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Purpose: . Adjuvant therapies have prolonged survival of non-metastatic breast cancer (NMBC) patients, but they also decrease bone mineral density (BMD). We have analyzed the effects of chemotherapy, hormone therapy with tamoxifen or both, on BMD of women with NMBC., Patients and Methods: We prospectively included 168 women with NMBC (stage I-III) referred to the Medical Oncology Service of University Hospital of Canary Islands between 1997 and 2001 (55 +/- 12 years; 37% premenopausal; 43 +/- 13 months of follow-up). We measured lumbar and hip BMD (g/cm2) at diagnosis, after chemotherapy and after 12 months of tamoxifen. If a low BMD was detected, women were treated with bisphosphonates., Results: BMD after chemotherapy (n = 83) significantly decreased at lumbar (1.014 +/- 0; 0.995 +/- 0, p = 0.0001), trochanter (0.701 +/- 0; 0.690 +/- 0, p = 0.001), intertrochanter (1.095 +/- 0; 1.078 +/- 0, p = 0.0001) and total hip (0.924 +/- 0; 0.915 +/- 0, p = 0.046) areas. Although 60% of the premenopausal women suffered amenorrhea after chemotherapy, there were not significant differences in BMD between them and women who retained menses. BMD of women who received 12 months of tamoxifen after chemotherapy increased--total hip (0.907 +/- 0; 0.922 +/- 0, p = 0.005) and intertrochanter (1.071 +/- 0; 1.091 +/- 0, p = 0.003)--or remained stable--lumbar, femoral neck, trochanter, and Ward's triangle (n = 39). When tamoxifen was the only adjuvant treatment, BMD after 12 months (n = 22) increased in trochanter area (0.644 +/- 0; 0.663 +/- 0, p = 0.011), and remained stable in all other sites. 50 (30%) patients were treated with bisphosphonates because of osteopenia., Conclusion: Women with NMBC are affected by early bone loss after adjuvant chemotherapy. This bone loss is attenuated by one year of tamoxifen treatment.

This study was performed in order to analyze the relative and combined effects of ethanol and protein deficiency on hair copper, zinc, manganese, and iron content in four groups of seven animals each which were pair-fed during 8 wk with (1) a nutritionally adequate diet, (2) a 36% (as energy) ethanol-containing isocaloric diet, (3) a 2% protein, isocaloric diet, and (4) a 36% ethanol, 2% protein isocaloric diet, respectively, following the Lieber-DeCarli model, and to analyze the relationship between hair copper, zinc, manganese, and iron content, and the liver and muscle content of these elements. Although there was a trend to higher levels of all the elements analyzed in the the hair of the low-protein fed animals, differences were statistically significant regarding copper and manganese, effects being solely attributable to the low protein diet, not to ethanol. Moreover, hair copper was significantly, inversely related with final weight and weight loss. There were significant relationship between liver zinc and muscle zinc (r = 0.57, p = 0.002), but not between liver or muscle zinc and hair zinc; no correlations were observed between muscle copper and hair copper, nor between liver manganese and hair manganese. An inverse, statistically significant correlation was observed between liver copper and hair copper (r = -0.39, p < 0.05).

This study was performed to analyze the relative and combined effects of ethanol and protein deficiency on bone histology and mineral metabolism in 4 groups of 7 animals each which were pair-fed during 8 weeks with 1) a nutritionally adequate diet; 2) a 36% (as energy) ethanol containing isocaloric diet; 3) a 2% protein, isocaloric diet; and 4) a 36% ethanol 2% protein isocaloric diet, respectively, following the Lieber-DeCarli model. Another group of five rats were fed ad libitum the control diet. The first and second lumbar vertebrae were removed after sacrifice, and processed for histomorphometrical analysis of undecalcified bone samples. Blood and 24-h urine were also collected. Protein malnutrition, but not ethanol, leads to osteoporosis and reduced osteoid synthesis, whereas ethanol and protein malnutrition both lead to impaired bone mineral apposition and increased urinary hydroxyproline excretion. These changes are accompanied by an increase in serum parathormone and serum 1,25 dihydroxy vitamin D3, a slight hypomagnesemia, hypercalciuria and hyperphosphaturia; protein deficiency plays an independent role in these alterations, whereas both ethanol and protein deficiency exert independent effects on decreasing serum testosterone levels; this last alteration may contribute to the bone changes mentioned before.

