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BACKGROUND: While the association between benzodiazepines (BZD) and single fall is long-known, the association between BZD and recurrent falls has been few studied. OBJECTIVE: The aims of this study were 1) to examine whether BZD were associated with recurrent falls while taking into account the effect of potential confounders, and 2) to determine whether there was an interaction in terms of risk of falls between BZD and balance impairment in a community-dwelling population-based adults aged 65 and older. STUDY DESIGN: Cross-sectional. SETTING: Three health centers in North-East of France. POPULATION: 7643 community-dwelling volunteers aged 65 and older. OUTCOME MEASURES: The use of BZD, the Mini Mental State Examination (MMSE) score, the Clock Drawing Test (CDT), the One Leg Balance (OLB) test, the Five Times Sit-To-Stand test (FTSS), and a history of falls were recorded. Subjects were separated into 4 groups based on the number of falls: 0, 1, 2 and ≥ 3 falls. RESULTS: Among the 1456 (19.2%) fallers, 994 (13.0%) were single fallers and 462 (6.1%) were recurrent fallers (i.e., > 2 falls). The number of falls increased significantly with age (Incident Rate Ratio (IRR)=1.04, P < 0.001), female gender (IRR=2.24, P < 0.001), the use of benzodiazepine (IRR=1.65 P < 0.001) and especially while subjects used bromazepam (IRR=1.44, P=0.006), clobazam (IRR=3.01, P=0.014) and prazepam (IRR=2.29, P < 0.001). A low MMSE score (IRR=0.96, P < 0.001), an impaired CDT (IRR=0.91, P < 0.001), and a bad performance at OLB and FTSS (respectively IRR=1.85, P < 0.001 and IRR=1.26, P < 0.001) were related to the recurrence of falls. After adjustment only the advance in age (IRR=1.02, P < 0.001), female gender (IRR=2.15, P < 0.001), clobazam (IRR=2.54, P=0.04), prazepam (IRR=1.63, P=0.03) and OLB (IRR=1.55, P < 0.001) were still significantly related to the number of falls. CONCLUSION: The current study shows that the age, the female gender, the use of clobazam or prazepam and a low score at OLB are related to the recurrence of falls.

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BACKGROUND: The aim of the study was to determine which risk factors were associated with the recurrence of falls among community-dwelling older adults. METHODS: Based on a cross-sectional design, 1066 community-dwelling volunteers aged 65 and older were recruited. The use of psychoactive drugs, the number of drugs taken per day, the basic mobility assessed with the Timed Up & Go test (TUG), the maximal isometric voluntary contraction strength of hand, the lower limb proprioception, the distance binocular vision, the fear of falling and the history of falls during the past year were recorded. Subjects were separated into 4 groups based on the number of falls: 0, 1, 2 and ≥ 2 falls. RESULTS: Among the 395 (37.1%) fallers, 291 (27.3%) were single fallers and 104 (9.8%) were recurrent fallers (i.e., > 2 falls). The numbers of falls increased significantly with age (Incident Rate Ratio (IRR)=1.03, p < 0.001), female gender (IRR=1.95, p < 0.001), institutionalization (IRR=1.66, p=0.002), number of drugs taken per day (IRR=1.05, p < 0.001), use of psychoactive drugs (IRR=1.29, p=0.009), increased time of TUG Test (IRR=1.02, p < 0.001), use of a walking aid (IRR=1.59, p=0.002), and fear of falling (IRR=3.08, p < 0.001). In addition, a high score at the handgrip test (IRR=0.97, p < 0.001) and distance binocular vision (IRR=0.92, p < 0.001) were associated with a decreased number of falls. After adjustment for potential confounders, only female gender (IRR=1.44, p < 0.001), vision (IRR=0.95, p=0.006) and lower limb proprioception (IRR=0.95, p=0.046), and fear of falling (IRR=2.68, p < 0.001) were still significantly associated with the number of falls. CONCLUSION. The current study shows that female gender, poor vision and lower limb proprioception, and fear of falling were associated with the recurrence of falls.

