Manejo del hydrops corneal mediante aire y micropunciones / Management of corneal hydrops using air and micro-punctures

CASO CLÍNICO: Mujer de 22 años con hydrops corneal agudo y rotura de la membrana de Descemet. Se trató mediante una inyección de aire intracamerular combinada con múltiples incisiones intraestromales para conseguir el drenaje del líquido intraestromal. No hubo complicaciones intraoperatorias y el líquido intraestromal desapareció a las 2 semanas. DISCUSIÓN: El hydrops corneal agudo es una importante complicación del queratocono. Sin tratamiento, se puede resolver en un período de 2 a 4 meses. El edema persistente puede causar complicaciones tales como neovascularización corneal, infección y perforación

CASE REPORT: A 22-year- old woman with an acute hydrops and Descemet membrane detachment was managed by intracameral air injection combined with multiple corneal stromal venting incisions for the drainage of intrastromal fluid. No intraoperative complications were encountered, and the intrastromal fluid was resolved over 2 weeks. DISCUSSION: Acute corneal hydrops is a significant complication of keratoconus. If not treated, resolution usually occurs over a period of 2-4 months. The persistent oedema can cause complications, such as corneal neovascularisation, infection and corneal perforation

[Management of corneal hydrops using air and micro-punctures]. / Manejo del hydrops corneal mediante aire y micropunciones.

CASE REPORT: A 22-year- old woman with an acute hydrops and Descemet membrane detachment was managed by intracameral air injection combined with multiple corneal stromal venting incisions for the drainage of intrastromal fluid. No intraoperative complications were encountered, and the intrastromal fluid was resolved over 2 weeks. DISCUSSION: Acute corneal hydrops is a significant complication of keratoconus. If not treated, resolution usually occurs over a period of 2-4 months. The persistent oedema can cause complications, such as corneal neovascularisation, infection and corneal perforation.

A pilot trial of fenofibrate for the treatment of non-alcoholic fatty liver disease.

BACKGROUND: Dyslipidaemia and insulin resistance are two important risk factors for non-alcoholic fatty liver disease. Both factors can improve with fenofibrate. AIMS: To evaluate the effect of fenofibrate on the clinical, analytical and histological evolution of patients with non-alcoholic fatty liver disease. SUBJECTS AND METHODS: Sixteen consecutive patients with biopsy-confirmed non-alcoholic fatty liver disease were treated with 200mg/day of fenofibrate for 48 weeks. A clinical and biochemical follow-up was done every 3 months. A new liver biopsy was performed in all patients at the end of therapy. RESULTS: All patients completed 48 weeks of therapy with fenofibrate, without adverse events. At the end of the study, a significant decrease in triglyceride, glucose, alkaline phosphatase and gamma-glutamyl transpeptidase and an increase of apolipoprotein A1 levels were found. Insulin levels and insulin resistance showed a trend to decrease. Moreover, a reduction in the proportion of patients with abnormal aminotransferase levels (>45IU/L) was observed (alanine aminotransferase: 93.7% vs. 62.5%, p=0.02; aspartate aminotransferase: 50% vs. 18.7%, p=0.02). The body mass index did not show any significant change, but the proportion of patients with metabolic syndrome decreased significantly (43.7% vs. 18.7%, p=0.04). A control biopsy after treatment revealed a decrease in the grade of hepatocellular ballooning degeneration (p=0.03), but the grade of steatosis, lobular inflammation, fibrosis or non-alcoholic fatty liver disease activity score did not change significantly. CONCLUSIONS: In patients with non-alcoholic fatty liver disease, treatment with fenofibrate is safe and improves metabolic syndrome, glucose and liver tests. However, its effects on liver histology are minimal.

Hyperhomocysteinemia and methylenetetrahydrofolate reductase 677C-->T and 1298A-->C mutations in patients with inflammatory bowel disease.

