Ana Isabel Turrión Nieves

The effects of truncal adiposity in forced spirometry: Sex differences

The aim of the current paper is to establish the influence of truncal fat accumulation on the spirometric results of a group of healthy individuals. A cross-sectional study of 305 healthy, non-smoking adult subjects (144 males, 161 females) was conducted. Forced spirometry and dual-energy X-ray absorptiometry to quantify body fat were performed. Partial correlation and multiple linear regression analyses were performed. In females, abdominal fat was negatively correlated with forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). In males, thoracic fat was negatively correlated with respiratory variables, as was abdominal fat. In the multiple linear regression, FEV1 was the spirometric parameter that showed higher R2 values in both sexes. Truncal fat had a greater influence on FEV1 than on FVC. In males, no significant differences between the influence of thoracic and abdominal fat on spirometric results were found, and total body fat was shown to have more influence than regional. In females, the influence of abdominal fat was higher.

Hemorragia digestiva alta (estómago de sandía) en paciente con esclerodermia limitada (síndrome de CREST)

Paciente de 52 años con esclerodermia limitada de 20 años de evolución y síndrome antifosfolípido, anticuerpos antinucleares (ANA) positivos 1/2.560 con patrón anticentrómero y anticoagulante lúpico positivo, en tratamiento con anticoagulantes orales por cuadro de trombosis en miembro inferior. Ingresa por episodio de melenas con datos de anemización, al realizar exploración endoscópica se evidencian en antro lesiones de aspecto vascular, confluentes hacia el píloro, compatibles con estómago en watermelon1,2 (fig. 1). Ante la presencia de sangrado activo en sábana, se realiza tratamiento con argón3 (fig. 2). La ectasia vascular gástrica antral (EVGA) constituye una causa rara, pero grave, de hemorragia gastrointestinal alta (4% de todas las hemorragias digestivas). Los hallazgos endoscópicos son característicos: imágenes lineales, orientadas en forma radial partiendo del píloro (imagen de estómago en sandía o watermelon stomach1,4). La EVGA se asocia con enfermedades crónicas subyacentes, fundamentalmente con cirrosis hepática. En enfermedades autoinmunes se relaciona con la existencia del fenómeno de Raynaud, siendo en la variante limitada de la esclerodermia (síndrome de CREST) la más frecuentemente descrita5,6. La serie más amplia de pacientes estudiados con EVGA incluye 45 pacientes, de los que un 62% presentaban a la vez conectivopatía, particularmente con fenómeno de Raynaud (31%) y esclerodactilia7 (20%). Su etiopatogenia es desconocida; se acepta como hipótesis que los cambios histológicos, sobre todo en la lámina propia son debidos a proliferación fibromuscular, dilatación vascular y trombosis,

Asociación de la masa muscular determinada mediante DEXA con los resultados espirométricos de individuos sanos

INTRODUCTION Muscle mass maybe a determining factor in the variability of spirometry results in individuals of the same sex and age who have similar anthropometric characteristics. The aim of this study was to determine the association between spirometric results from healthy individuals and their muscle mass assessed by dual energy X-ray absorptiometry (DEXA). METHODS A sample of 161 women and 144 men, all healthy non-smokers, was studied. Ages ranged from18 to77years. For each subject, spirometry results and total and regional lean mass values obtained by full body DEXA were recorded. A descriptive analysis of the variables and a regression analysis were performed to study the relationship between spirometric variables and lean body mass, correcting for age and body mass index (BMI). RESULTS In both sexes all muscle mass variables correlated positively and significantly with spirometric variables, and to a greater extent in men. After partial adjustment of correlations by age and BMI, the factor which best explains the spirometric variables is the total lean body mass in men, and trunk lean body mass in women. CONCLUSIONS In men, muscle mass in the lower extremities is most closely associated with spirometric results. In women, it is the muscle mass of the trunk. In both sexes muscle mass mainly affects FEV1.

Displasia fibrosa poliostótica. Datos importantes que el reumatólogo debe conocer

Fibrous dysplasia is a monostotic or polyostotic bone growth disorder caused by mosaicism involving the mesenchymal tissue. The presenting signs include pain and spontaneous fractures. Last year, Meneses et al. described a case in this journal1 and, in this letter, we report another. A year ago, a 36-year-old man was referred to us with pain and a significant increase in his alkaline phosphatase levels: 658 U/l (normal range: 40–130). He had never been examined by a rheumatologist, despite the fact that he had been diagnosed as having polyostotic fibrous dysplasia at the age of 5 years. He had undergone cranioplasty twice for cranial volume reduction and decompression surgery on another 2 occasions to relieve pressure on the left optic nerve. He had had a clavicular fracture and, shortly before our first encounter, fracture of left femur, without previous trauma, but with the fracture line over preexisting osseous cystic lesions. The examination revealed a head circumference of 67 cm, hypertelorism and thoracolumbar scoliosis, with a lump in left costal region that was painful on palpation. Moreover, he presented with right-sided coxa vara and leg length discrepancy. The patient was treated with pamidronate (180 mg/iv every 6 months), which relieved his symptoms and reduced his alkaline phosphatase level by over 20% to 390 U/l. This disease is caused by a point mutation (activation of the GNAS1 gene) in part of the bone tissue.2,3 It is characterized by the coexistence of cells having the genetic alteration and normal cells (mosaicism). This mutation induces an expansion of osteoprogenitor cells and their accumulation in the bone marrow spaces, provoking localized hematopoietic tissue loss and bone marrow fibrosis. The collagen shows changes in orientation and biochemical composition. Markers of bone remodeling may be elevated, as occurred in our patient. It is usually asymptomatic and the diagnosis is incidental, although there may be pain, swelling, deformity and/or neurological involvement. Seventy percent of the cases are diagnosed before the age of 30 years.4 The dysplastic tissue is highly vascularized, and is prone to spontaneous bleeding with subsequent cyst formation. The bones widen and the cortical bone thins, and spontaneous fractures can occur as a complication when the condition affects weight-bearing long bones. The presence