ATYPICAL FEMORAL FRACTURES AFTER LONG-TERM BISPHOSPHONATES THERAPY: CASE REPORT.

UNLABELLED: We present a 77-year-old woman with no histor of trauma, or associated with low-energy trauma, admitted to our clinic after three weeks of a left femoral fracture threated in Orthopedic Clinic. The patient was in treatment with bisphosphonates over 10 years for osteoporosis. DISCUSSION AND CONCLUSIONS: The causal re lationship between prolonged bisphosphonate use and the occurrence of atypical femora fractures (AFF) has not yet been established. For the patient at high risk of fracture, it may be beneficial to continue bisphosphonate treatment beyond five years. The absolute risk of atypical femoral fractures is low (about 100 cases per 100,000 person-years among long term users). For most people with osteoporosis, the proven fragility-fracture risk-reduction. benefits of bisphosphonates outweigh the risks of AFF.

VITAMIN D DEFICIENCY AND THE CLINICAL CONSEQUENCES.

Vitamin D is important for good health, growth and strong bones. Vitamin D is mostly made in the skin by exposure to sunlight. Most foods contain very little vitamin D naturally, though some are fortified with added vitamin D. Hypovitaminosis D is associated with cardiovascular disease, the metabolic syndrome, type 2 diabetes mellitus, cancer as well as with increased mortality. Further, Vitamin D deficiency is related to depression and impaired cognitive function. Increasing age and elevated body fat mass contribute to an increased risk of Vitamin D deficiency. A mild lack of vitamin D may not cause symptoms but can cause tiredness and general aches and pains. A more severe lack can cause s rious problems such as rickets (in children) and osteomalacia in adults). During menopause, the decline of estrogens results in increased bone turnover, a decrease in bone mineral density and elevated fracture risk. Treatment is with vitamin D supplements. Some people are more at risk of vitamin D deficiency, and so are recommended to take vitamin D supplements routinely. These include all pregnant and breastfeeding women, all infants (babies) and young children aged 6 months to 5 years, people aged 65 and over, and people who are not exposed to much sun. There are precise recommendations regarding a sufficient Vitamin D intake in order to prevent bone loss in peri- and postmenopausal women. It is also recommend routine supplements for certain people with darker skin, and for people with certain gut, liver or kidney diseases.

Thyroid fine-needle biopsy: aspiration versus capillary.

UNLABELLED: Thyroid nodules are a common pathology of the thyroid gland. Thyroid fine-needle biopsy (FNB) is a technique used as the first step in the assessment of thyroid nodules. Some au- thors have demonstrated the superiority of nonaspiration compared with aspiration biopsy. AIM: The objective was to assess whether there are significant differences between the two thyroid biopsy techniques. MATERIAL AND METHODS: The study group comprised 309 patients with thyroid nodules admitted to the Endocrinology Clinic of the Iasi "St. Spiridon "Hospital between 2005 and 2008 in which fine-needle nonaspiration or aspiration biopsy was performed. The slides were read by one pathologist. The smears were stained using the May-Grunwald-Giemsa method (MGG). The quality of smears obtained by the two sampling techniques was evaluated by using the scoring system developed by Mair. RESULTS AND DISCUSSION: No differences in smear quality between the two sampling techniques in terms of blood contamination, amount of cellular material, degree of cellular degeneration, degree of cellular trauma, and preservation of appropriate architecture were found. CONCLUSION: The results of this study show that the sensitivity and specificity of both techniques allow their use as standard screening methods for thyroid nodular lesions.

Diabetes mellitus, chronic complication in patients with acromegaly: case report and review of the literature.

UNLABELLED: Disturbances of glucose metabolism are frequently observed in patients with acromegaly. Excess amounts of GH and IGF1 interacts with metabolic regulation, and indeed, GH hypersecretion is associated with hepatic and peripheral insulin resistance; this and also other mechanisms are involved in the development of diabetes mellitus. It can quickly improve if the levels of GH decline after the therapy. CASE REPORT: We present a patientof 54 years old, admitted in the clinic in 2009, with diagnosis of acromegaly. MRI scan reveals an expansive pituitary tumor 15/16/17 mm. Values of GH, IGF1 and blood glucose were much above normal. Body mass index 27, 5 kg/m2. After 12 months of a medical treatment with somatostatin analogues, the evolution of blood parameters was favorable, but the patient has discontinued his treatment. At the hospitalization in 2012 there is a precarious control of the diabetes under oral antidiabetic agents. A new treatment has been applied: it was practiced surgical transsphenoidal ablation. At last admit, May 2014, the value IGF1 has been normal, GH has been below 1 ng/mL, and HbAlc was 5.27%. Dyslipidemic syndrome has been constantly present; the values of triglycerides and cholesterol should be a little more upper limit. CONCLUSIONS: Following successful treatment of acromegaly with surgery, glucose tolerance improves. Balancing type 2 diabetes, with return to normal HbA1c and the decrease in cholesterol and triglycerides values, represents the result of favorable normalization GH in our patients with acromegaly.

