[Epidemiology of Paget's disease. Peculiarities in the province of Zamora]. / Epidemiología de la enfermedad de Paget. Peculiaridades en la provincia de Zamora.

BACKGROUND: Some paramyxovirus (measles, respiratory syncytial virus, and dog's distemper virus) are currently considered to be responsible for Paget's disease of the bone. A relevant role is also given to inheritance as predisposing factor. Some authors have found an association between HLA antigens with this disease, but without unanimous agreement. Although this hypothesis of an interaction between a genetic factor and a viral infectious agent is the most accepted universally, there is not yet a definitive cause for the disease. The participation of some other environmental factors has not been ruled out. METHODS: One hundred and forty patients in the Zamora province were studied. The geographic distribution in the different areas of the province was analyzed and also whether there was family aggregation all cases. HLA-I was determined in 59 patients and HLA-II in cases with aggregation. The mineral composition (calcium, fluorine, magnesium, nitrates, and chlorine) analysis of public running water was carried out in all population centers in the province. RESULTS: Aggregation was found in four families (four, two, four, and three siblings, respectively). Although HLA-I antigens were determined in 59 patients, no association was found. HLA-II antigens were also determined in the involved patients with family links and no association was found between these antigens and the disease. A much higher aggregation was found in some particular areas in our province and these foci coincided with some characteristics of mineral composition of public running waters. CONCLUSIONS: There is a genetic factor predisposing to the disease, as family aggregation occurs with a higher frequency than would otherwise be expected. Nevertheless, no association with HLA antigens was found. This disease is more common in some particular geographic areas, thus supporting the hypothesis of an environmental factor as trigger. An association was found between mineral composition of public running waters and patient geographic distribution.

[Thyrotoxic periodic paralysis in a Spanish male]. / Parálisis periódica tirotóxica en un varón español.

One of the few cases of thyrotoxic periodic paralysis in our country is reported. A twenty-one year old male patient with Graves disease for more than three years had a poor compliance with the therapeutical regimen, with mainly nightly episodes of self-limited limb weakness associated with hypokalemia. The patient has no familiar antecedents of periodic paralysis and the clinical manifestations resolved with treatment of hyperthyroidism.