[Bacteraemia due to Eikenella corrodens secondary to periodontal infection in a neutropenic patient]. / Bacteriemia por Eikenella corrodens secundaria a infección periodontal en paciente neutropénico.

We present the case of a 44 year-old patient, without significant previous medical history, who presented a systemic infection due to Eikenella corrodens following a dental extraction in the context of an agranulocytosis of pharmacological origin due to carbimazole. During admission he was treated with broad-spectrum antibiotics and G-CSF 5 µg/kg/day, undergoing a favorable evolution and receiving hospital discharge on the seventh day. Invasive infections due to Eikenella corrodens that develop bacteriaemia are less than 20%, and are generally secondary to the drainage of previous abscesses and are usually isolated together with other microorganisms; while finding a monomicrobial primary bacteriaemia without the prior existence of endocarditis is exceptional. This is the first case of systemic infection due to this bacteria secondary to dental manipulation, where the state of transitory immunosuppression in which the patient found himself at that time was determinant in causing the disseminated infection.

[Diplopia and left palpebral ptosis as a first manifestation of hypophysary metastases of pulmonary adenocarcinoma]. / Diplopía y ptosis palpebral izquierda como primera manifestación de metástasis hipofisarias de adenocarcinoma pulmonar.

A patient, without significant previous medical history, who started with diplopia and left palpebral ptosis as the first manifestation of hypophysary metastases of a widely disseminated and previously undetected cancer of pulmonary origin. Together with a histological study of the lesions, the diagnosis was made with specific image tests of the hypophysary area, which detected a neoformation in the sella turca that was invading the left cavernous sinus with erosion of the verso of the sellar, together with the presence of pulmonary nodules and numerous adenopathies. An hypogonadotropic hypogonadism was detected as the only hormonal alteration due to the infiltration of the anterior hypophysis due to the osseous metastases at the base of the cranium. The patient, in spite of receiving several weeks of radiotherapy, suffered a progressive neurological deterioration and died after a few weeks.

Bacteriemia por Eikenella corrodens secundaria a infección periodontal en paciente neutropénico / Bacteraemia due to Eikenella corrodens secondary to periodontal infection in a neutropenic patient

Se expone el caso de un paciente de 44 años, sin antecedentes de interés, que presentó una infección sistémica por Eikenella corrodens posterior a una extracción dentaria en el contexto de una agranulocitosis de origen farmacológico por carbimazol. Durante el ingreso fue tratado con antibióticos de amplio espectro y G-CSF 5 microg/kg/día con una evolución favorable y alta hospitalaria en el séptimo día. Las infecciones invasivas por Eikenella corrodens, que desarrollan bacteriemia son menos del 20%, generalmente son secundarias a drenaje de abscesos previos y suele aislarse junto a otros microorganismos, siendo excepcional el hallazgo de una bacteriemia primaria monomicrobiana sin la existencia previa de endocarditis. Es el primer caso de infección sistémica por esta bacteria secundaria a manipulación dental, en el que fue determinante el estado de inmunosupresión transitorio en el que se encontraba el paciente en ese momento para causar la infección diseminada(AU)

We present the case of a 44 year-old patient, without significant previous medical history, who presented asystemic infection due to Eikenella corrodens following a dental extraction in the context of an agranulocitosis of pharmacological origin due to carbimazole. During admission he was treated with broad-spectrum antibiotics and G-CSF 5 microg/kg/day, undergoing a favorable evolution and receiving hospital discharge on the seventh day. Invasive infections due to Eikenella corrodens that develop bacteriaemia are less than 20%, and are generally secondary to the drainage of previous abscesses and are usually isolated together with other microorganisms; while finding a monomicrobial primary bacteriaemia without the prior existence of endocarditis is exceptional. This is the first case of systemic infection due to this bacteria secondary to dental manipulation, where the state of transitory immunosuppression in which the patient found himself at that time was determinant in causing the disseminated infection(AU)

Diabetes MODY tipo 5: a proposito de un caso / Maturity-onset diabetes of the young type 5: a case report

