Pharmacological osteonecrosis in maxillofacial surgery, period 2013-2019 / Osteonecrosis farmacológica en cirugía maxilofacial, periodo 2013-2019

Introduction: The word osteonecrosis (ONC) means "dead bone"; it is a bone disease secondary to the loss of blood supply to the bone, causing its collapse and subsequent death. It can occur in any bone in the body, including those of the maxillofacial region, it is more common in the jaw. In recent years, the relationship of ONC with drugs such as bisphosphonates, antiresorptive, steroids for prolonged use, angiogenesis inhibitor agents, among others, has been found. However, despite the studies carried out by various authors, ONC continues to be an underdiagnosed entity with variable management and treatment, which is why the inte­rest of this research arises with the main objective of reporting the cases of patients diagnosed with Pharmacological ONC. Material and method: A descriptive, retrospective, cross-sectional, observational study was carried out for approximately 6 years (January 1, 2013 - December 31, 2019), in the Maxillofacial Surgery service of the Specialty Hospital, of National Medical Center, "Siglo XXI", IMSS. Making a review of clinical records, collecting clinical and image controls, reporting the number of cases and the management of patients with ONC, as well as the number of cases of ONC that were related to drugs. Of 9 patients with a diagnosis of osteonecrosis (ONC), only 4 patients were Pharmacological ONC, from the Maxillofacial Surgery service. Results: From a universe of 9 patients with ONC, 4 representative cases of patients with pharmacological ONC were presented, with management based on the protocol used in the Maxillofacial Surgery service of the National Medical Center "Siglo XXI", IMSS; Likewise, the signs and symptoms with which the treatment was staged and determined are shown.(AU)

Introducción: La palabra osteonecrosis (ONC) significa "hueso muerto". Es una patología ósea secundaria a la pérdida de suministro de sangre al hueso, provocando su colapso y su posterior muerte. Puede presentarse en cualquier hueso del cuerpo, incluyendo los de la región maxilofacial; es más frecuente en la mandíbula. En los últimos años se ha encontrado la relación de la ONC con medicamentos tales como bifosfonatos, antirresortivos, esteroides por uso prolongado, agentes inhibidores de angiogénesis, entre otros. Sin embargo, pese a los estudios realizados por diversos autores, la ONC continúa siendo una entidad subdiagnosticada y con manejo y tratamiento variable; es por ello que surge el interés de esta investigación con el principal objetivo de reportar los casos de pacientes diagnosticados con ONC farmacológica. Material y método: Se realizó un estudio descriptivo, retrospectivo, transversal, observacional, durante aproximadamente 6 años (1 de enero de 2013- 31 de diciembre de 2019), en el servicio de Cirugía Maxilofacial del Hospital de Especialidades, del Centro Médico Nacional, Siglo XXI, IMSS. Haciendo una revisión de expedientes clínicos, recabando controles clínicos y de imagen, reportando el número de casos y el manejo de pacientes con ONC, así como el número de casos de ONC que estuvieron relacionados a fármacos. Se obtuvo una muestra de 9 pacientes con diagnóstico de osteonecrosis (ONC) en el Servicio de Cirugía Maxilofacial. Resultados: No se encontró predominio por algun género en específico, la edad promedio fue de 63,44 años, aproximadamente el 50 % de la muestra obtenida fueron pacientes diagnosticados con ONC farmacológica, de los cuales solo uno estuvo asociado a denosumab y 3 fueron ONC relacionada con bifosfonatos.(AU)

Efecto de la fragilidad y la sarcopenia sobre el riesgo de caídas y de fracturas osteoporóticas en población no seleccionada / Effect of frailty and sarcopenia on the risk of falls and osteoporotic fractures in an unselected population

