Technical Innovation for Visual Assessment of Preterm Newborns in a Neonatal Intensive Care Unit: Exploratory Study.

OBJECTIVE: The present study is aimed at assessing heart rate variability (HRV) and its correlation with visual acuity (VA) assessment of preterm newborns (PTNB) in neonatal intensive care units. METHOD: Cross-sectional study analyzing HRV during assessment of VA with the aid of a Polar RS800CX heart rate monitor (Polar Electro Oy, Finland). HRV was analyzed according to time and frequency domains and the chaos domain used the autocorrelation coefficient and entropy. The sample consisted of hospitalized PTNB, and static analysis included simple regression diagnosis. RESULTS: A total of 14 PTNB were included in the sample. VA varied between 0.23 and 1.60 cpd, and only five PTNB obtained below-expected values for age. Statistical analysis demonstrated a negative correlation between VA and time domain (SDDN and SD2) and a positive correlation between frequency domain (heart rate and hertz), but in simple linear regression analysis, these variables did not influence VA. CONCLUSION: The results of the study demonstrate that visual acuity was inversely correlated with SDNN and SD2 and during stimulation, showing that the higher the visual performance, the lower the autonomic modulation response.

[Histiocytic necrotizing lymphadenitis: report of 3 cases]. / Linfadenitis necrotizante histiocitaria: comunicación de 3 casos.

Histiocytic necrotizing lymphadenitis (also known as Kikuchi-Fujimoto's disease) is an uncommon, benign and self-limiting lymph disease. We report three patients aged 14, 22 and 50 years, who presented with fever and cervical lymphadenopathy, accompanied by skin lesions and joint pain in two of the three cases. One of the patient's sister suffered from histiocytic necrotizing lymphadenitis. Laboratory abnormalities varied and findings included leucopenia, relative neutrophilia, elevated C reactive protein, erythrocyte sedimentation rate and ferritin. Basic laboratory screening tests were performed on all patients to rule out autoimmune and infectious diseases. Lymph node biopsy and subsequent pathological examination were essential to establish the diagnosis. All patients received antibiotics at some point of their hospital stay. Two patients required glucocorticoid treatment, while the remaining case experienced a spontaneous recovery. Its pathogenesis is still unknown, but clinical and histopathological studies suggest a connection with autoimmune diseases. There is no established treatment, but apparently the disease responds to the administration of glucocorticoids.

Hepatitis alcohólica severa no respondedor a a glucocorticoides: reporte de un caso / Alcoholic hepatitis not responding to corticosteroids: a case report

INTRODUCCIÓN: La hepatitis alcohólica corresponde a un daño inflamatorio agudo sobre un hígado progresivamente dañado por la ingesta excesiva y prolongada de alcohol. Puede presentar ictericia, manifestaciones de alcoholismo crónico e insuficiencia hepática progresiva. PRESENTACIÓN DEL CASO: Varón de 60años con antecedentes de daño hepático crónico secundario a alcoholismo activo, que presentó cuadro de dos semanas de ictericia progresiva, prurito y bradipsiquia, asociado a leucocitosis, hiperbilirrubinemia, y elevación discreta de transaminasas, con predominio de GOT sobre GPT. Hemocultivos, urocultivo y serologías para virus hepatotropos fueron negativos. La ecografía abdominal mostró signos de hepatopatía crónica, sin dilatación de vía biliar. Con una función discriminante de Maddrey de 106 puntos se inició pentoxifilina, evolucionando tórpidamente. Se agregó prednisona durante siete días; se obtiene una puntuación de Lille de 0,99 (no respondedor), suspendiendo los corticoides. Progresó la insuficiencia hepática, con posterior insuficiencia renal aguda, acidosis metabólica, trastornos hidroelectrolíticos y fallecimiento al mes de evolución. DISCUSIÓN: La hepatitis alcohólica posee alta mortalidad. Existen múltiples escalas pronósticas. Los corticoides están indicados en casos severos, sin embargo hasta un 40 por ciento se catalogan como no respondedores. Se requieren nuevos tratamientos para mejorar la supervivencia de estos pacientes.