BACKGROUND: Hyperhomocysteinemia has been recently described in patients with inflammatory bowel disease (IBD), that could be related to the increased risk for thrombosis that exists in this disease. The aim of this study was the assessment of hyperhomocysteinemia in patients with IBD and its relation among vitamin B12 and folate levels, and methylenetetrahydrofolate reductase (MTHFR) 677C-->T and 1298A-->C mutations. PATIENTS AND METHODS: Fifty two consecutive patients with IBD were studied (29 women and 23 men); age: mean (standard deviation 41.7 [11.9] years) and 186 controls with no difference in age and gender. Hyperhomocysteinemia was considered as homocysteine levels higher than mean plus two standard deviations of the control group (> or = 13 micromol/l). RESULTS: patients had an elevated prevalence of hyperhomocysteinemia (17.3 vs. 3.7%; p = 0.002) and lower folate (7.6 [4.1] vs. 8.9 [3.7] ng/ml; p = 0.01) and B12 vitamin levels (499 [287] vs. 603 [231] pg/ml; p = 0.003). Homocysteinemia was higher (14.3 [5.8] vs. 9.1 [3.9] micromol/l; p = 0.006) in 6 patients (11.5%) that had suffered thromboembolism. Frequency of MTHFR 677C-->T (13.5 vs. 11.3%; p = 0.66) and 1298A-->C (7.8 vs. 7.0%; p = 0.76) mutations was not increased in patients. Odds ratio (OR) for IBD in hyperhomocysteinemic patient was 5.51, 95% confidence interval (CI), 1.81-16.76; p = 0.002). Hyperhomocysteinemia was negatively associated with feminine gender (OR 0.08, 95% CI 0.01-0.49; p = 0.006) and folate levels (OR 0.04, 95%CI: 0.007-0.20; p < 0.001). CONCLUSIONS: hyperhomocysteinemia is associated with IBD and low folate levels, and could be involved in development of thromboembolism. MTHFR 677C-->T and 1298A-->C mutations are not related with the disease.

[Venous thromboembolism and hyperhomocysteinemia as first manifestation of pernicious anemia]. / Tromboembolia venosa e hiperhomocisteinemia como primera manifestación de una anemia perniciosa.

INTRODUCTION AND OBJECTIVE: Hyperhomocysteinemia is associated to thrombosis and atherosclerosis. Vitamin B12 is among its main causes and may be due to a pernicious anemia. This study aimed to know the prevalence of this disease in patients who have venous thromboembolism and hyperhomocysteinemia. PATIENTS AND METHODS: A total of 80 consecutive patients (55 men and 25 women; age: mean [standard deviation] 63 [15] years) with pulmonary embolism and/or venous thrombosis and elevated values of homocysteine (> 12 micromol/l) were studied. RESULTS: Pernicious anemia was diagnosed (positive Schilling test, presence of anti-intrinsic factor antibodies and/or anti-parietal cells and fundal atrophic gastritis) in 5 patients (6.25% with range of age: 42-73 years. Only one of them had macrocytic anemia and there were no alterations in any of them in the thrombophilia study. The patients were treated with vitamin B12, administering it orally (1 mg/day) in 4 of them. The homocysteine and vitamin B12 values were normalized in every case at 6 months. CONCLUSIONS: Although the prevalence of pernicious anemia is not elevated in patients with venous thromboembolism and hyperhomocysteinemia, its existence must be ruled out to avoid other thrombotic and neurological complications.

Tromboembolia venosa e hiperhomocisteinemia como primera manifestación de una anemia perniciosa / Venous thromboembolism and hyperhomocysteinemia as first manifestation of pernicious anemia

Fundamento y objetivo. La hiperhomocisteinemia se asocia a trombosis y aterosclerosis. Entre sus principales causas está la deficiencia de vitamina B12, que puede deberse a una anemia perniciosa. El objetivo del estudio ha sido conocer la prevalencia de esta enfermedad en los pacientes que presentan tromboembolia venosa e hiperhomocisteinemia. Pacientes y método. Se estudiaron consecutivamente 80 pacientes (55 varones y 25 mujeres; edad: media [desviación estándar]: 63 [15] años) con embolia pulmonar y/o trombosis venosa y valores elevados de homocisteína (> 12 µmol/l). Resultados. En 5 pacientes (6,25%), con rango de edad: 42-73 años se diagnosticó una anemia perniciosa (prueba de Schilling positiva, presencia de anticuerpos antifactor intrínseco y/o anticélulas parietales y gastritis atrófica fúndica). Sólo uno de ellos tenía anemia macrocítica y en ninguno existían otras alteraciones en el estudio de trombofilia. Los pacientes se trataron con vitamina B12, administrándosela a 4 de ellos por vía oral (1 mg/día), y en todos los casos se normalizaron a los 6 meses los valores de homocisteína y de vitamina B12. Conclusiones. En los pacientes con tromboembolia venosa e hiperhomocisteinemia, aunque la prevalencia de anemia perniciosa no es elevada, es necesario descartar su existencia para evitar otras complicaciones trombóticas y neurológicas

