Estudio comparativo de la absorción neta de calcio de dos formulaciones distintas de carbonato de calcio en mujeres posmenopáusicas / Comparative study of net calcium absorption of two different pharma¬ceutical formulations of calcium carbonate in posmenopausal women

La suplementación con calcio reduciría, sola o asociada a otra medicación para osteoporosis, la pérdida de masa ósea y el riesgo de fracturas. Sin embargo, su tasa de adherencia es baja debido a la poca tolerancia. Objetivo: comparar la tasa de absorción neta de calcio entre dos formulaciones distintas de carbonato de calcio (500 mg): comprimidos vs. mousse. Material y métodos: 11 pruebas fueron realizadas en mujeres posmenopáusicas de 58,9±3 años. El diseño fue exploratorio abierto, aleatorizado, prospectivo cruzado de fase 4. Intervención: las participantes fueron aleatorizadas en dos grupos para recibir las dos formulaciones previa suplementación con vitamina D3. La tasa de absorción neta de calcio fue estudiada por la prueba de inhibición de hormona paratiroidea (PTH). Se obtuvieron muestras de sangre: basal y en la 1a, 2a y 3a hora posadministración del calcio asignado, y de orina de 2 horas basal y al final de la prueba. Determinaciones bioquímicas: calcio, fósforo, albúmina, 25-hidroxivitamina D y hormona paratiroidea intacta y calciuria. Análisis estadístico: método de los trapecios para calcular el área bajo la curva (AUC) de la concentración de calcio en el tiempo (R Development Core Team (2008). http://www.Rp-project.org) y Anova con dos términos de error para evaluar el efecto secuencia, período y formulación. Resultados: la mayor inhibición de PTH se observó a dos horas de la toma de ambas formulaciones (comprimidos -39,2% vs. mousse -38,0%; p=ns), con similar AUC0-3 h (comprimidos 3,35; IC 95%: 3,32; 3,37 vs. mousse 3,36; IC 95%: 3,33; 3,38). Cuando analizamos tolerancia y preferencias no se observaron diferencias estadísticamente significativas entre ambas formulaciones. Conclusión: el carbonato de calcio en mousse mostró similar tasa de absorción intestinal, preferencia y tolerancia gastrointestinal que en comprimido. (AU)

Calcium supplementation, administered alone or in combination with a specific medication for osteoporosis, would reduce bone mass loss and fracture risk in postmenopausal women. However, the adherence rate to calcium supplements is low, mainly due to low tolerance. Objective: comparisson of net calcium absorption rate between two different pharmaceutical formulations of calcium carbonate (PFCa) in postmenopausal women. Materials and Methods: 11 tests were performed in postmenopausal women aged 58.9±3 yrs. Design: Comparative, randomized, prospective, open-label exploratory crossover study of calcium mousse versus calcium pills. Intervention: Participants were randomized in 2 groups to receive the 2 different PFCa (500mg): pills vs. mousse, with previous vitamin D3 supplementation. The parathyroid hormone (PTH) inhibition test and the area-under-thecurve (AUC) of calcium were analyzed. Blood samples were taken at baseline and 1, 2 and 3 hrs after intake of the assigned PFCa. Urine samples (2hs) were obtained at -baseline, after 2hs of PFCa intake and at the end of the test. Biochemical Determinations: Serum: calcium, phosphorus, albumin, 25-hydroxyvitamin D, and intact PTH. In urine: calcium. Statistical Analysis: The trapezoid rule was applied to assess AUC in time (R Development Core Team (2008). http://www.Rp-project.org). An ANOVA model with 2 error terms was used to assess the effect of sequence, period, and formulation. Results: The highest inhibition PTH rates were observed after 2 hrs of PFCa (pills -39.2% vs. mousse -38.0%; p=ns). The AUC0-3hrs for both PFCa was similar (pills 3.35; 95%CI: 3.32; 3.37 vs. mousse 3.36; 95%CI: 3.33; 3.38). No statistically significant differences were observed when we analyze tolerance and predilection. Conclusion: The calcium carbonate in mousse showed an adequate rate of intestinal absorption, similarly predilection and gastrointestinal tolerance than the pill presentation. (AU)

