Aspectos epidemiológicos, manejo clínico y resultados a corto plazo en pacientes mayores diagnosticados de insuficiencia cardiaca aguda en urgencias en España: resultados del estudio EDEN-34 / Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study

Objetivo: Estimar la incidencia de diagnóstico de insuficiencia cardiaca aguda (ICA) en pacientes mayores en los servicios de urgencias (SU), la confirmación diagnóstica de la ICA en pacientes hospitalizados y los eventos adversos a corto plazo. Método: Se incluyeron a todos los pacientes de ≥65 años atendidos en 52 SU españoles durante una semana y se seleccionaron los diagnosticados de ICA. En los hospitalizados se recogieron los diagnosticados de ICA al alta. Como eventos adversos, se recogió la mortalidad intrahospitalaria y a 30 días, y evento adverso combinado (muerte u hospitalización) a 30 días posalta. Se calcularon las odds ratio (OR) ajustadas de las características demográficas, de estado basal y a la llegada al SU asociadas con mortalidad y evento adverso posalta a 30 días. Resultados: Se incluyeron 1.155 pacientes con ICA (incidencia anual: 26,5 por 1.000 habitantes ≥65 años, IC95%: 25,0-28,1). En el 86%, el diagnóstico de ICA constaba al alta. La mortalidad global a 30 días fue del 10,7%, la intrahospitalaria del 7,9% y el evento combinado posalta del 15,6%. La mortalidad intrahospitalaria y a 30 días se asoció con hipotensión arterial (OR ajustada: 74,0, IC95%: 5,39-1.015.; y 42,6, 3,74-485, respectivamente) e hipoxemia (2,14, 1,27-3,61; y 1,87, 1,19-2,93) a la llegada a urgencias y con precisar ayuda en la deambulación (2,24, 1,04-4,83; y 2,48, 1,27-4,86) y la edad (por cada incremento de 10 años; 1,54, 1,04-2,29, y 1,60, 1,13-2,28). Conclusiones: La ICA es un diagnóstico frecuente en los pacientes mayores que consultan en los SU. El deterioro funcional, la edad, la hipotensión e hipoxemia son los factores que más se asocian a mortalidad.(AU)

Objective: To estimate the incidence of acute heart failure (AHF) diagnosis in elderly patients in emergency departments (ED), diagnostic confirmation in hospitalized patients, and short-term adverse events. Methods: All patients aged ≥65 years attended in 52 Spanish EDs during 1 week were included and those diagnosed with AHF were selected. In hospitalized patients, those diagnosed with AHF at discharge were collected. As adverse events, in-hospital and 30-day mortality, and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Adjusted odds ratios (OR) for association of demographic variables, baseline status and constants at ED arrival with mortality and 30-day post-discharge adverse event were calculated. Results: We included 1,155 patients with AHF (annual incidence: 26.5 per 1000 inhabitants ≥65 years, 95%CI: 25.0-28.1). In 86% the diagnosis of AHF was known at discharge. Overall 30-day mortality was 10.7% and in-hospital mortality was 7.9%, and the combined event in 15.6%. In-hospital and 30-day mortality was associated with arterial hypotension (adjusted OR: 74.0, 95%CI: 5.39-1015. and 42.6, 3.74-485, respectively and hypoxemia (2.14, 1.27-3.61; and 1.87, 1.19-2.93) on arrival at the ED and requiring assistance with ambulation (2.24, 1.04-4.83; and 2.48, 1.27-4.86) and age (per 10-year increment; 1.54, 1.04-2.29; and 1.60, 1.13-2.28). The combined post-discharge adverse event was not associated with any characteristic. Conclusions: AHF is a frequent diagnosis in elderly patients consulting in the ED. The functional impairment, age, hypotension and hypoxemia are the factors most associated with mortality.(AU)

Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study.

