report a case of periorbital swelling, conjunctival edema an orbital proptosis in a male patient presenting malignant superior vena cava obstruction

[Severe ocular symptoms as an initial manifestation of superior vena cava syndrome]. / Manifestaciones oculares como presentación de un síndrome de vena cava superior.

Superior vena cava syndrome is obstruction of blood flow through the superior vena cava (SVC). It is most commonly caused by neoplasm, especially lung cancer. An obstructed SVC initiates collateral venous return to the heart from the upper half of the body and the classic symptoms and signs become obvious. Superior vena cava síndrome is a rare cause of ocular manifestations. We report a case of periorbital swelling, conjunctival edema an orbital proptosis in a male patient presenting malignant superior vena cava obstruction.

Metástasis cutánea: una opción a tener presente / Cutaneous metastasis: an option to keep in mind

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Fibrosis retroperitoneal idiopática tratada con tamoxifeno. Presentación de un caso y revisión de la bibliografía / Idiopathic fibrosis retroperitoneal treated with tamoxifen. Acase report and review of the bibliography

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Síncope e hipotiroismo. Una relación razonable / Syncope and hypothryroidism. A reasonable relation

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Ginecomastia por finasteride / Finasteride induced gynecomastia

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Rabdomiolisis por gemfibrozilo en un paciente con hipotiroidismo inadvertido / Gemfobrozil induced rabdomiolisis in a patient with unadvised hypothyroidism

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Carbón activado y «falsas melenas» / Activated carbon and «false melenas»

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Carbón activado y «falsas melenas» / Activated carbon and «false melenas»

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[Spontaneous tumor lysis syndrome in a patient with non-Hodgkin's lymphoma]. / Síndrome de lisis tumoral espontáneo en una paciente con linfoma no Hodgkin.

An 77-year-old woman with no previous history of malignancy was admitted to the hospital with generalized weakness and malaise. Physical examination demonstrate multiple cervical adenopathies. The day after admission the patient developed severe metabolic derangements (hyperuricemia, hypocalcemia, hyperkalemia, hyperphosphatemia and azotemia) and expired. Consent for necropsy was refused. The cytology and molecular studies of cervical adenopathy sample were diagnostic of high-grade non-Hodgkin's lymphoma. A presumptive diagnosis of non Hodgkin lymphoma with spontaneous tumor lysis syndrome was made.

Sobredosis de ciamida cálcica (carbimida): descripción de un caso y revisión bibliográfica / Carbimide overdosage: description of a case and review of the literature

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Síndrome de lisis tumoral espontáneo en una paciente con linfoma no Hodgkin / Spontaneous tumor lysis syndrome in a patient with non-Hodgkin´s lymphoma

Presentamos el caso de una mujer de 77 años sin antecedentes de proceso neoplásico que ingresa por la aparición en pocas semanas de múltiples adenopatías cervicales y que fallece a las pocas horas presentado hiperuricemia, hipocalcemia, hiperpotasemia, hiperfosfatemia e hiperazotemia. La citología y estudio molecular de una muestra de una adenopatía cervical fueron compatibles con de linfoma no Hodgkin de estirpe B de alto grado. Se trataría por tanto de un síndrome de lisis tumoral espontáneo como debut de un linfoma no Hodgkin

An 77-year-old woman with no previous history of malignancy was admited to the hospital with generalized weakness and malaise. Physical examination demostrate multiple cervical adenopathies. The day after admission the patient developed severe metabolic derangements (hyperuricemia, hypocalcemia, hyperkalemia, hyperphosphotemia and azotemia) and expired. Consent for necropsy was refused. The cytology and molecular studies of cervical adenopathy sample were diagnostic of high-grade non-Hodgkin’s lymphoma. A presumptive diagnosis of non Hodgkin lymphoma with spontaneous tumor lysis syndrome was made

Incidence of Type 1 diabetes in children in Cáceres, Spain, during 1988-1999.

AIM: To determine the incidence of Type 1 diabetes in Cáceres in children less than 14 years of age. We tested for differences in incidence by age, sex and season at diagnosis. METHODS: All Type 1 diabetes cases with onset <14 years of age between 1988 and 1999 were recorded retrospectively. Pediatric Unit registries provided the primary source of ascertainment. The secondary independent data source was based on the registries of local Diabetic Associations, diabetes camp records and guarantee cards of blood-glucose meters. We used the capture-recapture method for ascertainment. RESULTS: During the 12-year period, 137 new cases of Type 1 diabetes were identified. Completeness of ascertainment was 99.2%. Average annual observed incidence was 16.8/100,000/year (95% C.I. 14.1-19.8). Age-standardised incidence (world population): 16.5/100,000/year (95% C.I. 13.9-19.6). Average annual incidence for 0-4, 5-9 and 10-13-year-old groups: 12.7/100,000 (95% C.I. 8.8-17.9), 18.2/100,000 (95% C.I. 13.7-23.8) and 19.1/100,000 (95% C.I. 14.2-25.1). The highest age-specific annual incidence rate was found in the 10-13-year age group. There was a seasonal onset pattern, with the highest incidence in autumn and winter. November was the month with the highest number of cases (22/137). CONCLUSION: Cáceres has a moderately high incidence of Type 1 diabetes in children less than 14 years of age, similar to that found in other more developed and densely populated regions of Spain, and in the range of other countries of northern Europe. These data do not support the hypothesis of a decrease in the incidence of the disease from north to south over Europe.