Complicaciones neurológicas en pacientes sometidos a trasplante de progenitores hematopoyéticos / Neurological complications in haematopoietic stem cell transplant patients

Introducción: Las complicaciones neurológicas son algunas de las más importantes que se pueden presentar en un paciente sometido a un trasplante de progenitores hematopoyéticos (TPH), no sólo porque conllevan una mortalidad elevada, sino también por las secuelas que aparecen en los supervivientes. Las causas de dichas complicaciones son múltiples y, muy frecuentemente, coexisten en el mismo paciente: toxicidad del régimen de acondicionamiento, enfermedad del injerto contra el hospedador y su tratamiento, infecciones y su tratamiento, plaquetopenia y trastornos de la coagulación, fallo hepático o hipertensión arterial con plaquetopenia. Objetivos: El objetivo del presente estudio es el de aportar una descripción clínica y de los factores de riesgo de las complicaciones sobre el sistema nervioso central que pueden presentarse en el curso de un TPH, para ayudar en la detección precoz de estos trastornos que pueden influir negativamente en la morbimortalidad de estos pacientes. Desarrollo: Se describen los siguientes tipos de complicaciones neurológicas: infecciones sobre el sistema nervioso central, complicaciones vasculares, toxicidad farmacológica, complicaciones metabólicas, trastornos inmunomediados y carcinogenia pos-TPH, y efectos de la enfermedad del injerto contra el hospedador y de la microangiopatía trombótica sobre el sistema nervioso. Conclusiones: El paciente sometido a TPH es de especial riesgo para el desarrollo de complicaciones neurológicas. Se precisan un diagnóstico y un tratamiento precoces para intentar disminuir la elevada morbimortalidad de estos pacientes.(AU)

Introduction: Neurological complications are some of the most important complications that can occur in a patient undergoing haematopoietic stem cell transplantation (HSCT), not only because of the high mortality rate, but also because of the sequelae that appear in survivors. The causes of such complications are manifold and very often coexist in the same patient: toxicity of the conditioning regimen, graft-versus-host disease and its treatment, infections and their treatment, platelets and coagulation disorders, liver failure or arterial hypertension with low platelet count. Aims: The aim of the present study is to provide a clinical description and to describe the risk factors for complications involving the central nervous system that may occur during the course of HSCT, in order to assist in the early detection of these disorders that may have a negative influence on the morbidity and mortality of these patients. Development: The following types of neurological complications are described: central nervous system infections, vascular complications, pharmacological toxicity, metabolic complications, immune-mediated disorders and post-HSCT carcinogenesis, and effects of graft-versus-host disease and thrombotic microangiopathy on the nervous system. Conclusions: The patient undergoing HSCT is at particular risk for the development of neurological complications. Early diagnosis and treatment are needed to try to reduce the high morbidity and mortality in these patients.(AU)

[Neurological complications in haematopoietic stem cell transplant patients]. / Complicaciones neurológicas en pacientes sometidos a trasplante de progenitores hematopoyéticos.

INTRODUCTION: Neurological complications are some of the most important complications that can occur in a patient undergoing haematopoietic stem cell transplantation (HSCT), not only because of the high mortality rate, but also because of the sequelae that appear in survivors. The causes of such complications are manifold and very often coexist in the same patient: toxicity of the conditioning regimen, graft-versus-host disease and its treatment, infections and their treatment, platelets and coagulation disorders, liver failure or arterial hypertension with low platelet count. AIMS: The aim of the present study is to provide a clinical description and to describe the risk factors for complications involving the central nervous system that may occur during the course of HSCT, in order to assist in the early detection of these disorders that may have a negative influence on the morbidity and mortality of these patients. DEVELOPMENT: The following types of neurological complications are described: central nervous system infections, vascular complications, pharmacological toxicity, metabolic complications, immune-mediated disorders and post-HSCT carcinogenesis, and effects of graft-versus-host disease and thrombotic microangiopathy on the nervous system. CONCLUSIONS: The patient undergoing HSCT is at particular risk for the development of neurological complications. Early diagnosis and treatment are needed to try to reduce the high morbidity and mortality in these patients.

