Multidisciplinary Unit Improves Pregnancy Outcomes in Women with Rheumatic Diseases and Hereditary Thrombophilias: An Observational Study.

Rheumatic diseases (RD) and hereditary thrombophilias (HT) can be associated with high-risk pregnancies. This study describes obstetric outcomes after receiving medical care at a multidisciplinary consultation (MC) and compares adverse neonatal outcomes (ANOs) before and after medical care at an MC. This study is a retrospective observational study among pregnant women with RD and HT treated at an MC of a university hospital (southern Spain) from 2012 to 2018. Absolute risk reduction (ARR) and number needed to treat (NNT) were calculated. A total of 198 pregnancies were registered in 143 women (112 with RD, 31 with HT), with 191 (96.5%) pregnancies without ANOs and seven (3.5%) pregnancies with some ANOs (five miscarriages and two foetal deaths). Results previous to the MC showed 60.8% of women had more than one miscarriage, with 4.2% experiencing foetal death. MC reduced the ANO rate by AAR = 60.1% (95%CI: 51.6-68.7%). The NNT to avoid one miscarriage was 1.74 (95%CI: 1.5-2.1) and to avoid one foetal death NNT = 35.75 (95CI%: 15.2-90.9). A total of 84.8% of newborns and 93.2% of women did not experience any complication. As a conclusion, the follow-up of RD or HT pregnant women in the MC drastically reduced the risk of ANOs in this population with a previous high risk.

[Secondary hyperparathyroidism in advanced prostate cancer]. / Hiperparatiroidismo secundario en el cáncer de próstata avanzado.

BACKGROUND AND OBJECTIVE: High parathyroid hormone (PTH) concentrations are associated with increased bone resorption and bone matrix degradation. Some studies show elevated PTH concentrations and hypocalcemia in patients with advanced prostate carcinoma, although the pathophysiological significance of these findings is not well defined. MATERIALS AND METHODS: We performed a retrospective study of 60 patients diagnosed with advanced prostate cancer (44 nonmetastatic and 16 metastatic) treated with androgen deprivation. In all patients, PTH, calcium, phosphorus, 25 (OH) vitamin D and prostate-specific antigen (PSA) were determined. Bone scintigraphy had previously been performed. RESULTS: In patients with bone metastases, mean concentrations were as follows: calcium 9.19 mg/dl, phosphorus 3.47 mg/dl, 25 (OH) vitamin D 13.85 ng/ml, PTH 66.8 pg/ml and total PSA 101.27 ng/ml. For those without bone metastases, the results were calcium 9.39 mg/dl, phosphorus 3.38 mg/dl, 25 (OH) vitamin D 20.50 ng/ml, PTH 52.23 pg/ml and total PSA 2.52 ng/ml. PTH levels were significantly higher in patients with prostate cancer and bone metastases than in those without metastases (p=0.03). Vitamin D levels were also significantly lower in this group (p=0.03). There were no differences in other values. CONCLUSIONS: The present study found increased PTH concentrations in patients with advanced prostate cancer. This finding could be useful to predict disease progression.

Hiperparatiroidismo secundario en el cáncer de próstata avanzado / Secondary hyperparathyroidism in advanced prostate cancer

Antecedentes y objetivo Se conoce que concentraciones altas de PTH se asocian con aumento de reabsorción y degradación de la matriz ósea. Algunos estudios evidencian concentraciones elevadas de PTH e hipocalcemia en pacientes con carcinoma de próstata avanzado; sin embargo, su importancia fisiopatológica aún no está bien definida. Material y método Estudio descriptivo retrospectivo de 60 pacientes diagnosticados de cáncer de próstata avanzado (44 no metastásicos y 16 metastásicos) en tratamiento actual con bloqueo hormonal. En todos los casos se hicieron determinaciones de PTH, calcio, fósforo, 25 (OH) vitamina D y antígeno específico de la próstata (PSA). Se les realizó previamente gammagrafía ósea. Resultados Los pacientes con metástasis óseas presentaban unas concentraciones medias de: calcio 9,19mg/dl, fósforo 3,47mg/dl, 25 (OH) vitamina D 13,85ng/ml, PTH 66,8pg/ml y de antígeno prostático total de 101,27ng/ml. Para aquellos que no tenían metástasis óseas las medias fueron: calcio 9,39mg/dl, fósforo 3,38mg/dl, 25 (OH) vitamina D 20,50ng/ml, PTH 52,23pg/ml y antígeno prostático total de 2,52ng/ml. Los pacientes con cáncer de próstata y metástasis óseas presentaron concentraciones de PTH superiores a los no metastásicos de forma estadísticamente significativa (p=0,03). Las concentraciones de vitamina D también fueron significativamente menores en este grupo (p=0,03). No se apreciaron diferencias en el resto de los valores. Conclusiones En este estudio se ha observado un aumento de las concentraciones de PTH en los pacientes con cáncer de próstata avanzado lo que podría implicar valores pronósticos en cuanto a la evolución de la enfermedad (AU)

