Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT-0401 and REVERSE randomised clinical studies.

BACKGROUND: The goal of hepatorenal syndrome type 1 (HRS-1) treatment is to improve renal function. Terlipressin, a synthetic vasopressin analogue, is a systemic vasoconstrictor used for the treatment of HRS-1, where it is available. AIM: To compare the efficacy of terlipressin plus albumin vs. placebo plus albumin in patients with HRS-1. METHODS: Pooled patient-level data from two large phase 3, randomised, placebo-controlled studies were analysed for HRS reversal [serum creatinine (SCr) value ≤133 µmol/L], 90-day survival, need for renal replacement therapy and predictors of HRS reversal. Patients received intravenous terlipressin 1-2 mg every 6 hours plus albumin or placebo plus albumin up to 14 days. RESULTS: The pooled analysis comprised 308 patients (terlipressin: n = 153; placebo: n = 155). HRS reversal was significantly more frequent with terlipressin vs. placebo (27% vs. 14%; P = 0.004). Terlipressin was associated with a more significant improvement in renal function from baseline until end of treatment, with a mean between-group difference in SCr concentration of -53.0 µmol/L (P < 0.0001). Lower SCr, lower mean arterial pressure and lower total bilirubin and absence of known precipitating factors for HRS were independent predictors of HRS reversal and longer survival in terlipressin-treated patients. CONCLUSIONS: Terlipressin plus albumin resulted in a significantly higher rate of HRS reversal vs. albumin alone in patients with HRS-1. Terlipressin treatment is associated with improved renal function. (ClinicalTrials.gov identifier: OT-0401, NCT00089570; REVERSE, NCT01143246).

Calidad de imagen y reducción de dosis en angiotomografía computarizada de arterias coronarias usando protocolo de baja energía / Coronary artery CT image quality and dose reduction using low energy protocol

The objective of this study was to quantify the radiation dose reduction without impairing image quality, using 100 and 120 kiloVolts acquisition protocols. We analyzed 37 non-obese patients in a private hospital in Santiago, Chile, of which 20 were obtained with a protocol of 120 kiloVolts and the remaining 17 with low energy protocol. The quality of the image was evaluated quantitatively and qualitatively. The average image quality score for the 120 and 100 kiloVolts groups was 3.25 ± 0.8 and 3.41 ± 0.7 respectively, demonstrating an improvement in the image quality, although at a non-significant value (p= 0.58). In the images obtained with the 100 kiloVolts protocol, a reduction of 41.99% in the radiation dose was demonstrated in addition to a significant increase of the intensity of the signal and the noise. It was possible to demonstrate a decrease of the radiation dose without detriment in the diagnostic image quality in coronary angiography using computed tomography.

El objetivo de este estudio fue cuantificar la disminución de la dosis de radiación sin perjudicar la calidad de imagen, utilizando protocolos de adquisición de 100 y 120 kilovolts. Se analizaron 37 pacientes no obesos en un hospital privado de Santiago de Chile, de los cuales 20 fueron obtenidos con un protocolo de 120 kilovolts y los 17 restantes con protocolo de baja energía. Se evaluó la calidad de imagen cuantitativa y cualitativamente. El promedio de puntuación de la calidad de imagen para los grupos de 120 y 100 kilovolts fue de 3,25 ± 0,8 y 3,41 ± 0,7 respectivamente, demostrando una mejora en la calidad de imagen, aunque en un valor no significativo (p= 0,58). En las imágenes obtenidas con el protocolo de 100 kilovolts, se demostró una reducción en la dosis de radiación de un 41,99% además de un aumento significativo de la intensidad de la señal y del ruido. Se logró demostrar una disminución de la dosis de radiación sin perjuicio en la calidad de imagen diagnóstica en angiografía coronaria por tomografía computarizada.

Identification and Stratification of Diabetic Kidney Disease Using Serum Cystatin C and Serum Creatinine Based Estimating Equations in Type 2 Diabetes: A Comparative Analysis.

