Thanatophoric dysplasia type II with encephalocele and semilobar holoprosencephaly: Insights into its pathogenesis.

Thanatophoric dysplasia (TD) is a lethal form of short-limb skeletal dysplasia that is associated with macrocephaly, and variably cloverleaf skull. Two types of TD are clinically recognized, TD1 and TD2, mainly distinguished by their radiographic characteristics. The differences between the two are principally observed in the femur, which appears curved in TD1, while it remains straight but with a proximal medial spike in TD2, and are a less severe overall affectation in TD2. Both types of TD are caused by mutations in different functional domains of the FGFR3 gene. However, whereas several mutations in the different domains of FGFR3 cause TD1, the K650E mutation involving the change of a lysine to glutamic acid ("Lys650Glu") has been found in all TD2 cases to date. Here we describe a newborn infant with TD2 associated with brain defects that have either been infrequently observed (encephalocele) or not hitherto described (holoprosencephaly). Based on recent studies, we consider encephaloceles described in TD to be pseudoencephaloceles, since they are secondary to the intracranial pressure generated by severe hydrocephaly and to severe cranial structural anomalies. Finally, to analyze the mechanisms of holoprosencephaly observed in the case described here, we include a concise review on the current understanding of how FGFs and their receptors are expressed in the rostral signaling center (particularly Fgf8). In addition, we evaluated recent observations that FGF ligands and receptors (including FGFR3) act in concert to organize the whole telencephalon activity, rather than independently patterning different areas.

[Incidence and mortality due to cancer in Navarre, 1998-2002. Trends in the last 30 years]. / Incidencia y mortalidad por cáncer en Navarra, 1998-2002. Evolución en los últimos 30 años.

Between 1998-2002, 16,952 new cases of cancer were registered in Navarre. In men, the most frequently diagnosed cancers were in the following order: prostate, lung, colon and rectum, bladder and stomach, which accounted for 63.2%. In women, the sites were breast, colon and rectum, corpus uteri, stomach and ovary, which accounted for 57.6% of the cases. In the same period, 1998-2002, 4,127 men and 2,470 women died from cancer. Sixty percent of all deaths due to malign tumours in men were due to cancer of the lung, prostate, colon and rectum, stomach and bladder. In women this was due to cancers of colon and rectum, breast, stomach, pancreas and lung, which accounted for 49% of the cases. In men in Navarre there has been an increase in the incidence rates of cancer of the prostate, kidney and non-Hodgkin lymphoma. Avoidable cancers such as those related to smoking (lung, oral cavity and pharynx or pancreas) continue to rise, and represent a greater global risk of dying from cancer in the latest period studied than in the decades of the 1970s and 1980s. From 1995 up to the present, mortality due to cancer has moved from occupying the second place to become the first cause of death among men in Navarre. The global risk of death due to cancer in men is now equal to the first period studied, 1975-1977. Amongst women the global risk of death due to cancer fell by 25% between 1975 and 2002, basically at the cost of breast and stomach cancer. Tumours related to smoking increased both in mortality and in incidence and appear as a significant health problem amongst women in Navarre. Breast cancer has increased in incidence, with lower mortality figures than those of the first period 1975-1977. Invasive cancer of the cervix remains at very low rates in comparison with many European countries, including Spain. In both sexes colorectal and skin cancer has increased, while the incidence and mortality of stomach cancer continues to fall.

Incidencia y mortalidad por cáncer en Navarra, 1998-2002. Evolución en los últimos 30 años / Incidence and mortality due to cancer in Navarre, 1998-2002. Trends in the last 30 years

