[Quality of life in patients with inflammatory bowel diseases]. / Calidad de vida relacionada con la salud en pacientes con enfermedad inflamatoria intestinal.

BACKGROUND: To determine the health-related quality of life in patients with Crohn disease and ulcerative colitis, as well as to evaluate differences according to sex, type of disease and other sociodemographic variables. METHOD: Cross sectional study of 100 outpatients in the Digestive Service of the Navarre Hospital Complex.A questionnaire with sociodemographic and clinical variables was used, as well as a version of the Inflammatory Bowel Disease Questionnaire-32 adapted to Spanish, in order to measure quality of life. RESULTS: The average score of the questionnaire on quality of life was 166 points (D.T.=40.06) out of a maximum of 232. Statistically significant differences were found according to type of disease (p=0.005)and sex (p=0.001). CONCLUSIONS: People with Crohn disease or females perceive a worse quality of life related to health in comparison to patients with ulcerative colitis or men.

Quality evaluation of newborn screening programs.

In the last four decades in many countries and regions all over the world newborn screening programs have been developed. Traditionally, most programs focus on phenylketonuria and congenital hypothyroidism. However, with development of new technologies, screening for a large variety of other disorders has become available. The decision-making process on what to screen or not to screen for is usually driven by personal interest of the professionals involved, by local legislation and access to funding, resulting in large differences among countries. In general, quality evaluation is only applied to the pure laboratory analytical phase. Less attention is given to the pre-analytical phase (e.g. timely sampling, maximum coverage) and the post-analytical phase (follow-up and treatment, evaluation of long-term effects, cost-effectiveness, etc.). In order to gain more insight into the current situation worldwide we developed a questionnaire which was sent to leading screening centers in more than 30 countries. As expected, the results show large differences in degree of organization, turnover times, completeness of coverage and follow-up. There appears to be no relationship between screening procedures and the degree of legislation or the system of funding. In presenting the more detailed results we hope to be of service to program organizers.

99Tc(m)-MIBI scanning of the thyroid gland in patients with markedly decreased pertechnetate uptake.

Diffusely reduced 99Tc(m)-pertechnetate uptake is a relatively infrequent but annoying finding that impairs evaluation of the thyroid gland. We studied 32 female patients aged 19-85 years with markedly reduced pertechnetate uptake. The following causes of reduced pertechnetate uptake were recognized: treatment with iodinated pharmaceuticals (n = 15), suppression therapy with T4 (n = 11), subacute thyroiditis (n = 5) and massive tumour replacement (n = 1). 99Tc(m)-MIBI thyroid scintigraphy was performed within 24 h of the pertechnetate study. The results were correlated with neck ultrasound, serum TSH (n = 25) and surgical findings in patients who had been operated on. The technique identified the following conditions: normally sized thyroids (n = 4), diffuse goitres (n = 8), multinodular goitres (n = 17) and solitary thyroid nodules (n = 3). Moreover, substernal goitres were identified in nine patients. This condition was confirmed at surgery in seven patients. Ultrasonography was concordant in 29 of 32 patients in terms of thyroid size and structure, but failed to demonstrate substernal thyroid tissue. Our results suggest that 99Tc(m)-MIBI scintigraphy may contribute to the diagnosis of thyroid pathology and treatment planning in patients with diffusely decreased 99Tc(m)-pertechnetate uptake.

Are there any differences in the parathyroid response in the different types of renal osteodystrophy?

With the purpose of studying the curve of parathyroid response to variations of serum calcium during dialysis, we studied 20 patients on haemodialysis: 10 women and 10 men, with different forms of bone disease diagnosed by bone biopsy (adynamic bone disease, mild hyperparathyroidism, severe hyperparathyroidism). In all patients, we performed parathyroid stimulation by 4 h dialysis with 1 mEq/l of Ca2+ in the dialysate, and an inhibition test in another dialysis session with 4 mEq/l of Ca2+, with a 48 h interval. Ca2+ and intact parathyroid hormone (iPTH) were measured prior to dialysis and every hour subsequently, to obtain a Ca2+-iPTH for each patient. The analysis of the curves was made using Brown's four-parameter model. Stimulation and inhibition levels were similar in all groups, but basal iPTH and the response profiles obtained varied in the different histological groups. Basal, maximal and minimal iPTH were lower in adynamic forms than in the other two groups (P<0.04), and basal calcium was higher than basal calcium of severe hyperparathyroidism, expressing a basal inhibition status. In severe hyperparathyroidism, basal calcium was lower than the set-point, showing a permanent stimulation, and the slope was higher than in other groups, showing more sensitivity to serum calcium variations. The set-point of severe hyperparathyroidism was significantly higher than the set-point of mild and adynamic forms. In conclusion, the functional parathyroid study showed a different response in the different forms of renal osteodystrophy.

Can we use 99mTc-MIBI in functional studies of the parathyroid gland?