Background: Cystatin C is a low molecular weight protein produced by all nucleated human cells, with a stable production rate. Its levels are not influenced by inflammation, infections, hepatic or renal diseases, or by dietary or constitutional factors. We compared serum cystatin C and serum creatinine based predicting equations to estimate glomerular filteration rate (GFR) in type 2 diabetes mellitus, using the staging of chronic kidney disease (CKD) defined by the National Kidney Foundation. We also explored the relationship of urine albumin, GFR, serum creatinine and cystatin C concentrations. Methods: : A cross-sectional study was performed at a tertiary care hospital in New Delhi. Consecutive patients with type 2 diabetes mellitus above the age of 35 years were enrolled. Fasting and 2-hour-postprandial blood glucose, fasting lipid profile, lipoprotein(a), haemoglobin, microalbuminuria, glycated haemoglobin (HbA1c), liver and renal function tests were assessed. Serum levels of Cystatin C were measured using immune-turbidometric method (Dade Behring analyzer BN2). Estimated GFR (eGFR) was calculated using Cockcroft-Gault formula, Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease-Epidemiology (CKD-EPI) Cys C formula. The three sets of eGFR were compared using repeated measure ANOVA. Linear regression analysis was performed to find the factor that affects the albumin excretion rate (AER) and e-GFR levels using all three equations. Results: We assessed 172 patients with type 2 diabetes mellitus. Mean age of the patients was 61.4 ± 9.6 years with mean duration of diabetes of 11.40 ± 7.5 years. Approximately 70% of patients had hypertension. A family history of diabetes was present in 53.4% of subjects and a history of CAD in first degree relatives in 20.9%. The prevalence of coronary artery disease was 17.4%. Albumin excretion correlated with e-GFR estimated using each of the three equations. The best correlation was seen with the CKD-EPI equation derived e-GFR. The CKD-EPI equation also identified the maximum number of patients in the normo-albuminuria group as having CKD. Albuminuria correlated with blood urea levels (p = 0.014) and serum cystatin C levels (p < 0.005). Conclusion: The new cystatin C based Chronic Kidney Disease Epidemiology equation identifies more patients in early CKD and also patients with normo-albuminuric CKD compared to the creatinine based Cockcroft-Gault equation or the Modification of Diet in Renal Disease formulae.

Análisis de variables epidemiológicas, clínicas e histopatológicas del cáncer de piel en el Hospital Regional de Arica, Chile (2007-2011) / Analysis of epidemiological, clinical and histopathological variables of skin cancer in the Regional Hospital of Arica, Chile (2007-2011)

Introducción: el cáncer cutáneo es un problema de salud pública. Múltiples factores influyen en el desarrollo de esta neoplasia. El nortede Chile y particularmente Arica, tienen condiciones diferentes al restodel país, presentan mayores niveles de radiación solar, elevada foto exposición y un importante número de población amerindia. Objetivo: Determinar las tasas de incidencia de Carcinoma Basocelular (CBC),Carcinoma Espinocelular CEC y Melanoma Maligno (MM) en la población beneficiaria del Hospital Regional de Arica entre 2007 y 2011 ycaracterizar los tumores utilizando variables clínicas e histopatológicas. Metodología: Se analizaron 22.787 informes histopatológicos de biopsiasen el Hospital Regional de Arica, durante los años 2007 - 2011.Se obtuvieron 288 informes compatibles con cáncer de piel. Se analizaronlas variables de sexo, edad, raza, localización anatómica y tipo histológico. El análisis estadístico se realizó mediante test de Fisher considerando un valor de p menor a 0,05 significativo. Resultados: Se obtuvieron 183 pacientes (64%) con CBC, 93 (32%) con CEC y 12 (4%)de MM. Las tasas de incidencia en total presentaron fluctuaciones,con un patrón decreciente, en CBC (44,03/ 100.000 en 2007, a 13.68/100.000 en 2011) y CEC (16,08/100.000 en 2007 a 8,92/ 100.000 en2011). La localización más frecuente fue cabeza y cuello, 154 pacientespara CBC (84%) y 44 con CEC (47%). En cuanto MM la ubicación más frecuente fue tronco en varones y extremidades superiores e inferiores,en mujeres...