entre 1998-2002 se registraron 16.952 nuevos casos de cáncer en Navarra. En los hombres, los cánceres más frecuentes diagnosticados fueron, por este orden próstata, pulmón,colon y recto, vejiga y estómago, que sumaron el 63,2% de todos los casos de cáncer. En mujeres las localizaciones de mama, colon y recto, cuerpo de útero, estómago y ovario sumaron el 57,6% del total de los casos. En el mismo periodo, 1998-2002, fallecieron por cáncer 4.127 hombre y 2.470 mujeres. el 60% de todas las muertes producidas por tumores malignos en hombres se debieron a las localizaciones de pulmón, próstata,colon y recto, estómago y vejiga. En las mujeres las localizaciones de colon y recto, mama,estómago, páncreas y pulmón, sumaron el 49% de las defunciones por cáncer. En los hombre de Navarra han aumentado las tasas de incidencia del cáncer de próstata, riñón y linfoma no Hodgkin. Cánceres evitables, como los relacionados con el hábito de fumar (pulmón,cavidad oral y faringe o páncreas),continúan en ascento, y representan mayor riesgo global de morir por cáncer en el último periodo estudiado que en las décadas de los años 1970 y 1980. A partir de 1995 y hasta la actualidad, la mortalidad por cáncer pasó a ocupar el segundo lugar a ser la primera causa de muerte por cáncer en hombres se ha igualado al primer periodo estudiado 1975-1977. Entre las mujeres el riesgo gloval de muerte por cáncer descendió un 25% entre 1975 y 2002, a costa fundamentalmente del cáncer de mama y de estómago. Los tumores relacionados con el hábito de fumar muestran incrementos tanto en la mortalidad como en la incidencia y emergencia como un problema importante de salud entre las mujeres de Navarra. Ha aumentado la incidencia de cáncer de mama, en cambio en la mortalidad se sitúa en cifras inferiores a las del primer periodo 1975-1977. El cáncer invasivo de cérvix se mantiene en tasas muy bajas respecto a muchos países europeos, incluida España. En ambos sexos ha aumentado el cáncer colorrectal y el melanoma mientras que continúa el descenso de la incidencia y mortalidad por cáncer de estómago

Between 1998-2002, 16,952 new cases of cancer were registered in Navarre. In men, the most frequently diagnosed cancers were in the following order: prostate, lung, colon and rectum, bladder and stomach, which accounted for 63.2%, In women, the sites were breast, colon and rectum, corpus uteri, stomach and ovary, which accounted for 57,6% of the cases. In the same period, 1998-2002m 4,127 men and 2,470 women died from cancer. Sixty percent of all deaths due to malign tumours in men were due to cancer od the lung, prostate, colon and rectum, stomach and bladder. In women this was due to cancers of colon and rectum, breast, stomach, pancreas and lung, which accounted for 49% of the cases. In men in Navarre there has been an increase in the incidence rates of cancer on the prostate, kidney and non Hodgkin lymphoma. Avoidable cancers such as those related to smoking (lung, oral cavity and pharynx or pancreas) continue to rise, and represent a greater global risk of dying from cancer in the latest period studied than in the decades of the 1970s and 1980s. From 1995 up to the present, mortality due to cancer has moved from occupying the second place to become the first cause of death among men in Navarre. The global risk of death due to cancer in men is now equal to the first period studied 1975-1977. Amongst women the global risk of death due to cancer fell by 25% between 1975 and 2002 basically at the cost of breast and stomach cancer. Tumours related to smoking increased both in mortality and in incidence and appear as a significant health problem amongst women in Navarre. Breast cancer has increased in incidence, with lower mortality figures than those of the first period 1975-1977. Invasive cancer of the cervix remains at very low rates in comparison with many European countries, including Spain

Threonines at position 174 and 235 of the angiotensinogen polypeptide chain are related to familial history of hypertension in a Spanish-Mediterranean population.

This study investigates the association between the allelic distribution of two polymorphisms of the angiotensinogen (AGT) gene (T174M and M235T in the polypeptide chain) and blood pressure (BP) in a Mediterranean population in the south-west of Europe. The sample consists of 1322 participants from urban and rural areas, from the province of Albacete (218,462 inhabitants), located in the south-east of Spain. The subsample of this study, adjusted by age (over 18 years old) and sex, consists of 401 individuals. A case-control study is conducted which analyses 205 individuals from the group with the highest BP (fifth quintile) and 196 from the group with the lowest BP (first quintile). In addition, a comparative and associated analysis of these polymorphisms with BP level and family history of hypertension is carried out. The T174 allele proved to be more common in the fifth quintile group, although not statistically so. When the presence of threonine was analysed in both polymorphism positions (174 and 235), the TTTT genotype was found to be more common in the fifth quintile than in the first quintile. Moreover, the TTTT genotype was significantly more common in individuals with a family history of hypertension, indicating that it could be considered a predisposing factor to high BP in individuals from such families. In addition, the T174M-T235T genotype was more common in the first quintile group, and showed significant association (P=0.05) with the group that had no family history of hypertension.

