Introduction: Proton-pump inhibitors (PPIs) are widely used drugs, though it should be noted that excessive use is not in line with the accepted indications in Spain and throughout Europe. Furthermore, some authors have established a possible PPI link to the risk of fracture. In this paper, we make an initial approach to knowledge into PPI consumption and analyze what indication is prescribed. We also studied the drugs' possible association with increased risk of fragility fracture in users. Material and method: An observational, transversal, open and descriptive study in which a number of randomly-chosen patients were interviewed. These patients had been treated in outpatient, emergency and primary care centers. Some had also been treated in hospital wards. Results: Of the 411 patients interviewed, 54% received PPIs. The average age was 63.3 years, compared with 46% that did not take them and who were younger presenting a mean age of 50.9 years. Gender distribution was similar. PPIs were mainly used as a "gastric protector", in 39.8% of the patients, with no indication appearing in the technical specifications for this group of drugs. Consumers of PPIs presented a higher prevalence of all fragility fractures. Conclusions: More than half of the population surveyed consumed PPI. Of this group, about 40% did so without proper medical advice. Therefore, in addition to the higher prevalence of fragility fractures that suggest a possible increased risk of fracture among its users, we consider the need for a more rational use of these drugs. These preliminary findings point to a need for further studies to confirm the relationship between PPIs and the risk of osteoporotic fracture.

Introducción: Los inhibidores de la bomba de protones (IBP) son fármacos ampliamente utilizados, si bien esto conlleva a un sobreuso que no es acorde con las indicaciones aceptadas en España y en el resto de Europa. Por otro lado, algunos autores han establecido una posible implicación de los IBP en el riesgo de fractura. Con este trabajo hemos pretendido efectuar una primera aproximación al conocimiento del consumo de IBP en nuestro medio y analizar para qué indicación son prescritos, a la vez que estudiar su posible asociación con un mayor riesgo de fractura por fragilidad entre sus consumidores. Material y método: Estudio observacional, transversal, abierto, descriptivo, en el que se entrevistó aleatoriamente a un número de pacientes que fueron atendidos en diferentes ámbitos sanitarios: consultas externas hospitalarias, servicios de urgencias, consulta de Atención Primaria y pacientes ingresados en planta hospitalaria. Resultados: De los 411 pacientes entrevistados, el 54% de los pacientes recibían IBP, y cuya edad media era de 63,3 años, frente al 46% que no los tomaban y que eran más jóvenes, con una edad media de 50,9 años. La distribución por sexos fue similar. La principal razón de utilizar el IBP era como "protector gástrico", en el 39,8% de los pacientes, indicación no existente en la ficha técnica de este grupo de fármacos. Los consumidores de IBP tenían una mayor prevalencia de todas las fracturas por fragilidad. Conclusiones: Más de la mitad de la población encuestada consume IBP, y de ella cerca del 40% sin una indicación médica correcta. Por esto, unido a la mayor prevalencia de fracturas por fragilidad que presentan -que nos hace pensar en un posible mayor riesgo de fractura entre sus usuarios- consideramos la necesidad de un uso más racional de estos fármacos. Estas conclusiones son preliminares pero, a la vista de estos resultados, creemos que puede ser interesante realizar más estudios dirigidos a comprobar de manera más firme la relación entre los IBP y el riesgo de fractura osteoporótica.

Metastases of prostate cancer to intracranial meninges are rare and often confused with meningiomas or chronic subdural hematomas. These usually occur in patients with a known cancer diagnosis in advanced stages of the disease, and only in some rare cases do its manifestations precede the detection of the primary tumour. The clinical presentation is unspecific. However, due to the affinity of this tumour for the base of the skull, it must be included in the differential diagnosis of men over 70 years of age with cranial nerve palsy. The treatment of these lesions has not been standardized. Within the therapeutic options we find surgical resection, chemotherapy, radiotherapy or a combination of these measures, and yet survival is poor. We present the case of a 77 year old male patient whose initial symptoms of prostate cancer were caused by a metastatic lesion to the dura, confirmed by histopathology. We also review the epidemiological, clinical and imaging highlights of this condition.

