Gabriel Castro

[Bone mineral density disminution post Roux-Y bypass surgery].

INTRODUCTION Bariatric surgery has important metabolic complications such as bone mass loss. GOAL To assess bone mineral density (BMD) after Roux-en-Y gastric by-pass (RYGB) in patients under standard calcium and vitamin D supplementation. METHOD In patients with morbid obesity submitted to RYGB, 76 women and 22 men of diverse age, all with standard nutritional instruction including vitamin D and calcium, we measured BMD with a dual X-ray densitometer. They had lumbar spine and hips measurement 2-3 years post-surgery. Twenty females were followed up with BMD until of a mean of 54 months. Using World Health Organization (WHO) criterias, values were compared with young controls and same age and sex population, evaluating osteopenia and osteoporosis. RESULTS Inverse correlation was observed between BMD and age; positive between BMD and body mass index as well as with preoperative weight excess. In women younger than 45 years, we observed a diminished BMD in 26.8% of them, with no cases of osteoporosis. In older females, BMD was decreased in 65.7% (p = 0.0011); corresponding to 45.7% of osteopenia and 20% osteoporosis, more frequent in lumbar spine. In the females subgroup followed longer, BMD diminished progressively mainly in left hip. In men, there was 36% of osteopenia and 14% of osteoporosis. CONCLUSION Patients from both genders and diverse ages after BPYR presented osteopenia and osteoporosis, despite early supplement prescription of calcium and vitamin D. We consider important to perform serial BMD measurements and also to individualize therapy with risk factors control.Introduction: Bariatric surgery has important metabolic complications such as bone mass loss. Goal: To assess bone mineral density (BMD) after Roux-en-Y gastric by-pass (RYGB) in patients under standard calcium and vitamin D supplementation. Method: In patients with morbid obesity submitted to RYGB, 76 women and 22 men of diverse age, all with standard nutritional instruction including vitamin D and calcium, we measured BMD with a dual X-ray densitometer. They had lumbar spine and hips measurement 2-3 years post-surgery. Twenty females were followed up with BMD until of a mean of 54 months. Using World Health Organization (WHO) criteria’s, values were compared with young controls and same age and sex population, evaluating osteopenia and osteoporosis. Results: Inverse correlation was observed between BMD and age; positive between BMD and body mass index as well as with preoperative weight excess. In women younger than 45 years, we observed a diminished BMD in 26.8% of them, with no cases of osteoporosis. In older females, BMD was decreased in 65.7% (p = 0.0011); corresponding to 45.7% of osteopenia and 20% osteoporosis, more frequent in lumbar spine. In the female’s subgroup followed longer, BMD diminished progressively mainly in left hip. In men, there was 36% of osteopenia and 14% of osteoporosis. Conclusion: Patients from both genders and diverse ages after BPYR presented osteopenia and osteoporosis, despite early supplement prescription of calcium and vitamin D. We consider important to perform serial BMD measurements and also to individualize therapy with risk factors control.

