[Adverse effects of parenteral nutrition in cancer patients: systematic review]. / Efectos adversos de la nutrición parenteral en pacientes oncológicos: revisión sistemática.

Malnutrition in hospitals is of great concern in patients with cancer. This malnutrition in cancer leads to higher risk of complications, and worse response to treatments and outcomes. Parenteral nutrition (PN) in cancer is controversial due to the heterogeneous results found in scientific literature. This is the reason why the evaluation of adverse events of PN, its incidence and severity, is crucial when prescribing PN in cancer patients. This evaluation of adverse events of PN is the aim of the present systematic review of the randomized clinical trials (RCT) written in any language found in several databases. From the 74 articles found in our search, only 13 RCT (18 different types of cancer) met the criteria to be selected for the systematic review. These RCT included 669 patients receiving central PN in whom 225 adverse events (33.63%) of PN were described, and 92 patients with peripheral PN, with 54 adverse events (58.70%). There were no adverse events in a control group of 47 patients receiving parenteral fluids. We conclude that scientific literature is very heterogeneous and evaluate complications of parenteral nutrition only as a secondary aim. We think necessary that further research do define complications of parenteral nutrition homogeneously and study them as a main objective.

Efectos adversos de la nutrición parenteral en pacientes oncológicos; revisión sistemática / Adverse effects of parenteral nutrition in cancer patients; systematic review

La malnutrición hospitalaria tiene gran importancia en los pacientes con cáncer y lleva a mayor riesgo de complicaciones, menor respuesta al tratamiento y peor evolución de los mismos. El empleo de nutrición parenteral (NP) en estos pacientes es controvertida por los resultados heterogéneos publicados en la literatura científica. Éste es el motivo por el que la evaluación de los efectos adversos de la NP, de su incidencia y gravedad, es muy importante a la hora de prescribir una NP en estos pacientes. Esta evaluación de los efectos adversos de la NP es el objetivo de la presente revisión sistemática de los ensayos clínicos aleatorizados (ECA) encontrados en diversas bases de datos y publicados en cualquier idioma. De los 74 artículos encontrados en nuestra búsqueda, sólo 13 ECA (18 tipos diferentes de neoplasias) cumplían los criterios de inclusión para ser seleccionados para la revisión sistemática. Estos ECA incluyeron 669 pacientes con NP central en los que se describieron 225 efectos adversos (33,63%) de la NP, y 92 pacientes con NP periférica, con 54 efectos adversos (58,70%). No hubo efectos adversos en los 47 pacientes del grupo control que recibió fluidoterapia intravenosa. Podemos concluir que los estudios publicados son muy heterogéneos y evalúan las complicaciones de la nutrición parenteral únicamente de forma secundaria. Creemos necesario que futuros ensayos clínicos definan las complicaciones de la nutrición parenteral de forma homogénea y los estudien como objetivo primario (AU)

Malnutrition in hospitals is of great concern in patients with cancer. This malnutrition in cancer leads to higher risk of complications, and worse response to treatments and outcomes. Parenteral nutrition (PN) in cancer is controversial due to the heterogeneous results found in scientific literature. This is the reason why the evaluation of adverse events of PN, its incidence and severity, is crucial when prescribing PN in cancer patients. This evaluation of adverse events of PN is the aim of the present systematic review of the randomized clinical trials (RCT) written in any language found in several databases. From the 74 articles found in our search, only 13 RCT (18 different types of cancer) met the criteria to be selected for the systematic review. These RCT included 669 patients receiving central PN in whom 225 adverse events (33.63%) of PN were described, and 92 patients with peripheral PN, with 54 adverse events (58.70%). There were no adverse events in a control group of 47 patients receiving parenteral fluids. We conclude that scientific literature is very heterogeneous and evaluate complications of parenteral nutrition only as a secondary aim. We think necessary that further research do define complications of parenteral nutrition homogeneously and study them as a main objective (AU)

Actividad física, insulino resistencia y síndrome metabólico / No disponible

No disponible

[Peripheral parenteral nutrition]. / Nutrición periférica.

The Target of this review is to provide an up-to-date overview of the advantages and disadvantages of Peripheral Parenteral Nutrition (PPN), including techniques, indications and results. The new generation catheters, together with a better knowledge of the intermediary metabolism, give us the opportunity to use PPN in many clinical situations for short periods of time. PPN is an alternative to Total Parenteral Nutrition (TPN) and is also a complement to enteral nutrition and to the oral route. Progress in the design of catheters and their materials, in infusion techniques and better knowledge of optimal nutrients has made PPN into an effective, safe and useful therapy in the treatment of patients for certain periods of time.