Introduction and objective. Hyperhomocysteinemia is associated to thrombosis and atherosclerosis. Vitamin B12 is among its main causes and may be due to a pernicious anemia. This study aimed to know the prevalence of this disease in patients who have venous thromboembolism and hyperhomocysteinemia. Patients and methods. A total of 80 consecutive patients (55 men and 25 women; age: mean [standard deviation] 63 [15] years) with pulmonary embolism and/or venous thrombosis and elevated values of homocysteine (> 12 µmol/l) were studied. Results. Pernicious anemia was diagnosed (positive Schilling test, presence of anti-intrinsic factor antibodies and/or anti-parietal cells and fundal atrophic gastritis) in 5 patients (6.25% with range of age: 42-73 years. Only one of them had macrocytic anemia and there were no alterations in any of them in the thrombophilia study. The patients were treated with vitamin B12, administering it orally (1 mg/day) in 4 of them. The homocysteine and vitamin B12 values were normalized in every case at 6 months. Conclusions. Although the prevalence of pernicious anemia is not elevated in patients with venous thromboembolism and hyperhomocysteinemia, its existence must be ruled out to avoid other thrombotic and neurological complicationsIntroduction and objective. Hyperhomocysteinemia is associated to thrombosis and atherosclerosis. Vitamin B12 is among its main causes and may be due to a pernicious anemia. This study aimed to know the prevalence of this disease in patients who have venous thromboembolism and hyperhomocysteinemia. Patients and methods. A total of 80 consecutive patients (55 men and 25 women; age: mean [standard deviation] 63 [15] years) with pulmonary embolism and/or venous thrombosis and elevated values of homocysteine (> 12 µmol/l) were studied. Results. Pernicious anemia was diagnosed (positive Schilling test, presence of anti-intrinsic factor antibodies and/or anti-parietal cells and fundal atrophic gastritis) in 5 patients (6.25% with range of age: 42-73 years. Only one of them had macrocytic anemia and there were no alterations in any of them in the thrombophilia study. The patients were treated with vitamin B12, administering it orally (1 mg/day) in 4 of them. The homocysteine and vitamin B12 values were normalized in every case at 6 months. Conclusions. Although the prevalence of pernicious anemia is not elevated in patients with venous thromboembolism and hyperhomocysteinemia, its existence must be ruled out to avoid other thrombotic and neurological complications

Hiperhomocisteinemia y mutaciones de la metilentetrahidrofolato reductasa 677C→ T y 1298A→ C en pacientes con enfermedad inflamatoria intestinal / Hyperhomocysteinemia and methylenetetrahydrofolate reductase 677→T and 1298A→ mutations in patients with inflammatory bowel disease

