Densidad mineral ósea y remodelado ósea en mujeres posmenopáusicas con cirrosis hepática vírica / Bone Mineral density an bone remodeling in postmenopausal women with liver cirrohosis with viral origin

Introducción. Se conoce que la cirrosis hepática, tanto vírica como alcohólica, provoca pérdida de masa ósea en hombres. Sin embargo, poco se conoce del efecto de la cirrosis hepática sobre la masa ósea y remodelado óseo de mujeres posmenopáusicas con cirrosis vírica. Igualmente, se desconoce si realmente empeora aún más la masa ósea, ya deteriorada, de estas mujeres. Objetivo: Nuestro objetivo fue estudiar la masa ósea, remodelado óseo y factores hormonales relacionados con el metabolismo óseo en 49 mujeres con cirrosis hepática de etiología vírica y 22 controles sanas. Resultados: La ingesta etílica era inferior a 30 g a la semana. En todas ellas, se midió la densidad mineral ósea (DMO) entre las pacientes cirróticas y controles sanas (expresadas como Z-score) en LS (-0,13±0,025 vs 0,17±1,18; p<0,3) y FN (0,15±1,17 vs. 0,01±1,10; p<0,6). Las concentraciones séricas de estradiol eran más elevadas en mujeres con cirrosis que en las sanas (11,89±15,64 ng/ml vs. 6,54±5,30 ng/ml; p<0,04), existiendo una correlación positiva entre los valores séricos de estradiol y la gravedad de la cirrosis (r=0,49; p<0,001), Además, existía una correlación inversa entre los valores séricos de FSH y DMO (r= -0,31; p<0,03) y positiva de SHBG con la DMO (r=0.48; p<0,03), e inversa entre los valores de SHBG y estradiol (r=-0,29; p<0,05). Los valores séricos de insulina eran significativamente más elevados en las pacientes cirróticas (20,94 ± 15,21 µU/ml) que en los controles (12,96 ± 10,96 µU/ml); p<0,02 y había correlación positiva entre la insulinemia y la DMO (r=0,40; p<0,02) en pacientes cirróticas.Conclusiones: Los parámetros bioquímicos de remodelado óseo mostraban alto turnover, tanto en pacientes como en controles sin diferencias entre ellas. Nuestros hallazgos muestran que las mujeres posmenopáusicas con cirrosis hepática vírica no presentan mayor pérdida de masa ósea que las mujeres posmenopáusicas sanas. A ello, parece contribuir los niveles séricos elevados de estradiol e insulina que presentan las pacientes. No hay diferencias en el remodelado óseo, que es de alto turnover, tanto en las pacientes como en los controles

Introduction: Liver cirrohosis both with viral and alcoholic origin causes bone mass loss in males. However, the effect of liver cirrohosis on bone mass and bone remodeling in postmenopausal women with liver cirrhosis with viral origin is little know. Likewise, it is not known if it worsens even more the already damaged bone mass of these women. Aim: Our aim was to study the bone mass, bone remodeling, and other hormonal factors related to bone metabolism in 29 women with liver cirrhosis of viral etiology and 22 healthy controls. Results: Alcohol consumption was below 30g/week. Bone mineral density (BMD) was measured by dual x-ray absorptiometry in the lumbar spine (LS) and the femoral week (FN) in all the patients. Significant differences in BMD were not found between cirrhotic patients and healthy controls (expressed as Z-score) in LS (-0,13±0.025 vs. 0,17±1,18; p<0.3) and FN (0,15±1.17 vs. 0.01±1.10; p<0.6). Serum estradiol concentrations were higher in the cirrohotic women than in the healthy ones (11.89±15.64 ng/ml vs. 6.54±5.30ng/ml; p<0,04), being a positive correlation between the serum estradiol values and the cirrhosis seriousness (r=0,49; p<0.001) Besides, there was an opposite correlation between the serum values of FSM and BMD (r=0.31; p<0.03); a positive correlation of SHBG and BMD (r=0,48; p<0,03); and an opposite correlation between SHBG and estradiol values (r=-0.29; p<0.05). Serum insulin values were significantly higher in the cirrohotic patients (20.94±15.21 µU/ml) than in the controls (12.06±10.96 µU/ml), (p<0.02). There was a positive correlation between insulinemia and BMD in cirrhotic patients (r=0.40; p<0.02). Conclusion: Biochemical parameters of bone remodeling showed a high turnover both in patients and controls without differences between them. Our finds show postmenopausal women with liver cirrhosis with viral origin do not have a higher bone mass loss than healthy postmenopausal women do. The high serum insulin and serum estradiol levels seem to contribute to it. There are no differences in bone remodeling, which shows a high turnover both in patients and controls

Quimioprevención del cáncer colorrectal (CCR) con antiinflamatorios no esteroides (AINES) / Chemoprevention of gastrointestinal malignancies with nonsteroidal antiinflammatory drugs

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[Endometriosis: an infrequent cause of colonic obstruction]. / Endometriosis: una causa infrecuente de obstrucción colónica.

Endometriosis localized in the intestinal wall is not an infrequent finding. Diagnosis is difficult given the diverse symptomatology presented with unspecific abdominal pain being the most common. Implantation of endometrial tissue in the intestinal wall may involve the mucosa and present as rectorhagia, with colonscopic exploration providing diagnosis by biopsy of the affected area. In other cases this may only involve the intestinal wall producing very varied symptomatology. Presentation as a picture of colon obstruction is little reported. The main problem is its difficult differential diagnosis with neoplasm which, in most cases, leads to surgery. A case of colon obstruction provoked by implantation of endometrial tissue in the wall of the sigma which was surgically resolved is herein presented.

[Abdominal pain and ascites as manifestations of hereditary angioneurotic edema]. / Dolor abdominal y ascitis como manifestaciones del edema angioneurótico hereditario.

Hereditary angioneurotic edema (HAE) is an infrequent autosomal dominant disorder characterized by a decrease in the levels or a dysfunction of the complement C1 inhibitor factor (C1 inh). The clinical presentation varies widely and involves any area of the organism. Gastrointestinal involvement is usually as abdominal pain and may be accompanied by ascites. De novo diagnosis of HAE with abdominal pain and ascites as a form of presentation is difficult with differential diagnosis with abdominal pain of unknown origin. The appearance of ascites is rare with few cases reported in the literature. Both abdominal pain and ascites disappear a few days after initiation of medical treatment. Occasionally exploratory laparotomy has been required. A new case of abdominal pain and ascites as manifestations of HAE is herein reported.