OBJECTIVE: To estimate the incidence of acute heart failure (AHF) diagnosis in elderly patients in emergency departments (ED), diagnostic confirmation in hospitalized patients, and short-term adverse events. METHODS: All patients aged ≥65 years attended in 52 Spanish EDs during 1 week were included and those diagnosed with AHF were selected. In hospitalized patients, those diagnosed with AHF at discharge were collected. As adverse events, in-hospital and 30-day mortality, and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Adjusted odds ratios (OR) for association of demographic variables, baseline status and constants at ED arrival with mortality and 30-day post-discharge adverse event were calculated. RESULTS: We included 1,155 patients with AHF (annual incidence: 26.5 per 1000 inhabitants ≥65 years, 95% CI: 25.0-28.1). In 86% the diagnosis of AHF was known at discharge. Overall 30-day mortality was 10.7% and in-hospital mortality was 7.9%, and the combined event in 15.6%. In-hospital and 30-day mortality was associated with arterial hypotension (adjusted OR: 74.0, 95% CI: 5.39-1015. and 42.6, 3.74-485, respectively and hypoxemia (2.14, 1.27-3.61; and 1.87, 1.19-2.93) on arrival at the ED and requiring assistance with ambulation (2.24, 1.04-4.83; and 2.48, 1.27-4.86) and age (per 10-year increment; 1.54, 1.04-2.29; and 1.60, 1.13-2.28). The combined post-discharge adverse event was not associated with any characteristic. CONCLUSIONS: AHF is a frequent diagnosis in elderly patients consulting in the ED. The functional impairment, age, hypotension and hypoxemia are the factors most associated with mortality.

Male nurses' views of gender in the nurse-family relationship in paediatric care.

AIMS: (1) To learn how male nurses view and manage their relationships with families of hospitalized children, in contrast to how they view those established by female nurses. (2) To know if male nurses' relationships with families of hospitalized children are influenced by gender roles and stereotypes. BACKGROUND: Relationships are essential in care. Prevailing gender stereotypes suggest that males have more difficulties with relationships than with technical aspects of nursing. METHOD: Descriptive qualitative research in a public tertiary hospital September-December 2015. Participants were male nurses who worked in maternal and child health. Purposive sampling, based on criteria of homogeneity-regularity and heterogeneity-diversity. Semi-structured interviews and content analysis. FINDINGS: Twelve male nurses participated. Two key themes emerged. (1) Establishment of professional-family relationship. Male nurses denied that male and female nurses established relationships with families differently, attributing any differences to personality rather than gender. (2) Management of relationships. Male nurses claimed that they set more limits on their relationships with families than female nurses. DISCUSSION: Male nurses both disrupted and reproduced gendered stereotypes about relationships with families, revealing new models of masculinity. CONCLUSION: Male nurses reject the stereotype that nursing is a women's profession, but they interpret their relationships with families in terms of gender roles and stereotypes. IMPLICATIONS FOR NURSING AND NURSING POLICY: These findings contribute to understandings of the influence of gender stereotypes in nursing. They support the work of professional associations and labour unions in Spain and other countries to combat gender stereotypes and gender differences in nursing.

Tiempo de elevación del cabezal de la cama del paciente con ventilación mecánica y factores relacionados / Time of elevation of head of bed for patients receiving mechanical ventilation and its related factors

Introducción: La posición semiincorporada es una recomendación generalizada para la prevención de la neumonía asociada a ventilación mecánica. Objetivo: Identificar el tiempo de elevación de la cabecera de la cama del paciente sometido a ventilación mecánica y los factores del paciente relacionados con dicha elevación en una unidad de cuidados intensivos. Material y métodos: Estudio observacional, descriptivo y transversal. Realizado en una unidad de cuidados intensivos en hospital terciario, entre abril y junio de 2015. La población estudiada fueron pacientes con ventilación mecánica. Se registraron las horas diarias que los pacientes permanecían con el cabezal elevado (≥30°), datos sociodemográficos y variables clínicas. Resultados: Se recogieron 261 mediciones de elevación de cabezal. La media de horas diarias en que los pacientes permanecieron a ≥ 30° fue de 16h28′ (DE±5h38′), equivalente al 68,6% (DE±23,5%) del día. Factores relacionados a elevaciones ≥ 30° durante más tiempo fueron: llevar nutrición enteral, niveles de sedación profunda, diagnósticos cardíacos y neurocríticos. Factores que dificultaban la posición fueron: niveles de sedación de agitación y patologías abdominales. Sexo, edad y modalidad ventilatoria no obtuvieron relación significativa en elevaciones de cabezal. Conclusiones: A pesar de que elevar el cabezal es una medida preventiva fácil de realizar, económica y medible, su cumplimiento es bajo, existiendo factores específicos del estado clínico del paciente relacionados con dicho cumplimiento. Utilizar innovaciones como la medición continua de la posición del cabezal ayuda a evaluar la práctica clínica y permite llevar a cabo acciones de mejora cuyo impacto sea beneficioso para el paciente (AU)