Anabolic steroids for rehabilitation after hip fracture in older people

ABSTRACT BACKGROUND: Hip fracture occurs predominantly in older people, many of whom are frail and undernourished. After hip fracture surgery and rehabilitation, most patients experience a decline in mobility and function. Anabolic steroids, the synthetic derivatives of the male hormone testosterone, have been used in combination with exercise to improve muscle mass and strength in athletes. They may have similar effects in older people who are recovering from hip fracture. OBJECTIVES: To examine the effects (primarily in terms of functional outcome and adverse events) of anabolic steroids after surgical treatment of hip fracture in older people. METHODS: Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (10 September 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2013 Issue 8), MEDLINE (1946 to August Week 4 2013), EMBASE (1974 to 2013 Week 36), trial registers, conference proceedings, and reference lists of relevant articles. The search was run in September 2013. Selection criteria: Randomized controlled trials of anabolic steroids given after hip fracture surgery, in inpatient or outpatient settings, to improve physical functioning in older patients with hip fracture. Data collection and analysis: Two review authors independently selected trials (based on predefined inclusion criteria), extracted data and assessed each study's risk of bias. A third review author moderated disagreements. Only very limited pooling of data was possible. The primary outcomes were function (for example, independence in mobility and activities of daily living) and adverse events, including mortality. MAIN RESULTS: We screened 1290 records and found only three trials involving 154 female participants, all of whom were aged above 65 years and had had hip fracture surgery. All studies had methodological shortcomings that placed them at high or unclear risk of bias. Because of this high risk of bias, imprecise results and likelihood of publication bias, we judged the quality of the evidence for all primary outcomes to be very low. These trials tested two comparisons. One trial had three groups and contributed data to both comparisons. None of the trials reported on patient acceptability of the intervention. Two very different trials compared anabolic steroid versus control (no anabolic steroid or placebo). One trial compared anabolic steroid injections (given weekly until discharge from hospital or four weeks, whichever came first) versus placebo injections in 29 "frail elderly females". This found very low quality evidence of little difference between the two groups in the numbers discharged to a higher level of care or dead (one person in the control group died) (8/15 versus 10/14; risk ratio (RR) 0.75, 95% confidence interval (CI) 0.42 to 1.33; P = 0.32), time to independent mobilization or individual adverse events. The second trial compared anabolic steroid injections (every three weeks for six months) and daily protein supplementation versus daily protein supplementation alone in 40 "lean elderly women" who were followed up for one year after surgery. This trial provided very low quality evidence that anabolic steroid may result in less dependency, assessed in terms of being either dependent in at least two functions or dead (one person in the control group died) at six and 12 months, but the result was also compatible with no difference or an increase in dependency (dependent in at least two levels of function or dead at 12 months: 1/17 versus 5/19; RR 0.22, 95% CI 0.03 to 1.73; P = 0.15). The trial found no evidence of between-group differences in individual adverse events. Two trials compared anabolic steroids combined with another nutritional intervention ('steroid plus') versus control (no 'steroid plus'). One trial compared anabolic steroid injections every three weeks for 12 months in combination with daily supplement of vitamin D and calcium versus calcium only in 63 women who were living independently at home. The other trial compared anabolic steroid injections every three weeks for six months and daily protein supplementation versus control in 40 "lean elderly women". Both trials found some evidence of better function in the steroid plus group. One trial reported greater independence, higher Harris hip scores and gait speeds in the steroid plus group at 12 months. The second trial found fewer participants in the anabolic steroid group were either dependent in at least two functions, including bathing, or dead at six and 12 months (one person in the control group died) (1/17 versus 7/18; RR 0.15, 95% CI 0.02 to 1.10; P = 0.06). Pooled mortality data (2/51 versus 3/51) from the two trials showed no evidence of a difference between the two groups at one year. Similarly, there was no evidence of between-group differences in individual adverse events. Three participants in the steroid group of one trial reported side effects of hoarseness and increased facial hair. The other trial reported better quality of life in the steroid plus group. AUTHORS' CONCLUSIONS: The available evidence is insufficient to draw conclusions on the effects, primarily in terms of functional outcome and adverse events, of anabolic steroids, either separately or in combination with nutritional supplements, after surgical treatment of hip fracture in older people. Given that the available data points to the potential for more promising outcomes with a combined anabolic steroid and nutritional supplement intervention, we suggest that future research should focus on evaluating this combination.

