The lumbar and femoral bone mineral densities in a normal female Puerto Rican population

The aim of this study was to establish the reference values of the bone mineral density (BMD) of the lumbar spine and the proximal femur in a normal adult female Puerto Rican population. In the selection of the population, exclusion criteria included diseases, use of drugs and toxic habits (smoking and alcoholism)known to affect bone and mineral metabolism. The study population comprised 131 healthy females, ages 20 to 69 years. Spinal radiographs were taken of women age 60 or more to exclude spinal defects or artifacts. The bone mineral densities were measured using the dual energy X Ray absorptiometer (DEXA, Hologic model 1000). The peak BMD was found in the lumbar spine at the age 30 to 39 years and at the age 20 to 29 years in the femoral neck, trochanter and Ward's triangle. The decrease in BMD from peak values to those at age 60 to 69 years were 18 per cent for the lumbar spine, 16.3 percent for the femoral neck, 30.1 percent for the Ward's triangle and 12.4 percent for the trochanter. The major fall in the BMD was related to the menopause and compares with that of other series. There was no statistical difference from Hologic reference values in a mixed population of the USA

Unusual cases of hyperparathyroidism

The history, physical and radiologic findings, treatment and pathology in five unusual cases of hyperparathyroidism is presented. The hyperparathyroidism was caused by a large (113 grams) mediastinal adenoma in the first patient, who is alive 25 years after surgery. A parathyroid carcinoma with compression of the esophagus was documented in the second patient. This patient is alive and normocalcemic 23 years after surgical treatment. A third patient with hyperplasia returned with hypercalcemia 20 years postsurgery requiring reoperation. A fourth patient with advanced bone findings was found to have a parathyroid adenoma. The fifth case is a patient with tertiary hyperparathyroidism secondary to hypophosphatemic rickets

Bone densitometric profile among young adults in Puerto Rico: morphometric and SPA results

Through many contributing factors (ethnicity, diet, exercise, sun exposure, sex, etc.), bone density has traditionally been considered to reach a peak (PBD), during the third decade of life. More recently, data suggests this might occur earlier, mostly mediated by onset and duration of sexual maturation. In order to ascertain such contention, we studied 45 young (20-24 yr) adults utilizing single-photon absorption densitometry (SPA, Norland 2870), at the distal 1/3 of non-dominant arms, a site with 75 per cent cortical bone. A uniform questionnaire on their life styles, ethnic/racial background, & biochemical/hormonal tests established their healthy state, as usually found among medical student volunteers. All had reached Tanner V stage. BD was obtained dividing BMC (bone mineral content, gm/cm) by BW (bone width, cm), and expressed as gm/cm2. Wt (weight) of Males (n = 24, age = 22.8 +/- 0.8 yr) was 77.9 +/- 8.9 Kg, height, (Ht) was 176.1 +/- 5 cm, both significantly higher than for Females (n = 21, Wt = 58.4 +/- 9.8 Kg, Ht = 159.2 +/- 5 cm), p < 0.0001). BMI (body mass index, kg/m2) were: M = 25.3 +/- 2.5 while F = 23.0 +/- 2.9 (p < 0.008). Ages were similar: M = 22.8 +/- 0.83, F = 22.5 +/- 0.81 years. Results were analyzed using SAS (IBM PS) & Cricket-graph (Macintosh), expressed as arithmetic means +/- SD or sem. LR (regressions) were applied whenever feasible.(ABSTRACT TRUNCATED AT 250 WORDS)