One-Year Data from a Long-Term Phase IV Study of Recombinant Human Growth Hormone in Short Children Born Small for Gestational Age.

BACKGROUND: This prospective, open-label, non-comparative, multicentre, long-term phase IV study is examining the efficacy and safety of somatropin [recombinant human growth hormone (rhGH)] in short children born small for gestational age (SGA) and its impact on the incidence of diabetes. This report is the first interim analysis of patients who have completed 1 year of treatment. METHODS: A total of 278 pre-pubertal patients were enrolled. Key eligibility criteria included height standard deviation score (HSDS) <-2.5; parental adjusted SDS <-1; birth weight and/or length <-2 SD and failure to show catch-up growth by ≥4 years of age. Patients were treated with rhGH 0.035 mg/kg/day. The primary objective was to evaluate the long-term effect of rhGH on carbohydrate metabolism [including fasting glucose, stimulated glucose (2-h oral glucose tolerance test, OGTT) and glycated haemoglobin (HbA1c)]. Secondary objectives included evaluation of height parameters [body height, HSDS, height velocity (HV), HVSDS]; insulin-like growth factor 1 (IGF-I) and insulin-like growth factor-binding protein 3 (IGFBP-3) serum levels during treatment; and incidence and severity of adverse events (AEs). RESULTS: None of the children developed diabetes mellitus within the first year of treatment. Mean levels of fasting glucose, HbA1c and 2-h OGTT values remained stable during the study period. Treatment with rhGH was effective, as documented by all height parameters. Mean HSDS improved from -3.39 at baseline to -2.57 at Year 1. Mean HV increased markedly from 4.25 cm/year at baseline to 8.99 cm/year during the first year. Similarly, mean peak-centred HVSDS increased from -2.13 at baseline to +4.16 at Year 1. Mean IGF-I SDS and IGFBP-3 SDS also increased within the first year (by +1.80 and +0.41, respectively). 13 patients (4.7%) did not respond adequately to treatment (HVSDS <1); they were withdrawn from the study. In total, 192 children (69.3%) experienced treatment-emergent AEs; most (98.7%) were mild-to-moderate, and the majority (96.5%) were unrelated to study treatment. CONCLUSION: This interim analysis shows that short children born SGA can be effectively and safely treated with rhGH and that rhGH treatment has no major impact on carbohydrate metabolism after the first year of treatment.

Epidemiology and histology of malignant thyroid nodules in North East Region of Romania (Moldavia) before and after alimentary salt universal iodination.

UNLABELLED: Research on the relationship between iodine exposure and thyroid cancer risk is limited and the findings are inconclusive. OBJECTIVES: Given this molecular data on iodine we decided to evaluate the changes of incidence and histology of thyroid cancer in the North-Eastern region of Romania (Moldavia) after the government decision from 2004 that introduced the universal iodination of alimentary salt. After this decision values of urinary iodine increased from 50 microg/L (2001-2002) to 117 microg/L (2006 -2008). MATERIAL AND METHODS: We compared the incidence and the histology of thyroid cancer in residents living in an area known as a mild endemic goiter region (Moldavia-Romania) between 2001-2004 with the incidence and the histology of thyroid cancer between 2005-2008 in the same region after the introduction of universal iodization of alimentary salt. RESULTS: The number of papillary cancers increased from 125 cases (2001-2004) to 276 cases (2005-2008). The number of follicular cancer decreased from 52 cases (2001-2004) to 27 cases (2005-2008). The ratio between papillary and follicular cancers increased from 4.80 / 1 (2001-2004) at 10.61 / 1 (2005-2008). The number of medullar thyroid carcinoma increased from six cases (2001-2004) to 24 cases (2005-2008). Thyroid anaplastic carcinomas number increased from 7 cases (2001-2004) to 12 cases (2005-2008). The total number of thyroid cancer has increased dramatically after the introduction of universal iodination of alimentary salt with 178% compared to 2001-2004 (from 190 cases in 2001-2004 to 339 cases in 2005-2008), despite the fact that the number thyroidectomies decreased from 1734 (2001-2004) to 1449 (2005-2008). CONCLUSION: After the introduction the universal iodination of alimentary salt starting from 2004 the total number of thyroid cancers increased comparative with the period before universal iodination of alimentary salt.

[Clinical profile of thyroid nodules in Iasi, Department of Endocrinology, St. Spiridon Hospital, between 2005-2009]. / Profilul clinic al nodulilor tiroidieni in Clinica de Endocrinologie a spitalului "Sf. Spiridon" Iasi in perioada 2005-2009.