Introduction: skin cancer is a public health problem. Multiplefactors contribute to its appearance. Northern Chile, particularly Arica, has different conditions to the rest of the countryand showed higher levels of solar radiation, a higher sunexposure and a significant number of Amerindian population. Objetive: Determine the incidence rates of Basal Cell Carcinoma( BCC), Squamous cell carcinoma (SCC) and Malignantmelanoma (MM ) in the target population of Arica RegionalHospital, between 2007 and 2011 and characterize the skintumors according to the clinical and histopathological variables. Methodology: 22,787 histopathological reports from the Regional Hospital of Arica, during 2007-2011 were analyzed.288 reports compatible with skin cancer (BCC, SCC and MM)were obtained. For each tumor the variables of sex, age, race,anatomical location and histological type were analyzed. The statistical analysis was performed by the test of Fisher. Results:183 patients, 64% BCC, 32 % SCC and 4% MM wereobtained. Incidence rates of all skin cancer showed fluctuations with decreasing pattern in BCC (ranging from 44.03 /100,000 in 2007, to 13.68 / 100,000 in 2011) and SCC (rangingfrom 16.08 / 100,000 the year 2007 to 8.92 / 100,000 in2011). The most frequent location was head and neck, 154for BCC (84%) and 44 with SCC (47%). The most frequent location of MM was trunk in males and upper and lower limbsin females...

Trastornos ansiosos y desórdenes temporomandibulares en funcionarios de un centro de salud familiar en la comuna de Concepción, Chile / Temporomandibular and anxiety disorders in workers of a family health center in the area of Concepción, Chile

Los trastornos temporomandibulares (TTMs) involucran los músculos de la masticación, articulación temporomandibular (ATM) y otras estructuras asociadas a la cavidad oral y representan un conjunto de disfunciones de la articulación, a la cual se le asocia una naturaleza multifactorial, condición que puede llegar a tener de un 50 a 93 por ciento de prevalencia en la población y cuya etiología es asociada a estrés y/o estados psicológicos alterados. Se efectuó un estudio descriptivo observacional de corte transversal con el objetivo de determinar la prevalencia de Trastornos Ansiosos y TTM, en funcionarios del Centro de Salud Familiar (CESFAM) Tucapel, sector Barrio Norte, en la comuna de Concepción. De los 97 funcionarios, 79 aceptaron voluntariamente a participar del estudio y todos trabajan directamente con pacientes en un sector con numerosos problemas socioeconómicos y laborales. Se aplicó una encuesta orientada a la pesquisa tanto de patologías psicológicas, como signos y síntomas de TTM, además de un examen extra e intraoral complementario. En los encuestados se encontró trastornos ansiosos y estados asociados a burnout en un 81 y 27,8 por ciento respectivamente, además había TTM en un 98.7 por ciento de origen multifactorial, pero presente en todos los individuos encuestados y examinados con trastornos ansiosos y estados asociados a burnout.

Temporomandibular disorders (TMDs) involve the muscles of mastication, temporomandibular joint (TMJ) and other structures associated with the oral cavity and represent a multifactorial nature of disorders associated to this joint, condition that is in the range of 50 to 93 percent of prevalence in the population and whose etiology is associated with stress and / or altered psychological states. The present study is a descriptive cross-sectional observational in order to determine the prevalence of anxiety disorders and TMD in workers of the Tucapel Family Health Center (CESFAM), Barrio Norte, in Concepción’s commune. Of the 97 staff, 79 agreed to take part voluntarily of the study, all of these people also work directly with patients at a sector with numerous socioeconomic and employment problems. A survey aimed toward the inquiry of psychological, TMD (signs and symptoms) and extra-intra oral complementary examination, was conducted. Anxiety disorders and burnout associated conditions were found (81 and 27.8 percent respectively), multifactorial TMD was also reported (98.7 percent) but present in all individuals with anxiety disorders and conditions associated to burnout.

Operative start times and complications after liver transplantation.

The recent national focus on patient safety has led to a re-examination of the risks and benefits of nighttime surgery. In liver transplantation, the hypothetical risks of nighttime operation must be weighed against either the well-established risks of prolonging cold ischemia or the potential risks of strategies to manipulate operative start times. A retrospective review was conducted of 578 liver transplants performed at a single institution between 1995 and 2008 to determine whether the incidence of postoperative complications correlated with operative start times. We hypothesized that no correlation would be observed between complication rates and operative start times. No consistent trends in relative risk of postoperative wound, vascular, biliary, or other complications were observed when eight 3-h time strata were compared. When two 12-h time strata (night, 3 p.m.-3 a.m., and day, 3 a.m.-3 p.m.) were compared, complications were not significantly different, but nighttime operations were longer in duration, and were associated a twofold greater risk of early death compared to daytime operations (adjusted OR 2.9, 95% CI 1.16-7.00, p = 0.023), though long-term survival did not differ significantly between the subgroups. This observation warrants further evaluation and underscores the need to explore and identify institution-specific practices that ensure safe operations regardless of time of day.