TITLE: Complicaciones neurológicas en pacientes sometidos a trasplante de progenitores hematopoyéticos.Introducción. Las complicaciones neurológicas son algunas de las más importantes que se pueden presentar en un paciente sometido a un trasplante de progenitores hematopoyéticos (TPH), no sólo porque conllevan una mortalidad elevada, sino también por las secuelas que aparecen en los supervivientes. Las causas de dichas complicaciones son múltiples y, muy frecuentemente, coexisten en el mismo paciente: toxicidad del régimen de acondicionamiento, enfermedad del injerto contra el hospedador y su tratamiento, infecciones y su tratamiento, plaquetopenia y trastornos de la coagulación, fallo hepático o hipertensión arterial con plaquetopenia. Objetivos. El objetivo del presente estudio es el de aportar una descripción clínica y de los factores de riesgo de las complicaciones sobre el sistema nervioso central que pueden presentarse en el curso de un TPH, para ayudar en la detección precoz de estos trastornos que pueden influir negativamente en la morbimortalidad de estos pacientes. Desarrollo. Se describen los siguientes tipos de complicaciones neurológicas: infecciones sobre el sistema nervioso central, complicaciones vasculares, toxicidad farmacológica, complicaciones metabólicas, trastornos inmunomediados y carcinogenia pos-TPH, y efectos de la enfermedad del injerto contra el hospedador y de la microangiopatía trombótica sobre el sistema nervioso. Conclusiones. El paciente sometido a TPH es de especial riesgo para el desarrollo de complicaciones neurológicas. Se precisan un diagnóstico y un tratamiento precoces para intentar disminuir la elevada morbimortalidad de estos pacientes.

Proyecto de desarrollo de un Comité Multidisciplinar de Calidad Total en Unidades de radiodiagnóstico. Tomografía Computada Multicorte / No disponible

No disponible

Hipertensión arterial ¿Mal control? Quizá no tan malo / Hypertension poorly controlled? Perhaps not so poorly

Objetivo. Conocer el grado de control de hipertensos tratados, en consulta de enfermería y con automedidas domiciliarias. Material y métodos. Estudio descriptivo realizado en Atención Primaria. Mediante muestreo aleatorio simple se seleccionó una muestra de 600 hipertensos tratados, citados en consulta programada de enfermería. A los que aceptaron se les hizo 6 medidas consecutivas de presión arterial en consulta de enfermería, en condiciones estandarizadas y con aparato electrónico automático y se les entrenó para que hicieran 24 automedidas domiciliarias durante un día. Se consideró buen control en consulta cuando la presión arterial era < 140/90 mmHg y en domicilio cuando era < 135/85 mmHg. Resultados. Se midió la presión arterial en consulta de enfermería y domicilio a 583 pacientes (54,4 % mujeres) con una edad media de 62,9 (DE: 10,4) años. Los valores medios de presión arterial en consulta de enfermería fueron 139,3 (DE: 17,1) y 81,3 (DE: 9,4) mmHg para la sistólica y diastólica y con medidas domiciliarias 131,4 (DE: 15,7) y 78,7 (DE: 8,8) mmHg. El grado de control fue del 50,9 % en consulta de enfermería y del 55,4 % con medidas domiciliarias. Se observaron grados de control distintos en los diferentes momentos del día en los que se realizó la automedida y el control mejoró, tanto en enfermería como en domicilio, al excluir las dos primeras medidas. Discusión. Las medidas clínicas infraestimaron el grado de control de los hipertensos. Con automedida de la presión arterial domiciliaria el grado de control observado fue más elevado. Sería de interés estandarizar las condiciones de medida para tener una información más exacta del grado de control y hacer comparables los diferentes estudios epidemiológicos

Objective. To estimate the control rate of hypertensive patients who were treated, in the nurse office and with home self-measurements. Material and methods. Descriptive study developed in Primary Health Care. By means of a random sample, 600 hypertensive treated who go to the programmed nurse office, were selected. Those who agreed, their previously trained nurse, made them 6 arterial blood pressure consecutive measurements, in standardized conditions and with an electronic set, and these patients were trained to make 24 home self-measurements, with the same electronic set, in a day. Control office when < 140/90 mmHg and control at home when < 135/85 mmHg. Results. 583 patients (54.4 % women) were measured blood pressure at nurse office and at home being mean age 62.9 (SD: 10.4) years old. Mean blood pressure values at nurse office were 139.3 (SD: 17.1) and 81.3 (SD: 9.4) mmHg for systolic and diastolic and with home self-measurements 131.4 (SD: 15.7) and 78.7 (SD: 8.8) mmHg. The control rate was 50.9 % at nurse office and 55.4 % with home self-measurements. Different control grades were observed during the different moments of the day when home self-measurements were made, and improved, both at nurse office and in home, on excluding the two first blood pressure measurements. Discussion. Clinical measures understimates hypertension control rate. With home self-measurement the control rate is better. It would be interesting to standardize measure conditions to have a more exact control grade information and so make comparable the different epide miological studies

[Accuracy and precision in blood pressure measurement. Comparative study of home self-measurement with measurement in the clinic and out-patient monitoring]. / Exactitud y precisión en la medida de la presión arterial. Estudio comparativo de las automedidas domiciliarias con la medida en la consulta y la monitorización ambulatoria.

