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

Baja incidencia de patología endometrial en mujeres postmenopáusicas con sangrado anormal que reciben terapia de reemplazo hormonal / Low incidence of endometrial pathology in postmenopausal women with abnormal uterine bleeding during hormone replacement therapy

Se realiza un estudio para analizar la frecuencia de patología endometrial en mujeres posmenopáusicas sanas con sangrado uterino anormal bajo terapia de remplazo hormonal (TRH). Se estudiaron 104 mujeres posmenopáusicas que presentaron sangrado uterino anormal (irregular o excesivo) durante THR con estrógenos y progesterona en diferentes esquemas (57 por ciento secuencial continuo; 31 por ciento combinado continuo; 12 por ciento secuencial discontinuo). A todas las pacientes se les realizó una biopsia ambulatoria aspirativa de endometrio. El procedimiento fue bien tolerado y no se observaron complicaciones hemorrágicas o infecciosas. Los resultados histológicos fueron los siguientes: endometrio secretor 38.5 por ciento; endometrio proliferativo 25 por ciento; endometrio atrófico 11.5 por ciento; hierplasia endometrial sin atipias 4.8 por ciento; pólipo endometrial benigno 2.9 por ciento; tejido endometrial benigno, inactivo o fragmentos de epitelio 11.5 por ciento; adenocarcinoma de endometrio 1 por ciento y ausencia de tejido endometrial 4.8 por ciento. La biopsia aspirativa de endometrio permitió conocer la situación endometrial en alrededor del 95 por ciento de las pacientes. Muestra insuficiente para diagnóstico se obtuvo en un 5 por ciento de los casos siguriendo atrofía endometrial o patología focal no diagnosticada por el método. La ausencia de lesiones premalignas y la baja incidencia de patología maligna de endometrio en nuestro estudio confirman su baja incidencia en mujeres que reciben esquemas adecuados de terapia de remplazo hormonal

Hiperparatiroidismo primario, aislado y de carácter familiar: caso clínico / Familial and isolated primary hyperparathyroidism: report of an affected family

Familial hyperparathyroidism can be a part of a type 1 or 2 multiple endocrine neoplasia syndrome, can be associated to mandibular fibromas or can appear as an isolated disease. We report a family with 11 members affected by a primary hyperparathyroidism, all with a history of kidney stones and without evidences of other endocrine tumors. Not knowing the familial history of the disease, only one adenoma was resected in four cases and in all, the disease recidivated. Two were operated again, performing a total parathyroidectomy and heterologous autotransplantation of parathyroid tissue in the forearm. The presentation form of primary hyperparathyroidism in this family, is similar to other reported cases. It is more aggressive, is diagnosed at a lower age, has a higher incidence of recurrence and multiglandular involvement than the sporadic disease

Autoanticuerpos anti-tiroglobulina: detección y posible interferencia en la medición de tiroglobulina en suero / Thyroglobulin autoantibodies: detection and possible interference in serum thyroglobulin measurement

Background: Thyroglobulin measurement is useful for the follow up of patients subjected to total thyroidectomy for differentiated thyroid carcinoma. Thyroglobulin autoantibodies may interfere with its determination. Aim: To measure thyroglobulin autoantibodies and their interference with thyroglobulin determination. Material and methods: The presence of thyroglobulin autoantibodies was investigated in 801 serum samples sent to the laboratory for measurement of thyroglobulin levels. A serum was considered positive for these autoantibodies when radioactivity corresponding to 125I-thyroglobulin bound to thyroglobulin autoantibodies, precipitated with human gamma globulin, exceeded in 1.4 times that of a negative sera pool. In positive sera, thyroglobulin autoantibody concentration was measured and its interference with thyroglobulin radioimmunoassay was assessed through a recuperation test using exogenous thyroglobulin. Results: Thyroglobulin autoantibodies were detected in 149 sera (18.6 percent). Of these, 65 had a recuperation that fluctuated between 1 and 80 percent. Thyroglobulin autoantibody concentration was negatively correlated with recuperation percentages (r= -0.64; p <0.001) but not with thyroglobulin concentrations (r= 0.08). Thyroglobulin was higher in positive sera with a recuperation over 80 percent than in sera with a recuperation of less than 80 percent (12.7 ñ 1.7 and 5.9 ñ 0.6 ng/ml, respectively; p <0.001). Conclusions: Thyroglobulin autoantibodies interfere with thyroglobulin measurement by radioimmunoassay, sequestering variable amounts of thyroglobulin. The presence of these autoantibodies must be investigated prior to thyroglobulin determination