Candidiasis esofágica: análisis clínico y micológico / Oesophageal candidiasis: clinical and mycological analysis

Oesophageal candidiasis is an epithelial infection which requires an immune deficiency. C. albicans is commonly the cause, although other species may also be responsible. Resistance to fluconazole, drug of choice for treatment, is an emerging problem. The objectives of the current paper were: to determine the frequency of oesophageal candidiasis in patients submitted to upper gastrointestinal endoscopy, analyze risk factors, identify Candida species and determine in vitro susceptibility to fluconazole. During 12 months, 34 patients with oesophageal candidiasis were detected. Out of 1.230 HIV negative and 91 HIV positive patients submitted to upper endoscopy, 11 (0.9%) and 23 (25.3%), respectively, had candidiasis. Risk factors for HIV negative patients were systemic antibiotic therapy in 2, deficient dental cleaning in 2 aged patients, use of proton pump inhibitors in 3, inhaled steroids in 2, malignancy in 1 and oral steroids in 1. The histopathologic diagnosis was confirmed in 48.6% of cases. Cultures were positive in 91.2% C. albicans was prevalent (93.5%), and was associated to other species in 5 cases (16.1%), (3 C. glabrata, 1 C. tropicalis and 1 C. parapsilosis). One case cultured only C. glabrata and 1, only C tropicalis. Out of 31 cultures, 25 were susceptible to fluconazole, 4 dose dependent (1 C. albicans, 3 C. glabrata), and 2 resistant (1 C. albicans, 1 C. glabrata). Frequency of oesophageal candidiasis was low, except for HIV positive patients. The most common etiologic agent was C. albicans, though other Candida species were also found. C. albicans and C. glabrata showed dose dependency and resistance to fluconazole.

La candidiasis esofágica es una infección epitelial querequiere un defecto adicional inmunitario. Candida albicans es la especie más frecuente, aunque puedenencontrarse otras. Un problema emergente es la resistenciaal fluconazol, droga de elección para tratarla. Los objetivos fueron: determinar la frecuencia de candidiasisesofágica en pacientes sometidos a endoscopía, analizar los factores predisponentes, identificar las especiescausantes, y estudiar la sensibilidad in vitro al fluconazol. Durante 12 meses se realizaron 1.321 endoscopíasdonde se detectaron 34 pacientes con candidiasis esofágica. Se hicieron 1.230 endoscopías en pacientes HIV negativos y 91 en HIV positivos. Se diagnosticó candidiasis esofágica en 11 (0.9%) y 23(25.3%), respectivamente. En HIV negativos, fueron causas predisponentes: antibioticoterapia prolongada, prótesis dentarias sin higiene, uso prolongado de inhibidoresde la bomba de protones, secreción ácida, corticoides inhalatorios, malignidad y vasculitis bajo corticoterapia. La histopatología fue positiva en 48.6%. El cultivo se desarrolló en el 91.2%. C. albicans fue laespecie más frecuente (93.5%) y en 5 pacientes (16.1%) se la encontró asociada a C. glabrata (3) C. tropicalis (1) y C. parapsilosis (1). En un caso solo se cultivó C. glabrata y en otro C. tropicalis. De las 31 cepas, 25 fueron sensibles al fluconazol, 4 dosis dependientes (1 C. albicans, 3 C. glabrata), y 2 resistentes(1 C. albicans, 1 C. glabrata). En nuestro hospital, la frecuencia de candidiasis esofágica fue baja, excepto enHIV positivos. El principal agente etiológico fue C. alalbicans,aunque también se cultivaron otras especies. C. albicans y C. glabrata mostraron dosis dependencia yresistencia al fluconazol.