Disminución de masa ósea post-cirugía bariátrica con by-pass en Y de Roux

INTRODUCTION Bariatric surgery has important metabolic complications such as bone mass loss. GOAL To assess bone mineral density (BMD) after Roux-en-Y gastric by-pass (RYGB) in patients under standard calcium and vitamin D supplementation. METHOD In patients with morbid obesity submitted to RYGB, 76 women and 22 men of diverse age, all with standard nutritional instruction including vitamin D and calcium, we measured BMD with a dual X-ray densitometer. They had lumbar spine and hips measurement 2-3 years post-surgery. Twenty females were followed up with BMD until of a mean of 54 months. Using World Health Organization (WHO) criterias, values were compared with young controls and same age and sex population, evaluating osteopenia and osteoporosis. RESULTS Inverse correlation was observed between BMD and age; positive between BMD and body mass index as well as with preoperative weight excess. In women younger than 45 years, we observed a diminished BMD in 26.8% of them, with no cases of osteoporosis. In older females, BMD was decreased in 65.7% (p = 0.0011); corresponding to 45.7% of osteopenia and 20% osteoporosis, more frequent in lumbar spine. In the females subgroup followed longer, BMD diminished progressively mainly in left hip. In men, there was 36% of osteopenia and 14% of osteoporosis. CONCLUSION Patients from both genders and diverse ages after BPYR presented osteopenia and osteoporosis, despite early supplement prescription of calcium and vitamin D. We consider important to perform serial BMD measurements and also to individualize therapy with risk factors control.Introduction: Bariatric surgery has important metabolic complications such as bone mass loss. Goal: To assess bone mineral density (BMD) after Roux-en-Y gastric by-pass (RYGB) in patients under standard calcium and vitamin D supplementation. Method: In patients with morbid obesity submitted to RYGB, 76 women and 22 men of diverse age, all with standard nutritional instruction including vitamin D and calcium, we measured BMD with a dual X-ray densitometer. They had lumbar spine and hips measurement 2-3 years post-surgery. Twenty females were followed up with BMD until of a mean of 54 months. Using World Health Organization (WHO) criteria’s, values were compared with young controls and same age and sex population, evaluating osteopenia and osteoporosis. Results: Inverse correlation was observed between BMD and age; positive between BMD and body mass index as well as with preoperative weight excess. In women younger than 45 years, we observed a diminished BMD in 26.8% of them, with no cases of osteoporosis. In older females, BMD was decreased in 65.7% (p = 0.0011); corresponding to 45.7% of osteopenia and 20% osteoporosis, more frequent in lumbar spine. In the female’s subgroup followed longer, BMD diminished progressively mainly in left hip. In men, there was 36% of osteopenia and 14% of osteoporosis. Conclusion: Patients from both genders and diverse ages after BPYR presented osteopenia and osteoporosis, despite early supplement prescription of calcium and vitamin D. We consider important to perform serial BMD measurements and also to individualize therapy with risk factors control.

Daño vascular asociado a uso de cocaína: Caso clínico

BACKGROUND Cocaine abuse is associated with an increased risk of cardiac and cerebrovascular events, such as myocardial infarction, sudden cardiac death, and ischemic stroke. The underlying mechanisms leading to these complications are not fully understood although intravascular thrombus formation and accelerated atherosclerosis are prominent findings. We report a 39-year-old male addicted to cocaine, who presented with three consecutive ischemic events characterized by an acute myocardial infarction and two ischemic strokes complicated by cardiac failure and severe neurological sequelae. The pathophysiology of cocaine-induce vascular damage and the management of the ischemic complications are discussed.

Valor del índice de excentricidad del ventrículo izquierdo con tomografía spect de perfusión miocárdica en diversas condiciones

Resumen:Introduccion: El indice de excentricidad (IE) obtenido con SPECT miocardico permite evaluacion de esfericidad ventricular izquierda en remodelacion patologica. Objetivo: conocer IE en adultos con diversas con-diciones cardiacas. Metodo: Grupo I: Controles (n=44) con >2 fac-tores de riesgo cardiovascular exceptuando Diabe-tes Mellitus (DM); Grupo II: DM 2 (n=41). Ambos grupos asintomaticos sin enfermedad coronaria co-nocida. Grupo III: Con alteracion de motilidad seg-mentaria y/o infarto de miocardio (n=64). Grupo IV: Dilatados (n=21) con alteraciones de motilidad difu-sa o miocardiopatias. Se utilizo Sestamibi-Tc99m y procesamiento QGS. (IE esfera valor ≈0). Resultados: Las fracciones de eyeccion del ven-triculo izquierdo fueron significativamente mayores en grupos I y II que en grupos III y IV y los volu-menes de fin de diastole menores. Los IE en reposo fueron: Grupo I: 0.889±0.003; Grupo II: 0.873±0.03; Grupo III: 0.846±0.04 y Grupo IV: 0.820±0.06. Prueba t de student entre Grupos: I vs II (p=0.028); I vs III asi como I vs IV (p<0.0001). Sin embargo, el analisis multivariado ANOVA no mostro diferen-cia entre los grupos I vs II ni entre grupos III vs IV, aunque si entre I y II vs III y IV. El IE fue menor en grupos con alteraciones de motilidad que sin estas (p<0.001). No hubo Controles del Grupo I con fun-cion normal con IE <0.82. Los hallazgos de IE post estres fueron similares.