Fundamento: recientemente se ha descrito la existencia de hiperhomocisteinemia en la enfermedad inflamatoria intestinal(EII), que podría estar relacionada con el mayor riesgo de trombosisen esta enfermedad. El objetivo del estudio ha sido evaluar la hiperhomocisteinemia en los pacientes con EII y su relación con las concentraciones de vitamina B12 y folato séricos y con las mutacionesde la metilentetrahidrofolato reductasa (MTHFR)677C→T y 1298A→C.Pacientes y métodos: se estudiaron consecutivamente 52 pacientes con EII (29 mujeres y 23 varones; edad: media [desviación estándar] 41,7 [11,9] años) y 186 controles con edad y sexo similares. Se consideró hiperhomocisteinemia cuando los valoresde homocisteína eran superiores a la media más dos desviacionesestándar del grupo control (≥ 13 µmol/l).Resultados: los pacientes presentaban una mayor prevalenciade hiperhomocisteinemia (17,3 frente a 3,7%; p = 0,002) yunos valores más bajos de folato (7,6 [4,1] frente a 8,9 [3,7]ng/ml; p = 0,01) y de vitamina B12 (499 [287] frente a 603 [231]pg/ml; p = 0,003). En 6 pacientes (11,5%) que habían padecidoepisodios tromboembólicos la homocisteinemia era más elevada(14,3 [5,8] frente a 9,1 [3,9] µmol/l; p = 0,006). La frecuenciade las mutaciones MTHFR 677C→T (13,5% frente a 11,3%; p= 0,66) y de la 1298A→C (7,8 frente a 7,0%; p=0,76) no fuemayor en los pacientes. La odds ratio (OR) de EII en los pacienteshiperhomocisteinémicos fue 5,51, intervalo de confianza [IC]del 95%: 1,81-16,76; (p = 0,002). La hiperhomocisteinemia seasoció negativamente con el sexo femenino (OR 0,08, IC del95%, 0,01-0,49; p = 0,006) y con los valores de folato (OR0,04,IC del 95%: 0,007-0,20; p < 0,001).Conclusiones: la hiperhomocisteinemia se asocia a la EII y alas concentraciones bajas de folato, y puede estar implicada en eldesarrollo de tromboembolia. Las mutaciones MTHFR 677C→ Ty 1298A→ C no se relacionan con la enfermedad

Background: hyperhomocysteinemia has been recently describedin patients with inflammatory bowel disease (IBD), thatcould be related to the increased risk for thrombosis that exists inthis disease. The aim of this study was the assessment of hyperhomocysteinemiain patients with IBD and its relation among vitaminB12 and folate levels, and methylenetetrahydrofolate reductase(MTHFR) 677C→ T and 1298A→C mutations.Patients and methods: fifty two consecutive patients withIBD were studied (29 women and 23 men); age: mean (standarddeviation 41.7 [11.9] years) and 186 controls with no differencein age and gender. Hyperhomocysteinemia was considered as homocysteinelevels higher than mean plus two standard deviationsof the control group (≥ 13 µmol/l).Results: patients had an elevated prevalence of hyperhomocysteinemia(17.3 vs. 3.7%; p = 0.002) and lower folate (7.6[4.1] vs. 8.9 [3.7] ng/ml; p = 0.01) and B12 vitamin levels (499[287] vs. 603 [231] pg/ml; p = 0.003). Homocysteinemia washigher (14.3 [5.8] vs. 9.1 [3.9] µmol/l; p = 0.006) in 6 patients(11.5%) that had suffered thromboembolism. Frequency of MTHFR677C→T (13.5 vs. 11.3%; p = 0.66) and 1298A→C (7.8 vs.7.0%; p = 0.76) mutations was not increased in patients. Odds ratio(OR) for IBD in hyperhomocysteinemic patient was 5.51, 95%confidence interval (CI), 1.81-16.76; p = 0.002). Hyperhomocysteinemiawas negatively associated with feminine gender (OR0.08, 95% CI 0.01-0.49; p = 0.006) and folate levels (OR 0.04,95%CI: 0.007-0.20; p < 0.001).Conclusions: hyperhomocysteinemia is associated with IBDand low folate levels, and could be involved in development ofthromboembolism. MTHFR 677C→T and 1298A→C mutationsare not related with the disease

Intervalo de referencia de homocisteína plasmática por inmunoanálisis de fluorescencia polarizada (IMx®) en niños / Plasma homocysteine reference interval by a fluorescence polarization immunoassay (Imx) in children