OBJETIVOS: Valorar si la fuerza de agarre y la dificultad para realizar actividades cotidianas podrían ser predictores de caídas y fracturas osteoporóticas. MATERIAL Y MÉTODOS: Se seleccionaron aleatoriamente 624 hombres y mujeres mayores de 50 años, que fueron seguidos durante 8 años para conocer la incidencia de caídas y fracturas osteoporóticas no vertebrales. Al inicio se midió la fuerza de agarre en manos y se cumplimentó un cuestionario con variables clínicas, factores de riesgo relacionados con la osteoporosis y cuestiones relativas a la dificultad o incapacidad para realizar actividades cotidianas. RESULTADOS: La fuerza de agarre en manos no se asoció con la incidencia de caídas y fracturas. Sin embargo, la imposibilidad o dificultad de "estar sentado más de 1 hora en silla dura", "quitarse los calcetines o las medias" e "inclinarse desde una silla para coger un objeto del suelo" se asoció con caídas: 1,83 (1,16-2,89); 1,85 (1,14-3,00) y 1,68 (1,04-2,70), respectivamente. Del mismo modo, la imposibilidad o dificultad de "llevar durante 10 metros un objeto de 10 kilos" y "levantar una caja con 6 botellas y ponerlas sobre una mesa" se asoció con fractura: 2,82 (1,21-6,59) y 2,54 (1,12-5,81) respectivamente. CONCLUSIONES: No se encontró asociación entre la fuerza de agarre e incidencia de caídas y fracturas osteporóticas, pero sí con dificultad o incapacidad para realizar actividades cotidianas. Las relacionadas con mayor fuerza se asociaron con fractura, mientras que las relacionadas con capacidad funcional se asociaron con caídas. Realizar cuestionarios sencillos podría ayudar a predecir eventos antes de que ocurran

OBJECTIVE: Assess whether grip strength and difficulty in carrying out daily activities could be predictors of falls and osteoporotic fractures. MATERIAL AND METHODS: 624 men and women over 50 years of age were randomly selected and followed for 8 years to determine the incidence of falls and non-vertebral osteoporotic fractures. At the beginning, the grip strength in the hands was measured and a questionnaire was filled out with clinical variables, risk factors related to osteoporosis, and questions related to difficulty or inability to perform daily activities. RESULTS: Grip strength in the hands was not associated with the incidence of falls and fractures. However, the impossibility or difficulty of "sitting for more than 1 hour in a hard chair", "taking off socks or stockings" and "leaning from a chair to pick up an object from the floor" were associated with falls: 1.83 (1.16-2.89); 1.85 (1.14-3.00) and 1.68 (1.04-2.70), respectively. Similarly, the impossibility or difficulty of "carrying a 10-kilogram object for 10 meters" and "lifting a box with 6 bottles and putting them on a table" was associated with fracture: 2.82 (1.21-6.59) and 2.54 (1.12-5.81) respectively. CONCLUSIONS: No association was found between grip strength and incidence of falls and osteoporotic fractures, but it was found with difficulty or inability to perform daily activities. Those related to greater strength were associated with fracture, while those related to functional capacity were associated with falls. Taking simple questionnaires could help predict events before they happen

Niveles de calcidiol y mantenimiento de la función muscular, capacidad funcional y densidad mineral ósea en población española no seleccionada / Calcidiol levels and muscle function maintenance, functional capacityand bone mineral bone density in non-selected Spanish population

Introducción: La vitamina D posee efectos beneficiosos que supuestamente contribuirian a mantener la funcion musculo‐esqueletica. Objetivo: Analizar en una poblacion no seleccionada el efecto de los niveles de calcidiol sobre la funcion muscular en ambas manos, sobre actividades de la vida cotidiana y sobre los cambios en la densidad mineral osea (DMO). Material y métodos: Se utilizo la cohorte del estudio EVOS que realizo, entre otros, medidas de fuerza muscular de agarre en ambas manos, preguntas relativas a la dificultad para realizar actividades cotidianas, estudio densitometrico en columna lumbar y cadera, y bioquimica para determinar los niveles de calcidiol. Resultados: Valores de calcidiol ≥20 ng/mL se asociaron con mayor fuerza muscular de agarre en ambas manos. Tras ajuste por edad, sexo, IMC y estacionalidad, niveles de calcidiol <20 ng/mL se asociaron independientemente con menor fuerza muscular de agarre solo en la mano izquierda (OR=2,35; IC 95%: 1,03‐5,38). Del mismo modo, la incapacidad o tener dificultades para "coger un libro u objeto de una estanteria alta" e "incorporarse de la cama" se asociaron significativamente con niveles de calcidiol <20 ng/mL. Niveles de calcidiol <20 ng/mL se asociaron con mayores perdidas de DMO en cuello femoral y cadera total. Estas asociaciones se mantuvieron en el analisis multivariante. Conclusiones: Mantener niveles de calcidiol ≥20 ng/mL se asociaron con mayor fuerza muscular de agarre en las manos, mantenimiento de actividades cotidianas y menores perdidas de DMO en cadera. Este estudio corrobora la utilidad de mantener niveles adecuados de vitamina D para mantener la funcion musculo‐esqueletica

