Tumores pardos en múltiples localizaciones: manifestación de osteodistrofia renal severa. Caso clínico / Brown tumors in multiple locations: manifestation of severe renal osteodystrophy. Case report

We report a 25 years old woman with a four years history of end stage renal disease on hemodialysis. During the last two years of follow up, multiple tender nodules appeared in the left clavicle and ribs. These were diagnosed as brown tumors, secondary to osteitis fibrosa cystica, in the context of a secondary hyperparathyroidism. A subtotal parathyroidectomy was performed and a homologous parathyroid implant was done in the right forearm. The pathological study of the surgical pieces confirmed the presence of the brown tumors and parathyroid hyperplasia. Nine months after surgery, parathormone levels and brown tumor calcifications decreased significantly and bone mineral density increased by 20 per cent.

Es la etnia mapuche un factor de riesgo para padecer fractura de fémur proximal en adultos mayores? / Is Mapuche ethnicity a risk factor for hip fracture in aged?

BACKGROUND: Ethnic factors are involved in the risk for osteoporosis and hip fracture. AIM: To assess the effect of Mapuche ethnicity on the risk of hip fracture. PATIENTS AND METHODS: A case control study. Cases were subjects over 55 years of age admitted, during one year, for hip fracture not associated to major trauma or tumors. Controls were randomly chosen from other hospital services and paired for age with cases. The magnitude of the association between ethnicity and hip fracture was expressed as odds ratio in a logistic regression model. RESULTS: In the study period, 156 cases with hip fracture were admitted. The proportion of subjects with Mapuche origin was significantly lower among cases than controls (11.8 and 26.5 per cent respectively, p < 0.001). In the logistic regression model, Mapuche ethnicity was associated with hip fracture with an odds radio of 0.14 (p = 0.03, 95 per cent CI 0.03-0.8). CONCLUSIONS: In this sample, Mapuche ethnicity is a protective factor for hip fracture.

Hipofosfatemia revertida al extirpar hemangioendotelioma compuesto del dedo mayor del pie / Reversion of hypophosphatemia after the excision of a composite hemangioendothelioma in the great toe

We report a 43 years old male admitted to the hospital for progressive lumbar pain, lasting 20 years, that caused severe disability. On admission the patient had a serum phosphate of 2 mg/dl, an urine phosphate excretion over 300 mg/dl and serum alkaline phosphatases over 750 U/L. Serum intact parathormone was normal and tubular maximum phosphorus/glomerular filtration was 0.7 mg/dl. Bone scintigraphy showed an increased radionuclide uptake in condro-costal joints. Bone densitometry showed femoral osteoporosis. A violet colored mass was detected in a great toe. It was removed and the pathological diagnosis was a composite hemangioendothelioma. After tumor excision, serum phosphate levels returned to normal values and symptoms disappeared within 15 days.

Hipotiroidismo primario luego de la resección de un Struma ovarii / Primary hyperthyroidism after excision of a Struma ovarii

Struma ovarii is a teratoma composed of thyroid tissue and can be a rare cause of hyperthyroidism. We report a 35 years old woman with a left ovarian mass whose pathology revealed a Struma ovarii. This tumor was partially excised initially to avoid fertility problems and after a successful gestation, the tumor was completely removed during a cesarean section. Sixty days after delivery a hypothyroidism was diagnosed. Levothyroxine was started and euthyroidism was achieved.

Los antagonistas del calcio en la trombosis coronaria / Calcium antagonists in coronary thrombosis

El beneficio de los antagonistas del calcio en la cardiopatía isquémica se atribuye al aumento del flujo coronario por vasodilatación y a factores que reducen el consumo de oxígeno como son la disminución de la precarga, postcarga e inotropismo. Sorprende que el papel de estas sustancia en la trombosis coronaria haya recibido escasa atención, aun cuanto hay evidencias experimentales y clínicas que ponen de relieve su acción antiagregante plaquetaria. Se ha demostrado, por otra parte, que un grupo diferente de sustanccias anticálcidas cuyo prototipo está bien representado por la cinnarizina, flunarizina y bublomedil, tienen la propiedad de reducir la viscosidad sanguínea y mejorar el flujo de la microcirculación en condiciones de isquemia. Estas drogas participan en la defensa de la integridad del endotelio y en el aumento de la capacidad de deformación de los eritrocitos que está estrechamente ligado a los flujos de calcio. La acción de ambos grupos de inhibidores del calcio sobre el endotelio vascular y los elementos figurados de la sangre que están involucrados en el proceso de la coagulación, constituyen hallazgos auspiciosos que podrían influir en un mejor conocimiento de la trombosis arterial

Toxocariasis ocular. / Oculotoxocariasis

Se presenta un estudio clinico de 13 casos de pacientes con el sindrome de la presunta oculotoxocariasis. Los casos mas caracteristicos son aquellos que presentan una masa fusiforme, blanco-nacarada, epiretinal, que en su extremo central se aguza y forma um pliegue "papilofilico", ya que siempre llega hasta el disco optico.Se explica la utilidad diagnostica del examen serologico llamado ELISA test