INTRODUCTION: Alcoholic hepatitis constitutes an acute inflammatory episode due to prolonged alcohol abuse on a previously damaged liver. Clinical features include jaundice, signs of chronic alcoholism and progressive liver failure. CASE REPORT: A 60-yearold male with a history of cirrhosis due to ongoing excessive intake of alcohol presented a two week history of progressive jaundice, pruritus, and bradypsychia. Laboratory tests showed leukocytosis, hyperbilirubinemia and a mild elevation of liver enzymes (GOT over GPT). Blood and urine cultures as well as serological markers for viral hepatitis were negative. Abdominal ultrasound showed signs of chronic liver disease, with no bile duct dilatation. A modified Maddrey’s discriminant function of 106 was determinant on starting therapy with pentoxifyline. However, patient’s status deteriorated. Prednisone was added to the treatment but seven days later, the patient was categorized as a non-responder (Lille score of 0.99), so the glucocorticoids were suspended. The patient’s liver failure progressed, after which renal failure, metabolic acidosis and electrolytic abnormalities developed; that led to his death after one month from admission. DISCUSSION: Alcoholic hepatitis requires prompt diagnosis and treatment, due to its high death rate. There are various prognostic scales available, one of which is the modified Maddrey’s discriminant function. The fundamental therapeutic measure is the use of intravenous glucocorticoids; yet up to 40 percent of patients qualify as non-responders.

Fusión esplenogonadal como causa de masa testicular pediátrica: Caso clínico / Splenogonadal fusion, a rare cause of pediatric testicular mass: clinical case

La fusión esplenogonadal es una variación anatómica infrecuente, con un pequeño número de reportes en la literatura. La estrecha relación entre el bazo y la gónada primitiva izquierda en un momento del desarrollo embrionario logra explicar la existencia de este fenómeno. Objetivo: Comunicar el primer reporte en la literatura nacional de fusión esplenogonadal. Caso clínico: Preescolar de 2 años 10 meses que consultó por aumento de volumen silente en testículo izquierdo estudiado mediante ecografía, la cual reveló una masa hipervascular en su polo superior. Se decidió su exploración quirúrgica donde se apreció una estructura sólida, bien adherida al teste, de superficie similar a la del hígado. Fue resecada y enviada a biopsia rápida la cual se informó como un tejido esplénico benigno. Discusión: La literatura revisada describe los aspectos más importantes de ésta entidad, su desarrollo embrionario, clasificación, presentación clínica, métodos diagnósticos y tratamiento. El conocimiento de esta condición por parte del equipo médico y su inclusión en el diagnóstico diferencial de masa testicular, permite tomar medidas diagnósticas en el intraoperatorio para un tratamiento conservador. Una vez establecido el diagnóstico, habitualmente en el intraoperatorio, es suficiente la enucleación completa del tejido esplénico, evitando orquiectomías innecesarias.

The splenogonadal fusion is a rare anatomical variation, with only a few reports in the literature. The close relationship between the spleen and the primitive left gonad in a specific moment of the embryonic development could explain this phenomenon. Objective: To point out the clinical presentation and treatment of this condition, through the first case published in our country. Clinical case: We report the case of a male child, 2 years 10-month-old, who consulted for silent swelling of the left testis, which Doppler ultrasound study revealed a hypervascular, polar mass. A surgical exploration was performed, and a solid, adherent, liver-like structure was observed over the testicle. The intraoperatory biopsy was informed as benign splenic tissue. Conclusion: The reviewed articles describe important information about the development, classification, presentation and management of this condition. The knowledge and inclusion of this condition in the differential diagnosis of pediatric testicular masses allows the medical team to choose for conservative therapeutic measures. Once the diagnosis is established, often intraoperatively, a complete resection of the splenic tissue is enough for these patients, avoiding an unnecessary orchiectomy.