Introduction:Vitamin D offers beneficial effects that reportedly help maintain musculoskeletal function. Aim:To analyze the effect of calcidiol levels on muscle function in both hands, on activities of daily life and on changesin bone mineral density (BMD) in an unselected population.Material and methods:The EVOS study cohort was used, which carried out, among others, measures of muscularstrength of grip in both hands, questions related to difficulty in performing daily activities, densitometric study in thelumbar and hip spine, and biochemistry to determine the levels of calcidiol.Results: Calcidiol values ≥20 ng/mL were associated with greater grip strength in both hands. After adjusting for age,sex, BMI and seasonality, calcidiol levels <20 ng/mL were independently associated with lower grip strength only inthe left hand (OR=2.35; 95% CI: 1.03‐5.38). Likewise, the inability or difficulty to "pick up a book or object from a highshelf" and "get up from the bed" were significantly associated with calcidiol levels <20 ng/mL. Levels of calcidiol <20ng/mL were associated with greater BMD losses in the femoral neck and total hip. These associations were maintainedin the multivariate analysis.Conclusions:Maintaining levels of calcidiol ≥20 ng/mL was associated with greater muscular strength of grip in thehands, maintenance of daily activities and lower BMD losses in the hip. This study corroborates the utility of maintainingadequate levels of vitamin D to maintain musculoskeletal function

Clinical utility of an ultrasensitive thyroglobulin assay in the follow-up of patients with differentiated thyroid cancer: can the stimulation test be avoided in patients with an intermediate recurrence risk?

SUMMARY: Serum thyroglobulin (Tg) measurement during suppression with levothyroxine (LT4) using an ultrasensitive assay (OnT4-Tg) has been proposed as a replacement of TSH-stimulated Tg measurement (OffT4-Tg) in management of patients with differentiated thyroid cancer (DTC). The aim of this study is to evaluate the capacity of an ultrasensitive Tg assay in predicting an OffT4-Tg > 2.0 ng/mL based on the OnT4-Tg in patients with DTC and an intermediate recurrence risk. We analysed 101 patients with DTC and an intermediate (n = 92) or high risk of recurrence (n = 9) who were treated with total thyroidectomy and ablation with 131I, and followed for an average of 6 years. OnT4-Tg was undetectable in 64 of 101 patients; OffT4-Tg was #x003C; 2.0 ng/mL in 61 of these 64 patients, all with negative imaging results. Furthermore, 37 of 101 patients had detectable OnT4-Tg; 32 of these 37 patients also presented OffT4-Tg > 2.0 ng/mL, and only 3 of these 32 patients had metastases detected by neck ultrasound. Considering a cutoff point of 0.1 ng/mL for OnT4-Tg, the assay had a sensitivity of 91%, specificity of 92%, positive predictive value (PPV) of 86% and the negative predictive value (NPV) of 95% when predicting an OffT4-Tg > 2.0 ng/mL (biochemical disease). The use of an ultrasensitive Tg assay allows prediction of which patients will remain disease-free even if they are at an intermediate risk of recurrence, and to decrease the need for stimulated Tg assays in two-thirds of these patients.

Correlación entre Actividades de Interacción Social Registradas con Nuevas Tecnologías y el grado de Aislamiento Social en los Adultos Mayores / The Correlation Among Social Interaction Activities Registered Through New Technologies and Elderly's Social Isolation Level

El Aislamiento Social es un problema que se acentúa en la etapa de la vejez, poniendo en riesgo la integridad física y mental de los adultos mayores. Para mitigar este problema, se han desarrollado trabajos computacionales que fomentan la socialización a través de actividades de interacción social basadas en la comunicación y movilidad del adulto mayor. Sin embargo, son escasos los trabajos que proveen evidencia estadística acerca del impacto de las actividades de interacción social con el grado de aislamiento social. Por lo tanto, el objetivo de este trabajo de investigación consiste en identificar actividades de interacción social que tienen relación estadísticamente significativa con el grado de aislamiento social. Los resultados indican que, las actividades de interacción social basadas en las llamadas telefónicas a través del teléfono móvil tienen una correlación inversa con el grado de riesgo de aislamiento social. En contraste, las actividades de interacción social basadas en el tiempo de permanencia dentro del hogar tienen una correlación directa. A partir de las actividades identificadas es posible desarrollar sistemas de cómputo capaces de proveer advertencias oportunas de aislamiento social en los adultos mayores. Con estas advertencias oportunas e intervenciones adecuadas es posible reducir el riesgo de padecer depresión, deterioro cognitivo o el empobrecimiento de la red social, mejorando así, la calidad de vida de los adultos mayores.