Introduction: The semirecumbent position is a widespread recommendation for the prevention of pneumonia associated with mechanical ventilation. Aims: To identify the time of elevation of head of bed for patients under mechanical ventilation and the factors related to such elevation in an intensive care unit. Materials and methods: An observational, descriptive cross-sectional study. Conducted in an intensive care unit of a tertiary hospital from April to June 2015. The studied population were mechanically ventilated patients. Daily hours in which patients remained with the head of the bed elevated (≥30°), socio-demographic data and clinical variables were recorded. Results: 261 head elevation measurements were collected. The average daily hours that patients remained at ≥30° was 16h28' (SD ±5h38'), equivalent to 68.6% (SD ±23.5%) of the day. Factors related to elevations ≥30° for longer were: enteral nutrition, levels of deep sedation, cardiac and neurocritical diagnostics. Factors that hindered the position were: sedation levels for agitation and abdominal pathologies. Sex, age and ventilation mode did not show a significant relationship with bed head elevation. Conclusions: Although raising the head of the bed is an easy to perform, economical and measurable preventive measure, its compliance is low due to specific factors specific related o the patient's clinical condition. Using innovations such as continuous measurement of the head position helps to evaluate clinical practice and allows to carry out improvement actions whose impact is beneficial to the patient (AU)

Time of elevation of head of bed for patients receiving mechanical ventilation and its related factors. / Tiempo de elevación del cabezal de la cama del paciente con ventilación mecánica y factores relacionados.

INTRODUCTION: The semirecumbent position is a widespread recommendation for the prevention of pneumonia associated with mechanical ventilation. AIMS: To identify the time of elevation of head of bed for patients under mechanical ventilation and the factors related to such elevation in an intensive care unit. MATERIALS AND METHODS: An observational, descriptive cross-sectional study. Conducted in an intensive care unit of a tertiary hospital from April to June 2015. The studied population were mechanically ventilated patients. Daily hours in which patients remained with the head of the bed elevated (≥30°), socio-demographic data and clinical variables were recorded. RESULTS: 261 head elevation measurements were collected. The average daily hours that patients remained at ≥30° was 16h28' (SD ±5h38'), equivalent to 68.6% (SD ±23.5%) of the day. Factors related to elevations ≥30° for longer were: enteral nutrition, levels of deep sedation, cardiac and neurocritical diagnostics. Factors that hindered the position were: sedation levels for agitation and abdominal pathologies. Sex, age and ventilation mode did not show a significant relationship with bed head elevation. CONCLUSIONS: Although raising the head of the bed is an easy to perform, economical and measurable preventive measure, its compliance is low due to specific factors specific related o the patient's clinical condition. Using innovations such as continuous measurement of the head position helps to evaluate clinical practice and allows to carry out improvement actions whose impact is beneficial to the patient.

La enfermera experta en el cuidado del paciente crítico según Patricia Benner / The nurse expert in the care of the critical patients according to Patricia Benner

Introducción Al hablar de cuidados resulta impensable separar al individuo de su contexto más inmediato, la familia. Incorporarla en los cuidados de un paciente crítico supone una habilidad que no se desarrolla hasta que el profesional de enfermería es competente en términos de Benner. La habilidad que pueda tener la enfermera para implicarse en el cuidado de los pacientes y de la familia se adquiere con el tiempo y la experiencia.ObjetivoExplorar el comportamiento y el juicio clínico de la enfermera experta en áreas de cuidados críticos, según Patricia Benner, identificando las respuestas que esta ofrece a las necesidades del paciente y la familia.MetodologíaSe escogió a María, enfermera experta en una unidad de cuidados intensivos que relató un episodio clínico significativo relacionado con el cuidado a la familia. La lectura de la narración, el análisis y las conclusiones se realizaron, desde el dominio del cuidado a la familia, según los seis aspectos del juicio clínico y del comportamiento experto que señala Benner.ResultadosSe muestra cómo la expertez y el saber hacer de la enfermera impulsan un cambio importante en la práctica.ConclusionesAnimar a la familia a participar en los cuidados facilita la unión, decrece la impotencia y la ansiedad y ayuda a asimilar la situación del ser querido, aspectos que forman parte de la competencia enfermera para proporcionar un cuidado integral. A partir de la práctica clínica de María, se han podido observar los aspectos del juicio clínico y del comportamiento que Benner identifica en una enfermera experta(AU)

