ABSTRACT
In a previous study, we showed our experience in a group of 54 patients with a high risk of urolithiasis recurrence, who were subjected to a complete metabolic evaluation. Aim: To report the evolution of these patients after 5 years of follow-up. Patients and Methods: All patients underwent a general management of urolithiasis plus specific treatments for underlying metabolic disorders. Each patient had an annual medical assessment including a clinical examination, urinalysis and imaging studies (non-enhanced computed tomography scan, ultrasonography and plain abdominal Rx rays). In every case, the underlying metabolic disorder, treatment adherence, stones on imaging studies and symptomatology were evaluated. Adherence of general and specific measures were evaluated subjectively. Failure of secondary prevention was defined as the recurrence of clinical or imaging urolithiasis (increase of the number of lithiasis) despite a correct treatment of the metabolic disorders. Results: Twenty nine patients completed the follow-up. Mean age was 45 years old. Nineteen patients (65%) had only one metabolic disorder, three patients (10%) two disorders, one patient (3%) four disorders, and six patients (21%) a normal metabolic study. The median of follow-up was 54 months (45-60). During that period, twenty-three patients (79%) kept the treatment as it was indicated. In this subgroup, 21 had no clinical or imaging recurrence of urolithiasis during follow-up (91%). Total adherence to treatment and follow-up was 42% (23/54) of the initial group of patients. Conclusions: A complete metabolic study allows to identify patients with a high risk of urolithiasis recurrence, enabling a specific treatment of the metabolic disorder. Our experience shows that 75% (21/29) of patients remain free of recurrence at five years of follow-up.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Urolithiasis/prevention & control , Secondary Prevention/methods , Recurrence , Risk Factors , Follow-Up Studies , Urolithiasis/etiology , Metabolic Diseases/complicationsABSTRACT
Introducción: La urolitiasis es considerada actualmente una enfermedad metabólica con tendencia ala recurrencia. El objetivo de este trabajo es evaluar la prevalencia de alteraciones metabólicas en pacientes de alto riesgo y su impacto según sexo y edad. Materiales y métodos: Es un estudio descriptivo de 36 pacientes (25 hombres y 11 mujeres), portadores de patología litiásica con alto riesgo de recurrencia. El estudio metabólico consistió en: calcemia, uricemia, fosfemia, PTH sérica, calciuria/24 hrs, uricosuria/24 hrs, fosfaturia/24 hrs, oxalaturia/24 hrs,citraturia/24 hrs y creatininuria/24 hrs. Los valores obtenidos fueron ajustados de acuerdo a la creatininuria y peso. Para el análisis estadístico se utilizó t-student (STATA 7.0). Se consideró significativo p<0,05.Resultados: En el 69 por ciento (25/36) se observó alguna alteración metabólica; el 36 por ciento (13/36) presentó 2 omás alteraciones metabólicas. Las alteraciones más frecuentes fueron la hipercalciuria (30,6 por ciento; 11/36), la hipocitraturia (30,6 por ciento; 11/36), la hiperuricemia (19,4 por ciento; 7/36) y la hiperoxalaturia (13, por ciento; 5/36).No se observó diferencias significativas de edad o sexo entre los grupos con y sin alteración metabólica. Conclusiones: La mayoría de los pacientes con patología litiásica recurrente o de alto riesgo presentan una o más alteraciones metabólicas, predominando la hipercalciuria y la hipocitraturia. En este estudio no hubo diferencias entre ambos sexos en la mayoría de las alteraciones metabólicas, ni tampoco en su distribución etaria. Estos resultados demuestran la necesidad de realizar estudios metabólicos en pacientes de alto riesgo, dado que existen herramientas terapéuticas que permiten un manejo médico de las alteraciones metabólicas y de esta forma reducir la recurrencia de litiasis.