Background and Objective High parathyroid hormone (PTH) concentrations are associated with increased bone resorption and bone matrix degradation. Some studies show elevated PTH concentrations and hypocalcemia in patients with advanced prostate carcinoma, although the pathophysiological significance of these findings is not well defined. Materials and methods We performed a retrospective study of 60 patients diagnosed with advanced prostate cancer (44 non metastatic and 16 metastatic) treated with androgen deprivation. In all patients, PTH, calcium, phosphorus, 25 (OH) vitamin D and prostate-specific antigen (PSA) were determined. Bone scintigraphy had previously been performed. Results In patients with bone metastases, mean concentrations were as follows: calcium 9.19mg/dl, phosphorus 3.47mg/dl, 25 (OH) vitamin D 13.85ng/ml, PTH 66.8pg/ml and total PSA 101.27ng/ml. For those without bone metastases, the results were calcium 9.39mg/dl, phosphorus 3.38mg/dl, 25 (OH) vitamin D 20.50ng/ml, PTH 52.23pg/ml and total PSA 2.52ng/ml. PTH levels were significantly higher in patients with prostate cancer and bone metastases than in those without metastases (p=0.03). Vitamin D levels were also significantly lower in this group (p=0.03). There were no differences in other values. Conclusions The present study found increased PTH concentrations in patients with advanced prostate cancer. This finding could be useful to predict disease progression (AU)

Renal lithiasis in patients with primary hyperparathyroidism. Evolution and treatment.

OBJECTIVES: The relationship between hyperparathyroidism and lithiasis is quite known, so the study of parathyroid glands is especially mandatory in the face of relapses. Our objective is to analyze both primary hyperparathyroidism (PHPT) associated with renal lithiasis and the evolution of this condition after parathyroidectomy, as well as to study factors associated with the presence of lithiasis or bone pathology, and carry out a review on bibliography. METHODS: We describe a retrospective study of a series comprising 287 cases of hyperparathyroidism: 237 of them were primary and the remaining 50, secondary. We have included: sex, age, evolution time and symptoms, diagnostic tests (biochemical, radiological and histological). Factors such as number of episodes prior to diagnosis and treatments were analyzed in patients with symptomatic lithiasis to know whether patients exhibited residual lithiasis after the management of calculi or whether patients underwent episodes after parathyroidectomy, or whether or not they were treated. Statistical analysis was carried out through SPSS 15.0 for Windows. RESULTS: Forty five percent of the patients had suffered lithiasis episodes; 50%, osteopenia/osteoporosis; 23%, musculoskeletal pain; 23%, asthenia and/or depressive syndrome. In 13.5% of cases, diagnosis was supported by the presence of hypercalcemia; no other symptoms were detected. We have analyzed factors that favor or inhibit renal lithiasis formation and compared biochemical parameters from the group of primary hyperthyroidism that exhibited lithiasis (41 patients) with those patients who did not (49). We noted that lithiasis patients showed higher values of calcium, alkaline phosphatase, intact PTH, mean PTH, osteocalcin, and chlorine/phosphate, calciuria and phosphaturia indexes. Student's t test on two independent samples revealed significant statistical differences in calcium levels (p<0.05), intact PTH (<.05) and osteocalcin. CONCLUSIONS: Primary hyperparathyroidism patients with lithiasis presented higher values of parathormone, alkaline phosphatase, osteocalcin, and Cl/P and calciuria indexes than lithiasis-free PHPT patients. These patients exhibit objective improvement of symptoms after parathyroidectomy, and rarely a recurrence of lithiasis, a factor that generally coincides with persistence of residual lithiasis.