Linfadenitis necrotizante histiocitaria: Comunicación de 3 casos / Histiocytic necrotizing lymphadenitis: report of 3 cases

Histiocytic necrotizing lymphadenitis (also known as Kikuchi-Fujimoto's disease) is an uncommon, benign and self-limiting lymph disease. We report three patients aged 14, 22 and 50 years, who presented with fever and cervical lymphadenopathy, accompanied by skin lesions and joint pain in two of the three cases. One of the patient's sister suffered from histiocytic necrotizing lymphadenitis. Laboratory abnormalities varied and findings included leucopenia, relative neutrophilia, elevated C reactive protein, erythrocyte sedimentation rate and ferritin. Basic laboratory screening tests were performed on all patients to rule out autoimmune and infectious diseases. Lymph node biopsy and subsequent pathological examination were essential to establish the diagnosis. All patients received antibiotics at some point of their hospital stay. Two patients required glucocorticoid treatment, while the remaining case experienced a spontaneous recovery. Its pathogenesis is still unknown, but clinical and histopathological studies suggest a connection with autoimmune diseases. There is no established treatment, but apparently the disease responds to the administration of glucocorticoids.

Flegmasía cerúlea dolens: diagnóstico y tratamiento / Phlegmasia cerulean dolens: diagnosis and treatment

INTRODUCCIÓN: Flegmasía Cerúlea Dolens es una variante de la trombosis venosa profunda. La presentación clínica incluye edema, dolor y cianosis del miembro comprometido. Son múltiples los factores gatillantes, dentro de los cuales está el uso de anticoncepción oral y patología maligna, entre otros. La obstrucción severa del sistema iliofemoral determina un aumento de la presión de los compartimentos de la extremidad, que finalmente compromete la circulación arterial. La gravedad del cuadro radica en la posibilidad de pérdida de la extremidad e incluso la muerte. PRESENTACIÓN DEL CASO: Paciente mujer de 29 años. Consulta en servicio de urgencia del Hospital Parroquial de San Bernardo por cuadro de 30 minutos de evolución caracterizado por dolor, aumento de volumen y coloración violácea del miembro inferior izquierdo. Al ingreso se constata impotencia funcional, pulsos distales disminuidos y saturación de 70 por ciento en dicha extremidad. Se inicia anticoagulación endovenosa y se realiza ecotomografía Doppler que muestra signos sugerentes de trombosis venosa. Se realiza cirugía de urgencia. Evoluciona con disminución de la sintomatología. Es dada de alta en buenas condiciones con terapia anticoagulante oral. DISCUSIÓN: Frente a la sospecha clínica de flegmasía cerúlea dolens, resulta esencial el diagnóstico y tratamiento precoz, con el objetivo de salvar la extremidad y vida del paciente. Cabe destacar la importancia de exámenes complementarios como el uso de la ultrasonografía. El tratamiento debe ser agresivo, aunque aún la terapia de elección es motivo de controversia.

INTRODUCTION: Phlegmasia cerulean dolens is a variant of deep vein thrombosis. The clinical presentation includes edema, pain and cyanosis of the member involved. There are many triggering factors which includes oral contraceptive use and malignancy, among others. Severe obstruction of the iliofemoral system leads to an increase of pressure of the limb’s compartments that ultimately compromises the arterial circulation. Severity lies in the possibility of limb loss and even death. CASE REPORT: Female patient, 29 years old. Patient asks in emergency room of Hospital Parroquial de San Bernardo because of limb’s pain, swelling and purplish coloration, with 30 minutes of evolution. At the ingress it is found functional impotence, diminished distal pulses and saturation of 70 percent on the limb. Intravenous anticoagulation is initiated and Doppler ultrasonography is performed, showing suggestive signs of venous thrombosis. Emergency surgery is done, evolving with a decrease of symptoms. The patient was discharged in good conditions with oral anticoagulation therapy. DISCUSSION: When phlegmasia cerulean dolens is suspected, it is essential an early diagnosis and treatment, in order to save patient’s limb and life. We must emphasize the importance of complementary tests such as ultrasound. Treatment must be aggressive, although the therapy of choice is controversial.

Phylogenetic relationships of Asian and European pig breeds determined by mitochondrial DNA D-loop sequence polymorphism.