Síndrome de Cushing por secreción ectópica de ACTH: análisis del mecanismo fisiopatológico de la hipokalemia: comunicación de dos casos / Cushing syndrome with severe hipokalemia caused by ectopic ACTH secretion: report of two cases

We report a 42 years old male and a 66 years old female with a Cushing syndrome caused by ectopic ACTH secretion secondary to a carcinoid tumor. These patients had both severe hypokalemia, resistant to medical treatment and that subsided with bilateral adrenalectomy and supplementation with dexametasone. Cushing syndrome caused by ectopic ACTH secretion is characterized by a severe and rapidly evolving hypercortisolism. Hypokalemia is present in 90 percent of cases and is probably caused by a defect in 11 ß hydroxysteroid dehydrogenase, that limits the binding of cortisol to aldosterone receptor, metabolizing it to cortisone. Therefore, this alteration will increase the mineralocorticoid action of cortisol

Frecuencia de insulino resistencia y dislipidemia en mujeres jóvenes con síndrome de ovarios poliquísticos / Frequence of insulin resistence and dislipidemia in young women with polycystic ovarian syndrome

Se realizó una caracterización clínica, hormonal, de lipoproteínas y de resistencia insulínica en 31 pacientes con síndrome de ovarios poliquísticos sin tratamiento médico. Destaca la importante frecuencia de factores de riesgo cardiovascular en ellas; todas tienen índice de masa corporal aumentando, siendo el 71 por ciento obesas; 6,5 por ciento tienen presión arterial diastólica elevada; 35,5 por ciento de ellas presenta hipercolesterolemia, 13 por ciento tiene hipertrigliceridemia, y 83 por ciento son insulino resistentes. Estos hallazgos justifican la evaluación metabólica en mujeres anovulatorias hiperandrogénicas para indicar las medidas terapéuticas necesarias no sólo desde el punto de vista hormonal y de fertilidad, sino también desde el aspecto metabólico

Comparación de la acción antioxidante de estriol y estradiol in vitro sobre lipoproteínas de baja densidad en mujeres postmenopáusicas / Comparison of antioxidant actions of estriol and estradiol on low density lipoproteins in post menopausal women

Background: Estradiol (E2) has a potent antioxidant effect on low density lipoproteins (LDL) in vitro and in vivo, which could be important in explaining the cardioprotective effect of hormone replacement therapy (HRT) in post menopausal women. Estriol (E3), on the other hand, is a weak estrogen with low metabolic effects on different tissues, and at present no cardioprotective effect has been attributed to this steroid. Aim: To study the antioxidant effect of E3 on LDL and to compare it with the potent antioxidant action exhibited by E2. Subjects and methods: After LDL was isolated by ultra centrifugation from plasma of 12 healthy untreated post menopausal women, it was divided into aliquots containing 0.5 mg of LDL protein. Estriol and E2 in doses of 0, 1, 5, 15 and 50 µM were incubated with different aliquots of LDL. CuSO4 15 µM was added to each aliquot to induce an oxidative stress. The aliquots were then incubated during 4 hours at 37 ­C. Malonaldehyde (MDA) was measured as a marker of LDL oxidation, and expressed as nM/mg protein. Results (mean ñ SD): Estriol induced a dose-dependent decrease in MDA concentration (baseline 62.8 ñ 21.7; 1 µM: 61.5 ñ 23.0; 5 µM: 52.9 ñ 20,3; 15 µM 43.5 ñ 20.1 and 50 µM: 31.0 ñ 17.6 nM/mg protein; F= 92.4; p< 0.0001), reaching a mean decrease of 50.7 percent at the highest dose tested. Estradiol has a similar dose-dependent decrease in MDA concentration (F= 60.2; p< 0.0001), revealing a more potent effect than E3 (p< 0.05), with a mean decrease of 67.4 percent at the highest dose tested. Conclusions: Our results demonstrate that estriol shows an important antioxidant action of LDL in vitro, although its effect is less potent than estradiol. These results raise the possibility that estriol could have a cardioprotective effect in post menopausal women, possibility that has not been yet demonstrated

Macrotumor suprarrenal diagnosticado por tomografía axial computarizada: experiencia clínica en 33 casos / Adrenal macrotumor diagnosed by computarized tomography: clinical experience in 33 cases

Thirty three patients aged 9 to 86 years old, 15 female, with an adrenal macrotumor diagnosed by CAT scan, were analized. Thirty percent of tumors were functioning (70 percent secreted cathecolamines and 30 percent cortisol). Eighty two percent had an adrenal localization and 18 percent were para-adrenal. Thirty four percent were malignant. These tumors were mostly non functioning, 70 percent occured in men and 67 percent were metastatic. Most adrenal macrotumors in this series were non functioning and 36 percent were malignant