La diabetes MODY-5 es un tipo de diabetes monogenica infrecuente, causada por mutación en el gen del factor de transcripción nuclear hepático 1-beta (HNF-1¦Â). Esta mutación puede ser de tipo puntual o bien corresponder a delecciones grandes, y a su vez, puede aparecer de novo por mutación espontanea o bien ser transmitida de forma hereditaria con caracter autosomicodominante. Está asociada con un alto riesgo de complicaciones microvasculares de aparición temprana en las personas afectas, así como con alteraciones renales características del tipo quistes y anomalías del tracto genital, que estan presentes incluso antes del nacimiento. Por ello, está justificado hacer pruebas de detección para las mutaciones de HNF-1 en diabíticos no obesos, sobre todo, cuando existen alteraciones renales o genitales asociadas, sin tener en cuenta losantecedentes familiares (AU)

MODY-5 diabetes is an infrequent type of monogenic diabetes, caused by mutation in the gene of the nuclear hepatic transcription factor 1-beta (HNF-1¦Â).This mutation can be of a momentary type or it might correspond to big deletions, and, in its turn, it can appear due to spontaneous de novo mutation or it can be transmitted by hereditary with an autosomal dominant character. It is associated with a high risk of microvascular complications that appear early in affected people, as well as with characteristic renal alterations of the cyst type, and anomalies of the genital tract, which are present even before birth. That is why it is justified to carry out detection tests for HNF-1¦Â mutations in non-obese diabetics, above all when there are associated renal or genital alterations, without consideration of family antecedents (AU)

Osteoporosis secundarias / Secondary osteoporosis

Se denomina osteoporosis secundaria a aquella que es causada por patologías o medicaciones, distintas a la pérdida ósea explicable por la etapa postmenopáusica o envejecimiento. Las posibles patologías que pueden condicionar la pérdida de masa ósea son muy variadas: endocrinológicas, digestivas, genéticas, hematológicas, reumáticas, post-transplante, farmacológicas y un amplio grupo misceláneo. En el artículo se revisan esencialmente las causas endocrinológicas, con especial énfasis en los aspectos más controvertidos en la actualidad, seguidos de una aproximación clínica para el diagnóstico sistemático de estas patologías, frecuentes en los casos etiquetados inicialmente de osteoporosis primaria (AU)

Fisiología y fisiopatología ósea / Physiology and bone physiopathology

El tejido óseo es uno de los mayores del organismo, con funciones claras: servir de soporte y protección de las partes blandas, sustento del movimiento con el anclaje de los músculos, reservorio de minerales y almacén interactivo de la médula ósea. Para ejercer todas estas funciones el hueso debe mantener su calidad, concepto en el que se integran tanto su grado de mineralización como la microarquitectura y la capacidad de restaurar las lesiones, aspectos que se recogen en la definición amplia de osteoporosis: "Una enfermedad sistémica del esqueleto, caracterizada por una baja masa ósea y un deterioro de la microarquitectura del tejido óseo, que comportan un aumento de la fragilidad del hueso y el consecuente incremento del riesgo de fracturas", si bien desde el punto de vista clínico es necesario centrarnos en la mineralización, aspecto cuantificable, entendiendo como osteoporosis un descenso de la masa ósea mayor de 2,5 desviaciones estándar inferior a la de las pacientes jóvenes sanas. En el artículo se revisan los aspectos fisiopatológicos que influyen en el desarrollo de este frecuente cuadro clínico (AU)

[Physiology and bone physiopathology]. / Fisiología y fisiopatología ósea.

The bone tissue is one of the largest of the organism, with clear functions: to serve as a support and protection for the soft parts, as support for movement with the anchorage of the muscles, as mineral reserve and as interactive storage of the bone marrow. To exercise all these functions the bone must maintain its quality, a concept that combines its degree of mineralisation, its microarchitecture and its capacity to repair lesions, aspects that are included in the broad definition of osteoporosis: "A systemic disease of the skeleton, characterised by a low bone mass and a deterioration of the microarchitecture of the bone tissue, which jointly result in an increase in bone fragility and the consequent increase of the risk of fractures", although from the clinical point of view we have to centre our attention on mineralisation, a quantifiable aspect, understanding as osteoporosis a fall in bone mass greater than 2.5 standard deviations below that of young healthy patients. This article reviews the physiopathological aspects that influence the development of this frequent clinical picture.

[Secondary osteoporosis]. / Osteoporosis secundarias.