Anatomía Patológica en Cirugía Menor (Atención Primaria) / No disponible

No disponible

Ovarian endometriosis and clear cell carcinoma, leiomyomatosis peritonealis disseminata, and endometrial adenocarcinoma: an unusual, pathogenetically related association.

A 42 year-old female with a preoperative clinical diagnosis of ovarian cancer underwent laparotomy which revealed leiomyomatosis peritonealis disseminata (LPD) in the peritoneum and omentum and a left ovarian endometriotic cyst associated with a clear cell carcinoma. A grade 1, superfically invasive villoglandular endometrial endometrioid adenocarcinoma was also found. Microscopically, the endometriotic cyst wall contained an extensive peripheral band-like condensation of stromal cells. These cells were strongly positive for alpha inhibin and may have been the hormonal source responsible for the induction of the simultaneous LPD and endometrial adenocarcinoma. It is proposed that endometriosis is not only a precursor of clear cell carcinoma but, through secondary hormonal induction of the surrounding ovarian stroma, may also provide a hormonal stimulus for diverse proliferative processes.

[Accuracy and precision in blood pressure measurement. Comparative study of home self-measurement with measurement in the clinic and out-patient monitoring]. / Exactitud y precisión en la medida de la presión arterial. Estudio comparativo de las automedidas domiciliarias con la medida en la consulta y la monitorización ambulatoria.

OBJECTIVE: To compare accuracy and precision of self-measurement blood pressure (SMBP) at home, as a diagnosis method of hypertension, with mercury measurement in office and ambulatory blood pressure monitoring (ABPM). DESIGN: A comparison study of diagnosis methods.Setting.Hypertension Unit in the Hospital General de Albacete. PATIENTS: By means of a non-probabilistic sample, selected from consecutive cases that went to the unit, a 64 pharmacologically untreated hypertensive sample older than 18 has been selected. METHODS: All subjects were taken 3 measurements with mercury from a validated nurse in office, and were also taught to make 20 self-measurements of blood pressure in the morning at the office and 20 self-measurements in the evening at home with an automatic device Omron 705-CP, during the same day they were set a Takeda TM-2420 device programmed to measure their blood pressure for 24 hours. All proceedings were repeated 4 weeks later. Mean blood pressure values have been compared with every diagnosis method and sensitivity, specificity, positive and negative predictive value have been studied in every method reproducibility in every method has been analyzed. RESULTS: Subjects were 29 men and 35 women with a mean of 53 years old. The mean values of office blood pressure (OBP) have been higher than SMBP and ABPM in the two periods of the study. SMBP has had a higher specificity and predictive value than OBP. Reproducibility of repeated SMBP in standardized conditions is similar to ABPM. CONCLUSIONS: With a minimum program self-measurements at home, in standardized conditions, they can be considered as an accurate technique in the diagnosis of hypertension.

Exactitud y precisión en la medida de la presión arterial. Estudio comparativo de las automedidas domiciliarias con la medida en la consulta y la monitorización ambulatoria / Accuracy and precision in blood pressure measurement. Comparative study of home self-measurement with measurement in the clinic and out-patient monitoring