Candidiasis esofágica: análisis clínico y micológico / Oesophageal candidiasis: clinical and mycological analysis

Oesophageal candidiasis is an epithelial infection which requires an immune deficiency. C. albicans is commonly the cause, although other species may also be responsible. Resistance to fluconazole, drug of choice for treatment, is an emerging problem. The objectives of the current paper were: to determine the frequency of oesophageal candidiasis in patients submitted to upper gastrointestinal endoscopy, analyze risk factors, identify Candida species and determine in vitro susceptibility to fluconazole. During 12 months, 34 patients with oesophageal candidiasis were detected. Out of 1.230 HIV negative and 91 HIV positive patients submitted to upper endoscopy, 11 (0.9%) and 23 (25.3%), respectively, had candidiasis. Risk factors for HIV negative patients were systemic antibiotic therapy in 2, deficient dental cleaning in 2 aged patients, use of proton pump inhibitors in 3, inhaled steroids in 2, malignancy in 1 and oral steroids in 1. The histopathologic diagnosis was confirmed in 48.6% of cases. Cultures were positive in 91.2% C. albicans was prevalent (93.5%), and was associated to other species in 5 cases (16.1%), (3 C. glabrata, 1 C. tropicalis and 1 C. parapsilosis). One case cultured only C. glabrata and 1, only C tropicalis. Out of 31 cultures, 25 were susceptible to fluconazole, 4 dose dependent (1 C. albicans, 3 C. glabrata), and 2 resistant (1 C. albicans, 1 C. glabrata). Frequency of oesophageal candidiasis was low, except for HIV positive patients. The most common etiologic agent was C. albicans, though other Candida species were also found. C. albicans and C. glabrata showed dose dependency and resistance to fluconazole.(AU)

La candidiasis esofágica es una infección epitelial querequiere un defecto adicional inmunitario. Candida albicans es la especie más frecuente, aunque puedenencontrarse otras. Un problema emergente es la resistenciaal fluconazol, droga de elección para tratarla. Los objetivos fueron: determinar la frecuencia de candidiasisesofágica en pacientes sometidos a endoscopía, analizar los factores predisponentes, identificar las especiescausantes, y estudiar la sensibilidad in vitro al fluconazol. Durante 12 meses se realizaron 1.321 endoscopíasdonde se detectaron 34 pacientes con candidiasis esofágica. Se hicieron 1.230 endoscopías en pacientes HIV negativos y 91 en HIV positivos. Se diagnosticó candidiasis esofágica en 11 (0.9%) y 23(25.3%), respectivamente. En HIV negativos, fueron causas predisponentes: antibioticoterapia prolongada, prótesis dentarias sin higiene, uso prolongado de inhibidoresde la bomba de protones, secreción ácida, corticoides inhalatorios, malignidad y vasculitis bajo corticoterapia. La histopatología fue positiva en 48.6%. El cultivo se desarrolló en el 91.2%. C. albicans fue laespecie más frecuente (93.5%) y en 5 pacientes (16.1%) se la encontró asociada a C. glabrata (3) C. tropicalis (1) y C. parapsilosis (1). En un caso solo se cultivó C. glabrata y en otro C. tropicalis. De las 31 cepas, 25 fueron sensibles al fluconazol, 4 dosis dependientes (1 C. albicans, 3 C. glabrata), y 2 resistentes(1 C. albicans, 1 C. glabrata). En nuestro hospital, la frecuencia de candidiasis esofágica fue baja, excepto enHIV positivos. El principal agente etiológico fue C. alalbicans,aunque también se cultivaron otras especies. C. albicans y C. glabrata mostraron dosis dependencia yresistencia al fluconazol.(AU)

Campaña de prevención de cáncer de piel, organizada por el Servicio de Dermatología del Hospital Clínico Universidad de Chile, Exposol 2003 / Skin cancer awareness campaign organized by Dermatologic Service of Universidad de Chile Clinical Hospital, Exposol 2003