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In congenital thyroid hemiagenesis, one of the thyroid lobes, usually the left one, does not develop. This condition is generally asymptomatic. We report a 47 years old female with a diffuse left goiter. An ultrasound detected the right lobe hemiagenesis. She was subjected to a subtotal thyroidectomy. The pathological study of the surgical piece disclosed the presence of an encapsulated papillary carcinoma, follicular variant with a diameter of 2 mm.

La hemiagénesis tiroidea es una anormalidad congénita inhabitual en la cual uno de los lóbulos de la tiroides no se desarrolla. Su prevalencia es desconocida, debido a que generalmente es asintomática. Damos cuenta del caso de una mujer de 47 años, con bocio difuso de predominio izquierdo, operada, con presencia de microcarcinoma papilar en el lóbulo remanente. La detección de la hemiagénesis tiroidea es usualmente casual durante el examen de la glándula tiroides por otras causas. Es más frecuente en mujeres que en hombres (3:1), y el lóbulo izquierdo suele estar más comprometido que el derecho. Este caso muestra la inhabitual hemiagénesis tiroidea derecha con presencia de microcarcinoma papilar latente.

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La sobrevida media de las pacientes con cáncer de mama metastático ha aumentado desde la década de 1920 hasta la década de 1980, desde 21 a 41 meses. Y el porcentaje de pacientes que sobreviven cinco años ha aumentado desde un5 por ciento hasta un 25 por ciento en el mismo período(1). No obstante lo anterior, el cáncer de mama metastático sigue siendo hoy, por definición, una enfermedad incurable. Esto cobra importancia toda vez que aún en nuestros tiempos, un 5 a 10 por ciento de las pacientes son diagnosticadas inicialmente con enfermedad metastásica y las pacientes que son diagnosticadas con estadios más tempranos de la enfermedad, un 20 a 50 por ciento pueden desarrollar enfermedad metastásica dependiendo de las características anatómicas, patológicas y moleculares de la enfermedad (2). En la actualidad, un número cada vez mayor de pacientes, manejadas adecuadamente, pueden sobrevivir largo tiempo, incluso mucho más allá de cinco años (3). Presentamos a continuación la forma en que en el Centro Integral de la mama del Instituto Oncológico de Clínicas Las Condes, manejamos las pacientes con enfermedad metastásica y la racionalidad para esta conducta.

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Se presenta la experiencia del Centro Integral de la Mama (CIM) de Clínica Las Condes en diagnóstico y tratamiento del cáncer de mama, a diez años de su formación; y se evalúa si la intervención multidisciplinaria impacta en las posibilidades de conservar la mama y aumentar la sobrevivencia. Se busca establecer el impacto favorable del trabajo multidisciplinario sobre el cáncer de mama, principalmente en su etapa diagnóstica, aumentando los porcentajes de tumores menores de 2 cms, lo que permite incrementar los índices de cirugía conservadora de la mama, así como obtener una supervivencia global del 95 por ciento a cinco años.

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In the process of L-phenylalanine oxidation by Proteus mirabilis cytoplasmic membrane, hydrogen peroxide was produced at a rate corresponding to 1-3 per cent of the total electron flow (30-110 nmoles min-1mg-1). Peroxide was estimated using a fluorimetric assay with horseradish peroxidase, or by anodic oxidation on a platinum electrode. When using the former method, superoxide dismutase decreased the apparent yield of peroxide, a fact suggesting that H2O2 was in part the dismutation product of superoxide radicals. However the superoxide dismutase effect could be an artefact due to the generation of some superoxide during the peroxidatic reaction in the assay. Adrenaline was the reagent used for the detection of superoxide. There was no significant emergence of superoxide as the result of phenylalanine oxidation by the membrane (specific activity lower than 1-2 nmoles min-1mg-1). Thus it seemed that superoxide was not an intermediate for the bulk of H2O2 formed in this system. According to the results, peroxide was probably formed at a stage of electron transport earlier than the cytochrome level. The membrane phenylalanine dehydrogenase could be a site where peroxide was evolved in these experiments.

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