Gender dimorphism in body composition abnormalities in acromegaly: males are more affected than females.

BACKGROUND: Acromegaly changes body composition (BC), but long-term gender differences have not been reported. OBJECTIVE: To evaluate BC in active and controlled acromegalic patients. DESIGN AND METHODS: Clinical and biochemical variables and BC (by dual-energy X-ray absorptiometry) were evaluated in 60 acromegalic patients (19 active, 41 controlled) and 105 controls, matched for age and gender. RESULTS: Acromegalic males (n=24) had more total mass (89+/-13 vs 76.5+/-15.3 kg, P<0.001), lean body mass (LBM; 64.6+/-8.7 vs 56.4+/-5.8 kg, P<0.001), and bone mineral content (BMC; 2.9+/-0.5 vs 2.6+/-0.3 kg, P<0.05) than controls (n=33). Controlled male patients (n=14) had more total mass (89+/-14.7 vs 76.5+/-15.3 kg, P<0.05) and a trend to have more LBM (61.8+/-9.4 vs 56.4+/-5.8 kg, P=0.065) than controls. Only in active disease was a decrease in fat mass (FM) observed, compared with controlled patients and controls (males: 19.5+/-5.3 vs 27+/-6.2 and 25.9+/-4%, P<0.001; females: 30.3+/-6.7 vs 37.1+/-5.8 and 36.5+/-6.6%, P<0.01). In females, no further differences were observed. No differences in BMC were found between eugonadal and hypogonadal acromegalic patients, but in hypogonadal females, acromegaly appeared to prevent the BMC loss seen in hypogonadal postmenopausal controls. GH and IGF1 levels were negatively correlated with FM (males, P<0.05; females, P<0.001), but in the regression analysis GH was a predictor of FM only in women. CONCLUSIONS: Control of acromegaly reverts decreased FM in both genders; only in males more total mass and a trend for more LBM persist. The anabolic effect of GH on bone reverted in cured males, but persisted in females and appeared to override the bone loss of menopause.

Opresión cervical anterior como síntoma inicial en un caso de siringomielia / Anterior cervical pressure as an initial symptom in a Syringomyelia case

Presentamos el caso de una mujer joven que consulta por opresión cervical anterior como síntoma inicial. Tras persistencia de sintomatología y una exploración neurológica que muestra alteración de la sensibilidad térmica en el miembro superior derecho, se le realiza una resonancia magnética nuclear cráneo-cervical y se diagnostica una malformación de Arnold-Chiari con siringomielia cervical asociada. La paciente es intervenida y posteriormente dada de alta hospitalaria con control ambulatorio

We present the case of a young woman who consulted due to anterior cervical pressure. Due to persistence of the symptoms and after a neurological examination that showed thermal sensitivity alteration in the right arm, a cranial-cervical magnetic nuclear resonance was performed, diagnosing Arnold-Chiari's malformation with associated cervical syringomyelia. The patient was operated on and then discharged to out-patient care

Interacciones medicamentosas en la práctica asistencial de un equipo de Atención Primaria / Drug interactions in the care practice of a Primary Care team

OBJETIVO. Describir las interacciones medicamentosas (IM), tanto entre la prescripción crónica como entre ésta y la prescripción para patología aguda simultánea. MÉTODOS. Estudio descriptivo transversal realizado en un centro de salud urbano acreditado para la docencia, sobre una muestra de 299 pacientes con edad superior a 14 años, que dispusieran de cartilla de largo tratamiento (CLT). Se introdujo la medicación contenida en las CLT, así como la medicación prescrita para patología aguda y que el paciente tomó simultáneamente con la medicación crónica en los tres meses previos al estudio, en un programa informático para la detección de IM del Consejo General del Colegio de Farmacéuticos (BOT). RESULTADOS. Se detectaron IM en el 45,48% de los pacientes (IC 95%: 39,8-51%). El 20,6% correspondieron a IM crónico-agudas. La IM más frecuente fue antidiabéticos orales-glucosa con un 11,8% (IC 95%: 7,74-14,5%). El grupo terapéutico que con más frecuencia estuvo implicado fue el de los diuréticos 15,5% (IC 95%: 11,7-19,5%). Dentro del grupo de IM crónico-agudas las IM más frecuentes fueron paracetamol-acenocumarol 14,8% (IC 95%: 8,12-23%). La naturaleza de la IM más frecuentemente encontrada fue inhibición del efecto con un 31,61% (IC 95%: 26,5-36,5%). En cuanto a la significación clínica, en el 97,37% de las IM (IC 95%: 94,5-98,6%) se describe como importante. Las medidas a tomar recomendadas fueron en el 86,2% de los casos (IC 95%: 82-89,6%) el control clínico del paciente. CONCLUSIONES. La IM más frecuente fue la asociada a excipientes con sacarosa u otros azúcares susceptibles de ser transformados metabólicamente en glucosa en pacientes diabéticos. La prescripción aguda simultánea incrementó las IM en un 20,6%