Objetivo. Comparar la exactitud y precisión de la automedida domiciliaria de la presión arterial, como método diagnóstico de la hipertensión arterial, con el mercurio en la consulta y la monitorización ambulatoria de la presión arterial (MAPA).Diseño. Estudio de comparación de métodos diagnósticos. Emplazamiento. Consulta de Hipertensión del Hospital General de Albacete. Pacientes. Mediante muestreo no probabilístico, de selección de casos consecutivos que acuden a la consulta, se ha seleccionado una muestra de 64 pacientes hipertensos no tratados mayores de 18 años. Métodos. A todos los sujetos una enfermera validada les ha realizado 3 mediciones con mercurio en la consulta y les ha enseñado para que llevaran a cabo 20 automedidas por la mañana en la consulta y 20 por la tarde en su domicilio con un aparato automático Omron 705 CP; el mismo día les colocaba un Holter Takeda TM-2420, programado para realizar determinaciones durante 24 horas. Todos los procedimientos se hicieron en período basal y se repitieron a las 4 semanas. Se han comparado los valores medios de presión arterial obtenidos con cada técnica diagnóstica y se ha estudiado su sensibilidad, especificidad y valor predictivo positivo y negativo. Se analiza la reproducibilidad de cada técnica diagnóstica. Resultados. Se han estudiado 29 varones y 35 mujeres con una edad media de 53 años. Los valores medios de las presiones clínicas han sido superiores a los de las automedidas domiciliarias y a los de la MAPA en los 2 períodos del estudio. Las automedidas domiciliarias tienen una elevada especificidad y alto valor predictivo, superiores a los de las presiones clínicas. La reproducibilidad de las automedidas repetidas de PA en condiciones estandarizadas es similar a la de la MAPA. Conclusiones. Con un programa mínimo las automedidas domiciliarias, en condiciones estandarizadas, se pueden considerar como una técnica exacta y precisa en el diagnóstico de la hipertensión arterial (AU)

Automedidas domiciliarias de presión arterial y su relación con el diagnóstico de la hipertensión arterial y con la afección orgánica: estudio comparativo con monitorización ambulatoria / Home self-measurements of blood pressure and relationship with diagnosis of hypertension and target organ damage: comparative study with ambulatory monitoring

FUNDAMENTO: El diagnóstico de la hipertensión arterial (HTA) requiere una metodología de la medición exacta y precisa. Las técnicas clásicas sobrestiman con frecuencia su prevalencia y no se relacionan bien con la repercusión orgánica. El objetivo de este trabajo es conocer la asociación entre la automedición domiciliaria de la presión arterial y la afección orgánica de la HTA. PACIENTES Y MÉTODO: Estudio descriptivo en el cual se comparaba la asociación de diferentes técnicas de medida de la presión arterial (PA) con el diagnóstico de HTA y su repercusión orgánica. Mediante muestreo de selección de casos consecutivos, se seleccionaron 64 pacientes con HTA no tratados mayores de 18 años. A todos se les realizaron tres mediciones de PA con esfigmomanómetro de mercurio en la consulta y se les adiestró para hacer 20 automedidas por la mañana en la consulta y 20 automedidas por la tarde en su domicilio con un aparato automático Omron 705CP. El mismo día se realizó una monitorización ambulatoria de la PA (MAPA) de 24 h con un dispositivo Takeda TM-2420; además, se realizó visualización del fondo de ojo, determinación de microalbuminuria y ecocardiografía. RESULTADOS: Los valores medios de las presiones clínicas fueron significativamente superiores a los de las automedidas domiciliarias y a los de la MAPA, que tenían una buena correlación y concordancia entre sí. La correlación de las automedidas domiciliarias con el índice de masa ventricular izquierda (IMVI) fue significativamente superior a la de las presiones arteriales clínicas y similar a la de la MAPA, siendo esta correlación independiente de la edad, el sexo y el índice de masa corporal de los sujetos. La mejor correlación de las automedidas domiciliarias de PA con la MAPA y con el IMVI se obtuvo con los valores medios de la segunda a la sexta automedida. CONCLUSIONES: Un programa mínimo de automedidas domiciliarias de PA con aparatos automáticos obtiene un valor pronóstico y de relación con la afección orgánica de la HTA similar al de la MAPA (AU)

Aplicación de las oncoproteínas p21RAS, p53, Bcl-2 y del factor de proliferación celular Ki-67(MIB-1) en el diagnóstico y pronóstico de tumores tiroideos / Value of the Expression of p21RAS, P53, Bcl-2 Oncoproteins and Ki-67(MIB-1) Antigen of Cellular Proliferation in the Diagnosis and Prognosis of Thyroid Tumours

