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BackgroundThe impact of intrauterine and extrauterine growth on later insulin resistance and fat mass (FM) in very low birth weight (VLBW) infants is not well established. The aim of our study was to evaluate the effects of intrauterine and early/late extrauterine growth on later insulin resistance and body composition in VLBW infants from 6 months' corrected age (CA) to 36 months.MethodsProspective measurements of body composition by dual-energy X-ray absorptiometry and insulin resistance by homeostasis model assessment insulin resistance (HOMA-IR) along with other fasting plasma biochemistries were made in 95 VLBW infants at 6, 12, 18, and 24 months' CA and 36 months' postnatal age. Mixed-effect models were used to evaluate the effects of age, sex, maturation status, and Δweight SD score on percentage FM (PFM), FM index (FMI), fat-free mass index (FFMI), and HOMA-IR.ResultsPFM and FMI were negatively associated with a decrease in weight-SD scores from birth to 36 weeks' postmenstrual age (PMA; P=0.001) and from 36 weeks' PMA to 6 months' CA (P=0.003). PFM and FMI were higher in AGA than in small for gestational age (SGA) infants. HOMA-IR was not associated with the Δweight-SD scores in either period.ConclusionsCatch-down growth in terms of weight is associated with persistently lower adiposity but not insulin resistance up to 36 months of age.

Resumen Fundamento y objetivo Analizar prospectivamente la precision de la tomografia por emision de positrones/tomografia computarizada (PET/TC) frente al patron oro en la estadificacion inicial de los pacientes con linfoma no hodgkiniano (LNH) e identificar el protocolo tecnico mas adecuado. Pacientes y metodo Estudio transversal prospectivo de 76 pacientes diagnosticados de LNH durante 3 anos consecutivos en el Hospital Universitario La Paz de Madrid no tratados previamente. Todos los pacientes fueron estudiados con la tecnica PET/TC: inicialmente se obtuvo una TC de dosis baja, despues el escaner de emision de la PET y posteriormente un estudio de TC de dosis alta con contraste intravenoso. Se reconstruyeron dos estudios de PET/TC para cada paciente: uno de PET/TC de dosis baja (PET/TC DB) y otro de PET/TC de dosis alta (PET/TC DA). Cada modalidad de PET/TC fue evaluada en consenso por un equipo de medico nuclear y radiologo, diferente para cada una de las modalidades. Las imagenes de TC y de PET fueron interpretadas por separado por otro radiologo y otro medico nuclear independientes. Resultados La concordancia con el patron de referencia fue en el 52,2% de los pacientes (κ = 0,458) para la TC, 46% para la PET (κ = 0,335), 75% para la PET/TC DB (κ = 0,664) y 76,8% para la PET/TC DA (κ = 0,679), con p Conclusion La PET/TC es superior en la estadificacion inicial de los pacientes con LNH, siendo la PET/TC DA la tecnica mas precisa de las que hemos estudiado.

Hodgkin lymphomas (HL) and non-Hodgkin lymphomas (NHL) are clonal lymphoproliferative diseases that can present with different clinical manifestations that may be difficult to diagnose (Evans & Hancock, 2003; Re et al, 2005). The Ann Summary An accurate initial staging of patients with non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) is critical for the selection of an appropriate treatment. Computed tomography (CT) remains the standard imaging technique, although it is based on anatomic criteria. Positron emission tomography (PET) with 2-deoxy-2-(fluorine-18)fluoro-d-glucose (FDG) provides useful functional information but requires anatomical correlation to localise lesions accurately. We have prospectively compared the accuracy of combined PET/CT with that of CT and PET alone at initial staging in lymphoma patients. Forty-seven newly diagnosed patients were evaluated. PET/CT was superior compared with CT and PET in nodal evaluation and detection of extranodal disease. Using a staging algorithm with PET/CT resulted in the disease stage being increased in 11 of 47 patients (10 NHL and 1 HL) (McNemar test P ¼ 0AE012). Therefore, a different treatment strategy based on PET/CT findings was suggested for seven patients (14AE8%). PET/CT markedly improves accuracy in the diagnostic work-up of patients with lymphoma.

This is a retrospective study carried out in a group of 30 patients with differentiated thyroid cancer (age at diagnosis equal to or less than twenty years old). The aim of the study is to evaluate outcome after 131I therapy. Patients were classified into three groups on the basis of initial surgery, pathology and scintigraphic results: group I (thyroid extent), group II (locoregional extent), and group III (distant metastatic disease). Clinical parameters, 131I scans, serum thyroglobulin determinations and 131I therapeutic administered doses were evaluated in the follow-up. Some other complementary techniques such as chest X-ray and pulmonary function tests are also described. Scintigraphic absence of thyroid tissue has been observed in 83% of the cases; high thyroglobulin level is still detectable in 34% of the patients as a single evidence of disease, and 21% remain without any abnormal clinical, scintigraphic or analytical findings. Total doses administered have increased in groups I, II and III respectively, and have also been inversely proportional to the extension of lymph node surgery. At present, all the patients are alive and in good general condition. According to the results obtained, we conclude that children and young adults with DTC should undergo periodical 131I therapeutic doses in case of positive scans (once total thyroidectomy has been realized, with or without lymph node resection depending on the extension of disease). In our experience, the use of radioiodine is effective and safe in the follow-up of children and youngs with DTC.

