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H Pumarino

Publications and source records attributed to H Pumarino.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Bone density and mineral content in normal men. Measurement by dual photon densitometry].

The aim of this study was to measure whole body, L2 to L4 vertebral bodies and femoral neck bone density and mineral content, using a dual photon densitometer with a 153Gd source, in normal male subjects. One hundred twenty five males, aged 20 to 85 years, were studied. Subjects were separated, according to age in 5 year groups, with at least 10 subjects per group. Height did not show secular changes until 70 years of age, but a 9 kg increase in weight and a 3.8 kg/m2 increase in body mass index was observed. Lumbar spine bone density was 1.066 g/cm2 between 20 and 29 years and did not change with increasing age. In the same age group, femoral neck density was 1.034 g/cm2 and it decreased steadily after the age of 40 (slope = -0.003) with an annual loss of 0.23%. Total mineral content decreased from 2.477 g in the first age group to 2.316 g in subjects 70 years old or older. This represents a net loss of 6.5% in this period. Compared with normal females from a previous study, young men have similar spine and femoral neck densities than young women until the age of 50. In women over this age, there is a steady decline in lumbar spine density and the decrease in femoral neck density is more marked than in men. Also, total mineral content is higher in young men and its 6.5% loss with age is much lesser than the 31.6% loss observed in women.

Absorptiometry, Photon↗
PubMed1992

[Treatment of anorexia nervosa].

Treatment of anorexia nervosa integrates psychiatric and medical aspects. Elements of analytically oriented (not true psychoanalysis) and behavioral forms of psychotherapy are utilized. Emphasis should be placed in the setting, patient-therapist relation, and alliance with the family. Weight gain is the gauge and one of the goals of the therapy, having in mind that as it increases anxiety may be generated. From a behavioral point some restrictions are indicated. Antipsychotic (or neuroleptic) and antidepressant drugs should be used. Haloperidol is the drug of choice among antipsychotics while amitriptyline is usually preferred as antidepressant. General medical measures include adequate nutritional support, limitation of physical activity, eventual supplementation with iron, folic acid and vitamin B12. Estrogen therapy associated to progestins, calcium and vitamin D should be considered to prevent osteopenia.

Anorexia Nervosa↗
PubMed1992

[Percutaneous puncture thyroid cytology: cyto-histologic correlations in 136 nodular goiter surgical patients].

Percutaneous puncture for cytologic study was performed in 136 patients with nodular goiter. All patients were operated on and correlation of cytologic and histologic findings was obtained. Echographic study revealed a solid aspect in 72%, cystic aspect in 10% and mixed in 18%. The cytologic findings were classified as: benign--hyperplasia--, chronic thyroiditis, follicular neoplasm (adenoma and carcinoma), oxyphilic neoplasm (adenoma and carcinoma), papillary cancer, medullary cancer, anaplastic cancer and insufficient material. Surgery revealed cancer in 36 patients (26.5%). There were 3 false positives for cancer in the cytologic study. Percutaneous cytology was able to detect 88% of patients with cancer and 83% of patients with neoplasms. False negatives for cancer (n = 5) were due to insufficient sample (2), topographic error (2) and cytology error (1). No follicular cells were obtained in 13 patients with cystic follicular adenoma and the diagnosis was missed. Surgery confirmed that 24 of 25 patients with cystic aspect on echography had a basic underlying lesion. Thus, percutaneous cytology of the thyroid is useful in the evaluation of patients with cold nodules. Main limitations of the technique are found in patients with cystic lesions and follicular neoplasms.

Adolescent↗
PubMed1992

[Osteopenia in anorexia nervosa evaluated by dual photon-densitometry. Role of malnutrition and hypogonadism].