Introducción. El tiroides es un buen órgano para estudiar las alteraciones genéticas en el desarrollo y progresión tumoral, siendo de interés estudiar marcadores de proliferación celular y oncogenes. Material y métodos. Se han estudiado 36 adenomas, 58 carcinomas papilares, 32 carcinomas foliculares , 2 carcinomas anaplásicos y 12 carcinomas medulares . Se han estudiado factores clínicos e histológicos relacionados con el pronóstico y mediante inmunohistoquímica se ha estudiado Ki-67(MIB-1), p53, Bcl-2 y p21 RAS. Resultados. Se obtienen diferencias estadísticas en el índice proliferativo Ki-67 (MIB-1) entre adenomas y carcinomas foliculares. La proteína p53 no se expresa en adenomas y lo hace en aquellos carcinomas con mayor desdiferenciación histológica. También se correlaciona con la edad avanzada, el mayor tamaño y progresión tumoral. La expresión de Bcl-2 es alta en tejido tiroideo normal y en adenomas, se conserva en carcinomas y disminuye en relación a la desdiferenciación histológica, perdiéndose totalmente en los carcinomas anaplásicos. En carcinomas medulares su pérdida se correlaciona con la mortalidad. La expresión intensa de la proteína p21 RAS se asocia significativamente en carcinomas papilares con estadios clínicos avanzados. Conclusiones. Las diferencias en la actividad proliferativa entre adenomas y carcinomas foliculares puede ayudar al diagnóstico diferencial. La expresión de p53 y la pérdida de expresión de Bcl-2 se correlacionan con el proceso de desdiferenciación histológica. La sobreexpresión de p21 RAS en carcinomas papilares se relaciona con la progresión tumoral (AU)

[The prevalence of diabetes mellitus and its association with other cardiovascular risk factors in the province of Albacete. The Vascular Disease Group of Albacete (GEVA)]. / Prevalencia de diabetes mellitus y su asociación a otros factores de riesgo cardiovascular en la provincia de Albacete. Grupo de Enfermedades Vasculares de Albacete (GEVA).

OBJECTIVE: To find the prevalence of DM in the population of Albacete, and their relationship with other risk factors. DESIGN: A descriptive cross-sectional population study. SETTING: Community setting in the province of Albacete. PARTICIPANTS: A sample of 2121 people+ over 18 (843 from the capital and 1278 from the rest of the province) was selected through stratified random sampling. MEASUREMENTS AND MAIN RESULTS: Appointments were made by mail. All those attending underwent anamnesis, a physical examination, EKG and basic analytic test. 1263 people older than 18 years were studied. The prevalence of DM observed with WHO criteria was 6.7% (95% CI, 5.9%-7.4%), of which 6.5% corresponded to known DM and only 0.2% to unknown. If ADA criteria were used, the prevalence was 9.8%. We found association between DM and age, obesity, hypertension, hyperlipaemia, low HDL-c, high levels of fibrinogen, left ventricular hypertrophy, arrhythmias and personal history of ischemic cardiopathy and peripheric arteriopathy. CONCLUSIONS: DM is a highly prevalent pathology in Albacete. We consider necessary to standard epidemiological methods that allow us to know the real situation of DM in our country. Other cardiovascular risk factors are more prevalent in diabetic patients, increasing their coronary risk. The control of modifiable factors is fundamental to avoid as possible the chronic complications of the disease.

[Evaluation and validation of Omron Hem 705 CP and Hem 706/711 monitors for self-measurement of blood pressure]. / Evaluación y validación de los monitores Omron Hem 705 CP y Hem 706/711 para automedidas de presión arterial.