Social isolation is a condition that endangers the physical and mental integrity of the elderly. To mitigate this problem, there are computational approaches that encourage socialization through social interaction activities based on elderly's communication and mobility. However, few studies provide statistical evidence about the influence of the social interaction activities with the elderly's social isolation level. Therefore, the goal of this research work is to identify social interaction activities that have statistically significant association with elderly?s social isolation level. The results indicate that the social interaction activities based phone calls through the mobile phone have an inverse correlation with social isolation level. In contrast, the social interaction activities based on the time spent inside home have a direct correlation. From the identified activities, it is possible to develop computer systems capable of providing timely warnings of social isolation in older adults. This early warnings and appropriate interventions can reduce the risk of depression, cognitive impairment or impoverishment of the social network, thus improving the quality of life of elderly.

The impact of vitamin D levels on glycemic control and bone mineral density in postmenopausal women with type 2 diabetes.

OBJECTIVES: Whether glycemic control contributes to a decreased number of fractures or favorably impacts bone density in patients with type 2 diabetes mellitus (T2DM)has not been well established. Vitamin D (25 (OH) D3) deficiency appears to be related to glycemic control in patients with T2DM. The aim of this study was to determine the relationship between 25 (OH) D3 levels, glycemic control, bone mineral density (BMD), and the development of osteoporotic fractures (OPF) in postmenopausal women with T2DM. METHODS: We reviewed the charts of 110 postmenopausal women diagnosed with T2DM. Glycosylated hemoglobin A1c (HbA1c) values over the previous 5 years were recorded and an average was obtained. Based on these values,the patients were divided into three groups: optimal,suboptimal, and poor control. Bone mineral density and 25(OH) D3 levels were also recorded. RESULTS: In the group of patients with poorly controlled T2DM, 25 (OH) D3 levels were not significantly lower in comparison with the optimal control group 19.29 ± 7.70 vs 17.26 ± 6.93 (p = 0.53). No statistically significant linear relationship between HbA1c and 25 (OH) D3 levels( r(s) = −0.17, p = 0.06) was established. The frequency of osteoporosis and osteopenia was not significantly different between groups. The group with optimal glycemic control had an increased number of OPF events (p = 0.04). CONCLUSIONS: We do not appreciate a significant relationship between 25 (OH) D3 levels and glucose control or OPF. Therefore, more studies are needed to identify the specific effect of 25 (OH) D3 in T2DM physiopathology.

Caso clínico: varón de 47 años con dolor cervical de dos meses de evolución / Case report: a 47 year old male with cervical pain

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Determinants of incidence of osteoporotic fractures in the female Spanish population older than 50.

It is well known that the adoption of preventive measures for osteoporosis may contribute to minimizing its impact as a result of bone fractures. However, there are well-recognized risk factors involved in the onset of osteoporosis that are not possible to modify. Better knowledge of these non-modifiable factors could aid prevention in subjects at high risk of fractures. The aim of this study was to evaluate the likely association between gynecological, reproductive and family history of hip fracture with the incidence of vertebral and nonvertebral osteoporotic fractures in women older than 50. We studied 255 women aged 50 and over, randomly selected from a Spanish population that had participated in a study of prevalence of vertebral fractures (EVOS study). This cohort was prospectively followed for 8 years by means of four postal questionnaires, in order to find out the incidence of nonvertebral fractures. Concerning the incidence of vertebral fractures, participants were invited to repeat the lumbar spine X-rays 4 years after the initial study. A total of 31 women had incident osteoporotic fractures. The analysis of gynecological variables showed that an increase in the age at menarche was a risk factor for all incident osteoporotic fractures [OR=1.57 (1.04-2.37)]. The presence of amenorrhea at any age during the fertile period was associated with higher incidence of all osteoporotic fractures [OR=6.30 (1.61-24.70)]. Among all the reproductive variables analyzed (pregnancy, number of live births and breast-feeding) only pregnancy was an important protective factor in preventing incident Colles fracture [OR=0.15 (0.03-0.62)]. A family history of hip fracture was associated with a higher incidence of all osteoporotic fractures [OR=3.59 (1.01-12.79)]. In summary, a late age at menarche, the presence of amenorrhea and having close relatives with hip fracture were all risk factors which, independently of bone mineral density (BMD) and age, were associated with higher incidence of all osteoporotic fractures. Pregnancy was an important protective factor for the incidence of Colles fractures.

