Tratamiento farmacológico en la deshabituación tabáquica. Ventajas e inconvenientes de los tratamientos actuales / Advantages and drawbacks of current pharmacological treatments for smoking cessation

Actualmente disponemos de 3 familias de fármacos que son los que se utilizan habitualmente en la práctica clínica y que ayudan a los fumadores a dejar de serlo: la terapia sustitutiva con nicotina, bupropión y vareniclina. El conocimiento resumido de las particularidades, eficacia y contraindicaciones de cada uno de ellos nos puede resultar útil para realizar una prescripción adecuada a nuestros pacientes (AU)

There are currently three families of drugs that are commonly used in the clinic to help smokers to stop; nicotine replacement therapy, bupropion and varenicline. Summary knowledge of the specific efficacy and contraindications of each of them can be useful before prescribing them to our patients (AU)

[Advantages and drawbacks of current pharmacological treatments for smoking cessation]. / Tratamiento farmacológico en la deshabituación tabáquica. Ventajas e inconvenientes de los tratamientos actuales.

There are currently three families of drugs that are commonly used in the clinic to help smokers to stop; nicotine replacement therapy, bupropion and varenicline. Summary knowledge of the specific efficacy and contraindications of each of them can be useful before prescribing them to our patients.

Análisis de potenciales factores protectores del riesgo cardiovascular en una población mediterránea / Analysis of potential protective cardiovascular risk factors in a mediterranean population

Analizar si los factores que determinan competitividad entre la pareja se asocian a un mayor riesgo cardiovascular (RCV) en el varón. Valorar si el modelo conductual y la calidad de vida, se correlacionan con el RCV. Material y método Estudio transversal realizado en un municipio mediterráneo semirural. Se incluyeron 336 individuos. Se recogen datos que incluyen variables sociodemográficos, sociales y relacionadas con la competitividad de la pareja. Se realiza el test SF-36 para valorar la calidad de vida e Inventario de Jenkins para valorar el modelo conductual. Resultados En el análisis multivariante de las variables relacionadas con la competitividad de la pareja, ajustadas por las distintas variables que definen los factores de RCV, los hombres cuya mujeres trabajan fuera de casa y les molesta presentan mayor RCV (p:0,043). No se detecta asociación entre el RCV en el varón y el nivel cultural de su pareja. No se detecta relación entre el tipo de modelo conductual y el RCV. Conclusiones Si la mujer trabaja fuera de casa y a su marido le molesta, existe un mayor RCV en dicho marido. En el resto de variables no se aprecian asociaciones significativas (AU)

Objectives: Analyze if the factors that determine competitiveness between couples are associated to greater cardiovascular risk (CVR) in the male. Evaluate if the behavior model and quality of life are correlated with CVR. Material and methods: A cross-sectional study conducted in a semi-rural Mediterranean municipality that included 336 subjects. Data including socio demographic, social data and those related with competitiveness in the couple were collected. The SF-36 test was performed to evaluate Jenkin’s quality of life inventory to evaluate the behavioral model. Results: In the multivariant analysis of the variables related with competitiveness of the couple, adjusted for the different variables that define CVR factors, men whose wives work outside the home and who is unhappy with it, have greater CVR (p:0.043). No association was detected between CVR in the male and the cultural level of his partner. No relationship was detected between type of behavioral model and CVR. Conclusions: If the wife works outside of the home and her husband is unhappy with this, the husband has a greater CVR. No significant associations are observed in the rest of the variables (AU)

Crisis hipertensivas en pacientes como predictor de riesgo cardiovascular. Seguimiento durante 5 años / Hypertensive crises as a predictor of cardiovascular risk. Monitoring for 5 years

Introduccióna) Conocer la evolución durante 5 años que presentan los pacientes que han sufrido una crisis hipertensiva, y b) analizar si dichas crisis hipertensivas representan un mayor riesgo de sufrir eventos cardiovasculares (CV) en 5 años respecto a hipertensos sin crisis hipertensivas.Material y métodosEstudio de cohortes con un seguimiento durante 5 años realizado en 4 centros de salud semiurbanos. Participantes: 2 grupos: A) 224 pacientes, hipertensos conocidos o no, que habían padecido al menos una crisis hipertensiva (PAS≥220mmHg y/o PAD≥120mmHg) durante el último año previo al seguimiento, y B) 224 pacientes hipertensos conocidos en los que no constaba que hubiesen padecido nunca una crisis hipertensiva. Intervenciones: seguimiento durante 5 años. Mediciones principales: incidencia de los siguientes eventos: mortalidad CV, ictus no mortal, enfermedad coronaria e insuficiencia cardíaca (IC).ResultadosGrupo con crisis hipertensivas (grupo A; n=224). La incidencia de eventos fue la siguiente: mortalidad CV: 16 casos (7,14%); ictus: 10 casos (4,5%); enfermedad coronaria: 26 casos (11,7%), e IC: 6 casos (2,7%). Grupo sin crisis hipertensivas (grupo B; n=224).ResultadosLa incidencia de eventos fue la siguiente: mortalidad CV: 6 casos (2,7%); ictus: 6 casos (2,7%); enfermedad coronaria: 18 casos (8,1%), e IC: 2 casos (0,9%). Al comparar ambos grupos, se obtuvo significación estadística (p<0,05) en todos los eventos medidos, excepto en enfermedad coronaria.ConclusiónLa presencia de crisis hipertensivas incrementa significativamente el riesgo de padecer eventos CV(AU)