30 female patients with anorexia nervosa (AN) were studied and compared with 45 age-matched normal controls. All the patients had severe weight loss and nutritional involvement. Mean and SE body mass index, BMI (kg/m2) were 15.8 +/- 1.8 in anorectics compared to 21.7 +/- 4.7 in normals (p < 0.0001). All the patients presented amenorrhea lasting between 3 and 120 months (mean 24.8 +/- 25.3). A nutritional survey and a dual photon bone densitometry, including spine, hip, total body and total mineral content were performed. The mean values +/- SE in patients and controls were: spine densities (L2-L4) in g/cm2: AN 0.84 +/- 0.1, controls 1.03 +/- 0.1 (p < 0.002). Total mineral content (g): AN mean 1733 +/- 261, controls 2045 +/- 276 (p < 0.0001). In anorectic patients the correlations between bone density and BMI for spine were r: 0.52 (p = 0.002), for hip r: 0.37 (p = 0.04), and total mineral content vs BMI gave r: 0.64 (p = 0.0001). Mean calcium intake in 23 studied patients was lesser than the classic recommended dietary allowance in the whole group, it was less in the pure restricters as compared to vomiters. The relation between duration of amenorrhea and bone density showed than a decrease in the later was evident when the absence of menses was longer than 24 months. In conclusion, in patients with AN there is a real decrease in bone density which is strongly related to low weight and in lesser proportion to the duration of amenorrhea, particularly when it was longer than 24 month.

Absorptiometry, Photon↗
PubMed1992

[Primary hyperparathyroidism caused by a mediastinal adenoma with intermittent hypercalcemia and severe bone disease].

We report the case of a 33-year-old woman who was operated on with the diagnosis of primary hyperparathyroidism (PHP) in 1986. She had bone disease and slight hypercalcemia. Two parathyroid glands were removed with a lack of clinical improvement. Subsequently, the serum calcium levels were normal with occasional slight increases. Depressed phosphorus values and elevated alkaline phosphatases and PTH levels were also present, associated with severe bone involvement and muscular weakness. A second cervical exploration performed in 1989 disclosed only a normal parathyroid gland, which was not removed. In 1990, a thoracic CT scan showed the presence of a 1 cm mediastinal nodule close to the great vessels. A thoracotomy was performed to remove this nodule, which proved to be a parathyroid adenoma. After surgery, the patient presented with a "hungry bone" syndrome, characterized by very low levels of calcium, phosphorus and magnesium, which required enteral and parenteral calcium and magnesium supplements, plus dihydroxyvitamin D. The association of normocalcemia and intermittent hypercalcemia with severe bone disease is very rare, as is the presence of a mediastinal adenoma. This could explain the difficulty in the diagnosis in this case.

Adenoma↗
PubMed1991

[Epidemiology of fractures in Chile].

Bone fractures represented 3.3% of diagnosis among 1,003,267 patients discharged from National Health System Hospitals in Chile during 1985. Among 73,534 certified deaths, 1.2% followed fractures. Significantly higher rates were observed in males; after age 75, fractures were more common in females. Rates per 100,000 for different fractures were: radio-cubital 45.4, shine and fibula 41, ankle 28.1, humerus 25.3, and hip 23.5. Among males the figures were shine and fibula 66.2, radius and cubitus 64.9, face 37.5 and ankle 37.1. Among females, hip 28.2, radius and cubitus 26.3, ankle 19.3 and humerus 16.5. Hip fracture is clearly related to age, the incidence raising from below 60 per 100,000 under age 60 to 617 in females and 330 in males above that age. Other fractures that increase with age include radius and cubitus, shine and fibula, ankle, humerus and femur.

Adolescent↗
PubMed1991

[Plasma calcium levels in critical patients with and without sepsis].

We determined total plasma calcium levels in 44 critically ill patients without evidence of renal or hepatic failure, 25 of them with active systemic infection. Plasma Ca was 7.49 +/- 0.1 mg/dl in the septic group compared to 8.46 +/- 0.2 in non septic patients (p < 0.01). Corresponding levels of serum albumin were 2.26 +/- 0.1 and 3.05 +/- 0.2 milligrams, respectively (p < 0.01). Corresponding corrected plasma Ca levels were 9.19 +/- 0.1 and 9.39 +/- 0.1 mg/dl (NS). No correlation of lactate and plasma Ca levels was found. Mortality was 56% for septic and 16% for non septic patients. Patients with hypocalcemia had 53% mortality rate compared to only 16% in normocalcemic patients. PTH levels were normal in all but one patients, thus ruling out a rapid installation secondary hyperparathyroidism. Hypoperfusion does not appear related to ionic Ca levels given the lack of correlation of Ca and lactate levels. Mortality is related to sepsis and hypoalbuminemia but not to corrected Ca plasma levels.