Nutrición periférica / Peripheral parenteral nutrition

La Nutrición Parenteral Periférica (NPP) es el objeto de esta revisión. En ella se analizan críticamente las técnicas, las indicaciones y los resultados. Los catéteres de nueva generación, junto con una mejora del conocimiento del metabolismo intermediario, permiten la utilización de NPP en muchas situaciones clínicas durante períodos cortos de tiempo. La NPP es una alternativa a la Nutrición Parenteral Total (NPT) y es también un complemento a la Nutrición Enteral y a la vía oral. El progreso en el diseño de catéteres y de sus materiales, las técnicas de infusión y un incremento del conocimiento de los nutrientes óptimos ha hecho de la NPP una terapia eficaz, segura y útil para tratar pacientes durante determinados períodos de tiempo (AU)

The Target of this review is to provide an up-to-date overview of the advantages and disadvantages of Peripheral Parenteral Nutrition (PPN), including techniques, indications and results. The new generation catheters, together with a better knowledge of the intermediary metabolism, give us the opportunity to use PPN in many clinical situations for short periods of time. PPN is an alternative to Total Parenteral Nutrition (TPN) and is also a complement to enteral nutrition and to the oral route. Progress in the design of catheters and their materials, in infusion techniques and better knowledge of optimal nutrients has made PPN into an effective, safe and useful therapy in the treatment of patients for certain periods of time (AU)

La malnutrición hospitalaria / No disponible

No disponible

Encuesta de la Sociedad Española de Nutrición Básica y Aplicada (SENBA) sobre la situación de la valoración nutricional en pacientes hospitalizados en España / No disponible

No disponible

Papel de los carbohidratos en la resistencia insulínica / No disponible

No disponible

[Home enteral nutrition. Annual report 1999. NADYA-SENPE Group]. / Nutrición enteral domiciliaria. Informe anual 1999. Grupo NADYA-SENPE.

GOAL: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. RESULTS: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support. CONCLUSIONS: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs.

Effects of 2 lipid emulsions (LCT versus MCT/LCT) on the fatty acid composition of plasma phospholipid: a double-blind randomized trial.

BACKGROUND: Fatty acids from the diet or from IV fat emulsions are incorporated into the plasma and cell membrane phospholipids and act as substrates in the synthesis of eicosanoids. This study reports the effect of 2 parenteral lipid emulsions in plasma phospholipids fatty acids. METHODS: A total of 83 patients aged 18 to 75 years were randomized to receive long-chain triglycerides (LCT) or 50/50 mix of long- and medium-chain triglyceride emulsion (LCT/MCT). Blood samples were collected at baseline and at weekly intervals for 28 days. Plasma phospholipid fatty acids were measured by gas chromatography. RESULTS: Patients receiving LCT versus MCT/LCT emulsion have an increase in 18:2n6 and a decrease in 20:4n6 and 22:4n6 after 7, 14, and 21 days of treatment with parenteral nutrition. Phospholipid fatty acids at 15 days of treatment with parenteral nutrition with LCT versus MCT/LCT for 18:2n6 were 17.30% versus 22,90% (p < .05), for 20:4n6 10.44% versus 8.38% (p < .05), and for 22:4n6 0.51% versus 0.40% (p < .05). The 20:4n6 percentage inversely correlated with the percentage of 18:2n6 on days 7, 14, and 21: regression coefficients: -7.40 (p < .001), -7.39 (p < .001), and 5.70 (p < .001), respectively. CONCLUSIONS: Parenteral lipid emulsions modify fatty acid profiles in plasma phospholipids. MCT/LCT emulsions produce in phospholipids a fatty-acid profile that is closer to normality than that achieved with LCT emulsions. These changes in phospholipid fatty acids are suggestive of an inhibition of A-5-desaturase in patients who received LCT emulsions.

Plasma status of retinol, alpha- and gamma-tocopherols, and main carotenoids to first myocardial infarction: case control and follow-up study.