UNLABELLED: Thyroid nodules are common, with up to 50% of the adult population having palpable nodules. With the use of ultrasound, up to 10 times more nodules are likely to be detected. Given this we decided to evaluate by retrospective study the incidence of thyroid nodule in the North-Eastern Region of Romania (Moldavia) between 2005-2009. MATERIAL AND METHOD: We reviewed the records of patients admitted in the Department of Endocrinology, St. Spiridon Hospital Iasi between 1.01.2005-31.12. 2009 (4712 patients) and with selected the cases with nodular goiter. RESULTS: A total of 3105 cases of nodular goiter were identified. The women were most affected and highest prevalence was noticed for the patients with ages between 51-60 years. Most of the nodules were found in the right thyroidian lobe and the majority of the patients were euthyroid . The peak of incidence of nodular hyperthyroidism was different from that of diffuse hyperthyroidism. CONCLUSIONS: Thyroid nodules are the most common endocrine problem and the increasingly frequent detection of nonpalpable thyroid nodules in asymptomatic patients requires new approaches for their management.

[Postmenopausal osteoporosis. Digital Rx radiogrammetry in the diagnosis and follow-up of treatment with alfacalcidol]. / Osteoporoza de postmenopauza. Radiogrammetria Rx digitala (DXR) în diagnosticul si urmarirea tratamentului cu alfacalcidol.

Postmenopausal osteoporosis is characterised by an increased resorption of trabecular bone, a consequence of estrogen deficit. Changes in vitamin D metabolism are also an important contributors to the development of osteoporosis in postmenopausal women. Vitamin D and its active metabolites (Alfacalcidol, Calcitriol) perform important functions in regulation of the calcium balance and the bone metabolism. Aim of our study was to determine the efficacy of Alfacalcidol (Alpha D3) in reducing the loss of bone mass. 391 postmenopausal women with osteopenia and 165 postmenopausal women with osteoporosis were treated 24 months with Alfacalcidol. The bone mineral density (BMD) was measured by Digital Rx Radiogrammetry (DXR). In osteopenic women treated with 0.5 mg Alfacalcidol, bone mineral density increased after 12 and 24 months with 3.4% and 2.3%. In osteoporotic women the increase of BMD was 1.8% and 2.4% after 12 and respectively 24 months. On the control group BMD decreased with 3.4% after 24 months. In our study Alfacalcidol confirmed the abolishment of the loss of bone mass.

[Lipids profile in a group of hypothyroid patients vs. treated hypothyroid patients]. / Variatia profilului lipidic la un grup de hipotiroidieni vs. hipotiroidieni tratati.

UNLABELLED: Hypothyroidism, like obesity, is one of the pathological conditions most frequently associated to disorders of the lipid metabolism. Hypercholesterolemia is favored, due to the hormone deficit and to the decreased activity of the lipoprotein lipase. MATERIALS AND METHOD: We observed the determination of the serum concentrations of TSH, of the total cholesterol level, of the triglycerides, HDL, LDL, VLDL and BMI as well. RESULTS AND DISCUSSIONS: We observed the predominance of the female hypothyroid patients, ages 40 through 60 and BMI > 30kg/m2. The presence of the heart condition in the studied group was the predominance of the cases of ischemic heart disease. The cholesterol levels varied depending on the TSH levels. There are multiple mechanisms of the dyslipemic syndrome, its intensity depending on the degree of the thyroid insufficiency, however, not influenced being by its cause. It can be considered an indicator of the disease evolution or of the efficiency of the substitution treatment strategy. The absence of the total normalization of the lipid metabolism, under the conditions of a correct treatment strategy, may raise suspicions regarding a possible associated primitive hyperlipidemia, who need typical therapy.

[Normal bone mineral content levels determined by quantitative computer tomography (QCT) in the population of Moldavia]. / Valorile normale ale continutului mineral osos determinate prin computertomografie cantitativa (QCT) la populatia din Moldova.

UNLABELLED: To determine by QCT-BMD the normal osteodensitometric levels in the population of both sexes (18-80 years) from Moldavia districts. MATERIAL AND METHOD: The study used the BMD (bone mineral density) option of CT PACE GE-CGR (QCT) device which compares the CT levels in the area of interest restricted to the trabecular area of L1-L4 vertebrae with the values of a phantom with different hydroxyapatite concentrations. In order to develop a regional standard, an average of 10 both sexes subjects free of osteoporosis-generating diseases were investigated per each 5-year age group, age range 18 to 80 years, selected at random from the 8 districts of Moldavia. In both genders, data were plotted against age and were analysed with linear regression tests and the evolution curve (age-related) for each gender was drawn. RESULTS: The levels of score Z in both sexes were obtained. The obtained standard may be used as a reference database for the QCT investigation of the spine both in the male and female Romanian population.