DENSITOMETRIA OSEA EPUB DOWNLOAD

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Article Information, PDF download for Densitometria ossea: una breve guida per il nefrologo, Open epub for Densitometria ossea: una breve. mirai (Japanese Edition) [eBook site] pdf, epub free download now. .. Densitometria Ossea Na Prática Medica [Português] [Capa dura] PDF By author José. Fatores associados à osteopenia e osteoporose em mulheres submetidas à densitometria óssea. Article (PDF Download full-text PDF. Available via license .


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população de mulheres que fizeram exames de densitometria em uma clínica especializada submeteram à densitometria óssea entre janeiro e dezembro de Foi feita .. Osteoporos Int. [Epub ahead of print]. 7. TRABALHO DE PSICOLOGIA PDF DOWNLOAD (Pdf Club.) ePub File Size: Mb . DENSITOMETRIA OSEA INTERPRETACION PDF. Download Here http://eap Featuring over 1, mammographic images, this atlas is a comprehensive guide to interpreting mammograms.

This helps to select a population with a higher risk of fracture. Among CKD patients it is not common to use the Fracture Risk Assessment Tool FRAX , which estimates the probability at 10 years of major osteoporotic fracture clinical vertebral, hip, forearm and humerus applying an algorithm based on age, gender and clinical factors with or without BMD.

It provides information about the total amount of mineral in the scanned bone area — usually the neck of the femur and the vertebrae — although it does not distinguish changes in bone turnover or characteristics of the bone matrix.

In patients with CKD, tissue or vascular calcifications may interfere with bone measurements and give falsely elevated values. Likewise, post-transplant calcium mobilization could lower BMD values, without actually changing the bone mineral content.

In patients with CKD stages 3—5D, it is not recommended the routine performance of DXA for determination of BMD, due to its low predictive power of fractures and its inability to diagnose the type of renal osteodystrophy. The best location for BMD measurement is the distal radius.

Thus given that DXA is not able to fully detect bone resistance to fractures, additional diagnostic tests are needed to establish the risk of fracture.

Three diagnostic tests have emerged in recent years: - High resolution peripheral quantitative computer tomography, used in patients with CKD, 32 or KT 33 measures the volumetric density of the cortical and trabecular region separately, and has a resolution that allows analyzing the bone microarchitecture. However, it is expensive and so far not very accessible in usual practice. This was first described in a clinical series in To date, 2 main techniques have been developed: cyclical microindentation and impact microindentation.

Both are included in the generic term of reference point indentation and are based on the principle that the deeper a needle penetrates the anterior face of the tibia, the less resistant the bone tissue will be to a mechanic impact.

The cyclic microindentation was used in the first studies including patients 36 ; the study by impact microindentation, simplifies the method of measurement 37—39 and makes it preferable for clinical use. The procedure is simple.

The mean of 8 indentation values is transformed by a computerized algorithm. Then, 5 calibration indentations are made in a block of polymethyl methacrylate. The ratio between the value provided by the bone and by the block provides the final parameter, the bone mineral resistance index, which is expressed in absolute units. The propensity to bone fractures is the result of the deterioration of BMD, microarchitecture and bone tissue properties, which can occur individually or in combination and in different proportions depending on each pathophysiological situation.

Therefore, for a complete calculation we must contemplate the 3 components. Impact microindentation has been applied in the study of other patient populations in which the risk of fracture can only be partially established with DXA. By contrast, in women with type 2 diabetes, where both BMD and trabecular microarchitecture are preserved while the risk of fracture is clearly high, the bone mineral resistance index was the most abnormal component of bone strength.

The best method to estimate the risk of fracture in a patient with CKD is unknown. An improvement of the diagnostic methods to determine the risk of fracture is crucial as a first step for the indication of any preventive treatment Fig.

Comparison between the different diagnostic tests to estimate bone health. Bone health in the long-term kidney transplant patient In our group, we aimed to analyze the bone health of a cohort of long term kidney transplant patients, taking into account different bone properties that contribute to bone strength.