Pathology of the testicle after long-termanabolic steroid treatment in a thoroughbread horse from Venezuela

The aim of this study was to describe a case of pathology of the testicle after long-term anabolic steroid treatment in a Thoroughbread horse. Were study an equine Thoroughbread with cryptorchidism from Venezuela, male of 5 years old. With history of lameness chronic and subfertility. Necropsy was performed and samples of testicle tissue were collected. The tissue samples were fixed in formalin and processed by conventional H&E techniques. Additionally, the special staining procedure of Tricromico de Gomory and Blue VonKossa were also carried out. Samples of blood and urine were recollected for toxicological by competitive ELISA. The left testicle was diameter testicle 6cm. and cryptorchidism (testicle right). Macroscopic were observed bilateral fibrosis parenchyma testicle and atrophic. The histological study revealed atrophy of seminiferous tubules and interstitial fibrosis increases in collagen fibres in the lamina propria of seminiferous tubules and testicular interstitium. Lamina propria surrounding atrophic tubules was thickened by an increase in collagen type IV and elastic fibres and by proliferation of bizarre myoid cells. Basal lamina was also thickened but had decreased for collagen type IV. Special stain Tricromico of Gomory (+) showed fibrosis interstitium severed and VonKossa (-) no evidence mineral. Toxicological studies allowed the detection of boldenona and dexamethasone generic in blood and urine samples. To conclude, we detected the presence of pathology of the testicle associated a after long-term anabolic steroid treatment in a Thoroughbred horse.

The use of PTH in the treatment of osteoporosis / Uso do PTH no tratamento da osteoporose

Anabolic drugs have recently widened therapeutic options in osteoporosis treatment, as they influence processes associated with bone formation to a greater extent and earlier than bone reabsortion. They positively affect a number of skeletal properties besides bone density, as intermittent administration of parathyroid hormone (PTH) results in an increase in the number and activity of osteoblasts leading to an increase in bone mass and improvement in skeletal architecture at both the trabecular and cortical bone. Human recombinant parathyroid hormone (hrPTH 1-84) and human recombinant PTH peptide 1-34 (teriparatide) belong to this group. The objective of this paper is to review PTH actions, benefits and adverse effects, action on biochemical markers, combination therapy with antiresorptive agents, impact of antiresorptive therapy prior to anabolic treatment, sequential treatment, and effect on glucocorticoid-induced osteoporosis.

As drogas anabólicas ampliaram recentemente as opções terapêuticas no tratamento da osteo-porose e influenciam em maior escala os processos relacionados com a formação óssea, que ocorrem antes do efeito na reabsorção. Essas drogas afetam um grande número de propriedades esqueléticas, além da densidade mineral óssea. A administração intermitente de PTH leva a um aumento do número e atividade dos osteoblastos, ocasionando aumento da massa óssea e melhora da arquitetura, tanto do osso trabecular quanto cortical. O paratormônio recombinante humano (hrPTH 1-84) e o peptídeo recombinante humano 1-34 (teriparatide) pertencem a esse grupo de agentes. O objetivo deste artigo é revisar as ações, os benefícios e os efeitos adversos do PTH, assim como sua ação nos marcadores bioquímicos do metabolismo ósseo, a terapia combinada com drogas antirreabsortivas, o impacto do uso dos antirreabsortivos antes do tratamento anabólico, o tratamento sequencial e o tratamento da osteoporose induzida por glicocorticoides.

Turner syndrome: searching for better outcomes

OBJECTIVES: To assess the results of growth hormone on the growth of girls with Turner Syndrome and identify relevant parameters to improve outcomes. METHODS: Growth velocity and final height were studied in a historical cohort of 41 girls, regularly followed up for hormone distribution at three referral centers. The influence of oxandrolone and of estrogens on the final height was analyzed. The girls (initial chronological age=8.9±3.4years; initial bone age=7.0±3.1years) used 0.19 mg/kg/week of growth hormone for 4.0 ± 2.0 years. RESULTS: In the first year, growth velocity increased by 71.5 percent in 41 girls and 103.4 percent in those who reached final height (11 girls). The whole group had a gain in the height SDS of 0.8 ± 0.7 (p<0.01) and for those who reached a final height of 1.0 ± 0.8 (p<0.01). Final height (143.6 ±6.3 cm) was 3.9 ± 5.3 cm higher than the predicted height, and the height gain occurred before estrogen therapy. Oxandrolone had no significant influence on height gain. The significant variables contributing to the final height were the duration of growth hormone used and its use prior to starting estrogens, the initial height SDS, and the growth velocity during the first year of treatment. CONCLUSIONS: We concluded that the use of growth hormone significantly increased the final height, which remained lower than the target. Results point to a need for starting growth hormone use as early as possible and to maximize treatment before estrogen replacement. It has been observed that even moderate doses of growth hormone may significantly increase early growth velocity.