OBJECTIVE: To validate two devices for self-measurement of blood pressure--The Omron Hem-705CP and the Omron Hem 706/711--according to the revised protocol of the British Hypertension Society (BHS). The results were also analysed according to the criteria for accuracy of the revised standard of the Association for the Advancement of Medical Instrumentation (AAMI). DESIGN: The British Hypertension protocol for the evaluation of blood pressure measuring devices. SETTING: Primare care. Zone III Health Care in Albacete (Spain). PARTICIPANTS: 95 subjects to validate the Omron 706/711 and 100 subjets to Omron 705. RESULTS: Two monitors surpassed the validation according to the standars set out by the BHS protocol (705 with a A grading for SBP and DBP, 706/711 obtained a B grading for SBP and an A grading for DBP and a PASS for SBP and DBP. Upon analyzing the behavior of the appliances by subgroups of BP measures (high, mid, and low), 705 for SBP > 160 mmHg obtained a B grading for the BHS protocol, but it did not pass the accuracy AAMI criteria (SD, 8.5, but difference between observers-device is -0.1 mmHg). The rest of subgroups of BP obtained a A grading for the BHS protocol and a PASS (AAMI). 706/711 surpassed in all BP subgroups BHS protocol, for DBP 80-100, SBP > 160 and DBP > 100 with a B grading, for the rest of BP subgroups obtained a B grading and a PASS (AAMI). CONCLUSIONS: On the basis of these results, we conclude both monitors Omron HEM 706/711 and the Omron 705CP surpassed the accuracy criteria required for BHS and AAMI, and can be recommended for clinical use.

Angiotensin-converting enzyme (ACE) gene polymorphisms, serum ACE activity and blood pressure in a Spanish-Mediterranean population.

Angiotensin-converting enzyme (ACE) levels and ACE gene polymorphisms have been related with hypertension but with contradictory results between populations. We have investigated the association among the allelic distribution of the insertion-deletion (I/D) polymorphism of the ACE gene, identified by polymerase chain reaction (PCR), serum ACE activity determined by spectrophotometry, and the blood pressure (BP), in a Mediterranean population in the southwest of Europe. A total of 1322 randomised individuals were analysed, and a comparative study was conducted analysing 205 individuals from the group with highest BP (fifth quintyl) and 196 from the group with lowest BP (first quintyl). In addition we have studied the frequencies of alleles in separated groups of women and men. We conclude that in this population there is no association between I/D polymorphism and hypertension. However, we have found a statistically significant association between the presence of the D allele in the genotypes and an elevation of serum ACE activity.

Evaluación y validación de los monitores Omron Hem 705 CP y Hem 706/711 para automedidas de presión arterial / Evaluation and validation of the Omron Hem 705 CP and Hem 706/711 monitors for self-measurement of blood pressure

Objetivos. Validar 2 monitores semiautomáticos (Omron 705 y 706/711) para la medida de la presión arterial, y su comportamiento en presiones arteriales límites, de acuerdo con los protocolos de la British Hipertensión Society (BHS) y con los criterios de precisión de la Association for the Advancement of Medical Instrumentation (AAMI). Diseño. Protocolo de la BHS para la validación de monitores semiautomáticos de medida de la presión arterial. Emplazamiento. Atención primaria. Centro de Salud Zona III de Albacete. Participantes. Noventa y cinco sujetos para el monitor 706/711 y 100 para el 705. Resultados. Los 2 monitores superaron la validación según el protocolo de la BHS (705 con grado A para presiones arteriales sistólicas y diastólicas, 706/711 con grado B para sistólicas y A para las diastólicas); ambos monitores superaron también los criterios de precisión exigidos por la AAMI. Al analizar el comportamiento de los monitores por subgrupos de medidas de presión arterial (altas, medias y bajas), el 705 en sistólicas > 160 mmHg superó con grado B el protocolo BHS, pero no pasó los criterios de la AAMI (DE, 8,5), aunque las diferencias entre las medias de los 2 observadores de las columnas de Hg y la media del 705 fue -0,1 m Hg, el resto de subgrupos de presión arterial obtuvieron un grado A de la BHS y superaron los criterios exigidos por la AAMI. El 706/711 superó, a su vez, en todos los subgrupos de presión arterial el protocolo de la BHS, obtuvo un grado B para las diastólicas de 80-100 y > 100, y para sistólicas > 160; en el resto de subgrupos obtuvo un grado A; además cumplió en cada subgrupo los criterios de precisión exigidos por la AAMI. Conclusiones. En función de estos resultados puede concluirse que ambos monitores semiautomáticos superaron satisfactoriamente la gradación de la BHS y los criterios de precisión exigidos por la AAMI, por lo que pueden recomendarse para su uso clínico (AU)

Prevalencia de diabetes mellitus y su asociación a otros factores de riesgo cardiovascular en la provincia de Albacete / Prevalence of diabetes mellitus and its relationship with cardiovascular risk in the population of albacete