Introducción: La artritis idiopática juvenil es una enfermedad inflamatoria crónica que precisa con frecuencia corticoterapia. El retraso del crecimiento puede ser un problema importante en estos pacientes. Objetivo: Estudiar el crecimiento de los niños con artritis idiopática juvenil y analizar los factores implicados en las alteraciones de éste. Métodos: Se estudiaron 91 pacientes con artritis idiopática juvenil, seguidos durante al menos un año. Se realizó un estudio de corte transversal, uno longitudinal retrospectivo y otro prospectivo. Se valoró la talla en la primera consulta, en el estudio transversal y un año antes. Se calculó la velocidad de crecimiento. Se estudiaron parámetros relacionados con la actividad de la enfermedad, con la corticoterapia, con el estado nutritivo, con la situación hormonal y la densidad mineral ósea (DMO). Se realizó un estudio de correlación y un análisis de regresión multivariante. Resultados: La talla fue inferior o igual a –2 desviaciones estándar (DE) en el 14,3% del total de los pacientes y en el 55,6% de las formas sistémicas. Los factores asociados de forma independiente con la talla fueron la dosis total de corticoids recibida, la clase funcional, el índice nutricional, la DMO y la edad de comienzo de la enfermedad. La velocidad de crecimiento fue inferior a lo normal en el 25,3% del total y en el 61 % del grupo sistémico y los factores asociados de forma independiente con ella fueron la dosis de corticoide y el número de articulaciones inflamadas. Conclusiones: El retraso en el crecimiento en pacientes con arthritis idiopática juvenil se asoció a factores relacionados con la enfermedad, con la corticoterapia, con el estado nutritivo, con la DMO y con el comienzo precoz de la enfermedad. : Introduction: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that often requires steroid therapy. Growth retardation can be a serious complication in some of these patients. Objective: To study linear growth in patients with JIA and evaluate the factors involved in its disturbance. Methods: We studied 91 patients with JIA with a follow-up of at least one year. A cross sectional study, a longitudinal retrospective study, and a longitudinal prospective study were performed. Height in the first consultation, in the cross sectional study, and one year previously was evaluated. Height velocity (HV) was calculated. Several parameters related to disease activity, corticosteroid therapy, nutritional and hormonal status, and bone mineral density (BMD) were analyzed. A correlation study and multivariate regression analysis were carried out. Results: Height was # ≤2 SD in 14.3 % of the series and in 55.6% of the systemic group. Variables independently associated with height were total corticosteroid dose, functional class, nutritional index, BMD, and age at onset of the disease. HV was # ≤2 SD in 25.3 % of the series and in 61 % of the systemic group. Variables independently associated with HV were corticosteroid dose and the number of swollen joints. Conclusions: Growth retardation in patients with JIA was associated with factors related to the disease, corticosteroid therapy, nutritional status, BMD, and earlier onset of the disease.

Resumen La dialisis peritoneal (DP) constituye una alternativa plenamente contrastada en el tratamiento de la insuficiencia renal cronica, aunque no esta exenta de complicaciones. Entre las mas frecuentes se encuentran la peritonitis y las infecciones de la zona de acceso. El derrame pleural secundario a comunicacion pleuroperitoneal (CPP) es una complicacion grave y poco frecuente en estos pacientes. Presentamos el caso de un varon de 50 anos diagnosticado de insuficiencia renal cronica en tratamiento con dialisis peritoneal que presento disnea progresiva y derrame pleural derecho. La gammagrafia peritoneal con 99m Tc permitio confirmar el paso de liquido de dialisis intraperitoneal a cavidad pleural.

Peritoneal dialysis is a fully contrasted alternative for the treatment of chronic renal disease, although it is not free of complications. Peritonitis and exit-site infections are among the most frequent complications found. Pleural effusion secondary to pleuroperitoneal communication (PPC) is a serious and uncommon complication in these patients. We present the case of a 50-year-old man diagnosed with end-stage renal disease undergoing treatment with peritoneal dialysis who presented progressive dyspnea and right pleural effusion. Peritoneal scintigraphy with 99m Tc-MAA allowed confirmation of communication of intraperitoneal dialysis fluid to the pleural cavity.

Brain single photon emission computed tomography (SPECT) findings are described in four adult patients with the transient syndrome of headache with neurological deficits and cerebrospinal fluid (CSF) pleocytosis. Focal deficits consisted of right-sided hemisensory changes with or without motor dysphasia or dysarthric speech (n = 4) and confusional episodes (n = 1). All patients had a CSF pleocytosis (with a mean of 309 cells/mm3 on the first spinal tap; range 75 to 590) and an elevated total protein (mean 130.5 mg/dL; range 70 to 193). The EEG showed excessive focal slowing (n = 2). A technetium Tc 99m hexamethyl propylenamine oxime (HMPAO) brain SPECT was performed during a symptom-free period, within 8 and 25 days after the onset of symptoms (n = 4). Three patients showed a decreased tracer uptake in the anterior left hemisphere, topographically consistent with the neurological deficits and EEG slowing. One patient showed no abnormalities. These findings indicate either focally impaired neuronal metabolism or hypoperfusion in regional cerebral blood flow, which could bear some relationship with the clinical features. The possibility that SPECT abnormalities may represent an epiphenomenon was also considered.