Phylogenetic relationships among Asian and European pig breeds were assessed using 1036 bp of mitochondrial DNA (mtDNA) D-loop sequences. An unweighted pair-group method with arithmetic mean (UPGMA) tree was constructed on the basis of maximum likelihood distances using sequences determined for three Cheju (Korea), 11 Chinese, one Westran (Australian feral origin) and two European pigs (Berkshire and Welsh), and also published sequences for four Japanese (including two Wild Boars), one Yucatan miniature, five European (including Large White, Landrace, Duroc, Swedish and Wild Boar) and two Meishan pigs. The Colombian collared peccary (Tayassu tajacu) sequence was also determined and used as an outgroup. The maximum parsimony with heuristic search method was used to determine bootstrap support values. Asian-type pigs clustered together (bootstrap support 33%), but were separate from European-type pigs that also clustered together (93%). The Westran pig, derived from the feral descendants of pigs inhabiting Kangaroo Island of South Australia, clustered with Asian pigs, demonstrating Asian origin of their mitochondria. Berkshire and Large White clustered with Asian pigs, indicating that Asian pigs were involved in the development of these breeds. Our findings clearly demonstrate that pigs indigenous to China, Korea and Japan are only recently diverged from each other and distinctly different from European-type pigs. European pig breeds consist of pigs with mitochondria of Asian and non-Asian type, some of which were formed from closely related maternal ancestors, if not from a single ancestor.

[Infertility treatment before assisted reproductive techniques]. / Tratamiento de los trastornos de la fertilidad antes de las técnicas de reproducción asistida.

The prevalence of infertility has increased in recent years, but the medical services to treat these problems are not available for most of the affected couples. The prognosis for fertility is important in order to determine the therapeutic capacity of each service, and to select the couples that could be treated at a primary level, or to send them to more advanced levels of reproductive technology. In practice, the infertility is treated in primary medical levels and the assisted reproductive technology is available only to a limited sector of the poblation. In general, the managed-care plans do not compensate directly for infertility treatments, but they are indirectly paying some therapeutic procedures for fertility.

Prevalence of 21-hydroxylase-deficient nonclassic adrenal hyperplasia and insulin resistance among hirsute women from Puerto Rico.

OBJECTIVE: To determine the prevalence of 21-hydroxylase (21-OH)-deficient nonclassic adrenal hyperplasia (NCAH) and insulin resistance in hirsute women from Puerto Rico. DESIGN: Cross-sectional prospective study. SETTING: Clinical research center. PATIENT(S): 100 consecutive untreated hirsute women. MAIN OUTCOME MEASURE(S): Fasting total T, free T, DHEAS, insulin, and glucose were measured, and a 60-minute acute ACTH-(1-24) stimulation for 17-hydroxyprogesterone (17-HP) was performed. A diagnosis of 21-OH-deficient NCAH was considered when the stimulated 17-HP level was >30.3 nmol/L. The glucose/insulin ratio was calculated as a measure of insulin resistance (normal value, > or =4.5). RESULT(S): Patients had a mean (+/-SD) age of 26.8+/-6.6 years; 82 were oligomenorrheic. Overall, 12%, 8%, and 60% of patients had elevated levels of DHEAS, total T, or free T, respectively. One patient was identified as having 21-OH-deficient NCAH. Eight women, none of whom had NCAH, were found to be hyperglycemic; four of these women had type 2 diabetes mellitus. Excluding hyperglycemic patients, a glucose/insulin ratio of <4.5, consistent with IR, was found in 51.7%. CONCLUSION(S): The prevalence of 21-OH-deficient NCAH among patients from Puerto Rico does not differ significantly from that reported for other non-Jewish, non-Hispanic white populations.

Internal drainage of giant acute pseudocysts: the role of video-assisted pancreatic necrosectomy.