Introduction When discussing care, the individual cannot be considered separate from their most immediate context, that is, the family. Including the family in the cares for a critically ill patient requires a skill that is not developed until the nursing professional is competent in Benner's terms. The skill that a nurse can have to become involved in caring for patients and the family is acquired over time and through experience.ObjectiveTo explore the behavior and clinical judgment of a nurse qualified in areas of critical care, according to Patricia Benner, identifying the responses provided by the nurse for patient and family needs.MethodMaria, an expert nurse in an intensive care unit, was selected to report on a significant clinical episode related to caring for the family. Her narration was read, and analysis and conclusions were carried out, within the field of caring for the family and according to the six aspects of clinical judgment and expert behavior outlined by Benner.ResultsIt reveals how the expert skills and know-how of the nurse bring about a significant change in the practice.ConclusionsEncouraging the family to take part in the care promotes union, decreases impotence and anxiety and helps to assimilate the loved one's situation, aspects which form part of the nursing skill to provide complete care. Using Maria's clinical practice as a base, aspects of the clinical judgment and behavior that Benner identifies in an expert nurse can be observed (AU)

[The nurse expert in the care of the critical patients according to Patricia Benner]. / La enfermera experta en el cuidado del paciente crítico según Patricia Benner.

INTRODUCTION: When discussing care, the individual cannot be considered separate from their most immediate context, that is, the family. Including the family in the cares for a critically ill patient requires a skill that is not developed until the nursing professional is competent in Benner's terms. The skill that a nurse can have to become involved in caring for patients and the family is acquired over time and through experience. OBJECTIVE: To explore the behavior and clinical judgment of a nurse qualified in areas of critical care, according to Patricia Benner, identifying the responses provided by the nurse for patient and family needs. METHOD: Maria, an expert nurse in an intensive care unit, was selected to report on a significant clinical episode related to caring for the family. Her narration was read, and analysis and conclusions were carried out, within the field of caring for the family and according to the six aspects of clinical judgment and expert behavior outlined by Benner. RESULTS: It reveals how the expert skills and know-how of the nurse bring about a significant change in the practice. CONCLUSIONS: Encouraging the family to take part in the care promotes union, decreases impotence and anxiety and helps to assimilate the loved one's situation, aspects which form part of the nursing skill to provide complete care. Using Maria's clinical practice as a base, aspects of the clinical judgment and behavior that Benner identifies in an expert nurse can be observed.

[Factors related to haemolysis in the extraction of blood samples]. / Factores relacionados con la hemólisis en la extracción de muestras sanguíneas.

The choice of a venous access system to provide safe blood collection and reliable analytical results for that sample is of paramount importance in any accident and emergency department. The objective of this study was to identify the factors associated with haemolysis in venous blood samples, where the variables studied were: type of venipuncture (needle and catheter), type of catheter (3 catheters of 3 different materials) and diameter of the catheter. The sample was obtained from all patients who required a blood test in the accident and emergencies department of the Virgen del Camino Hospital over 34 days, collected in 3 different periods (September-November), involving a total of 1.933 procedures. Positive haemolysis determined by laboratory technicians was found in 2% (7/348) of samples obtained by needle compared to 14% (222/1585) obtained by catheter. We observe an 8% (39/475) of haemolysis in the samples taken by protective Teflon catheter, 18% (77/426) by Protectiv plus polyurethane and 15% (106/684) by BD-Nexiva Vialone. The haemolysis index fell with an increase in the size of the catheter, those of 18G showing 13% (115/867) and those of 20G showing 15% (107/708). The combination of catheter type and size maintains the smallest percentages of haemolysis in Teflon catheters and high diameters of 18G with 6% (19/301), less than half the haemolysis of the polyurethane catheters and a third of that for Vialone catheters respectively.