Introduction Children with PHACES syndrome (PS) and visual impairment or stridor show a dramatic and immediate response to propranolol. However, this beta-blocking drug could be responsible for an eventually increased risk of ischemic stroke due to the underlying cerebral vascular disease. To more accurately understand the effects of propranolol on brain vascularization, we examined PS patients treated with this drug for airway or visual complications using brain perfusion SPECT (Single Photon Emission Computed Tomography). In the past, this examination has been shown to be useful in the management of patients with different neurovascular disorders. Methods Clinical records and imaging studies were reviewed in 7 patients with a diagnosis of PS. All patients underwent magnetic resonance angiography (MRA), echocardiography, chest X-ray and ophthalmologic, neurological, and cardiologic assessments. They received 2–3 mg/kg/day propranolol in an attempt to treat stridor or avoid ophthalmologic occlusion. We performed SPECT after 3–6 months of treatment. Results SPECT showed a normal uptake in the frontal and temporal regions despite vascular abnormalities found with MRA imaging. Significant improvements of symptoms and in the volume of the hemangioma were noted in all cases without signs of a reduction of brain blood perfusion. Conclusions Propranolol treatment was safe in our patients who did not show signs of perfusion changes. The high sensitivity for detecting functional impairment makes brain perfusion SPECT useful in the diagnosis and follow-up of patients with PS considered at risk of neurovascular impairment. Accurate knowledge of its pathophysiological basis, together with the appropriate technique and careful interpretation of reporting, will enhance the clinical use of brain SPECT in those patients.

Peritoneal dialysis is a fully-contrasted alternative for the treatment of end-stage renal disease although it is not exempt of complications. Peritonitis and exit-site infections are among the most frequent complications found. Pleural effusion secondary to pleuroperitoneal communication (PPC) is a serious and uncommon complication in these patients. We present the case of a 50-year old man diagnosed of end-stage renal disease undergoing treatment with peritoneal dialysis who presented progressive dyspnea and right pleural effusion. The peritoneal scintigraphy with (99m)Tc-MAA makes it possible to confirm communication of intraperitoneal dialysis fluid to the pleural cavity.

Radioactive synoviorthesis, with (90)Y (knees) and (186)Rh (elbows and ankles) is a highly effective procedure that decreases both the frequency and the severity of recurrent intra-articular bleeds related to joint synovitis. The procedure should be performed as soon as possible to minimize the degree of articular cartilage damage, which based on many studies is irreversible. It can also be used in patients with inhibitors. On average, radioactive synoviorthesis has a 75-80% satisfactory outcome in the long-term. From the clinical standpoint, such efficacy can be measured by the decrease in the number of haemarthroses, with complete cessation for several years in some cases. One should bear in mind that in 20-25% of cases, radioactive synoviorthesis fails to control haemarthroses. In such cases, it can be repeated. Personal experience and the general recommendation among orthopaedic surgeons and haematologists is that when three early consecutive radioactive synoviortheses (repeated every three months) fail to halt synovitis, a surgical synovectomy (open or by arthroscopy) should be immediately considered.

The incidence of Hodgkin's disease (HD) and Non-Hodgkin's lymphoma (NHL) is around 8% of all malignancies. Fortunately, HD and NHL are among the few malignancies that are potentially curable with current existing treatment modalities, even in advanced or recurrent disease. Accurate staging, early therapy monitoring, and posttreatment evaluation of lymphomas are important for optimum management of these patients. We reviewed the imaging findings of patients with histologically proved lymphoma who underwent staging positron emission tomography/computed tomography (PET/CT), early monitoring therapy PET/CT (after 3 cycles of chemotherapy), and posttreatment PET/CT. PET/CT imaging findings are shown. Utility of PET/CT in recognizing false-positive and false-negative cases of CT and PET alone is addressed. Pitfalls and diagnostic difficulties are analyzed. PET/CT is a new imaging technology that improves the evaluation of lymphoma. This review will help the reader to better understand the imaging findings and applications of PET/CT in the management of lymphoma.

To evaluate bone mineral metabolism in HIV infected and asymptomatic patients receiving highly active antiretroviral therapy (HAART) containing protease inhibitors (PI) and naive patients. We studied 30 asymptomatic HIV infected male patients, 13 in the naive group and 17 in the IP group, both without differences in demographics characteristics. We excluded women and patients with any known factor associated to osteopenia. We did a nutritional questionnaire, a DEXA scan in lumbar spine and femur, a study of CD4 lymphocytes, viral load and an analysis of bone formation and resorption markers in all patients. We compared vitamin D and PTH levels with a control group of healthy male volunteers age-pareated. For the statistical analysis we used the SPSS program. Osteopenia was present in 17/30 (57%), 8/13 (61.5%) in the naive group and 9/17 (53%) in the PI group (not significant differences). We found a vitamin D deficiency in 86% of patients, with mean serum levels that was found to be significantly lower than those from a healthy control group (p=0.04). Testosterone level was significantly related to bone mineral density in lumbar spine (p≤0.05). HIV may be an individual risk factor in bone disorders, requiring calcium and vitamin D supplementation.

A patient with Sturge-Weber syndrome without the characteristic facial nevus presented with focal seizures which were difficult to control and borderline mental level. CT disclosed calcification in the right occipital zone. A marked decrease of the regional cerebral blood flow that extended beyond the abnormalities depicted on CT was seen by SPECT. Venous magnetic resonance (MR) angiography revealed reduction of the superficial cortical veins and prominent deep collateral venous system in the same side of the cerebral lesion. Cranial MR imaging with Gd-DTPA demonstrated the pial angioma.

This is a retrospective study carried out in a group of 30 patients with differentiated thyroid cancer (age at diagnosis equal to or less than twenty years old). The aim of the study is to evaluate outcome after 131I therapy. Patients were classified into three groups on the basis of initial surgery, pathology and scintigraphic results: group I (thyroid extent), group II (locoregional extent), and group III (distant metastatic disease). Clinical parameters, 131I scans, serum thyroglobulin determinations and 131I therapeutic administered doses were evaluated in the follow-up. Some other complementary techniques such as chest X-ray and pulmonary function tests are also described. Scintigraphic absence of thyroid tissue has been observed in 83% of the cases; high thyroglobulin level is still detectable in 34% of the patients as a single evidence of disease, and 21% remain without any abnormal clinical, scintigraphic or analytical findings. Total doses administered have increased in groups I, II and III respectively, and have also been inversely proportional to the extension of lymph node surgery. At present, all the patients are alive and in good general condition. According to the results obtained, we conclude that children and young adults with DTC should undergo periodical 131I therapeutic doses in case of positive scans (once total thyroidectomy has been realized, with or without lymph node resection depending on the extension of disease). In our experience, the use of radioiodine is effective and safe in the follow-up of children and youngs with DTC.

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that often requires steroid therapy. Growth retardation can be a serious complication in some of these patients.To study linear growth in patients with JIA and evaluate the factors involved in its disturbance.We studied 91 patients with JIA with a follow-up of at least one year. A cross sectional study, a longitudinal retrospective study, and a longitudinal prospective study were performed. Height in the first consultation, in the cross sectional study, and one year previously was evaluated. Height velocity (HV) was calculated. Several parameters related to disease activity, corticosteroid therapy, nutritional and hormonal status, and bone mineral density (BMD) were analyzed. A correlation study and multivariate regression analysis were carried out.Height wasor = -2 SD in 14.3 % of the series and in 55.6 % of the systemic group. Variables independently associated with height were total corticosteroid dose, functional class, nutritional index, BMD, and age at onset of the disease. HV wasor = 2 SD in 25.3 % of the series and in 61 % of the systemic group. Variables independently associated with HV were corticosteroid dose and the number of swollen joints.Growth retardation in patients with JIA was associated with factors related to the disease, corticosteroid therapy, nutritional status, BMD, and earlier onset of the disease.

Vitamin D deficiency has been frequently observed in the elderly population in Europe. However few information is available about the vitamin D status in postmenopausal women in the Mediterranean countries. The aim of this study was to evaluate the vitamin D status assessed by serum 25(OH)D3 (calcidiol) in postmenopausal women who attended a Rheumatology practice in Madrid area, and to evaluate calcidiol serum levels through one year after two forms of vitamin D administration.Calcidiol serum levels were measured in 171 postmenopausal women (111 with osteoporosis and 60 without osteoporosis). 82 women with calcidiol serum levels10 ng/ml were distributed in two groups: Group I received 800 U/day of vitamin D3 associated with calcium (1 g/day) and group II, one dose of 80,000 U vitamin D orally as calcidiol and latter a daily dose of 800 U vitamin D3 plus 1 g calcium. Calcidiol serum levels were measured by RIA in both groups at basal condition and after three, six and twelve months under treatment.Three cut-offs were considered: 10, 15 and 20 ng/ml of calcidiol. Percentages of postmenopausal women with vitamin D deficiency for such cut-offs were: 35.3%, 64.1% and 87.1%, respectively. After three months of treatment, women from group II showed calcidiol serum levels higher than group I. At six and twelve months calcidiol serum levels were similar in both groups.A high prevalence of vitamin D deficiency was observed in a group of postmenopausal women who attended a rheumatology practice in Madrid area. Both forms of vitamin D administration seem not sufficient to maintain the adequate calcidiol serum levels in postmenopausal deficient women. A dose of 80,000 U of calcidiol twice a year should be considered.

Conflicting results have been reported on the association between restriction fragment length polymorphism at the vitamin D receptor (VDR) gene locus and bone mineral density (BMD). Population differences in environmental factors, such as calcium intake and calcidiol levels which have strong influence in BMD, may alter this association.We analyzed the Bsml RFLP at the eight introm of the VDR gene in a population sample (n = 204) of postmenopausal Spanish women aged 50-65 years being seen clinically and studied calcium intake (dietetic questionnaire) and biochemical parameters (PTH and calcidiol). In parallel bone densitometry were measured in lumbar spine and proximal femur.We identified low BMD of the proximal femur in the BB group. This effect was not observed at other body locations. The calcium intake was lees than 500 mg/day in 60% of the studied population as calcidiol levels were lower than 10 ng/l in 36% of it. The total group population with normal calcium intake (1,000 mg/day) showed higher BMD (proximal femur and spine) than the group with low calcium intake, this variation not being observed in group BB alleles. Interestingly, we observed significant differences in BMD proximal femur between genotype groups BB versus Bb + bb when calcidiol levels were10 ng/l. Moreover, within the BB subgroup, those subjects with normal calcidiol levels have higher proximal femur BMD compared with those with low calcidiol levels.Our results indicate an effect of the VDR genotype on BMD proximal femur which is clearly influenced by calcium intake and calcidiol serum levels.

Osteoporosis may be associated with parenchymal hepatopathy and chronic alcoholism. Biochemical studies which are linked with bone metabolism and the bone densitometry may help to understand its physiopathology, before the symptoms appear and its consequences become inevitable.The study of bone metabolism and densitometry has been carried out in a population of 86 males, distributed in 4 groups: group I, control (17 men), group II, patients with chronic hepatopathy without alcoholism (25 patients), group III, chronic alcoholic without hepatopathy (21 patients), and group IV, patients with chronic alcoholic hepatopathy (23 patients). The results of densitometry and biochemical parameters in relation with bone metabolism are cross checked among these 4 groups.We found out that patients with chronic alcoholic hepatopathy have bone mineral density (BMD), at femoral level, significatively lower than that of the other 3 groups (p0.05). In chronic hepatopathy, regardless of its etiology, significant alterations in biochemical parameters of bone metabolism found, consisting basically in shrinked plasmatic level of 25-hydroxivitamin-D (25-OH-D) (p0.05). The plasmatic levels of calcitriol, magnesium and intact parathyroid hormone (PTHi) were significantly lower in chronic alcoholic hepatopathy than in the others 3 groups (p0.001, p0.001 and p0.05, respectively).Chronic hepatopathy is associated with deficiency in vitamin D. Alcoholism added to chronic hepatopathy has a negative influence on the plasmatic levels of calcitriol, magnesium and PTHi as well as in the femur BMD. Alcoholism not associated with chronic hepatopathy is not sufficient to cause significant alterations in the studied parameters.

Pseudomigraine with pleocytosis is a benign and autolimited syndrome. The etiology has been related to viral infection, but its pathophysiology is not yet well identified. To investigate this point, and to see if there were changes in cerebral blood flow (as in migraine), we performed single photon emission computed tomography (SPECT) studies in four patients who fulfilled the diagnostic criteria for this syndrome. This was done during the acute phase and we repeated SPECT after resolution of the syndrome in two of them. We found a reduction in brain blood flow on the side of origin of the neurological deficits during the acute phase. This normalized after recovery of the syndrome. The finding suggests that the neurological deficits in this syndrome could be produced by a spreading depression-like mechanism similar to that proposed for migraine with aura.

Renal transplantation improves many bone abnormalities inherent to chronic renal insufficiency, but also introduces new deleterious factors, especially those related to immunosuppressive drugs. We have studied the bone mineral content of 40 pediatric renal transplant recipients; moreover, we have analyzed its possible relationships with phosphorous-calcium metabolism, graft function and duration, steroid treatment and growth.Bone mineral content was measured by dual energy X-ray absorptiometry (DEXA). The results were expressed as a z score in relation to age and sex. Immunosuppression was achieved by using triple therapy: azathioprine, cyclosporine A and prednisolone. At the time of the DEXA, 59% of the patients were on daily steroid treatment and 41% on alternate-day treatment.All patients presented bone mass losses with a maximal decrease between 5 and 21 months post-transplantation and a posterior tendency to recovery. Fifty percent of the children had severe osteopenia (bone mineral density-1 SD). There was no statistically significant association between the severity of bone loss and values of ionized calcium, phosphorus, intact PTH, or calcitriol received. However, a linear correlation was found between cumulative steroid dose and osteopenia (r = -0.35, p0.05). Height and growth velocity were more affected in the severe osteopenia group. In this group, the proportion of children on daily steroid treatment was statistically higher (72% vs 45%, p0.05).Bone densitometry is an accurate, rapid and noninvasive method to measure renal transplant impact on the growing skeleton and it must be done in a periodic and standardized way.

Background The FRAX index is a tool developed by the WHO that estimates the 10-year probability of hip fracture and a major osteoporotic fracture. It is calculated using an algorithm that includes clinical risk factors and can be calculated with or without densitometry data (femoral neck T-score). Its usefulness in patients with Early Arthritis (EA) is poorly studied Objectives To evaluate if there is a difference between estimated 10-year fracture risk using the FRAX index, calculating it with and without densitometry data in patients with EA Methods This is a prospective study of 101 patients from our EA Unit. At the baseline visit, a protocol was carried out which registered the following: sociodemographic data, anthropometric data, osteoporosis (OP) risk factors, bone metabolism laboratory parameters, rheumatoid factor and Anti-CCP, clinical disease activity (patient and physician scoring, pain, HAQ, number of tender and swollen joints, acute phase reactants), radiography of the dorsolumbar spine, hands and feet and bone densitometry (Hologic). The FRAX Index was calculated with and without densitometry data in patients over 40 years of age. Statistical analysis: descriptive and kappa index concordance test Results At the initial visit, 39 patients were diagnosed with rheumatoid arthritis (ACR 1987 criteria) and the remainder were classified as undifferentiated arthritis. 84 women (83.2%) were studied, 40 premenopausal (pre-M) and 44 postmenopausal (post-M), as well as 17 (16.8%) men. The mean age was 52.7±16.6 years. The mean disease duration was 17.97±18.94 weeks with DAS28 mean 6.64±6.74. 12.9% had a family history of hip fracture, 10.9% had morphometric vertebral fractures, 75.2% started corticosteroid therapy after the initial visit, 41.3% were smokers or ex-smokers and 9.9% consumed alcohol. The prevalence of densitometric OP was 22.4% (7.8% pre-M, 34.9% post-M, 25% men) and the osteopenia 44.9% (43.6% pre-M, 46.5% post-M, 43.8% men). 22.1% of patients (20.45% post-M, 17.64% men, 1.25% pre-M) had a hip fracture risk greater than 3% according to the FRAX index calculated with densitometry and 27.8% without densitometry, which implies a concordance of 85% (p Conclusions In our patients with EA, the concordance observed when calculating the FRAX index with and without bone densitometry is very high, which makes it unlikely that performing densitometry would change the clinical risk of fracture and the indication for treatment. However, in a subgroup of our patients, introducing densitometry of the femoral neck only modified the clinical risk of fracture downwards Disclosure of Interest None Declared