BACKGROUND: Internal drainage of giant pancreatic pseudocysts secondary to acute pancreatitis is frequently complicated with postoperative retroperitoneal infection and hemorrhage. Recent data suggest that the risk factor is unrecognized pancreatic necrosis; presumably, pancreatic necrosis becomes infected with bacteria introduced by the cystoenteric anastomosis. HYPOTHESIS: Video-assisted pancreatic necrosectomy, performed at the time of internal drainage, may prevent postoperative retroperitoneal complications in patients with giant acute pseudocysts. DESIGN: A consecutive case-series. SETTING: An urban, university-affiliated, tertiary referral center. PATIENTS: Ten consecutive patients with acute pseudocysts measuring 10 cm or more in major diameter. The mean extent of pancreatic necrosis, as shown by contrast-enhanced computed tomography, was 50%. All patients were operated on electively, at an average time of 7.7 weeks from onset of the attack to surgical treatment. INTERVENTION: Through a midline incision, a 4-cm opening is made at the base of the pseudocyst. Standard laparoscopic instruments are introduced into the pseudocyst and video-assisted pancreatic necrosectomy is performed. The opening is then anastomosed to a Roux-en-Y limb of the jejunum. MAIN OUTCOME MEASURES: Feasibility and safety of video-assisted pancreatic necrosectomy, postoperative morbidity and mortality, hospital stay, and resolution of pseudocysts. RESULTS: Complete necrosectomy was safely performed throughout. There were neither postoperative retroperitoneal complications nor mortality. Mean hospital stay was 8.2 days and all pseudocysts resolved at a mean follow-up of 6.9 months. CONCLUSIONS: Video-assisted pancreatic necrosectomy at the time of internal drainage seems to prevent postoperative retroperitoneal complications in patients with giant acute pseudocysts. Depending on appropriate surgical timing, video-assisted necrosectomy is a feasible and safe procedure.

Evidence of chromosome instability in chronic pancreatitis.

In the current study we analyzed chromosome instability on peripheral blood lymphocytes cultured from 7 untreated patients with chronic pancreatitis (CP) by assessing telomeric associations (TAS), chromosome aberrations (CA) and sister chromatid exchanges (SCE). Seven healthy individuals were also analyzed. Mean frequencies of TAS were significantly higher in CP patients (X +/- SE: 11.00 +/- 2.37) compared to controls (1.00 +/- 0.30) (p<0.001). Chromosomes preferentially involved in TAS were: 9, 20, 16 and 21, being the most affected arms: 9p, 20q, 16p, 9q and 21q. All these terminal bands were coincident with cancer breakpoints (p<0.03), two of them (40%) were specifically associated to pancreatic carcinoma rearrangements. Three bands (60%) were coincident with oncogene location. The mean frequency of CA was significantly higher in patients (3.88 +/- 0.80) compared to controls (0.63 +/- 0.49) (p<0.001). Chromosomes 1, 2 and 13 were the most damaged. No specifically affected breakpoints were found. SCE analysis showed higher levels in patients (8.33 +/- 0.70) than in controls (6.62 +/- 0.34) (p<0.025), but no differences were observed in cell cycle kinetics. Our results clearly indicate that CP patients exhibit chromosome instability, showing the presence of an unstable genome that could be related to the cancer development observed in this disease.

[Monitoring of cytomegalovirus infection in patients with kidney transplantation: the first experience in Cuba]. / Monitoreo de la infección por citomegalovirus en pacientes con trasplante renal: primera experiencia en Cuba.

Kidney transplantation is at present the most efficient therapeutic tool to treat end-stage chronic kidney failure. Graft rejection and infections are the most important barriers to the success of transplantation, whereas cytomegalovirus (CMV) has been the most reported causal agent of morbidity in this type of patients. The evolution of a group of 12 patients who underwent kidney transplantation at the Nephrology Institute was studied during 16 weeks aimed at monitoring the infection caused by CMV. 58.4% of these patients were positive and 28% showed clinical evidences of the disease. Most of the infected patients were observed between the 4th and the 12th week after transplantation. CMV infection was confirmed in 70% of the individuals undergoing a high immunosuppression. 50% of the total of patients developed graft rejection episodes some time during the evolution and 83.3% were diagnosed CMV infection.

[Distribution of adipose tissue and insulin serum levels in women with gestational diabetes]. / La distribución del tejido adiposo y los niveles séricos de insulina en la mujer obesa que desarrolla diabetes mellitus gestacional.