Recomendaciones para el manejo de la osteoporosis

En la actualidad la osteoporosis se considera solamente como un riesgo de fractura y por lo tanto se debe analizar en compañía de otros riesgos para decidir la conveniencia del tratamiento. Es más importante considerar la calidad ósea que confiere la resistencia, en la que la densidad ósea es uno de los varios componentes junto con la microarquitectura, la matriz y el recambio óseo. El tratamiento de la osteoporosis se hace en forma individual, considerando la edad y el antecedente de fractura, para así seleccionar varios recursos que se pueden agrupar en antiresortivos y anabólicos. Entre los primeros están los estrógenos, los bisfosfonatos y los moduladores selectivos del receptor de estrógenos como los principales; los anabólicos aún se encuentran en estudio y el más adelantado es la parathormona sintética. La administración de calcio y vitamina D no es suficiente para el tratamiento de la osteoporosis. El principal problema del tratamiento, que ha provocado una baja adherencia es el costo de los medicamentos y la falta de información sobre la necesidad de que el tratamiento sea a muy largo plazo.

Osteoporosis has to be considered only as a risk factor for bone fractures and its measurement by the bone mass index has some limitations. The aim of treatment of osteoporosis is to reduce the frequency of fractures (especially at the vertebral and the hip) which are responsible for morbidity and mortality with the osteoporosis. It has been demonstrated that antiresorptive drugs (bisphosphonates, estrogens, raloxifen) as well as anabolic agents (synthetic parathormone) are useful for preventing fractures. Calcium and vitamin D supplementation is not sufficient to treat persons with osteoporosis. Choice of treatment depends of age, the presence or absence of prevalent fractures, and the degree of bone mineral density measured at the spine and hip. The main inconvenient for the adherence of treatment is the high cost of the medicaments and agents as well as the poor information given to the patients.

Agentes anabolicos oseos: Utilidad terapeutica / Bone anabolic agents

En este articulo se revisa la utilidad terapéutica del fluoruro de sodio y de la paratohormona, agentes anabólicos, en el tratamiento de la osteoporosis. Se discuten generalidades, mecanis10 de acción, efecto sobre la densidad mineral ósea indicaciones para su uso

Impedimentos para el uso exitoso de anabolicos en el cuidado clinico / Impediment for successfull use of anabolics in clinical care

Los factores de crecimiento son uno de los medios que dentro de poco tendrán gran importancia en los esfuerzos para proveer nutrición deficiente y efectiva a los pacientes catabólicos. Antes de eso, sin embargo, será necesario aclarar algunos puntos para hacer óptima su utilización. Por ejemplo, se deben conocer mejor los efectos de tales sustancias en los pacientes desnutridos, la influencia de las desciendas nutricionales sobre ios efectos anabólicos, el efecto de la inflamación sobre la síntesis de proteínas estimulada por factores de crecimiento, y se deben apreciar ciertas cuestiones relativas a seguridad y costos. La preparación adecuada de los médicos y algunos cambios en nuestra manera actual de tratar a los pacientes, pueden ser los mayores obstáculos que se deban vencer si en verdad se desea aplicar plenamente esta biotecnología al cuidado clínico de los enfermos

