Search

Introducción: Estudios previos han relacionado la vía Wnt con la alteración del metabolismo óseo y la patología cardiovascular. Así mismo, el control de la inflamación con terapia biológica tiene un efecto positivo sobre la densidad mineral ósea (DMO) y el riesgo cardiovascular. El objetivo de este estudio fue, por tanto, evaluar el efecto de la terapia biológica en pacientes con artritis reumatoide (AR) que no habían recibido previamente terapia biológica sobre la carga inflamatoria, y su relación con el riesgo cardiovascular y el metabolismo óseo. Pacientes y métodos: Estudio de cohortes prospectivo en pacientes con diagnóstico de AR activa que iniciaban terapia biológica. Los pacientes fueron seleccionados de forma consecutiva no seleccionada. Se recogieron: las concentraciones séricas de proteína Dickkopf-1 (DKK1) y esclerostina, ambas mediante el método ELISA (Biomedica Medizinprodukte GmbH and Co. KG, Viena, Austria); características sociodemográficas y clínicas; marcadores de remodelado óseo; la DMO en columna lumbar y en cadera mediante absorciometría de rayos X de energía dual (DXA); el grosor íntima-media carotídea (c-IMT); y la evaluación de riesgo cardiovascular mediante el modelo Systematic Coronary Risk Evaluation (SCORE). Resultados: El 46,7% de los pacientes presentaron respuesta EULAR al tratamiento a los 12 meses. Sólo en este subgrupo de pacientes encontramos un aumento en las concentraciones de DKK1 tras el inicio de la terapia biológica (basal: 20,55±8,13 pg/ml vs. 12 meses: 31,20±4,88 pg/ml, p=0,03). En cuanto a los marcadores de remodelado óseo, se detectó un aumento en los niveles de osteocalcina (basal: 11,25±3,28 ng/ml vs. 12 meses: 15,78,±4,11 ng/ml, p=0,01). No se encontraron cambios estadísticamente significativos en el c-IMT ni en el SCORE tras 12 meses de tratamiento. Conclusiones: En pacientes con AR tratados con terapia biológica y con respuesta al tratamiento hemos observado un aumento significativo de las concentraciones séricas de DKK1 a los 12 meses de tratamiento, no asociado a cambios en el metabolismo óseo o al riesgo cardiovascular.

Introducción: El objetivo del estudio es evaluar la relación entre la carga inflamatoria, el riesgo cardiovascular y el metabolismo óseo en pacientes con artritis reumatoide que inician tratamiento con terapia biológica. Pacientes y métodos: Se trata de un estudio de cohortes prospectivo realizado en pacientes con diagnóstico de artritis reumatoide (AR) activa evaluados en la Unidad de Reumatología y que inician terapia biológica. Los pacientes serán seleccionados de forma consecutiva. Presentamos los datos preliminares de 14 pacientes. Resultados: Encontramos una reducción en las concentraciones de Dickkopf-1 (DKK1) tras el inicio de la terapia biológica (basal: 53,12±60,43 pg/ml vs. 6 meses 23,2±13,5 pg/ml, p=0,307) pero no se alcanzó la significación estadística. Se encontraron cambios en los marcadores de remodelado con aumento en los niveles de osteocalcina y CTX que no alcanzó la significación estadística. Conclusiones: En pacientes con AR activa tratados con terapia biológica hemos observado un descenso no significativo de las concentraciones séricas de DKK1. La ampliación tanto de los sujetos de estudio como de las determinaciones bioquímicas pendientes nos permitirán en un futuro próximo establecer de forma más precisa esta asociación, así como la relación entre DKK1, remodelado óseo, terapia biológica y enfermedad cardiovascular en pacientes con AR.

Introduction: The aim of this study is to assess the relationship among inflammatory charge, cardiovascular risk and bone metabolism in patients with rheumatoid arthritis initiating biological therapy treatment. Patients and methods: This is a prospective cohort study conducted in patients diagnosed with active rheumatoid arthritis (RA) assessed in the Rheumatology Unit and initiating biological therapy. Patients will be selected consecutively, with preliminary data on 14 patients. We present preliminary data from 14 patients. Results: Reduced Dickkopf-1 (DKK1) concentrations after commencing biological therapy were detected (baseline: 53.12±60.43 pg/ml vs 6 months 13.5±23.2 pg/ml, p=0.307) but without statistical significance. Changes were found in markers for bone remodeling with increased osteocalcin levels and CTX which were not statistically significant either. Conclusions: We observed a nonsignificant decrease in DKK1 serum in patients with active RA treated with biologic therapy. Expanding the scope of study subjects and pending biochemical determinations will allow us, in the near future, to establish more precisely this link and the relationship of DKK1, bone remodeling, biological therapy and cardiovascular disease in RA patients. [ABSTRACT FROM AUTHOR]

