Osteoporosis: ¿Diagnóstico o signo de sospecha?

Objetivo: Se presenta un caso clínico de un paciente varón de 52 años que acude a consulta de Neurología por referir en los últimos meses deterioro progresivo del estado general con deterioro cognitivo, espe- cialmente de memoria y funciones ejecutivas, debilidad proximal en las cuatro extremidades, dolor en zona lumbar y disminución de 10 cm de talla. Se realizó una densitometría ósea siendo diagnosticado de osteoporosis precoz. Resultados/conclusión: En la analítica se objetivó aumento del cortisol libre en orina (1725 g/24h), con ACTH detectable (89 pg/ml) compati- ble con síndrome de Cushing ACTH-dependiente. Se realizaron pruebas para diferenciar un posible origen hipofi sario o ectópico realizándose un cateterismo de senos petrosos (CSPI) dado que se trata de la prueba con mayor sensibilidad demostrada. INGLÉS: We present the case of a fifty-year-old male who presented at the Neurology Service. During the previous months he had noticed progressive cognitive deterioration, and particularly a loss of memory and executive abilities, as well as proximal weakness of the four limbs and lumbar tenderness. He had lost ten centimetres of height. A bone densitometry was performed, which showed early osteoporosis. RESULTS/CONCLUSIONS: The laboratory results showed an increase in urine cortisol excretion (1725 g/24h), with detectable plasma ACTH concentration (89 pg/ml), suggesting ACTH-dependent Cushing's syndrome, Additional tests were run in order to determine a hypothalamic or ectopic location of the syndrome. To this end, a bilateral inferior petrosal sinus sample (BIPSS) was performed for ACTH determination. BIPSS is the test that has been proven to have the best sensitivity to achieve differential diagnosis of ACTH-dependent Cushing's syndrom

A colorectal cancer susceptibility new variant at 4q26 in the Spanish population identified by genome-wide association analysis

This work was partially supported by the CENIT program from the Centro Tecnológico Industrial (CEN-20091016), grants from the Spanish Institute of Health Carlos III (ADE10/00026, PI09/02444, PI12/00511, Acción Transversal de Cáncer) grants from the Fondo de Investigacion Sanitaria/FEDER (08/1276, 08/0024, PS09/02368, 11/00219, 11/00681), and by COST office through COST action BM1206. SCB is supported by contracts from the Fondo de Investigación Sanitaria (CP 03-0070). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Centro Tecnológico IndustrialInstituto de Salud Carlos IIIFondo de Investigación Sanitaria / FEDE

Unión Ibero-Americana, Año XXIX, Núm. 9

44 páginasGRABADOS: Cádiz: Vista panorámica tomada desde la Torre de Tavira.- Vistas de España (Cádiz): Botadura del trasatlántico Santa Isabel, verificada el 20 de agosto último en el astillero de Matogorda.- El nuevo buque Santa Isabel atracado al muelle. San Salvador: Patio de la actual Universidad Nacional; Un rincón de la Quinta Modelo; Escuela de Medicina. TEXTO: España y América.- La Fiesta de la Raza.- Explotación ganadera en el Paraguay, por el Dr. Tomás Osuna.- El idioma español en las Repúblicas rioplatenses, por Horacio Araujo Villagrán.- La fatiga escolar, por Félix Rosa González V.- Fiestas patrióticas colombinas en Huelva: Carta poética, por Miguel Benítez Castro.- La neutralidad de España, por Manuel de Saralegui y Medina.- Argentina: Presupuesto para 1916.- Derechos y deberes de los españoles fuera de España, por José Marginet.- Nuevo Presidente de Venezuela: El General D. Juan Vicente Gómez, por José María Barreto.- La minería sudamericana y la unión industrial de España con la América Latina, por Fernando B. Villasante.- Fomento del Trabajo Nacional: Premio anual de 5.000 pesetas, ofrecidas por D. José Deu y Mata.- Jesús y Colón, por Anselmo Ruiz Gutiérrez.- Intercambio comercial hispanoamericano (El Salvador, Cuba).- Episodios históricos salvadoreños (La guerra con Guatemala en 1863; Sus causas aparentes; Fusilamiento de Zepeda y Castellanos), por A. Funes.- Política económica hispanoamericana: Conferencia dada el 10 de agosto, en el Ateneo Hispano-Americano de Buenos Aires, por el Sr. A. Martín Jiménez.- Libros nacionales y extranjeros, por A. Balbín de Unquera.- Acepte usted la biblioteca gratuita que se le ofrece.- Catálogo de exportadores españoles.- IV Centenario del descubrimiento del Pacífico: Catálogo de la Exposición celebrada en el Archivo General de Indias en 1913 y 1914, por Pedro Torres Lanzas.- Índice de sumarios de los números publicados en el corriente año.- Anuncios

Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort : A prospective, observational study

BACKGROUND Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery. OBJECTIVE The objective of this study was to build a clinically useful predictive model for the development of PRF. DESIGN A prospective observational study of a multicentre cohort. SETTING Sixty-three hospitals across Europe. PATIENTS Patients undergoing any surgical procedure under general or regional anaesthesia during 7-day recruitment periods. MAIN OUTCOME MEASURES Development of PRF within 5 days of surgery. PRF was defined by a partial pressure of oxygen in arterial blood (PaO2) less than 8 kPa or new onset oxyhaemoglobin saturation measured by pulse oximetry (SpO(2)) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation. RESULTS PRF developed in 224 patients (4.2% of the 5384 patients studied). In-hospital mortality [95% confidence interval (95% CI)] was higher in patients who developed PRF [10.3% (6.3 to 14.3) vs. 0.4% (0.2 to 0.6)]. Regression modelling identified a predictive PRF score that includes seven independent risk factors: low preoperative SpO(2); at least one preoperative respiratory symptom; preoperative chronic liver disease; history of congestive heart failure; open intrathoracic or upper abdominal surgery; surgical procedure lasting at least 2 h; and emergency surgery. The area under the receiver operating characteristic curve (c-statistic) was 0.82 (95% CI 0.79 to 0.85) and the Hosmer-Lemeshow goodness-of-fit statistic was 7.08 (P = 0.253). CONCLUSION A risk score based on seven objective, easily assessed factors was able to predict which patients would develop PRF. The score could potentially facilitate preoperative risk assessment and management and provide a basis for testing interventions to improve outcomes. The study was registered at ClinicalTrials.gov (identifier NCT01346709)

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology