Subject(s)
Telangiectasia, Hereditary Hemorrhagic , Humans , Bevacizumab/therapeutic use , Telangiectasia, Hereditary Hemorrhagic/complications , Telangiectasia, Hereditary Hemorrhagic/drug therapy , Gastrointestinal Hemorrhage/drug therapy , Gastrointestinal Hemorrhage/etiology , Treatment Outcome , Chronic DiseaseABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Hyperaldosteronism/complications , Hyperaldosteronism/surgery , Hyperaldosteronism , Adrenocortical Carcinoma/complications , Adrenocortical Carcinoma/surgery , Adrenocortical Carcinoma , Adrenocortical Carcinoma/physiopathology , Hypertension/complications , Aldosterone/analysis , Renin/analysis , Blood Gas Analysis/methods , Tomography, Emission-Computed/methods , Heart Failure/complicationsABSTRACT
BACKGROUND: Treatment with GH promotes linear growth and decreases body fat in patients with isolated GH deficiency (GHD). However, few studies have analyzed how GH replacement modifies ghrelin levels and the adipokine profile and the relationship of these modifications with the metabolic changes. AIMS: To analyze the eventual differences between serum levels of leptin, leptin soluble receptor (sOBR), resistin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), total (TG) and acylated ghrelin (AG) and lipid and glycemic profiles in children with GHD, as well as to determine the effect of GH replacement on these parameters during the first year of therapy. SUBJECTS AND METHODS: Thirty pre-pubertal (Tanner stage I) GHD children and 30 matched controls were enrolled. Children with GHD were studied before and after 6 and 12 months of GH treatment. Weight, height, BMI, fasting glucose, insulin, lipid profile and serum levels of adipokines and ghrelin were studied at every visit. Adi - pokines, insulin and ghrelin levels were determined by using commercial radio- and enzymoimmunoassays. RESULTS: At baseline children with GHD had significantly higher sOBR (p<0.01) and adiponectin (p<0.01) levels than controls. Treatment with GH resulted in a decline in leptin (p<0.05) and TG (p<0.001) levels, an increase of homeostasis model assessment index and restored IGF-I levels (p<0.001). CONCLUSIONS: These data indicate that GH replacement has a negative effect on leptin levels and may also produce a slight unfavorable effect on carbohydrate metabolism. In addition, the changes observed in the adipokine profile appear to be independent of body mass index.
Subject(s)
Adiponectin/blood , Ghrelin/blood , Growth Hormone/administration & dosage , Human Growth Hormone/deficiency , Interleukin-6/blood , Leptin/blood , Resistin/blood , Tumor Necrosis Factor-alpha/blood , Anthropometry , Blood Glucose/metabolism , Body Mass Index , Carbohydrate Metabolism/drug effects , Child , Growth Hormone/pharmacology , Humans , Prospective Studies , Receptors, Leptin/metabolismSubject(s)
Aneurysm, False/complications , Gastrointestinal Hemorrhage/etiology , Aneurysm, False/diagnostic imaging , Aneurysm, False/drug therapy , Angiography , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/diagnostic imaging , Hemostatics/therapeutic use , Humans , Male , Melena/diagnosis , Melena/diagnostic imaging , Melena/etiology , Middle Aged , Thrombin/therapeutic use , Tomography, X-Ray Computed , UltrasonographySubject(s)
Gallstones/diagnostic imaging , Ileal Diseases/diagnostic imaging , Intestinal Fistula/diagnostic imaging , Intestinal Pseudo-Obstruction/diagnostic imaging , Vomiting/etiology , Aged , Constipation/etiology , Diagnosis, Differential , Female , Gallstones/complications , Gallstones/surgery , Humans , Ileal Diseases/complications , Ileal Diseases/surgery , Intestinal Fistula/complications , Intestinal Fistula/surgery , Intestinal Pseudo-Obstruction/complications , Intestinal Pseudo-Obstruction/surgery , Tomography, X-Ray ComputedABSTRACT
AIMS: Hyperandrogenism, although mostly due to polygenic interactions, is monogenic for some enzymatic adrenal deficiencies. This study evaluates mono- and biallelic 21-hydroxylase deficiency (21OHD)-related hyperandrogenism in pediatric patients. Sensitizing and protective polymorphisms were investigated in carriers and cryptic forms of 21OHD. METHODS: The study involved a monogenic analysis of CYP21A2 in patients (375 nonclassical 21OHD [NC21OHD] children; 306 hyperandrogenic 21OHD carriers, n = 306) and a polygenic association study (CAPN10-UCSNP44, PON1-108, TNFR2-M196R, IGF2-ApaI and IRS1-G972R polymorphisms) of 170 hyperandrogenic carriers plus 277 family members (control groups). The metabolic marker 17OH progesterone defined the degree of deficiency; clinical expressivity was determined by pediatric endocrinologists. RESULTS: The group of 21OHD carriers manifesting hyperandrogenism was enriched in the CAPN-UCSNP44 rare variant in homozygosity (4.9 vs. 0.4%, NCBI data for the general population; p = 0.004). In our patients and controls, contrasting distributions were observed for this and another polymorphism, TNFR2-196R. In a recessive model, their rare variants were more frequently detected among the forms with high (p = 0.048) and low (p = 0.034) expressivity respectively. CONCLUSIONS: 21OHD-related pediatric hyperandrogenism follows monogenic and polygenic models. The opposite behaviors in terms of clinical expressivity detected for CAPN-UCSNP44 and TNFR2-M196R rare variants suggest these variants to be sensitizing and protective factors respectively in adrenal hyperandrogenism.