OBJECTIVE: Epidemiologic studies have suggested that dietary intake and plasma concentrations of antioxidants have an inverse relation with coronary heart disease. To test whether fat-soluble antioxidants can play a role against the occurrence of myocardial infarction (MI), we measured plasma levels of retinol, tocopherols, and individual carotenoids in MI patients. METHODS: A case-control and follow-up study of patients in the Móstoles area (Madrid, Spain). One hundred six patients (62 after 1 y) and 104 control subjects participated in the study. Blood samples were collected after overnight fast or during the first 24 h of MI onset for biochemical profiles of retinol, alpha- and gamma-tocopherols, and carotenoid by means of a quality-controlled high-performance liquid chromatography. RESULTS: During the acute phase after MI onset, plasma levels of retinol, gamma-tocopherol, and xanthophylls (lutein/zeaxanthin and beta-cryptoxanthin) decreased, whereas alpha-tocopherol, alpha-carotene, beta-carotene, and lycopene showed levels similar to those of control subjects. Logistic regression analysis showed low concentrations of gamma-tocopherol (and retinol) in plasma as the only statistically significant factor associated with MI, after adjusting for traditional risk factors. However, 1 y later, the MI patients showed a general improvement in plasma lipids and fat-soluble antioxidant status, and none of the analytes was associated with MI. CONCLUSIONS: The decreased plasma status of retinol, gamma-tocopherol, and xanthophylls during the acute phase of MI normalized the year after the MI event, suggesting that most subjects had followed an overall healthier lifestyle and dietary pattern. The results also raise concerns on the usefulness of these plasma compounds as specific, relevant, and predictive markers in relation to coronary heart disease.

Nutrición enteral domiciliaria. informe anual 1999. Grupo NADYA-SENPE / Enteral nutrition at home. annual report 1999. NADYA-SENPE group

Objetivo: Durante 1999, como en años anteriores, el Grupo NADYA-SENPE ha realizado el registro anual de pacientes con Nutrición Artificial Domiciliaria, con el objetivo de mantener actualizados los conocimientos que sobre esta terapéutica tenemos. En el presente trabajo analizamos los resultados del sexto Registro Nacional de pacientes en tratamiento con Nutrición Enteral Domiciliaria correspondiente al año 1999, en el que han colaborado veintitrés centros de la red sanitaria nacional.Material y Métodos: La información se ha recogido en un cuestionario cerrado incluido en nuestra pagina web (www.nadya-senpe.com). El formulario incluye, además de los datos epidemiológicos, la indicación que motivó la nutrición, tratamiento nutricional, vía de acceso, complicaciones y hospitalizaciones, seguimiento del tratamiento, calidad de vida y evolución de los pacientes. La información total es procesada por el equipo coordinador. La Unidad de Nutrición del Hospital Universitario La Paz de Madrid, ha actuado como coordinador del grupo.Resultados: Durante el año 1999 han seguido tratamiento con Nutrición Enteral Domiciliaria (NED) 2262 pacientes en los veintitrés centros colaboradores. La edad media ha sido de 63,6 ñ 19,67 (H: 57,6 por ciento; M: 42,3 por ciento). El tiempo medio con tratamiento nutricional es de 5,89 ñ 4,25 meses. Las alteraciones neurológicas (37,5 por ciento) y las neoplasias (36,8 por ciento) han sido las indicaciones de NED más frecuentes. La mayoría de los pacientes utilizan la vía oral (50,7 por ciento), la utilización de vías artificiales es menos frecuente, la SNG es utilizada en el 27,9 por ciento y la PEG en un 12,7 por ciento. Las formulas polimericas son las mas empleadas (87,7 por ciento). Se contabilizaron 1403 episodios de complicaciones, lo que representa 0,62 complicac./paciente/año, el 40,8 por ciento gastrointestinales (0,26 complicaciones/paciente/año), el 18,7 por ciento complicaciones mecánicas, solo se contabilizaron 9 casos de broncoaspiración. En 836 ocasiones (0,38 hospitaliz./paciente) fue necesario hospitalizar al paciente, aunque debido generalmente a causas no asociadas con la nutrición (86,1 por ciento).Al finalizar el año el 51,4 por ciento de los pacientes continuaban con el soporte nutricional Conclusiones: La nutrición enteral domiciliaria es una técnica segura en pleno desarrollo en nuestro país.Requiere la existencia de equipos de nutrición adecuadamente dotados así como la colaboración de los servicios de atención primaria y la adecuada formación de familiares y pacientes. Es indispensable profundizar en el desarrollo y aplicación de vías clínicas que contemplen una metodología clara y concisa que abarque todos los aspectos relativos a la nutrición. La nutrición es, en si misma, una alternativa terapéutica independientemente de si el acceso se realiza por una vía natural o artificial. Es necesario que los responsables administrativos se den cuenta de que una nutrición adecuada de los pacientes redunda en una mejoría de su estado general, un tiempo de evolución mas corto y, por lo tanto, en una disminución de los costes (AU)