OBJECTIVE: To compare accuracy and precision of self-measurement blood pressure (SMBP) at home, as a diagnosis method of hypertension, with mercury measurement in office and ambulatory blood pressure monitoring (ABPM). DESIGN: A comparison study of diagnosis methods.Setting.Hypertension Unit in the Hospital General de Albacete. PATIENTS: By means of a non-probabilistic sample, selected from consecutive cases that went to the unit, a 64 pharmacologically untreated hypertensive sample older than 18 has been selected. METHODS: All subjects were taken 3 measurements with mercury from a validated nurse in office, and were also taught to make 20 self-measurements of blood pressure in the morning at the office and 20 self-measurements in the evening at home with an automatic device Omron 705-CP, during the same day they were set a Takeda TM-2420 device programmed to measure their blood pressure for 24 hours. All proceedings were repeated 4 weeks later. Mean blood pressure values have been compared with every diagnosis method and sensitivity, specificity, positive and negative predictive value have been studied in every method reproducibility in every method has been analyzed. RESULTS: Subjects were 29 men and 35 women with a mean of 53 years old. The mean values of office blood pressure (OBP) have been higher than SMBP and ABPM in the two periods of the study. SMBP has had a higher specificity and predictive value than OBP. Reproducibility of repeated SMBP in standardized conditions is similar to ABPM. CONCLUSIONS: With a minimum program self-measurements at home, in standardized conditions, they can be considered as an accurate technique in the diagnosis of hypertension.

Exactitud y precisión en la medida de la presión arterial. Estudio comparativo de las automedidas domiciliarias con la medida en la consulta y la monitorización ambulatoria / Accuracy and precision in blood pressure measurement. Comparative study of home self-measurement with measurement in the clinic and out-patient monitoring

Objetivo. Comparar la exactitud y precisión de la automedida domiciliaria de la presión arterial, como método diagnóstico de la hipertensión arterial, con el mercurio en la consulta y la monitorización ambulatoria de la presión arterial (MAPA).Diseño. Estudio de comparación de métodos diagnósticos. Emplazamiento. Consulta de Hipertensión del Hospital General de Albacete. Pacientes. Mediante muestreo no probabilístico, de selección de casos consecutivos que acuden a la consulta, se ha seleccionado una muestra de 64 pacientes hipertensos no tratados mayores de 18 años. Métodos. A todos los sujetos una enfermera validada les ha realizado 3 mediciones con mercurio en la consulta y les ha enseñado para que llevaran a cabo 20 automedidas por la mañana en la consulta y 20 por la tarde en su domicilio con un aparato automático Omron 705 CP; el mismo día les colocaba un Holter Takeda TM-2420, programado para realizar determinaciones durante 24 horas. Todos los procedimientos se hicieron en período basal y se repitieron a las 4 semanas. Se han comparado los valores medios de presión arterial obtenidos con cada técnica diagnóstica y se ha estudiado su sensibilidad, especificidad y valor predictivo positivo y negativo. Se analiza la reproducibilidad de cada técnica diagnóstica. Resultados. Se han estudiado 29 varones y 35 mujeres con una edad media de 53 años. Los valores medios de las presiones clínicas han sido superiores a los de las automedidas domiciliarias y a los de la MAPA en los 2 períodos del estudio. Las automedidas domiciliarias tienen una elevada especificidad y alto valor predictivo, superiores a los de las presiones clínicas. La reproducibilidad de las automedidas repetidas de PA en condiciones estandarizadas es similar a la de la MAPA. Conclusiones. Con un programa mínimo las automedidas domiciliarias, en condiciones estandarizadas, se pueden considerar como una técnica exacta y precisa en el diagnóstico de la hipertensión arterial (AU)

[Double-blind clinical trial comparing 5 days of dirithromycin versus 7 days of diacetylmidecamycin in acute bronchitis and acute exacerbations of chronic bronchitis]. / Ensayo clínico doble ciego comparando 5 días de diritromicina frente a 7 días de diacetilmidecamicina en bronquitis aguda y exacerbaciones agudas de bronquitis crónica.