The usefulness of technetium-99m-sestamibi (99mTc-MIBI) in patients with secondary hyperparathyroidism on haemodialysis was assessed. We studied 33 patients with parathyroid scintigraphy with i.v. (99mTc-MIBI). Static images in a scintillation camera were taken at 15 and 120 min after the injection. With P x Ca<80, we performed an inhibition test with calcitriol i.v. 2 microg, three times a week, for 2 weeks. The MIBI study and assessment of intact parathyroid hormone (iPTH) were performed before (baseline study) and after inhibition. A 'focal positive study' corresponded to one or more areas of abnormal hypercaptation in relation to surrounding thyroid tissue seen in early images and persisting in later images, and a 'negative study' did not correspond to the previous image. In the baseline study, iPTH in the positive MIBI group was significantly greater than in the negative group. Eight positive MIBI patients had a bone biopsy; six corresponded to severe osteitis fibrosa and two to mild osteitis fibrosa. In the negative MIBI group, four of the six patients who had bone biopsy had mild forms of osteitis fibrosa (Fisher=0.03); the other two had low turnover forms. A positive inhibition test was defined when the basal uptake disappeared after calcitriol administration. In these patients, we observed a significant decrease of iPTH, not observed in the negative inhibition test. In 10 patients who had been parathyroidectomized, those with alpha positive basal MIBI result had a nodular parathyroid hyperplasia. We conclude that a scintigraphic parathyroid study with 99mTc-MIBI showed a good correlation with functional parathyroid status. With the same inhibition test, only some glands were inhibited, suggesting that this could be the expression of different vitamin D receptor densities in inhibited glands and/or a different kind of proliferation in those glands. This test would be of value in functional studies when a therapeutic decision must be made.

[Lipid profile in diabetic patients, according to changes in glucose control: a 2-year study]. / Esquema lipídico en pacientes diabéticos, según las variaciones del control glucídico: estudio de dos años.

Disorders of the lipoprotein metabolism in diabetic patients are of great interest because their association to the presence of atheromatosis and because cardiovascular diseases are the major cause of mortality in diabetic patients. The aim of this study was to compare the lipidic scheme of our diabetic patients according to the type of diabetes, the age of onset and the evolution over the years, and to analyze the impact of variations in the glycemic control on such lipidic scheme. In the insulin-dependent diabetes mellitus, total cholesterol, LDL, HDL and triglycerides were within the recommended values for the age of the patients. There was a significant correlation between glycemia and HbAlc and triglycerides, total cholesterol and its LDL and HDL fractions. In non-insulin-dependent diabetes mellitus, we observed average values of total cholesterol and LDL fraction higher than what is recommended for diabetic patients with the characteristics of this group. There was a significant correlation between basal glycemia, HbAlc and triglycerides, as in the insulin-dependent diabetes, although there was no correlation with total cholesterol and HDL. This absence of correlation may be due to the effect of other factors: age, inadequate dietary follow-up obesity and hyperinsulinism.

[Hip algodystrophy and pregnancy]. / Algodistrofia de cadera y embarazo.

Pregnancy is a potential cause of hip algodystrophy. Mechanical loco-regional factors, as well as other potential factors, can explain this preference for the hip. This pathology must be always kept in mind when attending a pregnant patient or a patient with inguino-crural pain and functional impotence during the postpartum.

Emotional disturbances in endocrine patients. Validity of the scaled version of the General Health Questionnaire (GHQ-28).

The 28-item General Health Questionnaire (GHQ) has been validated against the criterion of the Clinical Interview Schedule (CIS) in Spanish patients in hospital with several types of endocrinological illnesses. The screening instrument correctly identified 91 of 100 respondents as exhibiting psychiatric disorder. The questionnaire's efficacy was similar at the time of medical discharge, when the rate of disorder was significantly lower. Significant correlations were found between GHQ total scores and endocrine blood measures in Addison's disease, and in Type I diabetes. The four subscales of the GHQ sum to provide additional information concerning somatic symptoms and anxiety.

Indium-111 leukocyte imaging. The skeletal photopenic lesion.

Photon-deficient lesions in the skeleton occasionally are seen in In-111 leukocyte imaging. Although the findings usually indicate past surgery, previous infections, or radiation therapy effect, they may be due to metastatic disease or active or partially treated infection.

Clastogenic action of a dimethyl p-benzoquinone of animal origin.

The cytogenetic action of a volatile dimethyl p-benzoquinone found in the natural secretion of an arachnid (Acanthopachylus aculeatus Kirby) was studied in cultured human peripheral leukocytes and in mouse bone-marrow cells. Continuous and pulse treatments carried out in vitro, as well as experiments performed in vivo, induced different chromatid and chromosome aberrations suggesting that this chemical has clastogenic properties. The biology of the animal and the possible role of one of the components of its secretion as a natural mutagenic agent are discussed.