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The correlation of the degree of association for the other two parameters was determined using the Pearson's r correlation test, validated by the Spearman's rank and Kendal tau correlation tests. Values of p less than 0. Mean body mass index BMI of the studied population was None of patients was evaluated, previously, for GHD.

Baseline endocrine evaluations proved normal values in all patients except in 4 The dynamic evaluation, performed by GHRH plus Arginine stimulation test, revealed an impairment of GH response in 11 8 females and 3 males out of 28 These patients compared with normo responsive group, showed non significant lower basal GH levels 0.

This subgroup of patients also showed lower levels of IGF-I Regarding the metabolic parameters we found a worse profile in GHD vs no GHD, specially for total cholesterol and triglycerides, where the differences were statistical significant Table 3.

Lastly the evaluation of bone mineral density, performed by DEXA, showed a worse mineral content in patients in which GH impairment was established vs the normo responsive ones, especially in the femoral site T score lumbar site: Every patient belonging to the control group ten patients at all, 5 females and 5 males showed normal baseline endocrine evaluation and a normal GH peak during the stimulation test.

The metabolic parameters and the mineral content were within the reference range for normal population. This condition is always seen, in the past, as a simple anatomical variant with poor clinical significance. In the older reports only hyperprolactinemia was underlined and hypopituitarism was seldom reported in symptomatic patients. The etiology of this condition is not fully understood.

Some authors have focalized their attention on autoimmune diseases like lymphocytic hypophysitis [] while the largest series reported in literature [11] failed to find a clear association with autoimmune disorders. Because of the clear association with sex female, some authors try to correlate pregnancy, during which pituitary volume could double, with the onset of the disease, especially in case of multiple pregnancies. Obesity is frequently present and it is believed responsible to induce hypercapnia that can be the cause of chronic CSF pressure elevation.

This one may lead, in subjects with predisposing anatomical factors like a hypoplasic diaphragm sellae, to the intrasellar herniation of the suprasellar subarachnoid space [9]. All these features and some recent reports, that show how hypopituitarism could be present and serious, allow us to verify this aspect. Some reports, indeed, underline that the development of hypopituitarism often goes unrecognized and that the diagnosis could be delayed.

Other few reports, more recently, found relevant pituitary function impairment in patients with a diagnosis of PES [8, 16, 17]. Moreover the importance of the unrecognised presence of an empty sella, with the onset of hypocortisolism related to ACTH deficiency, is showed in another recent case report in which, the presence of this condition has caused a profound cardiovascular distress in a patient underwent surgery for cardiovascular disease [18] and in another review that showed how a shade off complex symptomatology, complaints of weakness, fatigue, weight loss, nausea and vomiting, was related to a ACTH deficiency due to the presence of a PES [19, 31].

More recently some authors confirmed the clinical importance of a undiscovered PES [20]. Besides these, our attention is focalized on the relevant presence, in this kind of patients, of some clinical aspects that are typical of metabolic syndrome.

We know, from some years ago, how the GH deficiency syndrome itself could be seen as a particular metabolic syndrome and the Endocrine Society states a precise and defined space for GH deficiency's diagnosis and treatment [21, 22].

DENSITOMETRIA OSEA PDF

It is clearly defined, indeed, how patients suffering by these pituitary dysfunction showed a worse metabolic and cardiovascular profile [] and that these alterations are strictly related to the severity of the dysfunction [26]. In fact these two molecules are critical in achievement and maintenances of bone mass.

GH may act either directly on skeletal cells or through IGF-I, that could be synthesized by liver or by peripheral tissues. Osteoblast cell differentiation is greatly modulated by GH. Also IGF-I increases bone remodelling and regulates the function of the osteoblast. All these aspects become particularly significant if we keep in mind how our population is older than the past and how important is the impact of cardiovascular diseases and bone fractures on social cost and on health policy.

In fact, although the gold standard procedure to diagnose a state of GHD is represented by insulin tolerance test ITT , it's burdened by some technical and clinical aspects greater numbers of blood samples, necessity of a continue monitoring of glycaemia and vital functions of the patient both during and after the test, high risk of severe hypoglycaemic crisis.