Introduction: Urolithiasis is a metabolic disorder with a tendency to relapse. The aim of this study was to assess the prevalence of metabolic abnormalities in patients at high risk and the impact of sex and age. Materials and methods: Descriptive study of 36 patients (25 men and 11 women),with lithiasic pathology at high risk of recurrence. The metabolic study included the measurement of calcemia, uricemia, fosfemia, parathormone, calciuria/24hrs, uricosuria/24hrs, fosfaturia/24hrs, oxalaturia/24hrs, citraturia/ 24hrs and creatinine/24hrs. The values obtained were corrected according to weight and creatinine. The test used for statistical analysis was t-student (STATA 7.0). It was considered significant p <0.05.Results: In 69 percent (25/36) of the cases a metabolic abnormality was observed and in 36 percent (13/36) there was 2 or more alterations present. The metabolic disorders most frequently observed were hypercalciuria (30.6 percent; 11/36), hypocitraturia (30.6 percent; 11/36), hyperuricemia (19.4 percent; 7/36) and hyperoxaluria (13.9 percent; 5/36). There was no significant difference in age or sex between the groups with and without metabolic abnormality. Conclusions: Most patients with recurrent lithiasic pathology or at high-risk display one or more metabolic disorders, being hypercalciuria and hypocitraturia the most frecuently encountered. In this study, there was no difference between sexes in most of the metabolic disorders, nor in its age distribution. These results demonstrate the need for metabolic studies in high-risk patients, since there are tools that allow therapeutic medical management of metabolic disorders and thus reduce the recurrence of lithiasis.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Metabolic Diseases/complications , Metabolic Diseases/epidemiology , Urolithiasis/epidemiology , Urolithiasis/etiology , Age and Sex Distribution , Epidemiology, Descriptive , Hypercalciuria/complications , Hypercalciuria/epidemiology , Hyperoxaluria/complications , Hyperoxaluria/epidemiology , Hyperuricemia/complications , Hyperuricemia/epidemiology , Recurrence , RiskABSTRACT
El metabolismo energético intracelular compartimentalizado, activa la enzimo enolasa para formar ácido pirúvico. Este, substrato energético, debe ingresar a la mitocondria para continuar hacia el ciclo de losácidos tricarboxílicos. Sin embargo, durante la proliferación del epitelio seminífero ocurre una distribución y pérdida citoplasmática progresiva y disposición de las mitocondrias a nivel del flagelo inicial. en el presente estudio se describe la inmunoreactividad de la enzimo enolasa en las diferentes poblaciones celulares del epitelio seminífero, en testiculo humano senil. Se trabajo con un paciente de 70 años, sometido a orquiectomía subcapsular terapéutica. El tejido testicular fue fijado inmediatamente en formalina taponada al 10 por ciento y mantenido por 12 horas. Luego se procesó por técnicas histológicas corrientes e incluyo en parafina para obtener secciones de 5 um. Posteriormente se procedió a la reacción inmunohistoquímica para enolasa y revelación con complejo avidina-biotina. Finalmente se cuantificaron las distintas poblaciones celulares del epitelio seminífero con reacción positivo o negativa. Los resultados preliminares se expresan en porcentajes de células positivas respecto del total de células contadas (40x. se observó que la totalidad de las células de Sértoli presentaron reacción negativa a la enolasa. En el epitelio seminífero se encontró que el 76 por ciento de las gonias (gonias tipo A y B) mostraron reacción negativa a la enolasa, mientras que en citos 1 se redujo al 10 por ciento y ausencia total en espermátidas y espermatozoides. Por lo tanto, las célula somáticas (de origen mesodérmico), del epitelio seminífero presentarían isoenzimas enolasas de reactividad diferente en la relación con la línea germinal (espermatogonias). Adicionalmente, en la línea germinal la inmunoreactividad a enolasa disminuye mientras progresa la espermatogénesis
Subject(s)
Humans , Male , Aged , Seminiferous Epithelium/enzymology , Phosphopyruvate Hydratase , Pyruvic Acid/metabolism , Avidin , Seminiferous Epithelium/cytology , Immunohistochemistry/methods , Orchiectomy , Phosphopyruvate Hydratase , Spermatogenesis , Testis/cytology , Testis/enzymologyABSTRACT
We present the clinical and laboratory features of 2 patients with B prolymphocitic leukemia. Both are females of the fith and seventh decade of life. One had the classical clinical picture of massive splenomegaly and a high white cell count, with characteristic prolymphocytes and the other was asymptomatic, with a low white cell count. The cells were positive to B cell lineage reagents with strong surface immunoglobuline (Ig) and unreactive to T cell antibodies. Analysis of Ig genes at the DNA level demonstrated that both cases had heavy-chain gene rearrangements, confirming the B-cell origin. These are the first patients of prolymphocytic leukemia described in Chile