Secondary osteoporosis is caused by pathologies or medications, differing from the bone loss explainable by the post-menopausal stage or by ageing. The possible pathologies that can condition the loss of bone mass are very varied: endocrinological, digestive, genetic, haematological, rheumatic, post-transplant, pharmacological and a wide miscellaneous group. This article essentially reviews the endocrinological causes, with special emphasis on the more controversial aspects, followed by a clinical approach for the systematic diagnosis of these pathologies, which are frequent in cases initially labelled as primary osteoporosis

Composición corporal y obesidad / Body composition and obesity

La obesidad es la enfermedad que se caracteriza por un exceso patológico de tejido adiposo. Habitualmente, este exceso se mide según su repercusión en el peso y en el Índice de Masa Corporal. Los métodos de medida de la composición corporal, algunos de reciente introducción, van mostrando las consecuencias en la salud del exceso de grasa, en especial de la grasa visceral. Se revisan los marcadores epidemiológicos de obesidad, las técnicas de valoración de la masa grasa, la influencia de la distribución del tejido adiposo y los factores que condicionan la grasa visceral, así como la influencia de este tejido en el perfil metabólico del obeso (AU)

[Body composition and obesity]. / Composición corporal y obesidad.

Obesity is a disease that is characterised by a pathological excess of adipose tissue. Normally, this excess is measured according to its repercussion on weight and on the index of body mass. The methods for measuring body composition, some of which are of recent introduction, are showing the consequences on health of excess fat, especially visceral fat. A review is offered of the epidemiological markers of obesity, the techniques for evaluating fatty mass, the influence of the distribution of the adipose tissue and the factors that condition visceral fat, as well as the influence of this tissue on the metabolic profile of the obese patient.

[Continuous quality improvement in the control of the type2 diabetes in Navarra. GEDAPSNA study 1996]. / Mejora continua de la calidad en el control del diabético tipo 2 en Navarra. Estudio GEDAPSNA 1996.

Diabetes mellitus type 2 constitutes one of the principal public health problems today, representing an important burden on care and involving extremely high economic costs, both direct and indirect. To provide an adequate response from the different public health systems, the St. Vincent Declaration was drawn up containing certain recommendations on the protocol of care and the carrying out of controls of continuous quality improvement, since it is a chronic pathology that requires a proactive health policy, which prevents, and provides early detection of its complications. In the present work we set out the results of the first study carried out in Navarra on the indicators of quality in the care provided to diabetics in Primary Health care, carried out by the Study Group on Diabetes Mellitus in Primary Care (GEDAPSNA). The study was made of an aleatory sample of 496 patients, by means of gathering data about their clinical records for the year 1996. 12 process indicators and 12 indicators of intermediate and final results were used. The results detect some important deficiencies that require early intervention: lack of exploration and management of the lesions that make up so-called diabetic foot; low achievement of results in the control of arterial hypertension in this group of patients; and absence of exploration of the lesions of the fundus of the eye in more than 50% of type 2 diabetics.

[Weight-loss drugs: composition of diet pills prescribed in Navarra]. / Fármacos adelgazantes: Composición de preparados magistrales prescritos en Navarra.

BACKGROUND: The prescription, dispensation and sale of "Magisterial formulas" for weight loss is a very extended practice in Spain, in spite of being strongly unadvised by different Administration Department as well as by medical and sanitary groups. The composition of these preparations is not labelled if so only in a generic way. METHODS: The content of 54 capsules from 6 different origins (3 medical consultations, 1 pharmacist consultation, 1 free sale in pharmacies and 1 free sale in stores) was analysed in 2 laboratories. The presence and quantity of 29 active principles was searched by spectrophotometry, chromatography and radioimmunoassay. RESULTS: The presence of some of the 12 following substances was confirmed in 42 samples (77.8%): hormones (levothyroxine, cortisol and cortisone), appetite suppression phenetilamines (amphetamine, amphepranone, fenfluramine and fenproporex), benzodiazepines (diazepam, clorazepato and chlordiazepoxide) and diuretics (triamterene and ciclotiazide). The quantities of active principles was very variable in and among the six groups. In 13 of the capsules 1 active principle and in 29 combinations of two or more was found. None component of the labels, when available, corresponded with their analysed components. In 12 samples (22.2%) none of the which may correspond to some substances different from the 29 sought ones. CONCLUSIONS: The usage of formulas as the studied here on the overweight and obesity treatment should be obviously unadvised.