Modificación de la reabsorción ósea con terapia hormonal de reemplazo en la postmenopausia / Modification of bone resorption with replacement hormonal therapy in postmenopause

Eighty three postmenopausal women without replacement hormonal therapy, 54 postmenopausal women receiving replacement hormonal therapy and 16 premenopausal women (considered as control group) were studied. Hydroxyproline was measured in an early morning urine sample, after one day of diet without meat or gelatin. Urinary hydroxyproline in premenopausal women was 33.7ñ7.9 mg/g creatinine. The figure for postmenopausal women with hormonal replacement therapy was 33.5ñ7.9 mg/g creatinine. Postmenopausal women without replacement therapy had an urinary hydroxyproline of 47.4ñ8.5 mg/g creatinine, significantly higher than that of premenopausal and supplemented women. In 21 postmenopausal women, hydroxyproline was measured before and after 3 months of replacement therapy; values decreased 35.5ñ11 percent in this period and there was a direct correlation between initial values and the degree of reduction (r=0.69, p<0.001). Postmenopausal women receiving hormone replacement therapy have a urinary hydroxyproline excretion similar to that of premenopausal women

Rendimiento comparativo entre biopsia y citología obtenidas por aspiración con aguja fina en nódulos sólidos del tiroides / Comparative useful between biopsy and cytology obtained by fine needle aspiration in thyroid nodules

The correct management of thyroid nodules requires an accurate histological diagnosis to doscard carcinoma. One hundred and forty three thyroid nodules were punctured with a 21 G needle under continous aspiration obtaining a sample for cytological and histological diagnosis. Fifty patients were subjected to a thyroidectomy. The age of studied patients ranged from 12 to 78 years old and 94 percent were female. Mean nodule diameter was 2.7ñ1.4 cm. Two percent of procedures were complicated with local hematomas, that subsided spontaneously. A diagnosis of cancer was reached in 16 percent of all patients and 46 percent of operated patients. Cytology had a 50 percent sensitivity, 87.5 percent specificity, a 89.4 percent positive predictive value and a 87.5 percent negative predictive value. The figures for fine needle aspiration biopsy were 82.6, 100, 100 and 87 percent respectively. Fine needle aspiration biopsy has a better diagnostic accuracy than cytology and is a simple and safe procedure

Velocidad de disolución de diferentes preparados de calcio utilizados en clínica / Dissolution velocity of different calcium solutions used in clinics

Hydrochloric acid was added to destilled water in increasing amounts to obtain a final pH of 6.9, 3.0, 2.5, 2.0 and 1.5. Eighteen commercial calcium preparations were incubated in these solutions for 60 min and dissolution velocity was measured as the percentage of elemental calcium found in solution after this incubation period. Calcium carbonate preparations had a pH 1.5. Using the solution with pH 1.5 the dissolution velocity of different preparations varied widely from 56 to 100 percent. Calcium acetate, followed by calcium citrate and dicalcic phosphate were the salts in tablets with better dissolution velocities. Among powders and effervescent preparations, those containing calcium lactogluconate and citrate had the better dissolution velocities (95 to 115 percent), that were independent of the solution's pH. A studied preparation with integral bone had a very low dissolution velocity, not surpassing 33 mg of calcium per tablet. The dissolution velocity of different calcium carbonate preparations varies greatly and in conditions of achlorhydria, it is negligible. Calcium lactogluconate and citrate dissolution velocities are independent of the solution's pH

Fractura de la cadera: estudio de casos y controles en la región metropolitana I / Hip fracture: study of cases and controls at metropolitan region I

Hip fracture is a preventable cause of disability among elderly people. To study factors associated to hip fractures in Chile. Patients admitted to seven public hospitals in Chile, whith hip fracture not due to major accidents, were considered as cases. To each, at least one age and sex matched hospitalized control, without or neoplasic diseases, was assigned. All patients were subjected to an inquiry, using an instrument devised by the WHO. Two hundred sixty eight cases and 501 controls were studied. Cases and controls has similar educational and labor histories. The right hip was fractures in 47 percent of cases and the left in the rest. Compared with controls, cases had a higher body mass index; loss of height during life, rate of hysterectomy, incidence of smoking and a lower consumption of diary products. Cases had a higher risk of falls inside their homes and controls outside. The obtained information may contribute to the development of preventive measures and reduce the public health impact of hip fracture