El cáncer cutáneo ha aumentado en las últimas décadas en Chile. En noviembre, 2003, se realizó una campaña de prevención de cáncer de piel en nuestro hospital, que tuvo por objetivos educar a la gente de los riesgos de una alta exposición solar, como también, la detección precoz de lesiones malignas. Se registraron datos importantes sobre el conocimiento y conducta de las personas frente a este tema y se detectaron lesiones malignas en personas de alto riesgo. Un total de 2.142 personas asistieron a la campaña, de las cuales un 73,6 por ciento fueron mujeres y 26,4 hombres. El promedio de edad de los asistentes fue de 47,2 años. Un 91,5 por ciento declaró saber de la relación entre la radiación solar y cáncer de piel; sin embargo, solamente un 41,2 por ciento declara usar bloqueador solar. Mujeres, personas con pieles de fenotipos más claros y personas de mayor nivel educacional declaran usar más bloqueador solar. El examen físico para la detección de lesiones malignas fue realizado en 806 personas. Lesiones premalignas y malignas fueron detectadas en 145 personas (12,3 por ciento de queratosis actínica, 6,2 por ciento carcinoma basocelular, 0,24 por ciento de carcinoma espinocelular, 1,12 por ciento enfermedad de Bowen y 1,73 por ciento melanoma maligno). El grupo de personas con lesiones premalignas y malignas fue de mayor edad, de fenotipos de piel más claros y principalmente varones. Este tipo de campaña nos ayuda a reducir las tasas de mortalidad y morbilidad de cáncer de piel en nuestro país.

Mucormicosis rinosinusal en un paciente infectado por VIH / Rhinosinusal mucormicosis in an HIV positive patient

Mucormicosis es una infección fúngica oportunista producida por varias especies del orden Mucorales, como Rhizopus, Mucor, Cunninghamella y Absidia. Habitualmente se asocia con enfermedades oncohematológicas, diabetes mellitus, falla renal, tumores sólidos y trasplante de órganos sólidos o precursores hematopoyÚticos. Se presenta con una variedad de formas clÝnicas: rinocerebral, renal, pulmonar, cutßnea, gastrointestinal y diseminada. En pacientes infectados por VIH es poco frecuente. Presentamos una paciente atendida en el Hospital de Enfermedades Infecciosas Dr. Lucio Córdova, con infección por VIH en etapa C3 del CDC, CD4 < 100 cÚls/mm y tratamiento anti retroviral. La forma de presentación rinocerebral fue documentada por TAC que demostró la extensión de la lesión, y confirmada mediante biopsia y cultivo. Recibió anfotericina B mßs resección quirúrgica de todo el tejido necrótico. Completó 2.225 mg del antifúngico falleciendo un año y medio despuÚs, sin que se demostrara reactivación de la infección.

Cerebro, estrés y ovario poliquístico. Participación de la inervación simpática en el desarrollo del síndrome del ovario poliquístico / Brain, stress, and polycystic ovary. Role of sympathetic innervation in the development of polycystic ovary syndrome

El estrés, como un mecanismo general de respuesta simpática exagerada, involucra grandes cambios en la homeostasis del organismo. No existen dudas acerca de las alteraciones que provoca el estrés, tanto en el comportamiento sexual como en la capacidad reproductiva. En este trabajo discutiremos los cambios en la actividad nerviosa simpática que induce el estrés y su participación en la enfermedad ovárica de mayor frecuencia en mujeres durante su vida reproductiva, el síndrome del ovario poliquístico. Presentamos una revisión de los mecanismos centrales y periféricos de regulación de la actividad nerviosa simpática y su participación en el síndrome del ovario poliquístico. Se discuten los resultados de nuestro grupo en esta área. El uso de modelos animales para estudiar la participación del estrés en la enfermedad ovárica y trasladar este conocimiento hacia pacientes con síndrome del ovario poliquístico apoya fuertemente la participación de los nervios simpáticos en la función ovárica en condiciones normales y patológicas (AU)

[Treatment of hyperthyroidism with radioiodine: effects of administered dose on complications and thyroid function]. / Tratamiento del hipertiroidismo con radioyodo: efecto de la dosis administrada sobre la función tiroidea y complicaciones asociadas.

BACKGROUND: Radio-iodine is a definite therapy for Graves disease hyperthyroidism. However, the optimal dosage is still debatable. AIM: To assess the effects of different radioiodine doses on thyroid function and complications in patients with hyperthyroidism. MATERIAL AND METHODS: A retrospective analysis of 139 patients with hyperthyroidism, treated with ratio-iodine between 1988 and 1998. Radio iodine dose used was classified as low (< 10 mCi), intermediate (10-14.9 mCi) or high (> or = 15 mCi). RESULTS: Thirty-five patients were treated with low doses, 33 with intermediate doses and 71 with high doses. There were no differences between these patients in age, disease severity, frequency of post treatment euthyroidism or complications. Patients treated with low doses had a higher frequency of persistent hyperthyroidism than patients treated with high doses (25.7 and 4.2% respectively, p < 0.001). Likewise, the frequency of subsequent hypothyroidism was 60% in patients treated with low doses and 84.5% of those with high doses, in whom it also appeared earlier. Associated complications were clinically irrelevant. In seven patients, Graves ophthalmopathy progressed after treatment, but this progression was not associated with the dose used. CONCLUSIONS: Radio iodine in high doses is useful, safe and effective for the treatment of Graves hyperthyroidism.

