Equivalencia terapéutica y adherencia a tratamiento con ibandronato 150 mg y alendronato 70 mg en mujeres postmenopáusicas de la ciudad de Concepción, Chile / Therapeutic equivalence and adherence to treatment with ibandronate 150 mg and alendronate 70 mg in postmenopausal women of Concepción city, Chile

Antecedentes: El tratamiento de la osteoporosis se asocia a pobre adherencia. Ésta puede mejorar disminuyendo la frecuencia y la complejidad de la administración de medicamentos.El alendronato semanal (70 mg) y el ibandronato mensual (150 mg) se usan para el manejo de la osteoporosis postmenopáusica.Objetivo: investigar si el ibandronato oral mensual aumenta la densidad mineral ósea (DMO) lumbar y del cuello femoral en el mismo grado que lo hace el alendronato semanal; ambos agentes fueron comparados en un ensayo prospectivo y aleatorizado.Pacientes y métodos: el estudio incluyó mujeres chilenas postmenopáusicas (edad 50-61 años) de la región de Bio-Bio, T-score lumbar (L1-4) < -1,0 y > -3,5. Las pacientes fueron aleatorizadas para recibir alendronato semanal70 mg (n=31) o ibandronato mensual 150 mg (n=30). Todas recibieron carbonato de calcio 1.250 mg y vitamina D3 400 UI diariamente durante los 12 meses del estudio. La DMO lumbar y femoral fue estudiada con un equipo Lunar DPX. La tolerancia al tratamiento fue evaluada mediante el registro de efectos adversos (EA). Resultados: el alendronato semanal y el ibandronato mensual aumentaron la DMO lumbar de modo significativo (4,02% y 6,23% respectivamente); los incrementos fueron similares con ambos fármacos(p=0,095). No se observaron aumentos significativos en la DMO femoral con ninguno de ambos tratamientos. Ambas drogas fueron bien toleradas y la incidencia de EA gastrointestinalesfue de 5,1% y 5,8% con ibandronatoy alendronato respectivamente. La adherencia al tratamiento fue significativamente mayor con ibandronato mensual (93,3%) quecon alendronato semanal (74%). Conclusiones: este estudio demuestra que el alendronato semanal 70 mg y el ibandronato mensual 150 mg tienen la misma eficacia y seguridad, pero la adherencia resulta mayor con ibandronato, quizá debido a un intervalo más prolongado entre dosis

Anticuerpos anti-tiroglobulina en el seguimiento de pacientes con cáncer diferenciado de tiroides: ¿marcadores de enfermedad residual o recidivante? / Anti thyroglobulin antibodies in the follow up of patients with differentiated thyroid cancer

Background: Anti thyroglobulin antibodies are present in 25 percent of patients treated for a differentiated thyroid cancer, invalidating thyroglobulin determination. Those patients subjected to total thyroidectomy and free of disease, should reduce the production of these antibodies, due to the lack of antigenic stimulus. Therefore, anti thyroglobulin antibodies could be useful to detect early relapses. Aim: To assess the relationship between anti thyroglobulin antibodies and the evolution of the disease in patients treated for thyroid cancer. Material and methods: Retrospective analysis of 26 patients treated for thyroid cancer with positive anti thyroglobulin antibodies, followed for three years. These were divided in those with or without lymphocytic thyroiditis (19 and 7 respectively). Results: At the first year of follow up, anti thyroglobulin antibody concentration was 401ñ94.9 UI/ml (xñsem) in patients with thyroiditis and 38.9ñ8.9 UI/ml in those without thyroiditis (p < 0.005). During the three years of follow up, no differences in anti thyroglobulin antibodies were observed between patients with or without tumor relapse. Conclusions: Concentration of anti thyroglobulin antibodies was higher in patients with thyroiditis and did not differentiate patients with tumor relapse

Isquemia miocárdica reversible en el hipotiroidismo: comunicación de un caso / Reversible myocardial ischemia associated to hypothyroidism: report of one case

A silent, reversible myocardial ischemia with normal coronary angiography and reversible with thyroid hormone substitution, has been recently described in hypothyroid patients. We report a 49 years old male with an abnormal exercise electrocardiogram detected in a preventive medical examination. He had laboratory evidence of hypothyroidism and a history of two years of asthenia and progressive coarsening of the voice. The Thallium myocardial perfusion study, showed an alteration of coronary flow during exercise in the septum and lower wall of the left ventricle. Thyroid hormone substitution was started and three months later, a coronary angiography was normal. After six months a repeated Thallium perfusion study and exercise electrocardiogram were informed as normal

Adenoma silente subtipo 3: importancia del estudio ultraestructural en el diagnóstico diferencial del adenoma hipofisiario asociado a hiperprolactinemia en un caso / Silent pituitary adenoma type 3 associated to hyperprolactinemia: report of 1 case

The association of hyperprolactinemia over 100 ng/ml and a pituitary adenoma is usually diagnostic of prolactinoma. However type 3 pituitary adenomas can occur with similar serum prolactin values. We report a 31 years old woman that consulted due to headache and photopsiae. She had a serum prolactin level of 148 ng/ml and imaging studies showed a solid tumor that occupied the selar region and most of the left temporal fossa. The tumor was partially resected and the patient recovered her lost visual field. Light microscopy showed an acidophilic and in part chromophobe adenoma. Immuno-histochemistry was positive for prolactin and growth hormone. Electron microscopy disclosed features of a silent type 3 adenoma such as big cells with cytoplasmic prolongations, pleomorphic nuclei and a greatly developed rough endoplasmic reticulum

Apoplejía en metástasis hipofisiaria de carcinoma de células renales: caso clínico con 7 años de seguimiento / Pituitary apoplexy secondary to a metastatic renal cell carcinoma: report of a case followed for 7 years

We report a man in whom a 15 cm. renal tumor was excised at the age of 49. The pathological examination showed a clear cell carcinoma. Five years later, he presented with headache, vomiting and unilateral palpebral ptosis. Imaging studies showed a sellar tumor with pituitary apoplexy. The tumor was excised and the pathological study disclosed a clear cell tumor, positive for vimentin, cytokeratins AE1 and AE3 and immunohistochemically negative for LH, TSH, ACTH and GH. Considering the similar histopathological features, it was considered as a metastasis of the renal tumor. The patient was supplemented with thyroid, adrenal and gonadal hormones. Seven years later, he presented a new tumor in the remaining kidney, that corresponded to a cystic papillary renal cell carcinoma. Afterwards, he presented a transitional urinary bladder tumor. Mortality associated to renal cell tumors is 90 percent at 5 years, and pituitary metastases are extraordinarily uncommon