Goal: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. Material and Methods: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients’ quality of life and progress. All of the data are processed by the coordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. Results: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 ( 19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 ( 4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support Conclusions: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs (AU)

Valoración del estado nutricional en el paciente con cáncer / No disponible

No disponible

Lumbalgia como síntoma inicial de una adrenomieloneuropatía / Low-pain back as initial symptom of adrenomyeloneuropathy

Introducción. La adrenoleucodistrofia es una enfermedad peroxisomal, recesiva ligada al X, caracterizada bioquímicamente por acúmulo de ácidos grasos de cadena extralarga (AGCE).Se distinguen seis fenotipos: presintomático, forma cerebral infantil, del adolescente y del adulto, adrenomieloneuropatía y enfermedad de Addison aislada. Presentamos un paciente con adrenomieloneuropatía cuya manifestación clínica inicial fue una lumbalgia.Caso clínico. Varón de 23 años, sin antecedentes personales de interés, que acudió por lumbalgia de dos años de evolución. En la exploración del paciente había piramidalismo y disminución de las sensibilidades epicríticas en miembros inferiores. La analítica mostró una insuficiencia suprarrenal y aumento de las concentraciones de AGCE en suero, mononucleares y fibroblastos. Una RM mostró una lesión hiperintensa en la rodilla del cuerpo calloso. Los PESS fueron patológicos, mientras que el electroneurograma mostró un aumento bilateral de la latencia de la onda F. El paciente fue diagnosticado de adrenomieloneuropatía, por lo que se inició tratamiento con hidrocortisona, dieta pobre en AGCE y `aceite de Lorenzo'. La lumbalgia fue desapareciendo progresivamente, coincidiendo con la disminución de las concentraciones plasmáticas de AGCE. El aceite fue retirado por plaquetopenia moderada. Se inició, entonces, tratamiento con lovastatina 40 mg/día. Dos años después, el paciente se encuentra sin lumbalgia y estable desde el punto de vista neurológico. Conclusiones. La lumbalgia asociada a la adrenomieloneuropatía es probablemente debida a desmielinización en los tractos espinales. Aunque la lumbalgia es un cuadro habitualmente `benigno', se debe realizar una buena anamnesis a todo paciente con dicho síntoma (AU)

[Manufacturing a double-lumen tube with simple and inexpensive materials]. / Fabricación de sonda de doble luz con materiales simples y baratos.

Twin-channel enteral feeding catheters allow the administration of early enteral nutrition in various pathologies while avoiding the use of total parenteral nutrition. We describe how to manufacture one simply using cheap and easy-to-find materials whenever a commercial catheter of this type is unavailable.

Fabricación de sonda de doble luz con materiales simples y baratos / Manufacture of a twin-channel catheter with cheap, simple elements

Las sondas de alimentación enteral con doble luz permiten administrar nutrición enteral precoz en distintas patologías evitando el uso de nutrición parenteral total. Describimos cómo poder fabricar una fácilmente con materiales baratos y de fácil adquisición cuando no se disponga de una de estas sondas ya comercializadas (AU)

Twin-channel enteral feeding catheters allow the ad-ministration of early enteral nutrition in various pathologies while avoiding the use of total parenteral nutrition. We describe how to manufacture one simply using cheap and easy-to-find materials whenever a commercial catheter of this type is unavailable (AU)

[Estimate of osteoporosis fracture risk with ultrasound bone assessment]. / Estimación del riesgo de fracturas osteoporóticas mediante medición ultrasónica del hueso.