Factores relacionados con la hemólisis en la extracción de muestras sanguíneas / Factors related to haemolysis in the extraction of blood samples

La elección de un sistema de acceso venoso que proporcione una extracción sanguínea segura y unos resultados analíticos fiables en dicha muestra es de suma importancia en cualquier servicio de urgencias. El objetivo del estudio fue identificar los factores asociados a la hemólisis en muestras de sangre venosa, siendo las variables estudiadas el tipo de venopunción (con aguja y con catéter), el tipo de catéter (3 catéteres de 3 materiales diferentes) y el diámetro del catéter. La muestra se obtuvo de todos los pacientes que precisaron analítica de sangre en el Servicio de Urgencias del Hospital Virgen del Camino durante 34 días, recogidos en 3 períodos distintos (septiembre-noviembre). Se completó un total de 1.933 procedimientos. Se registró hemólisis positiva, determinada por los técnicos de laboratorio, en un 2% (7/348) de muestras obtenidas con aguja frente al 14% (222/1585) del catéter. Se observó un 8% (39/475) de hemólisis en las muestras extraídas mediante catéter Protectiv® de teflón, 18% (77/426) mediante Protectiv plus® de poliuretano y 15% (106/684) mediante BD-Nexiva® de vialón. El índice de hemólisis disminuyó al aumentar el calibre del catéter; así presentaron un 13% (115/867) los de 18G y un 15% (107/708) los de 20G. La combinación tipo de catéter y calibre mantiene los menores porcentajes de hemólisis para catéteres de teflón y diámetros altos de 18G con un 6% (19/301), menos de la mitad de hemólisis que los respectivos de poliuretano y menos de la tercera parte que los de vialón (AU)

The choice of a venous access system to provide safe blood collection and reliable analytical results for that sample is of paramount importance in any accident and emergency department. The objective of this study was to identify the factors associated with haemolysis in venous blood samples, where the variables studied were: type of venipuncture (needle and catheter), type of catheter (3 catheters of 3 different materials) and diameter of the catheter. The sample was obtained from all patients who required a blood test in the accident and emergencies department of the Virgen del Camino Hospital over 34 days, collected in 3 different periods (September-November), involving a total of 1.933 procedures. Positive haemolysis determined by laboratory technicians was found in 2% (7/348) of samples obtained by needle compared to 14% (222/1585) obtained by catheter. We observe an 8% (39/475) of haemolysis in the samples taken by protective Teflon® catheter, 18% (77/426) by Protectiv plus® polyurethane and 15% (106/684) by BD-Nexiva® Vialone. The haemolysis index fell with an increase in the size of the catheter, those of 18G showing 13% (115/867) and those of 20G showing 15% (107/708). The combination of catheter type and size maintains the smallest percentages of haemolysis in Teflon catheters and high diameters of 18G with 6% (19/301), less than half the haemolysis of the polyurethane catheters and a third of that for Vialone catheters respectively (AU)

Fenotipo acetilador y su relación con la toxicidad hepática de la isoniazida / Acetylator phenotype and relationship with hepatotoxicity of isoniazid

Se determina el fenotipo acetilador en un grupo de 128 sujetos representativos de la población de Castilla y León, una vez conocidas las proporciones de sulfametacina libre y acetilada en plasma y orina. Un 34,37 por ciento de los sujetos de nuestra serie eran acetiladores rápidos y un 65,63 por ciento acetiladores lentos. La hepatotoxicidad de la isoniazida determinada clínica, bioquímica y anatomopatológicamente es significativamente superior (p < 0,001) en los acetiladores rápidos. La asociación a la isoniazida de rifampicina y piracinamida en los sujetos acetiladores rápidos produjo hepatitis tóxicas severas (p < 0,03) e incluso un fracaso hepático agudo mortal (AU)

Infection by human parvovirus B19: "gloves and socks" papular purpuric syndrome.

Human parvovirus B19 is the cause of erythema infectiosum a benign and self-limited infection, but sometimes the virus causes an acute and self-limiting dermatosis. It consists of a edema and erythema of the hands and feet in a gloves and sock distribution and is associated with oral lesions and fever. We report a case of a "gloves and socks" infection by human parvovirus B19.

Cytogenetic analyses of secondary liver tumors reveal significant differences in genomic imbalances between primary and metastatic colon carcinomas.