Elevadas concentraciones de homocisteína total en plasma son consideradas un factor de riesgo de enfermedad vascular aterotrombótica. Su determinación resulta de gran utilidad en el diagnóstico de la homocistinuria. El objetivo de este estudio es el establecimiento del intervalo de referencia por un procedimiento de inmunoanálisis de fluorescencia polarizada (IMx®, Abbott Laboratories) en una población de niños sanos. Se han seleccionado muestras de 178 niños (102 varones y 76 hembras) en edades comprendidas entre 3 meses y 15 años (x- ñ s = 7,45 ñ 4,30) divididos en tres grupos. El análisis de varianza demostró que existen diferencias significativas de la homocisteína plasmática en relación con la edad (p <0,001). No encontramos diferencias significativas entre sexos. Los niveles de homocisteína se asociaron positivamente con la creatinina (r = 0,55; p < 0,01).Los intervalos de referencia de la homocisteína plasmática para los tres grupos estudiados fueron: < 6 años = 2,17-7,11 µmol/L; 6-10 años=2,87-7,95 µmol/Ly 11-15 años=3,00-10,70 µmol/L. En conclusión: Se ha establecido el intervalo de referencia de la homocisteína plasmática en niños. Existe un aumento de la homocisteína con la edad, pero no existen diferencias significativas con respecto al sexo (AU)

Acidosis metabólica severa en paciente tratado contrimetroprim-sulfametoxazol. Mecanismosfisiopatológicos / Severe metabolic acidosis in a patient treated with trimethroprim-sulfamethoxazole. Physiopathological facts

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Influence of apolipoprotein-E phenotypes on postprandial lipoprotein metabolism after three different fat loads.

The aim of this study was to evaluate the postprandial response to three fat-loading tests in healthy subjects with different apolipoprotein E (apoE) phenotypes. Thirty-four subjects were studied: 15 with apoE3/3 (7 men and 8 women), 12 with apoE4/3 (5 men and 7 women), and 7 with apoE2/3 (4 men and 3 women). All received three oral fat loads at 1-wk intervals in meals rich in monounsaturated fatty acid, polyunsaturated fatty acid, and saturated fatty acid, with retinyl palmitate (60000 IU/m(2) of aqueous vitamin A) to quantify lipoproteins secreted by the intestine. No significant differences in postprandial lipoproteins were found between the three different fat loads. Peaks and incremental areas under the curve of retinyl palmitate in non-chylomicron fractions were higher in the apoE2/3- than in the apoE3/3- and apoE4/3-phenotype groups in meals rich in monounsaturated and polyunsaturated fatty acids (P < 0.05). When the three fat loads were analyzed together, the incremental area under the curve of retinyl palmitate was much higher in the apoE2/3- than in the other apoE-phenotype groups (P = 0.0004). In conclusion, the magnitude of intestinal lipoproteins after fat load, especially with monosaturated and polyunsaturated fatty acids, is higher in subjects with apoE2/3 than in those with apoE3/3 and apoE4/3 phenotypes.

[Subclinical carotid atherosclerosis in patients with coronary disease]. / Aterosclerosis subclínica de la arteria carótida en pacientes con enfermedad coronaria.

BACKGROUND: B-mode ultrasonography is a simple and valid method to evaluate subclinical atherosclerosis of the major superficial arteries. The aim of this study was toknow by this technique the prevalence of carotid atherosclerosisin patients with coronary disease and related factors. PATIENTS AND METHOD: In 232patients (205 men and 27 women; age: mean [standard deviation]59 [8] years) with coronary disease, intima-media thickness (IMT),presence and number of atheroma plaques in carotid arteries wereevaluated by B-mode ultrasonography. Controls were 50 healthy subjects whose age was not different from patients. Carotid atherosclerosis was considered when IMT was higher than mean plus two standarddeviations of control values, and/or existence of atheroma plaques. RESULTS: Carotid IMT wasincreased in patients compared to controls 0.82 [0.22] vs 0.62[0.12] mm; p < 0.001) and there were more patients with plaques(67 vs 20%; p < 0.001). Carotid atherosclerosis was found in170 patients and 11 controls (73 vs 22%; p < 0.001). By multivariate analysis, carotid atherosclerosis was associated with age (oddsratio: 1.05; 95% confidence interval [CI], 1.01-1.09) and smoking(odds ratio, 2.11; 95% CI: 1.04-4.26). The presence of more thanone plaque was associated with levels of low-density-lipoprotein(LDL)-cholesterol (odds ratio, 1.01; 95% CI, 1.00-1.02). CONCLUSIONS: In the patients with coronary disease, prevalence of subclinical carotid atherosclerosisis very high (73%), and it is associated with age and smoking. The advanced stage of atherosclerosis, evaluated by the existence of more than one plaque, is correlated with LDL-cholesterol levels.