Síndrome de Tako-Tsubo: caso clínico

Tako-Tsubo syndrome resembles an acute myocardial infarction in symptoms, laboratory parameters and electrocardiographic changes. However, angiography does not show evidence of coronary occlusion, and typically an apical ballooning of the ventricle in systole is observed. We report a 78-year-old woman with no coronary risks factors, admitted to the emergency room due to acute chestpain and an electrocardiogram compatible with an acute coronary syndrome with ST elevation. Serum troponin and creatin-kinase (MB fraction) were elevated. An emergency coronary angiography did not show a coronary occlusion. Due to the apical ballooning observed in the left ventriculography, a probable diagnosis of Tako-Tsubo was proposed. The patient had a favorable evolution. A treadmill test, echocardiogram and myocardial perfusion SPECT, performed one month later, disclosed no abnormalities.

Utilidad del estudio PET con FDG en la evaluación de sarcomas de diverso origen y de tumores no sarcoma-no epiteliales

BACKGROUND The usefulness of positron emission tomography (PET) with fluorine-deoxyglucose (FDG) in sarcomas and non-sarcoma non-epithelial (NSNE) tumors is not clearly defined. AIM To report a Chilean experience with NSNE tumors evaluated using PET with FDG. MATERIAL AND METHODS Retrospective review of the database of a PET laboratory. Demographic data, indications and metabolic findings were compared with conventional imaging in 88 adults and children with diverse bone and soft tissue sarcomas as well as 24 gastrointestinal stromal tumors (GIST), 6 pleural malignant mesotheliomas in adults, and 9 medulloblastomas in children. RESULTS FDG showed good concordance with conventional imaging in NSNE tumors. It was helpful for staging, restaging, follow-up after treatment and for the detection of new not previously suspected lesions. CONCLUSIONS PET with FDG could have a prognostic role and help in patient management, mainly in musculoskeletal and high grade or less differentiated sarcomas. In GIST, it was a good tool for immunotherapy control.

Actualización de protocolos de cardiología nuclear para evaluación y manejo de enfermedad coronaria: Sociedad Chilena de Cardiología y Cirugía Cardiovascular

Resumen: Se revisan los protocolos de cardiologia nuclear actuales, con enfasis en los estudios tomograficos de foton unico (“SPECT”) de perfusion miocardica principalmente en evaluacion de enfermedad corona-ria (EC). Las indicaciones y protocolos mas utilizados son detallados, asi como la actualizacion bibliografica pertinente, tanto al uso clinico como al control de ca-lidad e interpretacion de los estudios. Palabras clave: SPECT, perfusion miocardica, enfermedad coronaria. Articulo de revision Departamento de Imagenes Cardiovasculares No Invasivas.Sociedad Chilena de Cardiologia y Cirugia Cardiovascular. *Becario Programa de Medicina Nuclear, Hospital Clinico Universidad de Chile Correspondencia: Teresa Massardo M.D.Seccion Medicina Nuclear, Hospital Clinico Universidad de ChileSantos Dumont 999-1E, Independencia, Santiago, Chile.Zip Code: 6531063Fono Fax (562) 7770569 E-mail: tmassardo@redclinicauchile.cl Introduccion : Se revisan los protocolos de cardiologia nuclear, que han sido ya publicados en esta revista en los anos 1996 y 2004, con enfasis en los estudios tomograficos de fo-ton unico SPECT de perfusion miocardica en evaluacion de enfermedad coronaria (EC)