OBJECTIVE. Describe drug-drug interactions (DDI), both between chronic prescription and between it and the prescription for acute simultaneous disease. METHODS. Cross-sectional descriptive study conducted in the an urban Health Care Center accredited for teaching on a sample of 299 patients over 14 years of age who were long treatment card users (LTCU). Long treatment card medication records and medications prescribed to treat acute diseases of patients who simultaneously took them during the three months prior to this study were introduced into a computer program to detect DDI developed by the General Council of the Pharmaceutical Association (GCPA). RESULTS. DDI was detected in 45.48% of patients (95% CI: 39.8%-51%). Of these, 20.6% corresponded to chronic and acute treatments. The most frequent DDI occurred between oral anti-diabetics and glucose with 11.8% (95% CI: 7.74-14.5%). the therapeutic group most frequently involved was that of diuretics, 15.5% (95% CI: 11.7%-19.5%). Within the chronic and acute group, the most frequent DDI was paracetamol-acenocumarol, 14.8% (95% CI: 8.12%-23%). The most frequent kind of DDI found was effect inhibition, 31.61% (95% CI: 26.5%-36.5%). In regards to the clinical significance, they were described as important in 97.37% of the DDI (95% CI: 94.5%-98.6%). The recommended measures were clinical monitoring of the patient in 82.2% (95% CI: 82%-89.6%). CONCLUSIONS. The most frequent DDI was that related to the interaction between sucrose and other sugar excipients which can be transformed into glucose metabolically in diabetic patients. Simultaneous prescription for acute diseases increased DDI by 20.6%

Detección de riesgos psicosociales en profesionales sanitarios de un área de salud / Detection of psychiatric and social risks in health professionals in a health district

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Clinical evaluation of drug-induced hepatitis.

OBJECTIVE: To ascertain the epidemiological characteristics, clinical symptoms, and evolution of drug-induced hepatitis over the last 22 years. EXPERIMENTAL DESIGN AND SUBJECTS: An observational, retrospective study between 1982 and 1993, and prospective study between 1994 and 2003. All patients in our department diagnosed with having drug-induced hepatitis were studied analyzing epidemiological (age, sex, cases per year, hospitalization) and clinical features (previous liver disease, hepatic symptoms, laboratory results), and follow-up (complete recovery or chronicity). RESULTS: A total of 61 patients were diagnosed as having drug-induced hepatitis, 26 men and 35 women (57%), mean age 52.4 years +/- 17 years, of which 72.2% were older than 40 years. A total of 43% were admitted to hospital. In 87% of cases, two or more drugs were involved, the most frequent being antituberculosis (19 cases), psychotropic (26 cases), and non-steroidal anti-inflammatory drugs (45 cases). Evolution showed that 94% of patients recovered after the withdrawal of suspected causal drugs. CONCLUSIONS: The incidence of drug-induced hepatitis is higher in patients over 40 years of age, it being more common in females. Non-steroidal anti-inflammatory, psychotropic, and anti-tuberculosis agents were the main drugs involved. Most patients made a complete recovery after withdrawal of the suspected causal drug.