[Influence of menopausal status in homocysteine plasma levels]. / Influencia de la menopausia en la concentración plasmática de homocisteína.

BACKGROUND: Some studies have found that postmenopausal women have increased plasma homocysteine levels while others do not. The aim of this study was to know if homocysteine levels are increased in Spanish postmenopausal women. PATIENTS AND METHODS: In 100 postmenopausal women (age: mean [SD] 56 [6] years) homocysteine, creatinine, folic acid, vitamin B12 and lipoproteins were determined. Controls were 50 premenopausal women (age: 29 [6] years), 50 men with similar age to postmenopausal women, and 50 men with similar age to premenopausal women. All the subjects of the study were healthy. RESULTS: Homocysteine concentrations were higher in postmenopausal compared with premenopausal women (8.6 [2.1]; 95% confidence interval [CI], 8.2-9.1 vs 7.7 [1.6]; 95% CI, 7.2-8.1 micromol/l; p < 0.05), but were not different between both men groups. Hyperhomocysteinemia was found in 9 postmenopausal but in any premenopausal women (9% vs 0%; p = 0.03). Low density lipoprotein cholesterol values were higher (155 [32]; 95% CI, 148-161 vs 111 [32]; 95% CI, 101-120 mg/dl; p < 0.05), and high density lipoprotein cholesterol lower (54 [12]; 95% CI, 52-57 vs 64 [18]; 95% CI, 59-69 mg/dl; p < 0.05) in postmenopausal than premenopausal women. In postmenopausal women homocysteine levels were negatively associated with folic acid and positively associated with creatinine levels, but there was not association with age, vitamin B12 serum levels and lipoproteins. CONCLUSION: In postmenopausal women increased homocysteine concentrations, together with hypercholesterolemia, could contribute to the raise of their cardiovascular risk.

Estudio de correlación de Homocisteína plasmática por cromatografía de intercambio iónico e inmunoanálisis de fluorescencia polarizada / Correlation sutdy of plasmatic homocysteine by ion-exchange chromatography and fluorescence

La determinación de Homocisteína plasmática tiene interés por ser un factor de riesgo independiente de padecer enfermedad cardiovascular. Los laboratorios clínicos deben ofrecer métodos para su determinación que sean rápidos y fiables, debido al importante papel que presentan los diferentes parámetros bioquímicos en el diagnóstico de la aterosclerosis. Nuestro laboratorio desarrolló un método de cromatografía de intercambio iónico utilizando un sistema de detección postcolumna de ninhidrina, el cual es lento y unido al aumento de la demanda de peticiones para la determinación de Homocisteína plasmática, nos llevó a evaluar un nuevo método de inmunoanálisis de fluorescencia polarizada completamente automatizado. Hemos evaluado y comparado ambos métodos. Los coeficientes de variación intra e interserie oscilaron entre 0,93 y 5,31 por ciento. La media de las recuperaciones obtenidas fue de 98,5 por ciento para ambos métodos. El límite de detección obtenido fue de 0,75 µmol/L y 0,79 µmol/L para el método cromatográfico y para el de inmunoanálisis de fluorescencia polarizada respectivamente. Encontramos una buena correlación entre el método de cromatografía de intercambio iónico y el de inmunoanálisis de fluorescencia polarizada (y = 0,81 + 1,65x; r = 0,98). En conclusión, el método de inmunoanálisis de fluorescencia polarizada es un procedimiento rápido y fiable que puede ser de gran utilidad para el análisis de rutina de los niveles de Homocisteína plasmática (AU)

Plasma homocysteine levels in renal transplanted patients on cyclosporine or tacrolimus therapy: effect of treatment with folic acid.