Tratamento hormonal de osteoporose / Hormonal treatment or osteoporosis

As pacientes que necessitam submeter-se a prevençäo ou tratamento da osteoporose devem ser identificadas através dos fatores de risco e, sempre que possível, pela medida da massa óssea obtida através da densitometria óssea. O uso da ultra-sonometria óssea ainda näo é um método empregado de rotina. Para o tratamento da osteoporose pós-menopausa, condiçäo de alto turnover ósseo, o tratamento hormonal inclui drogas antireabsortivas como a terapêutica com estrogênios e/ou progestágenos, tibolona, calcitonina, ou moduladores seletivos dos receptores estrogênicos. Estratégias para aumentar a adesäo ao tratamento, mantendo sua efetividade tem sido utilizadas, como estrógenos em baixas doses, podendo ser utilizados mesmo em idades mais avançadas, progestágenos em dias alternados, e tem-se estudado também os fitoestrogênios ou isoflavonóides sintéticos. Para a monitorizaçäo do tratamento, segundo alguns autores, se for observada uma queda dos marcadores ósseos superior a 25 por cento, ou um aumento de no mínimo 4,5 por cento na densidade mineral óssea, o tratamento pode ser considerado efetivo. A duraçäo do tratamento é controversa, embora um período de 7 a 10 anos seja preconizado, para uma reduçäo da incidência de fraturas. Alguns estudos sugerem que a retirada da TRH näo resulta em imediata instalaçäo do processo de perda óssea

Knowledge, attitudes and practices of anabolic steroid usage among gym users in Trinidad

Self-administered questionnaires were completed by 1062 gym-users in 14 gyms in Trinidad from February 1997 to July 1997 to determine the knowledge, attitudes and practices regarding anabolic steroids (AS). Five hundred and sixty (52.7 percent) females and 502 (48.3 percent) males completed the questionnaire. Half of the total sample were individuals in the 20 to 29 year age group. From the 17 questions that tested knowledge about AS, the median number of correct responses was 7 with a mode of 8. Increased muscle mass was correctly identified as one of the effects of AS by 841 respondents (79.2 percent), while 249 (23.6 percent) of the total sample thought asthma was treated with AS. Most (872 or 82.1 percent) felt that their knowledge about AS was inadequate and 700 (66.0 percent) were of the opinion that AS should be banned from use in competitive sports. Similarly, 733 (70.0 percent) of the gym-users thought AS should only be available by prescription. Thirty respondents reported having used AS (2.9 percent CI 2.0-4.1). The prevalence of AS use was higher among males than females (p<0.001). Improvement of physical appearance and not competitive advantage in sport was the main reason cited for AS use. Anabolic steroid users knew more about the adverse effects of AS than non-AS users but the therapeutic uses of AS were comparatively less well-known. This study demonstrated a general lack of knowledge concerning AS use and that a small but significant proportion of persons using gyms admitted to abusing AS.

Avaliaçäo do efeito da Tibolona (Livial) na sexualidade de mulheres na pós-menopausa / Evaluation of the effect of tibolone on sexuality and climacteric symptoms on postmenopausal woman

OBJETIVOS: Avaliar efeito da tibolona sobre a sexualidade e sintomas climatéricos de mulheres na pós-menopausa. TIPO DE ESTUDO: Estudo prospectivo, aberto, näo comparativo e multicêntrico. MATERIAL E MÉTODOS: 30 mulheres na pós-menopausa foram tratadas com 2,5mg de tibolona, por via oral, durante 24 semanas. Como parâmetros de avaliaçäo foram utilizados o Questionário de Sexualidade Feminina de McCoy e a Escala de Climatério de Greene, aplicados antes do início do estudo e após 4, 12 e 24 semanas de tratamento. Também foi realizado o exame de citologia hormonal vaginal antes do início do estudo e após o tratamento. O evento adverso mais comum foi o sangramento vaginal. Nenhuma paciente abandonou o tratamento devido a evento adverso. RESULTADOS: Houve um aumento significativo na pontuaçäo do Questionário de Sexualidade de McCoy do início (60,4 pontos) até o término do estudo (100,8 pontos). A pontuaçäo média da Escala de Climatério de Greene decresceu significativamente do início (52,3 pontos) até o término do estudo (27,9 pontos). Na citologia hormonal vaginal houve aumento da porcentagem de células do tipo superficiais. CONCLUSÃO: A tibolona, na dose diária de 2,5mg, foi segura e bem tolerada e demonstrou um evidente benefício na sexualidade e no controle dos sintomas climatéricos em mulheres na pós-menopausa.