Prevalence of osteoporosis in men and determinants of changes in bone mass in a non-selected Spanish population.

Osteoporotic studies conducted exclusively in men have been limited by the discrepancies in defining densitometric osteoporosis and, also, because osteoporosis has traditionally been associated only with women. The aims of this study were to describe the prevalence of low bone mineral density (BMD) and osteoporotic fractures as well as the rate of bone loss. The analysis of some risk factors for accelerated bone loss was also evaluated. Men aged 50 years and over, randomly selected from the Oviedo municipal register (n = 308), completed a questionnaire regarding risk factors related to osteoporosis; they underwent two lateral radiographs of the dorsal and lumbar spine and a dual X-ray absorptiometry (DXA) study at the lumbar spine and hip. In the 4th year of the follow-up period, participants were invited to undergo repeats of the same tests that had been carried out in the initial study. The prevalence of densitometric osteoporosis in men older than 50 years, standardized by age, was 8.1% with regard to at least one of the four studied bone areas, with a slight increase with age. The prevalence of osteoporotic fracture, standardized by age, was 24.4%, with a marked increase with age. Osteoporotic prevalent fracture was independently associated only with the rate of change in lumbar spine BMD. From all the osteoporotic risk factors analyzed, only low milk consumption and regular smoking were independently associated with loss of bone mass. In summary, prevalent osteoporotic fracture was independently associated with the rate of change in the lumbar spine BMD but not in the other segments studied. Avoiding smoking and ensuring an adequate milk intake might prevent the loss of bone mass in men.

Hormonal replacement therapy in an animal model with chronic renal failure and ovariectomy: biochemical and densitometric study.

BACKGROUND: In spite of estrogen replacement therapy being extensively used in clinical and experimental studies without renal impairment, there are no long-term studies concerning estrogen replacement in chronic renal failure. METHODS: In this experimental study, six groups of nephrectomized and ovariectomized animals were treated with different doses of 17beta-estradiol, alone or in combination with calcitriol, to evaluate the effect of these treatments on bone metabolism. RESULTS: Biochemical results showed that estrogen alone did not have any effect neither on calcium nor on PTH serum levels. By contrast, in the groups treated with calcitriol, the levels of serum calcium were significantly higher, and the levels of iPTH were significantly lower than those observed in the control group. Animals receiving the combined treatment with estrogen and calcitriol showed the greater gain in uterus weight and a better bone mineral density at the lumbar site and the proximal and distal tibia sites. CONCLUSION: The combination of estrogen and calcitriol is the most effective therapy to prevent bone mass loss in animals with chronic renal failure and estrogen deprivation.

The effect of vertebral fracture as a risk factor for osteoporotic fracture and mortality in a Spanish population.

There is little data concerning the morbidity, mortality, and epidemiology of vertebral fracture. The aim of this study was to evaluate the effect of prevalent and incident vertebral fractures as risk factors for further osteoporotic fractures and mortality. The study was performed on a cohort of 316 women and 308 men older than 50 belonging to the EVOS study, randomly selected from our city register. At the beginning of the study and 4 years later, lateral dorsal and lumbar X-rays were performed. In addition, evaluation of the incidence of osteoporotic nonvertebral fractures was performed throughout 8 years. The incidence of all osteoporotic fractures was higher in women than in men (two-fold increase in vertebral fracture incidence and five-fold increase in Colles' and femur incidence). Vertebral fracture was a strong risk factor for a new vertebral fracture [RR=4.7 (1.8-11.9)], hip fracture [RR=6.7 (2.0-22.7)] and Colles' fracture [RR=3.0 (1.1-7.8)]. Prevalent and incident vertebral fractures were associated with a higher risk of having a hip fracture [RR=10.0 (2.0-50.2)] and Colles' fracture [RR=5.5 (1.3-23.4)]. In addition, in women, the vertebral fracture was associated with a higher mortality. By contrast, no association was found in men. These results demonstrate the association between a previous vertebral fracture with increments in the incidence of osteoporotic fractures of any type. In addition, we found a significantly higher mortality rate in women having vertebral fractures. These findings support the necessity of preventing the occurrence of vertebral fractures to limit their strong negative impact on mortality.