Objetivo. Conocer la prevalencia de diabetes mellitus en la población general de Albacete y su relación con otros factores de riesgo cardiovascular. Diseño. Estudio poblacional de tipo transversal y descriptivo. Emplazamiento. Marco comunitario en la provincia de Albacete. Participantes. Mediante muestro aleatorio estratificado sobre población general de Albacete, se seleccionó una muestra de 2.121 sujetos mayores de 18 años (843 capital y 1.278 provincia). Mediciones y resultados principales. Se utilizó el sistema de cita personalizada por correo; a todos los que acudieron se les realizó anamnesis, exploración física, ECG y analítica básica. Estudiamos 1.263 sujetos mayores de 18 años. Aplicando los criterios de la OMS, obtuvimos una prevalencia global de diabetes mellitus del 6,7 por ciento (intervalo de confianza del 95 por ciento, 5,9-7,4 por ciento),correspondiendo un 6,5 por ciento a diabetes conocida y sólo el 0,2 por ciento a diabetes no conocida. Al aplicar los criterios de la ADA, la prevalencia observada fue del 9,8 por ciento. Encontramos asociación de diabetes con edad, IMC, HTA, hiperlipemias, cHDL bajo, fibrinógeno elevado, crecimiento ventricular izquierdo, arritmias y antecedentes personales de cardiopatía isquémica y arteriopatía periférica. Conclusiones. La diabetes mellitus es una patología de alta prevalencia en Albacete. Consideramos necesario estandarizar métodos epidemiológicos que nos permitan conocer la situación real de la diabetes en nuestro país. Otros factores de riesgo cardiovascular son más prevalentes en el paciente diabético y su asociación multiplica el riesgo coronario. El control de factores modificables es fundamental para evitar en la medida de lo posible las complicaciones crónicas de la enfermedad (AU)

[Home self-measurements of blood pressure and relationship with diagnosis of hypertension and target organ damage: comparative study with ambulatory monitoring]. / Automedidas domiciliarias de presión arterial y su relación con el diagnóstico de la hipertensión arterial y con la afección orgánica: estudio comparativo con monitorización ambulatoria.

BACKGROUND: The diagnosis of arterial of hypertension (AH) requires an accurate and precise measurement methodology. The habitual techniques overstimate the prevalence of AH and have a poor correlation with organ damage. The objective of the study is to know the associations between self-measurements of blood pressure (BP) at home and target organ damage of AH. PATIENTS AND METHOD: Descriptive study which compare the association of different techniques of BP measurement with the diagnosis of AH and its organ damage. Sampling selection of consecutive cases; we select 64 cases of hypertensives not treated hypertensive patients, older than 18 years. We achieved 3 BP measurements with mercury sphygmomanometer in the office and 20 self-measurements in the morning in the office and 20 self-measurements in the afternon at home with a automatic validated device, Omron 705CP; the same day BP was measured with ambulatory blood pressure measurement (ABPM) of 24 h with a Takeda TM-2420 device; we achieved eye fundus study, microalbuminuria analysis and echocardiogram. RESULTS: Mean values of office BP was higher than self-measurements at home and ABPM; these techniques had good correlations and concordance between them. The correlation of selfmeasurements at home with LVMI was higher than office BP and similar to ABPM; this correlation is independent of age, sex and body mass index. The best correlation of self-measurements at home with APBM and LVMI was with the mean values of 2nd-6th self-measurements. CONCLUSIONS: A minimum program of self-measurements of BP at home with automatic devices has a prognostic value and relationship with organ damage of AH similar to ABPM.

[Value of the expression of p21RAS, P53, Bcl-2 oncoproteins and Ki-67(MIB-1) antigen of cellular proliferation in the diagnosis and prognosis of thyroi]. / Aplicación de las oncoproteínas p21RAS, p53, Bcl-2 y del factor de proliferación celular Ki-67(MIB-1) en el diagnóstico y pronóstico de tumores tiroid.