Background The etiopathogenesis of bone loss seen in patients with rheumatoid arthritis (RA) is multifactorial. Factors that are intrinsic to the individual (age, gender), as well as disease- and treatment-related factors play a role. Longitudinal studies demonstrate that systemic bone loss occurs primarily in the initial stages of the disease and may be related to disease activity. Establishing bone status in patients with early arthritis (EA) may help to understand the true magnitude of osteoporosis (OP) in this arthropathy Objectives To study systemic bone involvement in patients with EA and to establish the relationship with the disease’s inflammatory activity Methods This is a prospective study which including 113 patients from our EA Clinic with a disease duration from onset of symptoms of less than one year and without previous treatment. At the baseline visit we recorder: sociodemographic and anthropometric data, OP risk factors, bone metabolism laboratory parameters, radiography of the dorsolumbar spine, hands and feet and bone densitometry (Hologic QDR-4500) in the hip (femoral neck, FN) and lumbar spine (LS). The FRAX Index was established in patients over 40 years of age. Clinical disease activity was scored based on pain, patient and physician scoring, number of tender and swollen joints, acute-phase reactants (ESR and CRP) and functional capacity (HAQ). Rheumatoid factor and anti-cyclic citrullinated peptide antibodies were determined. Descriptive analysis and correlation studies (Pearson and Spearman) were carried out Results At the initial visit, 31 patients met the ACR 1987 diagnostic criteria for RA and 82 the undifferentiated arthritis. Ninety-three women (82.3%) were studied, 42 premenopausal (pre-M) and 49 postmenopausal (post-M), as well as 20 (17.7%) men. The mean age was 50.8±16.1 years and the mean disease duration was 19.19±20.51 weeks. The prevalence of densitometric OP was 23.9% (7.3% pre-M, 36.7% post-M, 26.3% men) and the prevalence for osteopenia was 21.1% (12.2% pre-M, 26.5% post-M, 21.7% men). Eigthy-four percent had insufficient vitamin D levels ( In the subgroup analysis, the post-M showed a higher prevalence of OP (p 3% for hip fracture. A significant negative correlation was seen between PTH and T-score in LS (p Conclusions In our patients with EA, inflammatory activity influences bone loss in the hip. The subgroup of post-M women showed a greater prevalence of OP and greater inflammatory disease activity. Early follow-up of inflammation and close monitoring of bone status in patients with EA is necessary Disclosure of Interest None Declared

Background Inflammatory activity in patients with rheumatoid arthritis (RA) is associated with an increased risk for cardiovascular complications (CV). Nevertheless, data on CV risk in patients with early arthritis (EA) are limited. In recent years, a possible pathogenic interaction between bone metabolism and cardiovascular risk factors (CVRF) has also been proposed Objectives To study the prevalence of CVRF in our patients with EA and its possible association with certain aspects of bone metabolism and disease activity Methods This is a prospective study carried out from February 2009 to October 2011 including 110 patients from our EA Clinic (mean age 53.1±16.5 years, 92 (83.6%) women) with less than one year of disease activity and without prior treatment. Spondyloarthropathies and connective tissues disorders were excluded. At baseline we recorder: sociodemographic and anthropometric data, bone densitometry, FRAX index, inflammatory disease activity and CVRF (hypertension (HT), diabetes, hyperglycemia, hyperlipidemia, hypertriglyceridemia, tobacco use, BMI). Laboratory testing with metabolic bone parameters and lipid profile (total cholesterol, LDL, HDL triglycerides). The LDL/HDL and total cholesterol/HDL atherogenic ratios were calculated. Descriptive analysis and comparison with non-parametric tests were performed Results Fifty-one patients met the ACR 1987 criteria for RA and fifty-nine had undifferentiated arthritis. The mean DAS 28 mean of the cohorts was 4.65±1.44. Densitometric osteoporosis and osteopenia were found in 27 (24.5%) and 48 (43.6%) respectively. FRAX>3% for hip fracture 20 (20.2%) and global FRAX>20% 6 (6.1%). Vitamin D levels 30. LDL/HDL atherogenic ratio >3% (moderate CV risk) was found in 12 (10.3%) and cholesterol/HDL ratio >4.5 (high risk) in 11 (9,9%) Both atherogenic ratios correlated with ESR (p=0.041, p=0.034 respecty); hyperlipidemia with DAS 28 (p=0.05), SDAI (p=0.015) and CRP (p=0.016) and HT with number of swollen joints (p=0.03). The presence of hyperlipidemia and HT was associated with an increase in global FRAX (p=0.014,p Conclusions Inmunologic, clinical and laboratory activity parameters were associated with a pro-atherogenic lipid profile. In addition, there appears to be an association between CVRF (TA and hyperlipidemia) and fracture risk that needs to be clarified in order to better understand the pathogenesis in our patients with EA Disclosure of Interest None Declared