Obesity has been mentioned as a major risk factor to develop gestational diabetes mellitus (GDM). In this work the main purpose was to compare the distribution of body fat tissue and insulin serum levels in obese women suffering GDM. Twenty obese pregnant patients, ten with GDM and ten non-diabetic control subjects were selected. To define the body fat distribution the following anthropometric indexes were performed: subscapular/triceps skinfold index (STI) during pregnancy (24-28 weeks) and STI plus waist/hip ratio (WHR) in postpartum (6 weeks). The two obese groups were evaluated through an oral glucose tolerance test, taking blood at 0, 60, 120 and 180 minutes; after centrifugation glucose serum levels were measured immediately by the glucose oxidase technique and the rest of the sample was kept frozen at -20 degrees C until insulin determinations by radioimmunoassay. The ten patients with GDM presented upper body fat, segment distribution, while among those without GDM, only six had this last feature and four were found with lower body fat segment distribution (p < 0.047). Insulin serum levels in GDM group were higher than in women without GDM (p < 0.01). The STI during and after pregnancy correlated positively (r = 0.77, p < 0.00003) and also with WHR (r = 0.61, p < 0.0001). There was correlation between STI and WHR both measured in postpartum (r = 0.52, p < 0.0007).

Adrenal androgen excess in hyperandrogenism: relation to age and body mass.

OBJECTIVE: To determine whether DHEAS levels in hyperandrogenic (HA) women retain the normal age-related decrease. DESIGN: Prospective study. SETTING: Academic tertiary care medical center. PATIENT(S): One hundred forty-five HA patients with hirsutism and/or oligo-ovulation and 53 healthy women. INTERVENTION(S): Blood samples were obtained on days 3-8 of the menstrual cycle or after an IM progesterone-induced withdrawal bleed. MAIN OUTCOME MEASURE(S): Serum samples were assayed for progesterone, total testosterone, sex hormone-binding globulin, free testosterone, and DHEAS. RESULT(S): Controls and HA patients were similar in body mass index and age. A negative correlation between DHEAS levels and age, but not body mass index, was found among controls. In HA patients. DHEAS levels decreased with age. Dehydroepiandrosterone sulfate levels correlated with the hirsutism score in HA patients. When HA patients were subdivided into those with low, middle, and high DHEAS levels, those with low DHEAS levels were older and weighed more than those with high DHEAS levels. CONCLUSION(S): The negative association between DHEAS levels and age is preserved in HA women. Hyperandrogenic patients with high DHEAS levels are younger, thinner, and more hirsute than those with lower DHEAS levels. These findings suggest that the diagnosis of adrenal androgen excess in HA patients may require the use of age-adjusted normative values.

Upper body obesity and hyperinsulinemia are associated with anovulation.

The objective of this study was to determine the effect of body fat distribution and hyperinsulinemia on the occurrence of ovulation. Fifty-six women (20-35 years old) either with overweight or obesity (body mass index >/=25) were studied. They were classified in two groups according to waist/hip ratio (WHR); one with predominance of adiposity in the upper body segment (n = 29, WHR >0.85) and the other with predominant adiposity in the lower body segment (n = 27, WHR

[Uterine leiomyomatosis in the female in late menopause]. / Miomatosis uterina en la mujer en la posmenopausia tardía.

Leiomyomatosis is less frequent in old woman, and its clinical and histological characteristic in late postmenopause are unknown. Uterine leiomyomas were confirmed histologically in 14 out of 69 patients (20.2%) who were 65 or older and in whom a vaginal hysterectomy was performed. Another group without myomas was paired by age to the study group. In both groups, the uterine volume and the minor diameter of the uterus were compared, as well as age at menarche, menopause and duration of the menstrual life. Statistical analysis was done with ANOVA. It was observed, as expected, that uterine volumes of women with leiomyomatosis were significantly greater (p < 0.01) than those of women that did not have myomas; however, the smaller uterine diameters were not significantly different between the two groups, which is an important finding for surgical treatment of these patients. In addition, the menstrual life of patients with myomas was significantly greater (p < 0.04) than that of women without leiomyomatosis. In conclusion, one fifth women 65 years old or older can present myomas and consequently an increase in uterine volume, but without increase in minor diameters. Furthermore, the greater menstrual life span must be recognized as possible risk factor for the presence of leiomyomatosis.

Effect of clomiphene citrate on ovulation after treatment withdrawal.

