Androgenetic alopecia and insulin resistance in young men

Background  Epidemiological studies have associated androgenetic alopecia (AGA) with severe young-age coronary artery disease and hypertension, and linked it to insulin resistance. We carried out a case–control study in age- and weight-matched young males to study the link between AGA and insulin resistance using the homeostasis model assessment of insulin resistance (HOMA-IR) index or metabolic syndrome clinical manifestations.
Methods  Eighty young males, 18–35 years old, with AGA ≥ stage III in the Hamilton–Norwood classification, and 80 weight- and age-matched controls were included. Alopecia, glucose, serum insulin, HOMA-IR index, lipid profile and androgen levels, as well as metabolic syndrome criteria, were evaluated.
Results  The HOMA-IR index was significantly higher in cases than controls. Nonobese cases had a higher mean diastolic blood pressure and a more frequent family history of AGA than nonobese controls. A borderline difference in the HOMA-IR index was found in obese AGA cases vs. obese controls [ P =  0·055, 95% confidence interval (CI) 2·36–4·20 vs. 1·75–2·73]. Free testosterone values were significantly higher in controls than cases, regardless of body mass index (BMI). A statistically significant additive effect for obesity plus alopecia was found, with significant trends for insulin, the HOMA-IR index, lipids and free testosterone when BMI and alopecia status were used to classify the participants.
Conclusions  Our results support the recommendation for assessing insulin resistance and cardiovascular-related features and disorders in all young males with stage III or higher AGA, according to the Hamilton–Norwood classification.     

Vértebra plana. Revisión de concepto y aproximación diagnóstica

Vertebra plana is a concept introduced by Calvé in 1925 to name a process characterized by the collapse of a single vertebra with no involvement of the discs, widening of the intervertebral space of at least one third compared with normal width, and an increase in the density of the collapsed vertebra. Because of its benign and self-limiting nature, this entity was originally thought to be an osteochondritis. Later publications did not corroborate this view and connected this entity initially with eosinophilic granuloma and subsequently with additional malignant infiltrating tumoral processes, in particular with Ewing's sarcoma and lymphomas, thus posing difficulties for its management. The initial concept was extended in 1990 to crushed and wedged vertebrae, including developmental abnormalities such as bone dysplasias. The present article provides a general review of vertebra plana, including the concept, etiology and pathogenesis of related processes, clinical findings and diagnosis. We also discuss the debate on the benign or malignant nature of vertebra plana and on the need for an immediate biopsy versus observation, as well as the therapeutic orientations.     

Time Frames for Analysis of Inflammatory Mediators in Acute Pancreatitis: Improving Admission Triage

Improving the outcome of acute pancreatitis through prognostic markers has been a matter of ample research. We evaluate the clinical usefulness of four serum markers in comparison to Ranson’s score. Serum measurements of C-reactive protein (CRP), interleukin-6, -10 (IL-6, IL-10), and pancreatitis-associated protein (PAP) were performed. The usefulness of each marker for predicting severity was compared with that of Ranson’s score. Time of evolution was considered for improving their usefulness. Seventy-one patients were studied. Severe cases had higher levels of all markers, although only IL-10 had better accuracy than Ranson’s. In patients admitted during the first 48 h, IL-6, IL-10, and PAP had improved accuracy over Ranson’s; however, after this time frame, only CRP outperformed Ranson’s score. Analysis of time frames improved the accuracy of all markers. Therefore, time of evolution should be considered when using these parameters for a better prognosis.     

Late-onset periodic asystolia during vagus nerve stimulation

Cardiac changes may occasionally occur during vagus nerve stimulation (VNS) used in epileptic patients. As they can be potentially life-threatening, it is important to detect them, and this is why an intraoperative test is performed during the implantation. Few cases of asystole during this test have been described. Only one patient with late-onset bradyarrythmia caused by VNS has been reported. This patient had been implanted 2 years and 4 months before the episode. We present another case of late asystole in a patient whose VNS had been implanted 9 years before the arrhythmia onset. In our patient, each run of stimulation produced bradyarrhythmias and very often severe asystolia due to atrium-ventricular block.     

Prevalence of Cortical Osteoporosis in Mild and Severe Primary Hyperparathyroidism and its Relationship With Bone Markers and Vitamin D Status

Studies on the prevalence of site-specific osteoporosis in patients with different clinical presentations of primary hyperparathyroidism (PHPT) are scarce in the literature. The present study aims to determine the prevalence of cortical osteoporosis in such patients by using 3-site dual-energy X-ray absorptiometry (lumbar spine, femoral neck, 1/3 radius). We studied 49 patients, 12 males and 37 females, with PHPT, who were separated into 3 groups: asymptomatic (AS), renal stone disease (RS), and osteitis fibrosa cystica (OF). Osteoporosis occurred as follows: lumbar spine—48% for AS, 17.6% for RS, and 100% for OF (p = 0.0004); femoral neck—20% for AS, 12% for RS, and 85.7% for OF (p = 0.0014); 1/3 radius—71% for AS, 53% for RS, and 86% for OF (p = 0.2845). Serum calcium, parathyroid hormone, alkaline phosphatase, and β-carboxy-terminal telopeptide were significantly higher in the OF group. The mean values for 25-hydroxyvitamin D were lower in OF group than AS and RS groups (15.2 ± 6.3 ng/mL vs. 22.7 ± 11.9 ng/mL and 20.3 ± 7.0 ng/mL; p = 0.2139). Based on these results, we conclude that the prevalence of osteoporosis is high in all sites studied and is almost universal in the OF patients. The great prevalence of cortical osteoporosis is seen even in young patients with less severe forms of the disease.     

Efficiency of endoscopic treatment for vesico‐ureteric reflux in adults

OBJECTIVE

To evaluate the results of our experience with endoscopic management of vesico‐ureteric reflux (VUR) in adults, and to describe factors and complications that might contribute to the failure of the technique.

PATIENTS AND METHODS

Between 1992 and 2006, 21 patients (17 women and four men; mean age 32.1 years, sd 15.6) had endoscopic treatment for VUR (14 unilateral and seven bilateral ureteric units, UU). Patients previously operated for VUR were excluded. The VUR grades were II, III, IV and V in 10, 12, five and one UUs, respectively. The main indication for treatment was a history of repeated episodes of acute pyelonephritis (61%). Complications after surgery were evaluated.

RESULTS

The success rate of the first endoscopic treatment was 69%, and was 81% after the second. Two UUs with grade IV VUR were endoscopically managed for a third time with complete resolution. Only one UU with grade V VUR required open surgery. The success rate for VUR grades II, III and IV after the first treatment was five of eight, 12/12 and one of five, respectively. After the second treatment the success rate increased to seven of eight and two of five for grades II and IV, respectively. There were no complications related to the intervention. Factors related to a failure of technique were duplex ureter and dysfunctional voiding in eight UUs (seven patients).

CONCLUSIONS

The endoscopic management of VUR in previously untreated adult patients is a simple and efficient technique, with low comorbidity.