Nodular pseudoangiomatous stromal hyperplasia is a very rare benign breast lesion found in 0.4% of biopsies. It usually presents as a fast-growing palpable lesion in women between 30 and 40 years of age and is exceptionally rare in adolescents. Histological examination reveals a proliferation of stromal cells from connective tissue forming anastomosed empty pseudovascular spaces lined with myofibroblasts. We present the cases of two adolescents (13 and 18 years old) with fast-growing palpable breast nodules. Both underwent breast ultrasonography and core biopsy. The ultrasonographic findings of nodular pseudoangiomatous stromal hyperplasia were indistinguishable from those reported for juvenile fibroadenoma and for phyllodes tumor. Thus, histological study was required for the definitive diagnosis. Treatment depends on the size of the nodule. In our two patients, the lesion was surgically excised through tumorectomy and mastectomy., (Copyright © 2010 SERAM. Published by Elsevier Espana. All rights reserved.)

Purpose: To assess the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MR cholangiography for the detection of bile leaks after hepatobiliary surgery., Methods: Twenty-three patients with symptoms suggestive of bile leak underwent conventional fat-suppressed T1- and T2-weighted MR cholangiography followed by Gd-EOB-DTPA-enhanced MR cholangiography using gradient-echo (GRE) T2-weighted sequences and fat-suppressed T1-weighted 3D gradient-echo sequences 20 min after an intravenous bolus of Gd-EOB-DTPA. The results of Gd-EOB-DTPA-enhanced MR cholangiography correlated with clinical findings, surgical repair, and the results of endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography., Results: The results of Gd-EOB-DTPA-enhanced MR cholangiography were negative in 13 patients (cholecystectomy 5, liver transplantation 2, liver resection for focal lesions 2, cholangiocarcinoma 1, and partial hepatectomy after liver injury 1). In 10 patients in whom bile leaks were detected, this complication occurred after liver resection for focal lesions in 3, cholecystectomy in 4, liver transplantation in 2, and liver resection for intrahepatic cholangiocarcinoma in 1. The diagnostic accuracy of Gd-EOB-DTPA-enhanced MR for the detection or exclusion of bile leaks was 100%., Conclusions: Gd-EOB-DTPA-enhanced MR cholangiography is a highly reliable technique for the detection of bile leaks after hepatobiliary surgery and may avoid the use of other, potentially risky invasive diagnostic techniques.

Tympanic paragangliomas usually present as a vascular middle ear mass, with the most common presenting symptoms being pulsatile tinnitus and hearing loss. We report an unusual case of a recurrent tympanic paraganglioma extending along the Eustachian tube and nasopharynx, presenting with recurrent epistaxis., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Ganglioneuromas are benign tumors that are rare in children. They are made up of mature ganglion cells, Schwann cells, and connective tissue. The most common sites involved are the posterior mediastinum, retroperitoneum, suprarenal gland, and neck. They rarely involve bone. We present the case of a seven-year-old girl diagnosed with an intraosseous ganglioneuroma in the mandible. She had been treated for a suprarenal neuroblastoma (stage M) five years earlier. Bone scintigraphy and computed tomography of the mandible showed a lesion in the right mandibular ramus. Many osseous lesions can affect the mandible in children and the radiological appearance of most of them is unspecific. We discuss the differential diagnosis and main imaging findings of osseous lesions involving the mandible in children., (Copyright © 2010 SERAM. Published by Elsevier Espana. All rights reserved.)

Inflammatory myofibroblastic tumor is a rare lesion that is usually located in the lung. The most commonly reported extrapulmonary locations are the mesentery and the retroperitoneum. We report the case of an 8-year-old girl with an inflammatory myofibroblastic tumor in an unusual location. The patient was referred to our center for suspected complicated appendicitis. Abdominal ultrasonography detected ileoileal intussusception with a mass in the distal portion. Emergency laparotomy confirmed ileoileal intussusception secondary to an intraluminal tumor. Histologic study revealed the mass was an inflammatory myofibroblastic tumor. Inflammatory myofibroblastic tumors are rare mesenchymal masses usually found in children. When located in the abdomen, they can mimic malignant lesions like lymphomas, sarcomas, or metastases. The cause and prognosis of inflammatory myofibroblastic tumors are unknown., (Copyright © 2009 SERAM. Published by Elsevier Espana. All rights reserved.)