Subject(s)
Adrenal Hyperplasia, Congenital/enzymology , Hyperandrogenism/enzymology , Steroid 21-Hydroxylase/genetics , Adrenal Hyperplasia, Congenital/genetics , Alleles , Aryldialkylphosphatase/genetics , Calpain/genetics , Child , Child, Preschool , DNA/chemistry , DNA/genetics , Female , Humans , Hyperandrogenism/genetics , Infant , Insulin Receptor Substrate Proteins/genetics , Insulin-Like Growth Factor II/genetics , Male , Polymerase Chain Reaction , Polymorphism, Single Nucleotide , Receptors, Tumor Necrosis Factor, Type II/genetics , Steroid 21-Hydroxylase/biosynthesis , Steroid 21-Hydroxylase/metabolismABSTRACT
We report a case of idiopathic retroperitoneal fibrosis and rapidly progressive glomerulonephritis with serum antiproteinase 3 antineutrophil cytoplasmic antibodies (anti-PR3-ANCA), without clinical or histological signs of Wegener's granulomatosis, in a 46-year-old man. Our case and previously reported cases showing the same association support the hypothesis that the association is not fortuitous, but reflects a common immunological mechanism.
Subject(s)
Antibodies, Antineutrophil Cytoplasmic/blood , Glomerulonephritis/complications , Myeloblastin/immunology , Retroperitoneal Fibrosis/complications , Glomerulonephritis/immunology , Humans , Male , Middle Aged , Retroperitoneal Fibrosis/immunologyABSTRACT
We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax.
Subject(s)
Adenocarcinoma/diagnosis , Adenocarcinoma/secondary , Chylothorax/etiology , Neoplasms, Unknown Primary/diagnosis , Autopsy , Fatal Outcome , Female , Humans , Lymphangitis , Middle AgedABSTRACT
Presentamos el caso de una paciente diagnosticada de quilotórax bilateral y de linfangitis carcinomatosa pulmonar, que evolucionó de forma desfavorable conduciendo al fallecimiento por insuficiencia respiratoria, en el contexto de un adenocarcinoma metastásico de primario desconocido tras el estudio necrópsico. A partir de este caso, revisamos la etiología, el diagnóstico y las opciones disponibles en el tratamiento de los quilotórax
We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax
Subject(s)
Female , Aged , Humans , Chylothorax/diagnosis , Chylothorax/therapy , Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Lymphangitis/complications , Lymphangitis/diagnosis , Pleural Effusion/diagnosis , Pleural Effusion/therapy , Thoracotomy/methods , Thoracoscopy/methods , Tomography, Emission-Computed/methods , Tomography, Emission-Computed/trendsABSTRACT
No disponible
Subject(s)
Humans , Hepatitis, Autoimmune/complications , Crohn Disease/complications , Crohn Disease/diagnosis , Antibodies, Antineutrophil CytoplasmicABSTRACT
OBJECTIVE: To analyze mortality and associated factors in community-acquired bacteremia admitted to an Internal Medicine Department. PATIENT AND METHODS: Prospective study of bacteremia admitted in 1 year (May 1999-April 2000). We have collected demographic data, previous comorbid conditions, functional status, source of infection, complications, vital signs, laboratory values, APACHE II and SOFA scores, blood cultures, therapy and 28-day mortality. In bivariate analysis, we have used Chi-square, Student-t test and Mann-Whitney U as needed. Significant variables have been introduced in a stepwise backward logistic regression model with mortality as the dependent variable. RESULTS: We have observed 115 episodes of bacteremia in 114 patients. The source of bacteremia was urinary tract in 57.4% episodes and the most common isolate was Escherichia coli (54.4%). 28-day mortality was 15.3%. Factors independently associated with mortality were septic shock (OR 10.4), non-urinary source of bacteremia (OR 9.3), APACHE II score higher than 20 (OR 5.5), and previous dependent functional status (OR 4.8). CONCLUSIONS: Mortality risk factors were septic shock, non-urinary source of bacteremia, APACHE II score and dependent functional status.