Introduction1) To know the course over 5 years presented by patients who have suffered a hypertensive crisis. 2) To analyze whether these hypertensive crisis represent an increased risk of cardiovascular events in 5 years compared to hypertensive subjects with no hypertensive crisis.Material and methodsA study of cohorts was followed for 5 years in 4 semi-urban health centers.ParticipantsTwo groups: A) 224 patients with known or unknown hypertension, who had suffered at least one hypertensive crisis (SBP>220mm Hg and/or DBP>120mm Hg) during the last year prior to monitoring. B) 224 hypertensive patients known in whom no record could be found that they had ever experienced a hypertensive crisis.InterventionsMonitoring for 5 years.Main measurementsIncidence of the following events: cardiovascular mortality, non-fatal stroke, coronary disease and heart failure.ResultsA) Group with hypertensive crises: (n=224). The incidence of events was as follows: 16 cases cardiovascular mortality (7.14%), stroke 10 cases (4.5%), coronary disease 26 cases (11.7%) and heart failure “HF” 6 cases (2.7%).ResultsB) Group without hypertensive crises: (n=224). The incidence of events was as follows: CV mortality 6 cases (2.7%), 6 cases (2.7%), coronary disease 18 cases (8.1%), HF 2 cases (0.9%). When comparing the two groups, statistically significant p<0.05 was found in all the events measured, except for coronary diseases.ConclusionThe presence of hypertensive crises significantly increases the risk of cardiovascular events(AU)

Pericardial tamponade as initial presentation of papillary thyroid carcinoma.

We herein describe a 19-year-old woman who presented with pericardial effusion that resulted in heart tamponade. The clinicopathological study revealed papillary carcinoma of the thyroid metastasized to the heart. Although malignant pericardial effusion is a known complication of thyroid cancer, it is rarely the first manifestation and shows a relatively favourable prognosis despite widespread metastases if adequate treatment is given.

Los nuevos factores de riesgo cardiovascular / The new cardiovascular risk factors

En esta revisión se definen las características y criterios epidemiológicos de los factores de riesgo cardiovascular (FRCV), su clasificación según su importancia y la posibilidad de intervención, su tendencia a asociarse entre sí y la multiplicación del riesgo que ello entraña. De entre los llamados "nuevos FRCV", se analizan la reactividad cardiovascular, el fibrinógeno, la microalbuminuria, la homocisteína y la lipoproteína (a). En el estudio de la reactividad cardiovascular se definen los tipos de estresores y la respuesta hemodinámica al estrés. Se detalla la relación de la reactividad cardiovascular como factor desencadenante de hipertensión arterial (HTA). Respecto del fibrinógeno, se analizan las evidencias científicas y epidemiológicas que lo avalan como FRCV y se detallan los factores que modifican su tasa. Sobre la microalbuminuria se definen y pormenorizan los métodos de su determinación, así como su importante relación con la diabetes y la HTA. Se expone la fisiopatología de la hiperhomocisteinemia, así comos sus causas y correlación con la enfermedad cardiovascular, su detección y posible tratamiento y control. Referido a la lipoproteína (a), se analiza su metabolismo y los factores que influyen sobre su concentración. Se repasan sus funciones fisiológicas y su relación con la cardiopatía coronaria (AU)

Primary renal lymphoma: report of 3 cases and review of the literature.

Primary renal lymphoma is a controversial entity. Only 29 cases have been reported since 1980. Diagnostic criteria are not well established. We report here 3 new cases and review the literature. Primary renal lymphoma was considered on the basis of uni- or bilateral nonobstructive nephromegaly with or without renal failure. In all cases, the diagnosis was made after renal biopsy. Extrarenal abdominal involvement was excluded by imaging techniques. The role of staging laparotomy remains controversial. Chemotherapy is the treatment of choice, but the prognosis is poor. We propose a clinical definition of primary renal lymphoma in order to achieve a better management of the disease.

Antihypertensive monotherapy and stress-induced changes in physiological activity.

The effects of two types of laboratory stressors, a structured interview and the cold pressor test, on blood pressure (BP) and heart rate (HR) were studied in normotensive individuals (n = 16), unmedicated hypertensive patients (n = 12), and medicated hypertensive patients (n = 46). Fifteen patients were in the bisoprolol group, 16 patients were in the enalapril group, and 15 patients were in the nitrendipine group. Concurrent physiologic measures, finger pulse volume (FPV), electrodermal activity, and respiratory frequency (RF), were also used to evaluate the level of stress reached by the subjects during and after the tasks. No significant differences were evident between the different treatments in BP and other physiologic responses to stressors. Patients receiving bisoprolol maintained lower HR and systolic BP values, but these differences were not related to the reaction to the stressors. No significant differences were noted in diastolic BP (DBP) between the different groups. The highest physiologic responses were obtained during the structured interview. Antihypertensive monotherapy does not attenuate cardiovascular reactions induced by acute stress in controlled laboratory conditions. In laboratory studies of the relationships between stress and hypertension, it is important that social stressors be used and that physiologic rather than cardiovascular measures of stress be recorded.