[Hungry bone syndrome: clinical experience in its diagnosis and treatment]. / Síndrome de "huesos hambrientos": experiencia clínica en su diagnóstico y tratamiento.

Hungry bone syndrome is a unusual complication of the postoperative period of primary hyperparathyroidism. This syndrome is characterized by hypocalcemia, hypophosphatemia and hypomagnesemia, due to an excessive bone remineralization. We report the clinical features, laboratory and therapy in four females (aged 39 to 73 years old) with a long standing hyperparathyroidism, elevated alkaline phosphatases and decreased bone mineralization in two. The mean size of the adenoma was 2.9 +/- 1.1 cm. Hypocalcemia appeared between days 1 and 6 of the postoperative period. All were treated with calcium, calcitriol and magnesium at different timing and dosages. The mean hospitalization period was 19.8 +/- 2.1 days. As reported previously, low bone mineralization and a large adenoma are risk factors for the syndrome. Serial monitoring of serum calcium and magnesium and an early supplementation of these minerals could prevent hypocalcemia and decrease the hospitalization time.

Undetected hepatocellular carcinoma: clinical features and outcome after liver transplantation.

The aim of the study was to define the clinical characteristics and outcome of patients found to have an undetected hepatocellular carcinoma (HCC) at liver transplantation. Patients who underwent liver transplantation and were found to have a hepatoma with a prior workup showing normal alpha-fetoprotein levels and no corresponding lesion on radiological evaluation were defined as having an undetected HCC. Detailed information was collected, and the last abdominal computed tomographic (CT) scan before transplantation was performed was retrospectively reviewed. Thirty-nine patients had a tumor that met the criteria for an undetected hepatoma. The most common causes for pretransplantation liver disease were hepatitis C virus (HCV) (49%) and alcohol use (28%). Tumor size was 2 cm or less in 85% of the patients, vascular invasion was detected in 31% of the patients, and tumor, node, metastasis (TNM) classification was stage I or II in 77% of the patients. Review of the last CT scan before transplantation showed that the lesion was evident in retrospect in only 15% of the patients. Thirty-two patients (82%) remained alive at the time of the study with a mean follow-up of 30 months. Metastatic HCC was detected in 1 patient 7 months after transplantation. There were no other tumor recurrences. Survival analysis showed no significant differences when tumor size, stage, presence of vascular invasion, or causes of pretransplantation liver disease were compared. Undetected HCCs represent a significant percentage of total hepatomas in patients undergoing liver transplantation. Most patients have small, early-stage tumors, but tumors greater than 2 cm or of advanced stage are also frequently found in this population. Overall and tumor-free survival appear to be favorable.

[Cushing with transition from pituitary to adrenal origin. Study with SPECT scintigraphy of the adrenal cortex with norcholesterol-I 131 in a case]. / Transición de Cushing de causa hipofisiaria a suprarrenal. Estudio con cintigrafía SPECT de corteza suprarrenal con I131 norcolesterol en un caso.

The case of a 49 yr old alcoholic women with clinical and laboratory findings that suggested a Cushing syndrome is presented. The functional tests showed cortisol suppression greater than 50% of the basal value with 8 mg of dexamethasone and no response in the combined dexamethasone/desmopressin test. Pituitary Nuclear Magnetic Resonance (NMR) was negative, Abdominal Computed Axial Tomography suggested hyperplastic adrenal glands; adrenal nodules were not found in the NMR. Pituitary or hipothalamic Cushing with secondary autonomous micronodular adrenal hyperplasia was suspected. Norcholesterol-I131 SPECT scintigraphy under dexamethasone suppression demonstrated a functional adrenal hyperplasia which was hystologically confirmed.