The relationship between vitamin D and bone density was studied in 150 selected, mature (45-74), postmenopausal women with a lumbar spine Z score below 0. Vitamin D status was evaluated using calcidiol serum levels. Serum calcitriol and parathyroid hormone (PTH) values were also evaluated in some subjects. Bone mass was evaluated by ascertaining bone density and Z and T scores in the lumbar spine and femur region. The reference group consisted of 25 premenopausal women. The postmenopausal group was divided into subgroups according to age, i.e., under or over 60 years old. Additionally, the whole group was also subdivided according to their lumbar spine Z scores into group I (Z-1), group II (Z-1;-2), and group III (Z-2). Group III of postmenopausal women had higher PTH and lower calcitriol levels than premenopausal women. Calcidiol serum levels were lower in postmenopausal women groups II or III than in the group I and premenopausal women. Calcidiol serum levels and the bone mass values for the lumbar spine were correlated positively in all the postmenopausal women; in the women over 60 years of age, calcidiol levels also correlated with the bone mass values expressed as the bone density in three femur regions: femoral neck, trocanter, and Ward's triangle. In conclusion, mature post-menopausal woman showed high PTH levels and low calcidiol and calcitriol values. Calcidiol status is significantly related to bone mineral density in the lumbar spine and in women over 60 years, calcidiol levels also correlated with bone density in the femur regions.

Abstract 2793 Background: DLBCL is the most frequent aggressive non Hodgkin's lymphoma in adults. The International Prognostic Index (IPI) is currently the most used tool to identify different risk patients. The role of an interim PET to early identify patients with bad response to chemotherapy is still controversial. Aims: The aim of this analysis is to evaluate the predictive value for event-free survival of an interim PET (after 2 chemotherapy cycles) and at the end of therapy (after 6 chemotherapy cycles) of dose-dense R-CHOP in patients with DLBCL. Methods: This is a prospective clinical trial for patients with DLBCL older than 65 with IPI 0–5 or younger than 65 with IPI 0–2. Treatment consists on 6 cycles of R-CHOP administered every 14 days followed by pegfilgrastim (6 mg per cycle) on day 2. In this sub-analysis we have included 69 patients who completed the 6 cycles of chemotherapy and who have PET evaluation at diagnosis, after 2 cycles of R-CHOP and at the end of treatment. All evaluations were made by combined PET/CT, except for 14 patients who were evaluated by PET alone. PET was determined to be positive or negative based on the local radiology reports. Interim PET results did not change the planned treatment. Results: 124 patients were included in the trial, 19 (15.3%) did not finish 6 cycles of treatment: 2 due to serious adverse events, 2 due to progression disease/stabilization, 7 due to investigators decision and 8 due to death. Over 105 patients who completed 6 cycles of treatment, 69 patients with complete PET evaluation (at diagnosis, after 2 cycles and at the end of treatment) were included in the analysis. Median age was 61.6 years old (range 18.2–82.8), 34 (49.3%) were older than 65 yo, 37 (53.6%) were male, 59 (85.5%) had ECOG 0–1. Characteristics of the disease at diagnosis were as follows: stage III-IV: 45 (65.2%), bulky disease: 17 (24.64%), >2 extra-nodal sites involvement: 4 (5.8%), B symptoms: 18 (26.1%), elevated LDH: 36/67 (53.7%), elevated beta-2-microglobulin: 23/62 (37.1%), IPI 3–5: 23 (33.3%). The median relative dose intensity (RDI) for cyclophosphamide and adriamycin calculated according to 3-week interval as a reference was 139.8% (≥130% in 75.2% of patients): 141.6% in younger patients and 138.6% in the elderly. Thirty-five (50.7%) patients achieved a negative PET evaluation after 2 R-CHOP cycles and 57 (82.6%) at the end of therapy. Patients with bulky disease had a positive interim PET more frequently (64.7% vs 44.2%), but most of them turned negative at the end of treatment (positive end-of-treatment PET for bulky disease: 11.7%). With a median follow-up of 28 months (limits 2.3–49), event-free survival (EFS) was 70.6% for patients with positive interim PET and 92.9% for patients with negative interim PET (p=0.14). The negative predictive value (NPV) of a negative interim PET was 94.3% and the positive predictive value (PPV) of a positive interim PET was 14.7%. EFS was 47.6% for patients with positive end-of-treatment PET and 95.6% for patients with negative end-of-treatment PET (p Conclusions: A negative interim PET is highly predictive of a good outcome. Patients with a positive interim PET have worse EFS (not statistically significant), but their PPV is 14.7%. Patients with bulky disease turn to a negative PET later. Although longer follow-up is needed, these results do not support early intensification of patients with DLBCL based only in a positive interim PET and, probably, other factors should be taken into account. Disclosures: No relevant conflicts of interest to declare.

Objective: Compare body composition in the first two years between undernourished Very Low Birth Weight Infants (UNVLBWI), adequately nourished (AN) VLBWI and term infants (T). Methods: Cohort study of 95 VLBWI, - 2) and 35 T. Fat Mass (FM) and BMD measured by DXA and TBW estimated using BIA at 6, 12, 18 and 24 months. FM was normalized for height to give FMI and for weight to give % FM. Results: FM was not different between AN and T from 12 months on, while UN had lower FM than T in every time point. Table FFM from TBW was significantly lower in preterm infants in all time points irrespective of nutritional status at 36 weeks PMA. Table Conclusion: Undernutrition at 36 weeks PMA but not prematurity is associated with lower %FM and FMI at 12 and 24 months CA. FFM was higher in term than in preterm irrespective of nutritional status at discharge.