The effect of clomiphene citrate (CC) on ovarian function in cycles subsequent to treatment withdrawal was studied. Thirty two out of 45 patients with anovulation due to polycystic ovarian syndrome (PCOS) and with no other factor affecting fertility who got pregnant were included. All patients received CC to induce ovulation. Pregnancies in CC treated cycles and after treatment were recorded. Twenty pregnancies were achieved during CC treated cycles and 12 in the cycles after it was withdrawn. In the latter group, eight pregnancies were achieved in the cycle following CC therapy, and four in the second subsequent cycle. In relation to pregnancy complications no significant statistical differences were found between the group of patients who became pregnant during the stimulation cycles and in the cycles after CC.

Bone mineral density in patients with pancreatic insufficiency and steatorrhea.

OBJECTIVES: Low bone mineral density (BMD) has been demonstrated in some patients with chronic intestinal disorders accompanied by diarrhea and malabsorption. However, very few studies have evaluated BMD in patients with pancreatic insufficiency due to cystic fibrosis. Our aim was to assess the prevalence and severity of bone loss in a cohort of patients with pancreatic insufficiency as a consequence of chronic pancreatitis. METHODS: Fourteen patients with chronic pancreatitis were studied. All of them presented with severe pancreatic insufficiency (secretin test: bicarbonate < or = 40 mEq/L) and steatorrhea (fecal fat > 7 g/day) and had been abstinent from alcohol for a median of 2.5 yr (range 1-15 yr). BMD was measured with a total-body scanner for dual-energy x-ray absorptiometry. Results were expressed as T-score (number of SD by which a patient density differs from the mean of sex-matched 30-yr-old healthy controls) in lumbar spine (L2-L4) and femoral neck. Total serum calcium, 25-(OH)D3, alkaline phosphatase, and midmolecular parathyroid hormone were determined. RESULTS: Ten patients demonstrated osteopenia (T-score -1 to -2.5) in the lumbar spine and in the femoral neck. Three patients displayed osteoporosis (T-score < -2.5) in the lumbar spine and two in the femoral neck. Mean T-scores (+/- SEM) were -1.44 +/- 0.37 in the lumbar spine and -1.79 +/- 0.27 in the femoral neck. Total and ionic serum calcium, serum parathyroid hormone, and alkaline phosphatase were in the normal range in all patients. Serum 25-(OH)D3 was below normal range in 7 of 12 patients. T-scores of patients with pancreatitis of alcoholic etiology (n = 10) were similar to those of nonalcoholic patients (n = 4). BMD did not correlate with age, bicarbonate secretion, fecal fat excretion, stool volume, parameters of mineral metabolism, duration of alcoholism, or mean alcohol intake. CONCLUSIONS: Most patients with pancreatic insufficiency as a consequence of chronic pancreatitis exhibit osteopenia, and some show evidence of osteoporosis. Identifying the intimate mechanisms for low BMD are beyond the limitations of the present study. More in-depth metabolic studies are necessary to define the pathogenic mechanism of osteopenia associated with chronic pancreatic disorders.

Sperm characteristics and hormonal profile before and after treatment with follicle-stimulating hormone in infertile patients.

Fourteen asthenoteratozoospermic (ATZS) patients were treated with 75-IU follicle-stimulating hormone (FSH) injections 3 times a week for 3 months. In the group as a whole, sperm motility, viability, and morphology were improved, but not significantly. Only 3 patients impregnated their wives following treatment. Semen characteristics of the 3 patients whose wives were pregnant showed significant improvement in sperm morphology (p = .001). Only FSH levels were statistically higher (p = .022) than controls. The administration of FSH in weekly doses can improve the fertilization potential of sperm.

[Intranasal administration of GnRH in the treatment of uterine myomatosis]. / Uso de análogos de GnRH por vía nasal en el tratamiento de miomatosis uterina.

Nine patients in which an intranasal GnRH agonist analog (napharelin acetate) was administered with the purpose of decreasing the size of the myomas, were studied. In all a decrement in uterine and myoma size was observed. The FSH levels decreased since the first treated cycle, whereas LH and E2 levels initially increase, but finally decreased. The patients had menstrual bleeding between four and eight weeks after napharelin withdrawal. The mentioned results elicit the effectivity of GnRH agonist analog for leomyomata treatment.