BACKGROUND: Multiple studies suggest that ultrasound measurement of the bone can be a rapid, cheap, and radiation-free alternative to determine the fracture risk. In this paper the ultrasound measurement of the bone was performed among 288 postmenopausal women, and the influence of gynecologic history and factors related to lifestyle on the obtained values was examined. PATIENTS AND METHODS: One hundred nineteen healthy postmenopausal women and 169 women with previous osteoporotic fractures were included in the study. Both weight and height were determined and a clinical questionnaire was administered to assess factors related to bone mineral density. The values of broadband ultrasound attenuation (BUA) and speed of sound (SOS) were obtained with a contact ultrasound analyzer. RESULTS: Among women without fractures the mean BUA and SOS values (64.1 [14.9] and 1,601.1 [34.5], respectively) were significantly higher than mean BUA (48.8 [17.3]) and SOS (1,573 [57.8]) values among women with fractures (p < 0.001). Using the logistic regression analysis for predicting fracture risk, the model that suited best was that including BUA (OR = 0.668 [0.544-0.818]), age (OR = 1.102 [1.055-1.151]), age at postmenopause (OR = 0.794 [0.731-0.862]) and height (OR = 0.932 [0.883-0.983]). The area under the curve for this model was 0.871. CONCLUSIONS: BUA and SOS values are lower among women with osteoporotic fractures. The fracture risk can be predicted by means of a model including the variables BUA, age, postmenopausal age, and height.

Estimación del riesgo de fracturas osteoporóticas mediante medición ultrasónica del hueso / Assessment of osteoporotic fracture risk by ultrasound measurement of the bone

Fundamento. Múltiples estudios sugieren que la medición ultrasónica del hueso puede ser una alternativa rápida, barata y sin radiación para determinar el riesgo de fracturas. En este trabajo hemos realizado medición ultrasónica del hueso en 288 mujeres posmenopáusicas, analizando la influencia de la historia ginecológica y de factores relacionados con el estilo de vida en los valores obtenidos. Pacientes y métodos. Se incluyeron 119 mujeres postmenopáusicas sanas y 169 con fracturas osteoporóticas previas. Se midió peso y talla y se realizó un cuestionario clínico para valoración de los factores relacionados con la densidad mineral ósea. Se obtuvieron las medidas de atenuación ultrasónica de banda ancha (BUA) y velocidad del sonido (VS) con un analizador ultrasónico de contacto. Resultados. En las mujeres sin fracturas los valores medios de BUA y VS (64,1 [14,9] y 1.601,1 [34,5], respectivamente) fueron significativamente superiores a los de BUA (48,8 [17,3]) y VS (1.573,6 [57,8]) en las mujeres con fracturas (p < 0,001). En el análisis de regresión logística para predicción del riesgo de fracturas el modelo que mejor se ajustaba era el que incluía BUA (OR = 0,668 [0,544-0,818]), edad (OR = 1,102 [1,055-1,151]), edad de la menopausia (OR = 0,794 [0,731-0,862]) y talla (OR = 0,932 [0,883-0,983]).El área bajo la curva receiver operating characteristic (ROC) de este modelo fue 0,871. Conclusiones. Los valores de BUA y VS son inferiores en las mujeres con fracturas osteoporóticas. El riesgo de fractura se puede predecir a través de un modelo que incluya las variables BUA, edad, edad de la menopausia y talla (AU)

[Backache as the initial symptom of adrenomyeloneuropathy]. / Lumbalgia como síntoma inicial de una adrenomieloneuropatía.

INTRODUCTION: Adrenoleukodystrophy is a paroxysmal disorder, with recessive linking to the X chromosome, characterized biochemically by the accumulation of extra-long-chain fatty acids. Six phenotypes are distinguished: pre-symptomatic, infantile, adolescent and adult cerebral forms, adrenomyeloneuropathy and isolated Addison's disease. We describe a patient with adrenomyeloneuropathy in whom the presenting symptom was lumbago. CLINICAL CASE: A 23 year old man with no significant previous clinical history complained of having lumbago for over two years. On examination he had pyramidal signs and reduced epicritic sensitivity of the legs. Laboratory investigations showed adrenal failure, increased plasma extra-long-chain fatty acids concentration, mononuclear cells and fibroblasts. On MR there was a hyperintense lesion of the genu of the corpus callosum. SSEP were pathological while the electroneurogram showed bilateral increase in latency of the F wave. The patient was diagnosed as having adrenomyeloneuropathy and treatment started with hydrocortisone, a diet low in extra-long-chain fatty acids and 'Lorenzo's oil'. The lumbago gradually disappeared while the plasma extra-long-chain fatty acids concentration dropped. The oil was stopped because of moderate thrombocytopenia, and treatment was started with lovastatin 40 mg/day. Two years later the patient has no lumbago and is neurologically stable. CONCLUSIONS: The lumbago associated with adrenomyeloneuropathy is probably due to demyelination of the spinal tracts. Although lumbago is usually a benign condition, a careful history and examination is necessary in all such cases.