Abstract 3692 Poster Board III-628 Background DLBCL is the most frequent aggressive non Hodgkin's lymphoma in adults. The International Prognostic Index (IPI) is currently the most used tool to identify different risk patients. The role of an interim PET to early identify patients with bad response to chemotherapy is controversial. However end of therapy PET correlates strongly with progression free survival. Aims The aim of this analysis is to evaluate the results of an interim PET (after 2 chemotherapy cycles) and PET at the end of treatment (6 chemotherapy cycles of dose-dense R-CHOP) in patients with DLBCL. Methods This is a prospective clinical trial for patients with DLBCL older than 65 with IPI 0-5 or younger than 65 with IPI 0-2. Treatment consists of 6 cycles of R-CHOP administered every 14 days followed by pegfilgrastim (6 mg per cycle) on day 2. 63 patients, who completed all 6 cycles of chemotherapy and have had both PET evaluations after 2 cycles of R-CHOP and at the end of treatment, have been selected for this sub-analysis. All evaluations were made by combined PET/ CT, except for 14 patients who were evaluated by PET alone. PET was determined to be positive or negative based on the radiology reports. Interim PET results did not change the planned treatment. Results 109 patients were analyzed for response. 17 patients (15.5%) did not finish 6 cycles of treatment: 2 due to serious adverse events, 3 due to progression disease / stabilization, 5 due to investigators decision and 7 due to death. Over 92 patients who completed 6 cycles of treatment, 63 patients who had both a PET evaluation after 2 cycles of treatment and at the end of treatment, were included in this analysis. Median age was 60 years old (range 18.2-78.9), 30 (47.6%) were older than 65, 32 (51%) were male. Fifty-four (85.7%) had ECOG 0-1. Characteristics of the disease at diagnosis were as follows: stage III-IV: 39 (61.9%), bulky disease: 15 (23.8%), > 2 extra-nodal sites involvement: 4 (6.4%), B symptoms: 15 (23.8%), elevated LDH: 31 (49.2%), elevated beta-2-microglobulin: 20/57 (35.1%), IPI 3-5: 19 (30.2%). Thirty-one (49.2%) patients achieved a negative PET evaluation after 2 R-CHOP cycles and 53 (84.1%) at the end of treatment. Twenty-nine (93.6%) patients with an interim negative PET remained negative at the end of therapy. Among the 32 patients with a positive PET after 2 cycles of therapy, 24 (75%) turned negative at the end of therapy. Patients with bulky disease had a positive interim PET more frequently (66.7% vs 45.8%), but most of them turned negative at the end of treatment (positive PET 6.7%). Conclusions An early positive PET is not predictive of a persistent positivity at the end of treatment. In fact, patients with bulky disease more frequently have an early positive PET, but most of them turn negative after 6 cycles of R-CHOP14. On the other hand, an early negative PET is highly predictive of a negative end-of-treatment PET. In conclusion, our data do not support an early intensification of patients with DLBCL with a positive interim PET, although a longer follow-up is necessary to confirm these results. Disclosures: No relevant conflicts of interest to declare.

Abstract 3920 Poster Board III-856 Introduction Accurate staging is critical in patients with lymphoma. Despite the lack of functional information CT remains the standard imaging technique based on anatomic criteria. PET with FDG provides functional evaluation but lacks of specificity due to the absence of anatomic landmarks. We have prospectively compared the accuracy of combined PET/CT with that of CT and PET alone at initial staging in lymphoma patients. Material and Methods. Patients with newly diagnosed lymphoma were prospectively included in the study. All patients underwent conventional staging studies which included clinical history, physical examination, laboratory work-up, biopsy of enlarged lymph node and of the iliac crest bone marrow, and PET/CT (either with full-dose contrast enhanced CT (FD PET/CT) and with low-dose non-enhanced CT (LD-PET/CT)) before starting therapy. The combined results of the clinical and imaging studies and the results of biopsies of suspected sites involved with lymphoma, when possible, formed the basis of our reference standard. The primary objective of the study was to address the accuracy of the PET/CT examination in clinical staging. For each patient, staging was assessed according to the Ann Arbor classification system on the basis of CT, PET images alone and the PET/CT images. The results were then compared with the true clinical stage based on the reference standard. Secondary objectives were: evaluation of the influence of clinical staging with PET/CT in the treatment approach, assessment of the efficacy of PET in evaluating bone marrow (BM) involvement, and definition of the accuracy of PET/CT imaging in the staging of different histologic subgroups. Results. 108 patients (64 female and 44 male; mean age 50 years; range 18-75 years) were included in the study. 76 patients had NHL and 32 had HL. 36% of the patients (28) had DLBCL whereas 18% (14 patients) had Follicular lymphoma. Other subtypes of NHL accounted for less than 10%. 31 of HL patients had classic variants. True clinical stage for NHL patients was I (7), II (11), III (6) and IV (52), and for HL was II (17), III (4) and IV (10). Agreement in staging was statistically significant between the reference standard and the staging algorithms by CT (k=0.493 p Disclosures: No relevant conflicts of interest to declare.