Influência do exercício físico aeróbico e da tibolona sobre a antropometria e o perfil lipídico na menopausa / Effects of aerobic exercise and tibolone on anthropometric measure and lipid profile in menopause

OBJETIVO: Avaliar as repercussöes sobre a antropometria e perfil lipídico da mulher em menopausa, submetidas ao exercício físico aeróbico associado à tibolona. PACIENTES E MÉTODOS: Estudou-se, por 18 meses, 19 mulheres na pós-menopausa, divididas em obesas (n=12) e näo obesas (n=7). Realizou-se exercício físico aeróbico isolado, por 6 meses, com duraçäo de 75 minutos, em três períodos semanais. A seguir o exercício foi associado à timbolona, na dose de 2,5 mg/dia, durante 12 meses. A antropometria foi avaliada pelo índice de massa corpórea (IMC), pela relaçäo cintura-quadril (RCQ) e pela medida de pregas cutâneas. Considerou-se obesidade o IMC maior ou igual a 30 kg/m² e a distribuiçäo de gordura androgênica, quando RCQ > 0,80. A porcentagem de gordura corporal, obtida pelo somatório das medidas de pregas cutâneas, foi considerada elevada, acima de 30 por cento. Avaliou-se no perfil lipídico o colesterol total, as lipoproteínas de alta densidade (HDL), de baixa densidade (LDL) e de muito baixa densidade (VLDL) e os triglicerídeos. RESULTADOS: Inicialmente, observou-se o colesterol total e LDL elevados, com HDL, VLDL e triglicerídeos normais em todas as pacientes. Independentemente do ICM e da porcentagem de gordura corporal, as pacientes apresentavam RCQ androgênica. Com exercício físico aeróbico isolado, ocorreu reduçäo significante da porcentagem de gordura corporal e queda do colesterol total, VLDL e dos triglicerídeos, enquanto o HDL, o IMC e a RCQ näo se alteraram. Quando associado à tibolona näo se observou ganho de peso ou de gordura corporal, mas ocorreu diminuiçäo significante da RCQ ao final do estudo. Os valores de colesterol total e LDL mantiveram-se inalterados, enquanto houve a queda acentuada do HDL, com seis meses de tibolona, retornando seus valores próximos aos basais no final dos 12 meses. Os triglicerídeos e VLDL continuaram em decréscimo significativo até o final do estudo. Observou-se homogeneidade das respostas entre obesas e näo obesas quanto ao perfil lipídico e parâmeros antropométricos. CONCLUSöES: O exercício físico aeróbico isolado contribui para a reduçäo da gordura corporal, do colesterol total, LDL e triglicerídeos. Ao associar-se a tibolona, houve decréscimo da RCQ, dos triglicerídeos e transitória do HDL, sem alterar o IMC. Estes resultados sugerem que o exercício físico aeróbico e a tibolona podem ter efeitos benéficos e complementares sobre a antropometria e o perfil lipídico, na mulher em menopausa.

Nuevas propuestas en el manejo de la enfermedad hepática por abuso de alcohol / New proposals in management of alcoholic liver diseases

Some recent proposals in management of alcoholic liver disease are discussed focusing on early diagnosis and treatment of alcohol abuse itself, alcoholic hepatitis early mortality, clinical meaning of nutrional therapy, serological approach and treatment of hepatic fibrosis, and problems in liver transplantation for end stage alcoholic liver cirrhosis. CAGE or similar systematized brief questionnaires, and desialylated transferrin/total transferrin ratio as serological marker, seeems to be interesting contributions to "hidden" alcohol abuse diagnosis and abstinence control while psyco-social support and voluntary incorporation to self-aid groups are the best weapons to reach persistent abstinence. Corticosteroids seems to improve survival in a selected group of patients with severe alcoholic hepatitis, specially in those presenting encefalopathy but free of Gl bleeding, decompensated diabetes, active infections, pancreatitis, and other contraindications or adverse effects of these drugs. Relationship between direct toxicity and nutritional deficiencies in pathogenesis of alcoholic liver injury are not clear enough, but malnutrition is generally present in patients requiring hospitalization, and related to clinical severity; oral, enteral or parenteral nutritional suplementation in this order of preference according to patients condition, associated or not with steroid anabolics, are useful in cases with moderate to severe alcoholic hepatitis or decompensated cirrhosis to eliminate the catabolic state, reaching a better nitrogen balance and liver function tests, without special adverse effects. A special role on liver regeneration is discussed...

Síndrome de Turner: uma atualizaçäo / Up-to-date on Turner's Syndrome

Foi feita uma revisäo bibliográfica atualizada sobre Síndrome de Turner, enfocando principalmente a terapêutica com esteróides anabolizantes e hormônio de crescimento