Las metástasis del cáncer de próstata en las meninges intracraneales son raras y con frecuencia son confundidas con meningiomas, hematomas epidurales o subdurales crónicos. Usualmente se presentan en pacientes con diagnóstico oncológico conocido en estadios avanzados de la enfermedad y solo en algunos raros casos sus manifestaciones han precedido a la detección del tumor primario. La presentación clínica es inespecífica, sin embargo, por la afinidad de estos tumores por la base del cráneo, constituye un diagnóstico diferencial del compromiso de pares craneales en varones mayores de 70 años. El tratamiento de estas lesiones no ha sido estandarizado y dentro de las opciones terapéuticas están la resección quirúrgica, quimioterapia, radioterapia o la combinación de estas medidas y aún así la supervivencia es corta. Se presenta el caso de un varón de 77 años cuya manifestación inicial del cáncer de próstata fue la sintomatología producida por una lesión metastásica en la duramadre, confirmada por histopatología. Se revisan los aspectos epidemiológicos, clínicos y de imagen más sobresalientes de las metástasis meníngeas del cáncer de próstata.

Chiari malformation type I and Poland's syndrome are two rare diseases and their simultaneous presentation had not been previously described in the literature. We report the case of a 27 year old male with history of Poland's syndrome, who referred headache and motor impairment of the intrinsic muscles of the left hand. In a cervical spine MR a Chiari I malformation with syringomyelia from C1 to T2 was found, which was treated by foramen magnum decompression, dural plasty and removal of the posterior arch of the atlas. A discussion of the embryological mechanisms that might be involved in the coexistence of these two entities is presented, emphasizing the role of para-axial mesoderm.

La malformación de Chiari tipo I y el síndrome de Poland son dos patologías infrecuentes, más aún su presentación simultánea no había sido previamente descrita en la literatura. Se presenta el caso de un paciente varón de 27 años con antecedentes de síndrome de Poland, quien refirió cefalea y alteraciones motoras de los músculos intrínsecos de la mano izquierda. En los estudios de resonancia magnética de columna cervical fue encontrada la malformación de Chiari tipo I con siringomielia desde C1 a T2, la cual es tratada mediante descompresión del foramen magno, plastia de duramadre y remoción del arco posterior del atlas. Se presenta una discusión de los mecanismos em-briológicos que podrían estar implicados en la coexistencia de estas dos entidades, haciendo énfasis en el rol del mesodermo para-axial.

Clear cell meningioma is a rare variety of meningiomas, occurring frequently at the cerebellopontine angle and spinal canal. A case of a female patient 28 years of age with a complete cauda equina syndrome was described. Magnetic resonance imaging of lumbo-sacral spine revealed a mass lesion occupying the spinal canal from L3 to S1. Subtotal resection was performed and pathological examination revealed a clear cell meningioma. Radiotherapy was indicated, however, it was delayed because we discovered that the patient was pregnant. The recurrence was clinically evident at seven months and a new surgical resection previous complementary radiotherapy was necessary. A systematic review of literature was performed, exposing the behavior of clear cell meningioma in the spinal canal.

El meningioma de células claras es una variedad rara de meningioma, que se presenta con particular frecuencia a nivel del ángulo ponto-cerebeloso y el canal raquídeo. Se describe un caso de un paciente femenino de 28 años de edad con un síndrome de cauda equina completo. La resonancia magnética nuclear de columna lumbo-sacra reveló una lesión tumoral que ocupa el canal raquídeo desde L3 a S1. Se realizó una resección subtotal cuyo examen histopatológico reveló un meningioma de células claras. Fue indicada radioterapia complementaria, sin embargo, se descubrió que la paciente estaba embarazada, por lo que debió ser pospuesta La recidiva fue clínicamente evidente a los siete meses, requiriendo nueva resección y radioterapia complementaria. Se realizó una revisión sistemática de la literatura, exponiéndose el comportamiento del meningioma de células claras dentro del canal espinal.