Strontium metabolism has attracted considerable interest because of to its interaction with calcium, the bone alterations detected after treatment with strontium, and its potential value as a paleodietary indicator. The effects of ethanol on strontium and barium metabolism-another divalent cation which also accumulates in bone--is largely unknown. Based on this fact, we have determined bone content and fecal and urinary excretion of Ba and Sr in four groups of eight animals each pair-fed for 8 wk with (1) a nutritionally adequate diet, (2) a 36% (as energy) ethanol-containing isocaloric diet, (3) a 2% protein, isocaloric diet, and (4) a 36% ethanol, 2% protein isocaloric diet, following the Lieber-DeCarli model. Five additional rats were fed with the control diet ad libitum. We have found that ethanol tends to decrease and a low protein diet to increase bone strontium content; the decrease in bone strontium in the ethanol-fed rats is accompanied by an increase in the absolute excretion of strontium in urine. Ethanol also decreases bone barium content, but the effect of ethanol on urinary barium excretion is opposite that of strontium, a decrease. Thus, we conclude that ethanol alters both barium and strontium metabolism and bone deposition.

The present study determined the lead concentration in bone tissue from 40 prehistoric individuals of Gran Canaria, and in a sample of 19 modern day residents of the Canary Islands. Higher bone lead values were observed in the modern sample (18.65 +/- 12.13 &mgr;g/g dry bone tissue) than in the ancient sample (4.41 +/- 3.45 &mgr;g/g dry bone tissue, P < 0.001). Older individuals showed higher bone lead values than younger individuals, but only in the modern group. The correlation between age and bone lead approached statistical significance (P = 0.058). Low bone lead observed in the prehistoric sample suggests a low lead exposure in prehispanic times in Gran Canaria. Am. J. Hum. Biol. 11:405-410, 1999. Copyright 1999 Wiley-Liss, Inc.

The relative contribution of protein deficiency to the altered metabolism of certain trace elements in chronic alcoholics is not well defined, so this study was performed to analyse the relative and combined effects of ethanol and protein deficiency on liver, bone, muscle, and blood cell content of copper, zinc, iron, and manganese, and also on serum levels and urinary and fecal excretion of these elements in four groups of eight animals each that were pair-fed during 8 weeks with a nutritionally adequate diet, a 36% (as energy) ethanol-containing isocaloric diet, a 2% protein isocaloric diet, and a 36% ethanol 2% protein isocaloric diet, respectively, following the Lieber-DeCarli model. Five additional rats were fed ad lib the control diet. Protein malnutrition, but not ethanol, leads to liver zinc depletion. Both ethanol and protein malnutrition cause muscle zinc depletion and increase urinary zinc and manganese excretion, whereas ethanol also increases urinary iron excretion and liver manganese content. No differences were observed regarding copper metabolism.

The present study has been performed in order to determine concentrations of lead in the bone of 14 individuals who were interred towards the beginning of the 18th century at the church 'La Concepción' (Santa Cruz de Tenerife) of 15 Pre-Hispanic individuals of Tenerife and a modern sample for Tenerife, composed of 25 individuals. We have observed higher bone lead values in the modern population than in the ancient one (P = 0.0022), although Pre-Hispanic individuals and those of the 18th century showed similar bone lead values.

This study examined the diagnostic accuracy of the corticomedular index obtained at the midpoint of the shaft of right tibia as an indicator of osteopenia in a prehistoric sample composed of 133 individuals. Osteopenia was assessed by a histomorphometrical measure of trabecular bone volume (TBV) in an undecalcified bone section of a small part of the proximal epiphysis to: Mild, moderate, and severe osteopenia were defined as TBV values less than 17.5%, 15%, and 12.5%, respectively. The corticomedular index (CI) was determined on X-ray films of the tibiae. Mean TBV of the sample was 17.93 ± 4.97%, it was moderately correlated with CI (r = 0.43, p < 0.0001). CI values under 0.20 showed high specificity in the diagnosis of all degrees of osteopenia, whereas CI values under 0.275 showed relatively high sensitivity (90.4%) in the diagnosis of severe osteopenia. These methods were then prospectively applied in a further sample of 41 right tibiae also from a prehistoric sample of Gran Canaria. The results were similar to those in the larger sample. Thus, CI may be a useful tool in detecting osteopenia in earlier populations. Am. J. Hum. Biol. 10:37-44, 1998. © 1998 Wiley-Liss, Inc., (Copyright © 1998 Wiley-Liss, Inc.)

A 45-year-old alcoholic male patient presented with hypovolemic shock and intense anemia (Hemoglobin 04.7 g/dl), and was operated on. A bleeding retroperitoneal varix located near the right colon was responsible for the clinical picture and was sutured. After operation the patient developed haemodynamic instability and pneumonia a situation which was reverted with intensive medical therapy. The patient is now doing well.