Considering these aspects, we preferred GHRH plus Arginin test that is nowadays recognised as an adequate alternative tool due to the better profile of safety and tolerability. Moreover for this test clear BMI-related cut off limits has been established [22]. It is worthy of note how our population does not showed a significant clinical symptomatology, but only unspecific signs. The reasons that lead us to the discovery of PES were, in the mostly of cases, headache and menstrual disturbances.

Mean BMI of the entire population was Furthermore, we would clearly underline the clinical implications of our work.

The correlation of GH deficit with serum markers, like cholesterol and triglycerides, showed once again that patients with GH impairment could be more susceptible to suffer from cardiovascular accidents. To our knowledge this is the first work, in literature, that states these aspects in PES.

The association of GHD to a more presence of overweight, in our population, do not alter the significance of the data. We keep in consideration, in the analysis of the dynamic evaluation, the recommended BMI-related cut off limits [22]. Regarding the study of bone status we show how the presence of GH deficiency is related to a worse densitometric data, at femoral site specially.

Lastly many patients referred, as initial tool for investigation, depression and fatigue.

These are other aspects that are present in GH deficiency syndrome [28, 29] and that could be improved by replacement therapy [30]. We think that our work is very important for two reasons: the first is that we confirm, like others recently reported, the presence of GHD in these kind of patients; the second one is that we prove, for the first time in patients with a diagnosis of PES, how this functional impairment has a great clinical impact, both on bone and on metabolic parameters.

Obviously more reports are needed with a more numerous population to confirm these data.

Further randomized clinical trials are needed to evaluate the impact of replacement therapy on bone and metabolic diseases, in this particularly kind of patients. We think, particularly, to neurologists, internal medicine specialists, general practioners and radiologists too. Anyone of them has to alert the patient, in case of incidental findings, on the necessity of a careful endocrine evaluation. This consultation will be strongly recommended, particularly, in those patients suffering from or with a history of metabolic features, bone diseases or impaired sense of well being.

Conflict of interest statement There are no potential conflicts of interest or any financial or personal relationships with other people or organizations that could inappropriately bias conduct and findings of this study. Busch W.

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Morphology of sella turcica and its relation to the pituitary gland. Virchows Arch ; DOI: Primary empty sella turcica: a radiological-anatomical correlation. Australas Radiol ; 44 3 Bjerre P. The empty sella. A reappraisal of etiology and pathogenesis. Acta Neurol Scand Suppl ; Presence of anti-pituitary hormone antibodies in patients with empty sella syndrome and pituitary tumors.

Clin Endocrinol Oxf ; Komatsu M, Yamauchi R, et al. Antipituitary antibodies in patients with the primary empty sella sindrome.

J Clin Endocrinol Metab ;67 4 An unusual case of recurrent autoimmune hypophysitis. Exp Clin Endocrinol Diabetes ; 5 Empty sella and primary autoimmune hypothyroidism. Clin Exp Med. Primary empty sella: Why and when to investigate Hypothalamic-pituitary function. J Endocrinol Invest ; Endocrine disturbances in empty sella syndrome: case reports and review of literature.

Endocr Pract ;11 2 Impairment of GH secretion in adults with primary empty sella. J Endocrinol Invest ; 25 4 Some authors have focalized their attention on autoimmune diseases like lymphocytic hypophysitis [] while the largest series reported in literature [11] failed to find a clear association with autoimmune disorders.

Both are included in the generic term of reference point indentation and are based on the principle that the deeper a needle penetrates the anterior face of the tibia, the less resistant the bone tissue will be to a mechanic impact.

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Parole chiave: sindrome della sella vuota primaria, ormone della crescita, osteoporosi. Three diagnostic tests have emerged in recent years: - High resolution peripheral quantitative computer tomography, used in patients with CKD, 32 or KT 33 measures the volumetric density of the cortical and trabecular region separately, and has a resolution that allows analyzing the bone microarchitecture. Endocr Pract ;11 2 The procedure is simple.

Anaesthesia ;62 8 : Hillier, E. An Med Interna ;25 6 : Still, the development of a strategy to improve peak bone mass and prevent fractures and osteoporosis would probably be beneficial.