Litiasis renal en pacientes con hiperparatiroidismo primario. Evolución y tratamiento / Renal lithiasis in patients with primary hyperparathyroidism. Evolution and treatment

OBJETIVO: La relación hiperparatiroidismo-litiasis renal es bien conocida y el estudio de paratiroideses obligado en paciente con litiasis, sobre todo si hay recidivas. Nuestro objetivo es analizar los casos de HPTP con litiasis renal y su evolución tras paratiroidectomía;estudiar los factores que se asocian a la presencia de litiasis o patología ósea y revisión bibliográfica.MÉTODOS: Estudio descriptivo retrospectivo de una serie de 287 casos de hiperparatiroidismo: 237 primarios,50 hiperparatiroidismos secundarios. Hemos analizado: sexo, edad, tiempo de evolución, clínica, pruebas diagnósticas (bioquímicas, radiológicas e histológicas).En pacientes con clínica de litiasis se ha analizado el número de episodios previos al diagnóstico y su tratamiento,si presentaban litiasis residual tras el tratamiento del cálculo, si sufrieron episodios posteriores a la paratiroidectomíay si fueron tratados o no. Análisis estadísticocon SPSS 15.0 para Windows.RESULTADOS: El 45% de pacientes había presentado episodios de litiasis, 50% osteopenia/osteoporosis, 23% algias osteomusculares, astenia y/o síndrome depresivoel 23%; en el 13,5% de los casos el diagnóstico se realiza tras el hallazgo de hipercalcemia sin otros síntomas.Analizamos factores favorecedores o inhibidores de formaciónde litiasis renal, hemos comparado parámetros bioquímicos del grupo de hiperparatiroidismos primarioscon litiasis (41 pacientes) con grupo sin litiasis (49). Observamos que enfermos con litiasis presentan cifras más elevadas de calcio, fosfatasa alcalina, PTHi, PTHm, osteocalcina, índice cloro/fosfato, calciuria y fosfaturia. Al aplicar el test “t” Student para dos muestras independientesse encontraron diferencias estadísticamente significativasen niveles de calcio (p<0,05), PTHi (p<0,05) y osteocalcina...(AU)

OBJECTIVES: The relationship between hyperparathyroidism and lithiasis is quite known, so the study of parathyroid glands is especially mandatory in the face of relapses. Our objective is to analyze both primary hyperparathyroidism (PHPT) associated with renallithiasis and the evolution of this condition after parathyroidectomy,as well as to study factors associated with the presence of lithiasis or bone pathology, and carry out a review on bibliography.METHODS: We describe a retrospective study of a series comprising 287 cases of hyperparathyroidism: 237 of them were primary and the remaining 50, secondary.We have included: sex, age, evolution time and symptoms, diagnostic tests (biochemical, radiologicaland histological). Factors such as number of episodesprior to diagnosis and treatments were analyzed in patients with symptomatic lithiasis to know whether patients exhibited residual lithiasis after the management of calculi or whether patients underwent episodes after parathyroidectomy, or whether or not they were treated. Statistical analysis was carried out through SPSS 15.0 for Windows.RESULTS: Forty five percent of the patients had suffered lithiasis episodes; 50%, osteopenia/osteoporosis; 23%, musculoskeletal pain; 23%, asthenia and/or depressive syndrome. In 13.5% of cases, diagnosis was supported by the presence of hypercalcemia; no other symptoms were detected.We have analyzed factors that favor or inhibit renal lithiasisformation and compared biochemical parameters from the group of primary hyperthyroidism that exhibited lithiasis (41 patients) with those patients who did not (49). We noted that lithiasis patients showed higher valuesof calcium, alkaline phosphatase, intact PTH, mean PTH, osteocalcin, and chlorine/phosphate, calciuria and phosphaturia indexes. Student’s t test on two independentsamples revealed significant statistical differencesin calcium levels (p<0.05), intact PTH (<0.05) and osteocalcin...(AU)

Successful use of infliximab in a patient with neuro-Behçet's disease.

Behçet's disease (BD) is a systemic vasculitic disorder of unknown aetiology characterised by recurrent oral and often genital ulcers, which may be associated with ocular, cutaneous, articular, neurological or vascular involvement. We report a 52-year-old woman diagnosed of neuro-BD who was treated with infliximab with a dramatic response to this treatment.