To investigate if karyotypic features of secondary liver tumors may provide diagnostic information and if the cytogenetic patterns of primary and metastatic colorectal carcinomas (CRC) are different, 33 liver metastases were analyzed: 25 CRC, 4 small intestine carcinoids, 1 ovarian carcinoid, 1 lobular breast cancer, 1 head-and-neck squamous cell carcinoma, and 1 uveal malignant melanoma. Chromosomal aberrations were detected in 24 cases, whereas 5 had normal karyotypes and 4 were uninformative due to lack of mitoses. Trisomy 12 was detected in 2 small intestine carcinoids, suggesting that +12 may be of pathogenetic importance in this tumor type. The breast and head-and-neck carcinomas and the uveal melanoma displayed aberrations previously reported as characteristic in primary tumors, e.g., der(1;16) and deletion of 3p in the breast cancer, losses of 3p and 8p and partial gain of 8q in the head-and-neck carcinoma, and monosomy 3 and i(8)(q10) in the uveal melanoma, indicating that cytogenetic investigations provide important diagnostic information in secondary liver tumors. In the 18 CRC metastases with chromosomal abnormalities, the cytogenetic findings agreed well with previously reported primary CRC. Common numerical abnormalities included gains of chromosomes 7, 11, 13, and 20, and losses of Y, 4, 18, 21, and 22. Structural rearrangements most often affected chromosome bands 1p13, 1q10, 3p21, 5q10, 5q11, 7q10, 8q10, 8q11, 12q13, 16p13, 17p11, 20p13, 20p11, and 20q10, and frequently resulted in losses of 1p, 8p, and 17p, and gains of 5p, 6p, 7p, 8q, and 20q. Comparing the present cases with primary CRC previously analyzed in our department revealed that additional gains of 6p, 6q, 7p, and 20q, and losses of 1p, 4p, 4q, 8p, 18p, 18q, and 22 were more common (P < 0.05) in the metastases, suggesting that these genomic sites harbor genes of importance in the metastatic process of CRC.

Side-effects of sodium valproate, mainly related to its hepatic and pancreatic toxicity.

A study was made of 134 patients (67 males and 67 females) treated with sodium valproate, with ages from 1.5 to 70 years (50 on monotherapy and 84 on multitherapy), to detect side-effects of this treatment. To meet this goal, a clinical questionnaire was used with special emphasis on biological parameters to detect hepatic and pancreatic toxicity. 71.6% developed side-effects, without differences either between groups of sex or age, or patients on monotherapy and multitherapy, or the duration of the treatment, longer or shorter than six months. The side-effects were mild and transient, and without relationship with doses or plasma levels of the drug. The most noticeable side-effects in the study were the increase in amylase values, mainly in urine (23.9%), eosinophilia (30% in the monotherapy group), increase in gamma-glutamyltranspeptidase (20.2% in the polytherapy group) and weight gain in 25% of adult women on polytherapy. Only a 4.7% developed mild and transient elevation of transaminases, that did not differ from the control population. The relevance of using a clinical questionnaire and biological parameters to evaluate the side-effects of a drug is emphasized.

Histological, ultrastructural and mitochondrial oxidative phosphorylation studies in liver of rats chronically treated with oral valproic acid.

The effects of oral administration of valproic acid (VPA) have been studied on the liver of female adult Wistar rats, at doses of 60 and 120 mg/kg/day during 4 and 18 weeks (periods I and II). Other groups received the same doses of VPA with phenobarbital (PB). The animals developed periportal steatosis, more intense at the end of period II and in groups non-induced by PB, and also some degree of mitochondrial swelling. An uncoupling of the oxidative phosphorylation was also evident with both doses in the non-induced groups, and only with the high dose of VPA in the induced group. An in vitro study on isolated liver mitochondria showed uncoupling only with very high concentration of VPA (10 mM). We comment on these findings and propose a chronic model of experimental hepatotoxicity of oral VPA in the rat.

[Hypothalamic-hypophyseal-gonadal axis in patients with liver cirrhosis of alcoholic origin]. / Estudio del eje hipotálamo-hipofisario-gonadal en pacientes con cirrosis hepática de etiología alcohólica.

Plasma levels of testosterone, 17-beta-oestradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone were estimated in 19 males with alcoholic cirrhosis and in 10 healthy age matched controls in basal conditions and after administration of clomiphene citrate. The gonadal hormone response is normal in the cirrhotic group after stimulation with clomiphene citrate, suggesting a normal functional reserve of the gonad of the cirrhotic patients. It is emphasized the direct damage that the alcohol produces in the Leydig cell.