Hyperhomocysteinemia, an independent risk cardiovascular factor, has been reported in renal transplanted patients (RTP). The aim of the present study was to evaluate homocysteine levels in RTP treated with cyclosporine or tacrolimus, and the changes observed in the two groups of patients after treatment with folic acid. Forty-two RTP with stable function (21 treated with cyclosporine and 21 with tacrolimus, matched by gender and age) were studied. Forty healthy control subjects were matched by age and gender with the patients. In RTP, homocysteine was increased compared with the controls (16.4 +/-5.2 vs 8.0 +/- 1.8 micromol/L; p < 0.001), but there was no difference in vitamin B12 and folic acid levels. Thirty-three patients and one control showed hyperhomocysteinemia (78.5 vs 2.5%; p < 0.001). Homocysteine correlated negatively with creatinine clearance in the patients (p = 0.04), but no correlation was found with vitamin B12, folic acid and lipoproteins. By univariate analysis, patients treated with cyclosporine had higher homocysteine than those treated with tacrolimus (p = 0.03), but multivariate analysis did not confirm these results. In 21 patients with hyperhomocysteinemia and folate levels similar to those of the controls, folic acid (5 mg/d for 3 months) was administered. Homocysteine decreased significantly (19.1 +/- 4.8 vs 13.2 +/- 3.4 micromol/L; p < 0.001), with a median reduction of 31% and with no differences observed in patients treated with either cyclosporine or tacrolimus. We concluded that hyperhomocysteinemia is very frequent in RTP, but homocysteine levels are not different in patients treated with cyclosporine or tacrolimus. Folic acid therapy produces a significant decrease in homocysteine concentrations, in the absence of clear folate deficiency, without differences in relation to immunosuppressant therapy.

Lipoprotein abnormalities in patients with asymptomatic acute porphyria.

There have been discrepancies in reports of total cholesterol and low density lipoprotein (LDL)-cholesterol levels in patients with acute porphyria. Some studies have found that acute porphyria patients have increased levels while others do not. The aim of this study has been to evaluate the lipid profile in a series of patients with acute porphyria, in order to help clarify these differences. Serum lipoprotein levels were studied in 30 patients (25 women and five men; age:38+/-10 years) with asymptomatic acute porphyria. Controls were 30 healthy volunteers matched for age and gender. For 13 patients and 15 controls, lipoprotein lipase and hepatic lipase activities were determined. Patients exhibited increased levels of total-cholesterol, LDL-cholesterol, high density lipoprotein (HDL)-cholesterol and apolipoprotein (apo)-A1 compared with controls (P4 mmol/l in 15 patients (50%). Levels of total triglycerides, very low density lipoprotein (VLDL)-triglycerides, VLDL-cholesterol, apo-B and lipoprotein(a) were similar in patients and controls. The hepatic lipase activity tended to be lower in patients than controls (33.8+/-17.7 vs. 50.4+/-23.0 pkat/ml; P=0.05). In conclusion, in patients with asymptomatic acute porphyria an increase of total and LDL-cholesterol was found. The cardiovascular risk conferred by this factor may be attenuated by increased HDL-cholesterol and apo-A1.

Desarrollo de un nuevo método cromatográfico de intercambio iónico para la determinación de homocisteína total en plasma / An improved ion-exchange chromatographic method to determine total homocysteine levels in plasma

La medida de la concentración de la homocisteína total en plasma es de gran utilidad como marcador de riesgo cardiovascular. Las técnicas convencionales para su medición plasmática están basadas en métodos de HPLC, aunque últimamente se han desarrollado técnicas de inmunoensayo. El objetivo de nuestro estudio fue establecer un procedimiento rápido y exacto de cromatografía de intercambio iónico para determinar la homocisteína total en plasma en un analizador convencional de aminoácidos, utilizando ninhidrina como reactivo de detección. Asimismo, hemos establecido el intervalo de referencia para la homocisteína y metionina en plasma en una población de adultos sanos. Los coeficientes de variación intra e interserie oscilaron entre 1,6 y 4,6 por ciento. El límite de detección obtenido fue de 0,75 micromol/L. La media de las recuperaciones obtenidas fue de 98,5 +/- 5,2 para la homocisteína y de 101,7 +/- 4,6 para la homocisteína. El intervalo de referencia establecido para la población de adultos sanos (120 controles de edad media: 44,7+/- 12,4) fue de 3,13 a 12,01 micromol/L para la concentración plasmática de homocisteína y de 14,16 a 33,08 micromol/L para la metionina (AU)