Foram conduzidos três experimentos para determinar a quantidade ótima da injeção de selênio-vitamina E (Se-vit E) para manter o nível aceitável do status de selênio no sangue de cabras e cabritos e determinar essa relação com o status sobre a taxa de mortalidade de cabritos. No primeiro experimento, 238 cabras foram usados em um dos três grupos durante o período do acasalamento: A1- controle, A2- 0,06mgSe+0,8UI vit E/kg de peso-vivo e A3- 0,125mgSe+1,7UI vitE/kg de peso-vivo. Não houve diferenças (P>0,05) entre os grupos para fertilidade e prolificidade. A concentração de Se no sangue não foi diferente entre os grupos que receberam Se-vit E e o controle antes da injeção e ambos os grupos mostravam deficiência de Se. Sessenta dias pós-tratamento houve tendência (P<0,05; 32%) de aumentar o nível de Se no sangue e não houve diferença entre os grupos A2 e controle. Houve diferença significativa (P<0,05; 103%) entre os grupos A1 e A2 e o grupo A3. No segundo experimento, 48 cabras foram divididas em quatro grupos: B1- controle, B2- 0,125mgSe+1,7UI vitE/kg de peso-vivo, B3- 0,25mgSe+3,4UI vitE/kg de peso-vivo e B4- 0,31mgSe+4,2UI vitE/kg de peso-vivo. O grupo B4 alcançou a concentração mais alta no terceiro mês depois da injeção (0,11ppm) e diminuiu depois de 100 dias, quando o valor foi apenas ligeiramente maior que os valores dos grupos B2 e B3, aos 135 dias da gestação. Os resultados dos grupos B2 e B3 foram ligeiramente mais altos que os do grupo B1 (P<0,05). No terceiro experimento, 194 cabritos (3 a 7 dias de idade), nascidos de cabras deficientes em Se, foram usados para comparar a efetividade da injeção de Se. Foram divididos em três grupos: C1- controle, C2- 0,3mgSe+4,2UI vit E/kg de peso-vivo e C3- 0,6mgSe+8,4UI vit E/kg de peso-vivo. A porcentagem de mortalidade foi mais alta em C1 (60%) e mais baixa nos grupos tratados com Se (22%). A concentração de Se no sangue no 20º após o início do tratamento aumentou rapidamente, de acordo com o nível de injeção de Se. A injeção com 0,3mgSe/kg de peso-vivo aumentou a concentração de Se no sangue em cabras gestantes e a dose foi efetiva para prevenir a doença de músculo branco e aumentar a sobrevivência dos cabritos até o desmame.

Three experiments were carried out to determine the optimum selenium-vitamin E injection level to maintain acceptable blood selenium (Se) status of does and kids, as well as to determine the relation of that status to mortality rates in kids. In experiment 1, 238 goats were assigned to one of three groups during the mating period: A1-control, A2- 0.06mgSe+0.8IU vitE/kgBW and A3-0.125mgSe+1.7IU vitE/kgBW. No differences (P>.05) for fertility and prolificacy were observed among the groups. Blood Se concentration did not differ among Se-vit E groups and control group before injection, and both groups showed Se deficient condition. There was a trend (P<.05, 32%) to increase Se blood level 60 days post-treatment, but difference was not observed between A2 and control groups, while difference (P<.05; 103%) was observed between A1 and A2 groups vs high Se injection (A3 group). In experiment 2, 48 goats were divided into four groups: B1- control, B2- 0.125mgSe+1.7IU vitE/kgBW, B3- 0.25mgSe+3.4IU vitE/kgBW and B4- 0.31mgSe+4.2IU vitE/kgBW. The B4 group reached the highest concentration at the third month after injection (0.11 ppm), then started to decline after 100 days, reaching a value slightly higher than B2 and B3 on the 135th day of pregnancy. Results of B2 and B3 groups were slightly higher that those of B1 (P<0.05). In experiment 3, 194 kids (3 to 7 days postpartum) born from Se-deficient goats were used to compare the effectiveness of Se injection. They were divided into three groups: C1- control, C2- 0.3mgSe+4.2IU vit E/kg BW and C3- 0.6mgSe+8.4IU vit E/kg BW. C1 showed the highest percentage of mortality (60%) as compared to treated Se groups, that scored equal percentage of deaths (22% averaged). The concentration of Se in blood, on day 20th after the onset of the treatment rapidly increased, according with level of Se injection. The 0.3mgSe/kgBW Se injection increased the blood Se concentration in pregnant goats and it was effective to prevent white muscle disease lesions, besides enhancing the survival of kids until weaning.