[Role of tumor necrosis factor alpha in atherosclerosis]. / Participación del factor de necrosis tumoral-alpha en la aterosclerosis.

We describe tumour necrosis factor alpha and its role in the development of the atherosclerotic lesion, and detail the effects of this cytokine upon vascular endothelial cells under normal and high risk conditions. We propose that TNF-alpha performs a central role in the progression of the lesion since, once the endothelial cell feedback regulatory mechanisms are altered, there is an increase in the microenvironment TNF-alpha concentration, which together with some of the already well known risk factors, generates an environment that favours and perpetuates the development of the atheromatous lesion.

[Hyperhomocysteinemia. A new coronary risk factor]. / Hiperhomocisteinemia. Un nuevo factor de riesgo coronario.

Cardiovascular disease is the leading cause of mortality in Mexico, as well as in other Western countries. Conventional risk factors for atherosclerosis, such as cigarette smoking, systemic hypertension, diabetes mellitus, and hypercholesterolemia, do not explain this association completely. Recently, it has been recognized that hyperhomocysteinemia contributes to the atherosclerotic process, promoting endothelial damage and oxidative stress in the vascular wall. Homocysteine, an amino acid generated under physiologic conditions after ingestion of protein-rich foods, is used in a variety of metabolic pathways. Elevated plasma levels of this amino acid (higher than 15 mmol/L or lower in the presence of other cardiovascular risk factors) promote the development of atherosclerosis. Folic acid and vitamin B6 and B12 supplements decrease plasma levels of homocysteine effectively and may play an important role in the prevention and treatment of atherosclerotic vascular disease.

[Effect of vertebral fracture on health related quality of life in a Spanish population older than 54 years]. / Efecto de la fractura vertebral sobre la calidad de vida relacionada con la salud en población asturiana mayor de 54 años.

BACKGROUND: Effect of vertebral fracture on the perceived health using the SF-36 Health Questionnaire in a representative population older than 54 years. SUBJECTS AND METHOD: Randomly cohort from the register of the city Hall of Oviedo. All the 299 subjects (147 men and 152 women) completed the traduced and validated Spanish SF-36 questionnaire four years after radiologic studies were performed to evaluate prevalent vertebral fractures. RESULTS: Vertebral fracture decreased the health related quality of life, particularly in physical function dimension in males and in mental health dimension in women. This effect was increased when osteopenia was present. CONCLUSIONS: This first study performed in both sexes shows worse perceived health in people with fractures.

[Prevalence of vertebral fracture in population older than 50 years in Asturias (Spain) defined following different radiological criteria]. / Prevalencia de fractura vertebral en población asturiana mayor de 50 años de acuerdo con diferentes criterios radiológicos.

BACKGROUND: In spite of vertebral fracture is one of the most frequent osteoporotic fracture, the epidemiology of this entity remains unknown. The aim of this study was to know the prevalence of vertebral fracture in Oviedo (Spain), according to the most used radiologic criteria in research. SUBJECTS AND METHODS: A random sample of 624 men and women older than 50 years from the Oviedo's municipality took part in this analysis. All participants performed two thoracic and lumbar spinal lateral radiographs. In 615 subjects the presence of vertebral fracture was performed using a semicuantitative radiological criteria (Genant) and two morphometric criteria (Eastell and McCloskey). RESULTS: Prevalence of vertebral fracture varies between 17.4 and 24.6%, according to the radiological criteria used. The prevalence was higher in women than in men, but the differences were lower than expected, and there was a relative high frequency of vertebral fractures in men from 50 to 65 years old. In both sexes, prevalence of vertebral fracture increased with age, although in a steeper manner in women. The incidence of vertebral fracture in women was almost twice than in men. The incidence increased with age. Every ten years the prevalence of vertebral fracture increased two times. CONCLUSIONS: Prevalence of vertebral fracture was high in women and men older than 50 years, mainly in women older than 70 years, independently of the radiological criteria used. The average prevalence of vertebral fracture in Oviedo (Spain) has been similar to that observed in studies of American, European and Asian populations.

Evidence of a linkage between neurocardiogenic dysfunction and reactive hypoglycemia.