The aim of the present study is to analyse the relative and combined effects of ethanol and protein deficiency on serum testosterone and LH, and on gonadal histology, in ethanol fed rats. The study was performed in 32 animals divided into four groups, fed with the Lieber & DeCarli control, 36% ethanol, 2% protein, and 36% ethanol 2% protein containing diets, respectively. Two months later, rats were anaesthetized with pentobarbital and sacrificed, and the right testes and epididymus were carefully removed. Both ethanol and protein deficiency independently lead to a decrease in serum testosterone levels, and to testicular atrophy, lowest testosterone levels and highest degrees of atrophy being observed in the rats receiving the 36% ethanol, 2% protein containing diet. Both serum testosterone and testicular size and weight significantly correlated with final weight and serum albumin. Hypospermia, atrophy of the seminiferous tubules, and reduced epididymal diameter were also observed in this last group of animals. Thus, protein deficiency may contribute to hypogonadism of alcoholics.

Harris lines were assessed in 48 right tibiae of prehispanic inhabitants of El Hierro (one of the Canary Islands), belonging to 23 adult females and 25 adult males. No Harris lines were detected in sixteen (33%) of the adult individuals (7 females = 30% and 9 males = 36%), these differences are not statistically significant. Female tibiae showed a slightly higher mean number of Harris lines at the distal end than male ones (2.091 +/- 1.9 in females vs 1.417 +/- in males). Ages at which Harris lines were formed show two peaks, a major one at the age of 2 years, and another one between 11 and 13, particularly in the females. Harris lines were more frequently observed at the proximal than at the distal end of the bone. No relation was found between the number of Harris lines and stature. The relative high number of lines detected in our population speak for several stressful episodes suffered during growth.

The aim of the present study is to analyse the relative and combined effects of ethanol and protein malnutrition on muscle zinc, copper, iron, potassium, and magnesium in ethanol-fed rats. The study was performed in 32 animals divided into four groups, fed with the Lieber-DeCarli control, 36% ethanol, 2% protein, and 36% ethanol 2% protein containing diets, respectively. Right gastrocnemius muscle was removed 2 months later, and was studied both chemically and histochemical-morphometrically. Both muscle zinc and potassium, but not copper nor iron nor magnesium, were significantly decreased in the protein-deprived, ethanol-fed animals, the main effect of these variations being attributable to ethanol rather than to protein deprivation. However, coexisting protein deprivation aggravated the decrease in both muscle zinc and potassium. Both muscle zinc and potassium were significantly related to serum albumin, weight loss, and type IIb fibre atrophy; and muscle zinc, in addition, to the decrease in type IIb fibre proportion. Therefore, a decrease in muscle content of both elements is related to histochemical-morphometrical changes observed in alcoholic myopathy. In addition, both ethanol and protein deficiency exerted independent, highly significant effects both on type IIb fibre atrophy and proportion.

Peripheral and autonomic neuropathy has been evaluated, both by clinical and neurophysiological and by clinical methods, respectively, in 33 alcoholics, 20 of them cirrhotics. Nerve dysfunction was compared with liver function parameters, the Child-Pugh score, and parameters derived from ethanol consumption. Few relationships were obtained between the autonomic and peripheral nerve dysfunction, and between these and liver function impairment, although Pugh's score was higher when hyporeflexia and altered heart rate response to orthostatism were present. Thus, in the alcoholic, autonomic and peripheral neuropathy, seem to be dependent on each other, whereas there appears to be a weak correlation between liver function and both autonomic and peripheral neuropathy.

Bone biopsies of 52 histologically confirmed alcoholic cirrhotic patients and 15 age- and sex-matched controls have been histomorphometrically analyzed determining trabecular bone volume (TBV), mineralized bone volume (MBV), and osteoid volume (OV). We also determined serum PTH, 25-OH-D3, calcitonin, FSH, LH, estradiol, testosterone, T3 and T4, urine cortisol, routine liver function tests, serum and urinary calcium, phosphorus, and magnesium. We found a high prevalence of osteoporosis: TBV was significantly lower in cirrhotic patients (T = 7.23, P less than 0.001), 41 of them being in the range of osteoporosis; none of them had osteomalacia. Levels of all the above-mentioned hormones and electrolytes were almost normal, and no correlation was found between them and liver function tests, as occurred with the bone parameters.

In 117 patients affected by chronic alcoholic liver disease, we have histomorphometrically determined hepatocyte and nuclear areas, total amount of fat and total amount of fibrosis, comparing them with the following clinical and biochemical parameters: ascites, encephalopathy, jaundice, spiders, collateral circulation, splenomegaly, prothrombin activity, serum albumin, gammaglobulin, bilirubin, ASAT, ALAT, GGT, leukocyte and platelet count, and daily consumption of ethanol. Both hepatocyte and nuclear areas closely correlated with most of the parameters indicative of hepatic function derangement, whereas fat amount correlated with them inversely, but positively with the daily consumption of ethanol. The degree of fibrosis was greater in patients with a worse hepatic function, and there was a direct relationship between the degree of fibrosis and hepatocyte and nuclear areas, and an inverse one between the degree of fibrosis and the total amount of fat.