Evaluación clínica de las hepatitis producidas por fármacos / Clinical evaluation of drug-induced hepatitis

Objetivo: conocer las características epidemiológicas, manifestaciones clínicas y la evolución de las hepatitis producidas por fármacos en los últimos 22 años. Diseño experimental y pacientes: estudio observacional, retrospectivo entre 1982 y 1993 y prospectivo entre 1994 y 2003, donde incluimos todos los pacientes atendidos en nuestro Servicio que fueron diagnosticados de hepatitis por fármacos. Analizamos los factores epidemiológicos -edad, sexo, número de casos por año, ingresos hospitalarios-, clínicos -antecedentes de enfermedad hepática, manifestaciones clínicas-, analíticas y evolutivos -evolución a curación o cronicidad. Resultados: diagnosticamos un total de 61 pacientes con hepatitis por fármacos, 26 hombres y 35 mujeres, con edad media 52.4 ± 17 años y edades superiores a los 40 años en el 72,2%. Se produjo ingreso hospitalario en el 43% de los casos. En la mayoría de los pacientes (87%) existían dos o más fármacos siendo los antiinflamatorios no esteroideos, neurofármacos y antituberculosos, los que con más frecuencia encontramos implicados en la aparición de la enfermedad hepática. La evolución a curación se produce en el 94% de los casos. Conclusiones: las hepatitis por fármacos se presentan más frecuentemente en edades superiores a los 40 años (72%) y en mujeres (57%), siendo los fármacos más frecuentemente implicados los antiinflamatorios (45 casos), neurofármacos (26 casos) y antituberculosos (19 casos). La mayoría de los casos evolucionó a la curación

Objective: to ascertain the epidemiological characteristics, clinical symptoms, and evolution of drug-induced hepatitis over the last 22 years. Experimental design and subjects: an observational, retrospective study between 1982 and 1993, and prospective study between 1994 and 2003. All patients in our department diagnosed with having drug-induced hepatitis were studied analyzing epidemiological (age, sex, cases per year, hospitalization) and clinical features (previous liver disease, hepatic symptoms, laboratory results), and follow-up (complete recovery or chronicity). Results: a total of 61 patients were diagnosed as having drug-induced hepatitis, 26 men and 35 women (57%), mean age 52.4 years ± 17 years, of which 72.2% were older than 40 years. A total of 43% were admitted to hospital. In 87% of cases, two or more drugs were involved, the most frequent being antituberculosis (19 cases), psychotropic (26 cases), and non-steroidal anti-inflammatory drugs (45 cases). Evolution showed that 94% of patients recovered after the withdrawal of suspected causal drugs. Conclusions: the incidence of drug-induced hepatitis is higher in patients over 40 years of age, it being more common in females. Non-steroidal anti-inflammatory, psychotropic, and anti-tuberculosis agents were the main drugs involved. Most patients made a complete recovery after withdrawal of the suspected causal drug

Contractile effects of arginine analogues on human internal thoracic and radial arteries.

OBJECTIVES: Plasma levels of endogenous guanidino-substituted analogues of L -arginine are increased in various pathologic conditions. In the present study we determined the effects of some of these compounds on basal and stimulated release of nitric oxide in human internal thoracic and radial arteries. METHODS: Rings of human internal thoracic and radial arteries were obtained from 16 multiorgan donors. The rings were suspended in organ baths for isometric recording of tension. RESULTS: N(G)-monomethyl L -arginine (10(-6) to 10(-3) mol/L) and N(G),N(G)-dimethyl L -arginine (10(-6) to 10(-3) mol/L) caused concentration- and endothelium-dependent contractions. Maximal force of contractions for N(G)-monomethyl L -arginine and N(G),N(G)-dimethyl L -arginine in the internal thoracic artery were 18.0% +/- 4.3% and 17.8% +/- 3.8%, respectively, of the contraction to 100 mmol/L KCl, and those found in the radial artery were 9.6% +/- 2.5% and 9.1% +/- 2.4%, respectively. Aminoguanidine (10(-5) to 3 x 10(-3) mol/L) and methylguanidine (10(-5) to 3 x 10(-3) mol/L) produced endothelium-independent contractions. L -Arginine (10(-3) mol/L) prevented the contractions by N(G)-monomethyl L -arginine and N(G),N(G)-dimethyl L -arginine but did not change contractions induced by aminoguanidine and methylguanidine. N(G)-monomethyl L -arginine and N(G),N(G)-dimethyl L -arginine inhibited, in a concentration-dependent manner, the endothelium-dependent relaxation to acetylcholine in the internal thoracic artery and had little attenuating effect in the radial artery; aminoguanidine and methylguanidine were without effect. CONCLUSIONS: The results suggest that the contractions induced by N(G)-monomethyl L -arginine and N(G),N(G)-dimethyl L -arginine are due to inhibition of both basal and stimulated nitric oxide production, whereas aminoguanidine and methylguanidine do not affect the synthesis of nitric oxide. An increase in the plasma concentration of N(G)-monomethyl L -arginine and N(G),N(G)-dimethyl L -arginine is likely to represent a risk factor for abnormal vasomotor tone in conduit arteries used as coronary grafts.