Pheochromocytoma: a twenty year experience at the University Hospital

Durante los últimos 20 años (1970-90), hemos tenido 24 pacientes con feocromocitomas: 19 diagnosticados clínicamente y 5 en autopsia. Sus edades variaron de 17 a 74 años (promedio de 43.2) y el número de varones (14), fueron mayor que el de las hembras (n=10). La mayoría de los sujetos tuvieron síntomas (95%) consistentes en la tríada típica de dolor de cabeza, palpitaciones y sudoración. El hallazgo más frecuente fue la hipertensión (95%), la cual fue sostenida en 60% y paroxística en 35% de los casos. Un 25% (n=6) de casos tenía tumores bilaterales, todos familiares. Quince eran tumores adrenales solitarios (63%) y 3 (12.5%) eran extra-adrenales: 2 en el abdomen (órgano de Zuckerbandl) y uno intratorácico (paraganglioma del atrio derecho del corazón). De los 6 casos familiares, 4 estaban asociados a la enfermedad de Von Hipper-Lindau (VHL), mientras que 2 tenían el síndrome de neoplasia múltiple tipo 2 (MEN-II. Todos los casos familiares eran bilaterales y se hallaban en las adrenales. No hubo tumores malignos. Entre los 19 casos diagnosticados pre-operatoriamente, fueron positivas las pruebas en orina del ácido vanililmandélico (VMA) en 95% y la de catecolaminas totales en 100%. Se logró visualizar los tumores pre-operatoriamente por medio de tomografía computadorizada (CT) o por imagen de resonancia magnética (MRI) en 62% de los pacientes más recientes. En 5 casos más antiguos sólo se hizo el diagnóstico post-mortem: 3 murieron de hemorragias cerebrales, 1 de infarto del pons y otro en fallo cardíaco congestivo. Hubo dos muertes post-operatorias y otra, 13 años post-operación, de carcinoma medular del tiroides. De los 19 operados 13 (68% fueron curados. Se concluye que los feocromocitomas aún retienen un considerable potencial de morbilidad y alguna mortalidad. Estos raros tumores constituyen un reto diagnóstico clínico, pero conllevan una gran satisfacción para el médico que los atiende

Fine needle thyroid aspiration: University Hospital Experience

El aspirado tiroideo de aguja fina (ATAF) para el diagnóstico de enfermedad tiroidea fue iniciado en el Hospital Universitario en 1983. ATAF se realizó en 54 pacientes referidos de diciembre de 1984 a diciembre de 1985. Se recomendó cirugía, siempre y cuando no hubiera contraindicación médica, para evaluar la certeza diagnóstica del aspirado. La cirugía se practicó en 34 (63%) de los pacientes. En 20 no se realizó debido a: contraindicaciones médicas en 3, abandono médico en 2, rehusaron 3, ATAF inapropiado en 7 y por razones desconocidas en 5. Ninguno tuvo complicaciones. La citología se clasificó de la siguiente manera: Clase O; inapropiada; Clase 1: benigna; Clase 2; intermedia; y Clase 3: maligna. Los casos "no benignos" fueron 14,7 intermedios (Clase 2) y 7 malignos (Clase 3). Cuatro de los últimos se confirmaron en cirugía. De los 19 casos con citología benigna (Clase 1) hubo uno con cáncer. Un paciente tuvo una muestra inapropiada (Clase O). La sensitividad fue 80%, especifidad 65% y la certeza diagnóstica 67%. Todos estos valores estadísticos están dentro del margen de lasquince series revisadas. Por lo tanto, ATAF en el UDH tiene un valor diagnóstico comparable al descrito en la literatura. Este se puede utilizar como una prueba segura y confiable junto al resto de la evaluación clínica para reducir el número de cirugía tiroideas, aumentar el porciento de casos malignos en los pacientes operados y hacer el diagnóstico de cáncer mas temprano

Incidence of insulin dependent diabetes mellitus in Puerto Rico: the University Pediatric Hospital experience

The incidence of newly-diagnosed Insulin-dependent diabetes mellitus (IDDM) in a pediatric population has been found to increase with colder seasons in countries at latitudes where a marked weather change presumably triggers a higher prevalence of viral infections (especially respiratory), that may induce an insulitis which could be etiologically related with IDDM. In order to assess whether the apposite is true for a country with rather uniform climate, like Puerto Rico, we have studied the seasonal pattern of newly diagnosed IDDM seen at our institution during a 10 year period (1973-1982). also, recent reports on a higher mortality from diabetes in Puerto Rico going from 16.6 in 1977 to 31.0 in 1983, prompted us to look at a possible secular trend of increasing incidence of IDDM. There were a total of 269 new cases of IDDM or 27 cases/year, with standard deviation (SD) of ñ 5.3, range 18 to 33, and no secular trend at all. Sex distribution was quite variable, having male: female (m/f) ratios from 1:2 to 3:1, and an over-all m/f of 13.3/13.6. Incidence of IDDM per month of year went from a low of 1.7 for April and November to a high of 3.0 for March and 2.9 for September, 2.8 for October, with a mean of 2.21 ñ 0.48 cases/month. Again, no significant seasonal differences were noted. Mean incidence for our "cold" months (November to April was 2.25/month; for our "hot" seson (May to October) was 2.3/month; for our "rainy" season (July to December) 2.3 and for our "dry" season (January to April) 2.3/month. Thus, it appears that there are no such seasonal trends of IDDM In Puerto Rico