Bacterial Infections↗
PubMed1991

[Density and bone mineral content and their relation to anthropometric parameters in a normal Chilean population. A study with women].

We studied 227 normal women from 20 to 89 years of age. Bone density and mineral content was measured in vertebral bodies L2 to L4, both femurs and whole body, using a double beam photon densitometer with a 153Gd source. Body height remained between 156 and 158 cm up to age 64, then decreased gradually to 152 cm. Weight increased from age 35 to 69 (mean 9 kg) and then decreased. Mean bone density of the lumbar spine was 1.07 g/cm3 up to age 50. A marked decrease in density was observed for 10 years after that age, gradually slowing in later years. Mean density of the femoral neck was 0.931 g/cm3 up to age 50. A steady decline is observed in later ages down to 0.763. The density ratio of spine to femoral neck remains under 1.2 up to age 60, then increases progressively. Total mineral content, absolute or relative to body weight, was a less sensitive index. Total content decreased from above 2000 gm to about 1550 gm after age 70. The greater proportion of mineral contents is found in the lower extremities (30%). With increasing age a greater mineral loss was observed in the trunk, including spine and hips, compared to other segments. Our findings reveal bone densities somewhat lower than those reported from USA and higher than those reported from Denmark.

Absorptiometry, Photon↗
PubMed1991

[Nutritional study of alcoholics with specific reference to calcium and phosphorus].

We performed a nutritional study of 80 alcoholic males at least 15 days after an acute episode of alcoholic intake. 43 patients were intermittent drinkers with mean age 37.9 years and 37 patients were continuous drinkers with mean age 440.30 healthy subjects were studied as controls. Body mass index was 23.7 (range 19.2-37.9) in intermittent drinkers compared to 23.1 (range 18.1-29.8) in continuous drinkers (NS). Wine was the main alcoholic beverage in 70% and 89%, respectively. Mean daily alcohol intake was 170 g for 17 years and 358 g for 23 years, respectively. Mean caloric intake and % of calories from alcohol were 3387 and 42% for intermittent compared to 4271 and 66% for continuous drinkers, respectively. Daily calcium intake was 757 g and 774 g in each group. Alcoholic beverages supplied 16% and 34% of calcium intake, respectively. The intake of phosphorus was adequate. Alcoholic subjects did not manifest anemia or hypoalbuminemia, compared to controls. The present study fails to disclose significant caloric and protein undernutrition in alcoholic subjects. However, the intake of calcium is inadequate and a high percentage of it is provided by alcoholic beverages. This deficiency in conjunction with alcoholic damage to intestinal mucosa may lead to osteopenia in alcoholic patients.

Adult↗
PubMed1991

[Active acromegaly and gigantism: some clinical characteristics of 50 patients].

50 patients with autonomous growth hormone excess (48 with adult acromegaly and 2 with gigantism) were studied between 1966 to 1986 (2.38 pts/year). Characteristic clinical presentation, an increase in growth hormone (GH) uninhibited by glucose, and/or hyperphosphemia and hyperhydroxiprolinuria were present in all patients. No cases of hypercalcemia were recorded. Phosphemia was increased in 55.8%, alkaline phosphatases in 61.7%, calciuria in 26.9% and hydroxyprolinuria in 74.2% of the patients. Basal GH was over 5 ng/ml (89.9 DS +/- 170.9) in 42 pts, and in 37 was not suppressed after glucose administration, 38% had an increased (paradoxical response) and 62% a flat response (less than 50% change of basal values). TRH test was performed in 14 patients, 8 presented an increase in GH titer. Hyperprolactinemia was seen in 4 of 12 patients in whom this hormone was measured. The size of the sella turcica was increased in 93%, and although the larger sellar size correlated to higher levels of GH, correlation was not significant. 20% of the pts had rheumatological disease, 14% goiter, 12% cardiac disease, 26.5% had diastolic hypertension and 4% renal lithiasis (hypercalciuric pts). 38% had hyperglycemia with a diabetic glucose tolerance test and 18% had non-diabetic abnormal glucose tolerance test.