Effects of some guanidino compounds on human cerebral arteries.

BACKGROUND AND PURPOSE: Accumulation of endogenous guanidino-substituted analogues of L-arginine in chronic renal failure might contribute to some of the vascular and neurological disorders of this pathology. We tested the hypothesis that in human cerebral arteries, some guanidino compounds may increase vascular tone, through nitric oxide (NO) synthase inhibition, and impair endothelium-dependent relaxation. METHODS: Rings of human middle cerebral artery were obtained during autopsy of 26 patients who had died 3 to 12 hours before. The rings were suspended in organ baths for isometric recording of tension. We then studied the responses to N(G)-monomethyl-L-arginine (L-NMMA), N(G),N(G)-dimethyl-L-arginine (asymmetrical dimethylarginine; ADMA), aminoguanidine (AG), and methylguanidine (MG). RESULTS: L-NMMA (10(-6) to 3x10(-4) mol/L) and ADMA (10(-6) to 3x10(-4) mol/L) caused concentration- and endothelium-dependent contractions (median effective concentrations [EC(50)]=1.1x10(-5) and 1.6x10(-5) mol/L, respectively; E(max)=35. 5+/-7.9% and 43.9+/-5.9% of the response to 100 mmol/L KCl). AG (10(-5) to 3x10(-3) mol/L) and MG (10(-5) to 3x10(-3) mol/L) produced endothelium-independent contractions (E(max)=44.3+/-8.8% and 45.7+/-5.8% of the response to 100 mmol/L KCl, respectively). L-Arginine (10(-3) mol/L) prevented the contractions by L-NMMA and ADMA but did not change contractions induced by AG and MG. L-NMMA and ADMA inhibited endothelium-dependent relaxation induced by acetylcholine in a concentration-dependent manner; AG and MG were without effect. CONCLUSIONS: The results suggest that the contractions induced by L-NMMA and ADMA are due to inhibition of endothelial NO synthase activity, whereas AG and MG do not affect the synthesis of NO. An increase in the plasma concentration of L-NMMA and ADMA associated with uremia is likely to represent a diminished release or effect of NO, and consequently, an increased cerebrovascular tone in uremic patients is highly conceivable.

Relaxant effects of antidepressants on human isolated mesenteric arteries.

AIMS: The therapeutic action of tricyclic agents may be accompanied by unwanted effects on the cardiovascular system. The evidence for the effects on vascular and nonvascular smooth muscle comes from animal studies. Whether these studies can be extrapolated to human vessels remains to be determined. Therefore, the present study was designed to investigate the influence of amitriptyline, nortriptyline and sertraline on the contractile responses of human isolated mesenteric arteries to electrical field stimulation, noradrenaline and potassium chloride. METHODS: Arterial segments (lumen diameter 0.8-1.2 mm) were obtained from portions of the human omentum during the course of 41 abdominal operations (22 men and 19 women), and rings 3 mm long were mounted in organ baths for isometric recording of tension. In some artery rings the endothelium was removed mechanically. RESULTS: In precontracted artery rings amitriptyline, nortriptyline and sertraline (3x10(-7)-10(-4) m ) produced concentration-dependent relaxation that was independent of the presence or absence of vascular endothelium. Incubation with indomethacin (3x10(-6) m ) reduced the pD2 values thus indicating the participation of dilating prostanoid substances in this response. Amitriptyline and nortriptyline inhibited both the neurogenic-and noradrenaline-induced contractions. In contrast, only the highest concentration of sertraline reduced the adrenergic responses. Amitriptyline, nortriptyline and sertraline inhibited contractions elicited by KCl and produced rightward shifts of the concentration-response curve to CaCl2 following incubation in calcium-free solution. CONCLUSIONS: These results indicate that amitriptyline and nortriptyline could act as adrenoceptor antagonists and direct inhibitors of smooth muscle contraction of human mesenteric arteries, whereas sertraline might principally exert its action only as direct inhibitor of smooth muscle contraction. This relaxant mechanism involves an interference with the entry of calcium.