OBJECTIVE: Reactive hypoglycemia is a common medical problem whose pathophysiology is not completely understood. The objective of this study was to investigate the prevalence of autonomic nervous system abnormalities in patients with reactive hypoglycemia compared with controls. METHODS: Six women, mean age 31 +/- 5 years, with reactive hypoglycemia, and 5 healthy controls women aged 24 +/- 4 years were studied. We investigated the heart rate variability and blood pressure changes after an upright tilt with and without an isoproterenol infusion. A positive result was defined as syncope or presyncope associated with bradycardia, hypotension or both. RESULTS: In response to the orthostatic stress alone or in conjunction with a 4 micrograms isoproterenol infusion, 5 of 6 patients had a positive test as did one of the five control subjects. Patients had a baseline hyperadrenergic tone, with a sympathetic to parasympathetic ratio of 2.3 +/- 0.8 under basal conditions and 10.1 +/- 4.1 during the isoproterenol infusion, compared to 0.7 +/- 0.3 (p = 0.06) and 0.5 +/- 0.1 (p < 0.01) respectively, in the control group. CONCLUSION: Patients with reactive hypoglycemia may be at the extreme end of a spectrum of normal biologic variability, they may have an hyperadrenergic tone and, after a provocative stimulus, sympathetic nerve firing and or synaptic release of NE may not be sufficient to maintain an adequate vascular tone. Alternatively, the vascular response to NE may be impaired. An excessive and paradoxic vasovagal or parasympathetic response was not observed.

[Study of incidence of osteoporotic fractures in a cohort of individuals older than 50 years from Asturias, Spain, after a 6 year follow-up period]. / Estudio de incidencia de fracturas osteoporóticas en una cohorte mayor de 50 años durante un período de 6 años de seguimiento.

BACKGROUND: The present work, performed as follow-up of the prevalence study of vertebral fractures (EVOS Study), evaluates in a 6 year period the incidence of vertebral fractures and other osteoporotic fractures in Oviedo (Asturias, Spain) in people older than 50 years. SUBJECTS AND METHODS: The study was performed in a cohort from the Oviedo's local registry in 1986. 624 men and women were followed by 3 postal questionnaires. The first questionnaire referred to the history of falls and fractures that happened during the follow-up period performed. Between the 2nd and 3rd follow-up subjects were invited to repeat the X-rays previously performed in the initial study. RESULTS: The incidence of osteoporotic fractures was higher in women than in men. In both sexes, vertebral fracture was the one which reached the highest incidence. Compared with men, Colles' fracture in women occurred earlier, with 5 times higher incidence. The incidence of hip fracture was twice higher in women than in men. A prevalent vertebral fractures increased until 5 times the incidence of vertebral and hip fracture. CONCLUSIONS: Among the osteoporotic fractures, vertebral fracture had a highest incidence values in both sexes. Although vertebral and hip fractures were twice incident in women compared with men, the incidence of Colles fracture was five times higher in women. A pre-existing vertebral fracture is an important risk factor to develop a new vertebral or hip fracture.

[The surgical treatment of cardiac myxomas: 10 years of experience]. / Tratamiento quirúrgico de mixomas cardíacos: experiencia de 10 años.

Over a ten-year period (September 1980-July 1990) 3172 patients underwent open heart surgery in our hospital. Twenty five patients (0.78%) had a cardiac myxoma. There were 18 female and 7 male patients, mean age of 32.3 +/- 21 years (4-61). Left atrial myxomas were diagnosed in 18 patients, left ventricular myxoma in three, right atrial myxoma in two, and one in right ventricle; there was a biatrial myxoma in one case, another had biatrial and left ventricular myxoma. The clinical manifestations of right sided myxomas was congestive heart failure. Patients with left myxoma frequently presented embolic episodes. Myxoma diagnosis was made by means of chest films, EKG and two-dimensional echocardiography which proved effective in twenty four of our patients; cardiac catheterization was performed in ten of them. Symptoms before diagnosis lasted an average of 16.3 months and mean time from diagnosis to operation was 6.6 days. Different surgical approaches are analyzed and discussed. Concomitant surgical procedures were performed in five patients: mitral annuloplasty in one, mitral valve replacement in four (two biological and two mechanical prosthesis). In eight patients the resulting septal defect due to resection of pedicle was closed with pericardial or dacron patches. There were two operative deaths due to pulmonary emboli in one and multiple organ failure in other. Cardiac myxoma is the more frequent primary neoplasm of the heart; its "benign" nature is doubtful; cure by surgical excision can be considered in vast majority of patients and its morbidity is reasonably low.