Acromegaly↗
PubMed1990

[Osteoporosis in a man with idiopathic hypercalciuria, renal variety, treated with a hypocalcic diet].

A 61 year old man with a calcic urinary stone at age 46 was submitted to a prolonged low calcium diet (about 400 mg/day). Normal serum calcium and elevated urinary Ca (725 mg/day were demonstrated). After a diet with a normal Ca content (900 mg/day) urinary excretion did not change. PTH, serum Ca and P were normal. Biphoton bone densitometry revealed severe osteopenia, with a spine density of 51% of normal. The addition of hydrocortisone (50 mg/day) reduced urinary Ca output over 25%; the addition of phosphate, 1125 mg/day, brought Ca output to normal levels. Thus, prolonged dietary restriction of Ca in the presence of high urinary Ca loss may produce severe osteopenia and osteoporosis.

Calcium↗
PubMed1990

[Idiopathic tumoral calcinosis. A clinical case].

A 25-year-old Chilean woman of Jewish ancestry developed subcutaneous nodules at the thighs, axillae, elbows and coccygeal areas. X rays disclosed heavily calcified lesions at these levels. The patient's father had Whipple's disease, her mother and one brother had early hip osteoarthrosis and one son had idiopathic pancreatitis. Laboratory studies ruled out hyper or hypoparathyroidism. Electromyogram showed evidence of mild myopathy and inflammatory elements were present on muscle biopsy. However, the diagnosis of polymyositis associated to calcinosis was ruled out. Skin biopsy disclosed calcifications and fat necrosis. After 20 years of follow up, an increase in calcification specially at the pelvis and periarticular regions has been observed. Etiology, differential diagnosis and treatment are discussed.

Arthrography↗
PubMed1989

[Hematologic changes in anorexia nervosa].

We studied the hematologic values of 25 patients with anorexia nervosa. Age ranged from 12 to 38 years and 22 were females. Mean hematocrit was decreased to 36% and total leukocyte count to 4.400/microliters. Anemia was diagnosed in 13 patients. It was normocytic in 7 hypochromic microcytic in 7 and megaloblastic in 2. Seven of these anemic patients corrected their anemia with the treatment of anorexia nervosa, 3 required iron supplement and 2 folic acid. Bone marrow studies in 23 patients demonstrated hypoplasia in 17. Four patients had global bone marrow hypoplasia with decreased numbers of erythroblasts and megakaryocytes. A mucopolysaccharide substance substituted for a decreased fat content of bone marrow. A decreased bone marrow reserve of neutrophils and their margination in blood vessels contributed to leukopenia, which was not associated to an increased number of infections. Blood coagulation tests and platelet aggregation were normal.

Adolescent↗
PubMed1989

[Idiopathic hypoparathyroidism, a syndrome with various clinical expressions: analysis of 10 cases].

We report 10 patients with primary hypoparathyroidism. Age at onset varied from 7 months to 52 years (mean 28); 7 were female. Diagnosis was established at a mean of 4.1 years after the appearance of clinical manifestations. Unexplained hypocalcemia (mean 5.3 mg/dl) and hyperphosphatemia (mean 6.4 mg/dl) were present in all patients. Prevalent symptoms included tetany (9 patients), seizures (5) and hypocalcemic cataracts (4). Clinical manifestations may be grouped into 5 types 1) tetany; 2) seizures; 3) other neurologic disorders (basal ganglia calcification, pseudotumor of the brain, ataxia, nystagmus, hypertonus, paresis); 4) disorders of the lens including fully developed cataracts and 5) skin alterations like psoriasis and others. Some of these run on acute course (seizures, tetany), others a subacute one (skin alterations) while others are rather chronic (cataract and other neurologic disorders). Seizures and electroencephalographic disorders predominate in younger patients while tetany is more prevalent in older subjects.

Adult↗