Subject(s)
Bacteremia/mortality , APACHE , Aged , Aged, 80 and over , Community-Acquired Infections/mortality , Female , Hospitalization , Humans , Internal Medicine , Logistic Models , Male , Middle Aged , Prognosis , SpainABSTRACT
Objetivo: Estudiar la mortalidad y los factores asociados a la misma en las bacteriemias adquiridas en la comunidad que ingresan en el servicio de Medicina Interna de un hospital terciario. Pacientes y métodos: Estudio prospectivo de las bacteriemias ingresadas durante 1 año (mayo 1999-abril 2000). Se han recogido datos demográficos, patología previa, situación funcional, foco infeccioso, complicaciones, constantes vitales, valores de laboratorio, puntuaciones del APACHE II y SOFA, resultados de los hemocultivos, tratamiento y supervivencia a los 28 días. En primer lugar se ha realizado un análisis bivariante con la prueba de la Chi-cuadrado, la t de Student y la prueba no paramétrica de Mann-Whitney, según correspondiera. Las variables significativas se han introducido en un modelo de regresión logística múltiple de exclusión escalonada paso a paso, utilizando la mortalidad como variable dependiente. Resultados: Se han observado 115 casos de bacteriemia en 114 pacientes. El foco urinario supuso el 57,4% de los casos y el microorganismo aislado con mayor frecuencia fue Escherichia coli (54,4% de los aislamientos). La mortalidad a los 28 días fue del 15,3%. Los factores asociados de forma independiente a la misma fueron el shock séptico (OR 10,4), el foco de bacteriemia diferente del urinario (OR 9,3), la puntuación en el APACHE II mayor o igual a 20 (OR 5,5) y la existencia de un estado funcional dependiente previo al episodio (OR 4,8). Conclusiones: Los factores de riesgo de mortalidad fueron el shock séptico, el foco no urinario, la puntuación del APACHE II y el estado funcional previo
Objective: To analyze mortality and associated factors in community-acquired bacteremia admitted to an Internal Medicine Department. Patient and methods: Prospective study of bacteremia admitted in 1 year (May 1999-April 2000). We have collected demographic data, previous comorbid conditions, functional status, source of infection, complications, vital signs, laboratory values, APACHE II and SOFA scores, blood cultures, therapy and 28-day mortality. In bivariate analysis, we have used Chi-square, Student-t test and Mann-Whitney U as needed. Significant variables have been introduced in a stepwise backward logistic regression model with mortality as the dependent variable. Results: We have observed 115 episodes of bacteremia in 114 patients. The source of bacteremia was urinary tract in 57.4% episodes and the most common isolate was Escherichia coli (54.4%). 28-day mortality was 15.3%. Factors independently associated with mortality were septic shock (OR 10.4), non-urinary source of bacteremia (OR 9.3), APACHE II score higher than 20 (OR 5,5), and previous dependent functional status (OR 4.8). Conclusions: Mortality risk factors were septic shock, non-urinary source of bacteremia, APACHE II score and dependent functional status
Subject(s)
Male , Female , Aged , Aged, 80 and over , Humans , Bacteremia/mortality , APACHE , Community-Acquired Infections/mortality , Hospitalization , Internal Medicine , Logistic Models , SpainABSTRACT
No disponible
Subject(s)
Aged, 80 and over , Aged , Male , Humans , Methicillin Resistance , Catheterization , Staphylococcal Infections , Bacteremia , Psoas AbscessSubject(s)
Bacteremia/complications , Catheterization , Methicillin Resistance , Psoas Abscess/etiology , Staphylococcal Infections/complications , Aged , Aged, 80 and over , Bacteremia/etiology , Catheterization/adverse effects , Humans , Male , Staphylococcal Infections/drug therapy , Staphylococcal Infections/etiologyABSTRACT
La temperatura corporal se mantiene en unos márgenes muy estrechos, regulada por una serie de mecanismos complejos coordinados en el hipotálamo anterior. Las alteraciones de la termorregulación engloban una serie de entidades en cuya sintomatología destaca la alteración de la temperatura corporal, sin que existan trastornos de los mecanismos de termorregulación. En la hipotermia accidental existe un descenso de la temperatura del organismo por debajo de los 35°C, generalmente asociada a la exposición a temperaturas ambientales bajas. En la hipertermia se produce un aumento de la temperatura, bien por aumento de la producción de calor o bien por una alteración en la eliminación del mismo. Los síndromes de mayor trascendencia clínica son los trastornos por exposición al calor, hipertermia maligna, síndrome neuroléptico maligno y síndrome serotoninérgico. Se revisan la fisiopatología, manifestaciones clínicas y tratamiento de estas entidades, que deben diagnosticarse y tratarse en los servicios de urgencias (AU)