BACKGROUND: Dirythromycin has several pharmacokinetic characteristics (long half life and high tissue concentrations) which suggest the possibility of administering shorter treatments than those conventionally used. The aim of this study was to determine and compare the efficacy of a 5 day treatment with dirythromycin once a day, versus diacetylmidecamycin twice a day over 7 days in the treatment of patients with acute bronchitis and acute exacerbations of chronic bronchitis. METHODS: A parallel, multicentric, randomized, double blind clinical study was carried out in 8 Spanish hospitals. RESULTS: One hundred seventy-four patients were included in the study, with 87 (80 evaluable) being randomly assigned to receive dirythromycin (500 mg/day over 5 days) and 87 (83 evaluable) diacetylmidecamycin (600 mg, twice daily over 7 days). A favorable symptomatic response (cure or improvement) was observed in 72/80 of the first group (90%) and in 74/83 (89.2%) of the second group. No statistically significant differences were found in the efficacy and safety between the two treatment groups in either the evaluable patients or on intention to treat analysis. CONCLUSIONS: The results of this study suggest that the administration of dirythromycin, once a day over 5 days, is as safe and effective as diacetylmidecamycin, twice a day over 7 days, in the treatment of acute bronchitis and acute exacerbations of chronic bronchitis.

Study of the secretion of substance P, neurotensin and somatostatin in patients with cholelithiasis.

A comparative, case-control study on the pre- and postprandial release of three gastrointestinal peptides implicated in gallbladder motility has been carried out in humans in the attempt to determine their possible role in the pathogenesis of cholelithiasis. Fifty-seven adult patients (40 females and 17 males) with an ultrasound diagnosis of gallstones and 20 healthy subjects (9 females and 11 males) without cholelithiasis or other digestive pathology were studied. Plasma substance P, neurotensin and somatostatin were measured by means of RIA-I125 in basal fasting conditions and 30, 60 and 90 minutes after the oral intake of a semiliquid mixed meal. The levels of secretion of each hormone were compared in patients and healthy controls on an overall basis and in terms of sex, age and body weight. We found a basal and postprandial hypersecretion of substance P in patients with gallstones when compared with controls. Individuals with cholelithiasis showed a moderate decrease in neurotensin secretion after the oral meal. Somatostatin release was unchanged. In conclusion, patients with gallstones may present a functional disorder in the secretion of gastrointestinal hormones involved in gallbladder motility.

Intracellular increases of cAMP induce opposite effects in glutamic acid decarboxylase (GAD67) and glial fibrillary acidic protein immunoreactivities in C6 cells.

C6 is a cell line that expresses glial and neuronal markers. Treatments that increase intracellular cAMP levels induce the differentiation of these cells. We had previously demonstrated that forskolin, an agent that activates adenylate cyclase, produced changes in gene expression in C6 cells. As a consequence of this treatment, glutamic acid decarboxylase (GAD) activity and the mRNA for GAD67, one of the isoforms of the enzyme, decreased. In contrast, this treatment increased the transcription of the glial fibrillary acidic protein (GFAP) gene. We now show, by immunocytochemistry, that the changes in gene expression are phenotypically reflected by corresponding changes in the levels of the proteins encoded by the GAD67 and GFAP genes. Computer-assisted image analysis demonstrated that both the increase in GFAP immunofluorescence, and the decrease in GAD67 immunofluorescence are statistically significant. The changes in gene expression and in protein immunoreactivity are part of the differentiation process of the C6 cells towards a more mature glial phenotype.

[Traumatic tear of the diaphragm]. / Rotura traumática del diafragma.

We have carried out a 9-month retrospective study in the Emergency Resuscitation Unit; 21 patients with abdominal trauma, 42 patients with chest trauma and 895 patients with multiple injuries were treated; 197 (22%) of the latter had also chest and/or abdomen involvement. Of the 260 patients with chest and/or abdomen involvement, six (2.3%) patients had traumatic tear of the diaphragm and four of them, presented thoracic herniation of abdominal content. Diagnostic suspicion was entertained in five patients by means of x-ray plain chest film; diagnosis was confirmed by a barium meal in two patients. In one patient, the diagnosis was established perioperatively. All patients had associated lesions. Four patients required mechanical ventilation after the operation. One patient died of cardiogenic shock on the fourth postoperative day. We emphasize the importance of the suspicion of such condition in patients with multiple injuries with chest and/or abdomen involvement.