INTRODUCTION: The thyroid gland is a good organ for the study of genetic alterations in tumoural development and progress. The study of oncogenes and antigens of cellular proliferation is of interest. MATERIAL AND METHODS: 36 cases of thyroid adenomas, 58 papillary carcinomas, 32 follicular carcinomas, 2 anaplastic carcinomas and 12 medullary carcinomas were selected. Clinical and histological prognostic factors were studied and an immunohistochemical study with Ki-67 (MIB-1), p53, Bcl-2 and p21 RAS antibodies was performed. RESULTS: The proliferative rate Ki-67 (MIB-1) showed statistical differences in adenomas and follicular carcinomas. The p53 protein did not appear in adenomas, but was shown in those carcinomas with bigger histological dedifferentiation. A relationship was also established with greater age, larger size and progression of the tumour. The Bcl-2 protein was high in the normal thyroid, in the adenomas and in the carcinomas, decreasing in correlation with histological dedifferentiation, and totally disappearing in the anaplastic carcinomas. In medullary carcinomas its disappearance was correlated with mortality. The intense expression of the p21 RAS protein in papillary carcinomas is statistically correlated with advanced clinical studies. CONCLUSIONS: The differences in the proliferative rate between adenomas and follicular carcinomas can be of help in differential diagnosis. The p53 manifestation and the loss of the Bcl-2 expression are correlated with the histological redifferentiation process. An intense manifestation of p21 RAS in papillary carcinoma is correlated with tumoural progression.

[Prevalence of obesity and its relationship with cardiovascular risk in the general population of Albacete]. / Prevalencia de obesidad y su relación con el riesgo cardiovascular en la población general de Albacete.

OBJECTIVE: To find the prevalence of obesity and overweight in the population of Albacete, and their relationship to other cardiovascular and coronary risk factors. DESIGN: A descriptive, crossover population study. SETTING: Community setting in the province of Albacete. PARTICIPANTS: A sample of 2121 people over 18 (843 from the capital and 1278 from the rest of the province) was selected from Albacete's population through stratified random sampling in two stages. MEASUREMENTS AND RESULTS: Appointments were made with each person by mail. All those attending underwent Anamnesis, a physical examination, ECG and basic analytic tests. 1230 people between 20 and 93 years old were studied. 394 were considered not obese (32%) and 836 were adjudged obese or overweight (68%). 47% of men were overweight and 23.2% of them obese; 33.5% of women were overweight and 32.5% obese. CONCLUSIONS: Obesity is a highly prevalent pathology in this province and increases with age. Overweight is more common among men and obesity among women. Hypertension, Hyperlipaemia, Diabetes and high Fibrinogen are more prevalent in obese than in non-obese patients and increase in prevalence along with the obesity. Patients with the risk factors under study are generally obese. The coronary risk calculated was higher among the obese, the risk increasing along with excess of weight.

[Psoas muscle abscess. Description of a series of 19 cases]. / Absceso del músculo psoas. Descripción de una serie de 19 casos.

Abscess of the psoas muscle (PA) is every more frequently observed in recent years. The PA diagnosed in the authors' center over a period of 91 months are presented, analyzing the main clinical features, microbiologic causal agents, risk factors, treatment and the differences between primary and secondary PA. A total of 19 cases of which 14 were secondary PA (73.7%) and 5 primary PA (26.3%) were diagnosed. The main foci of infection of the former were the bone and the genitourinary tract, with intestinal infection being rare. The most frequent clinical data were lumbar pain with possible irradiation to the lower limb, fever, and leucocytosis with neutrophilia. Gram negative and enteric anaerobes were the bacteria most often identified, followed by Staphylococcus aureus and Mycobacterium tuberculosis. In a high percentage of patients (57.8%) a history of immunodeficiency was reported. In regard to treatment, surgical drainage was performed in 5 cases (26.3%), while ten cases (52.6%) were treated by DPCT. Four patients (21%) were exclusively treated with antibiotics. Recurrence was observed in three cases (15.3%) of the DPCT group requiring new drainage. Of all the cases, 18 were cured while one death occurred, being attributed to the underlying tumoral disease of advanced stage. The authors believe DPCT to be a good therapeutic option in both primary and secondary PA, thereby avoiding the risks of major surgery. In the cases with no underlying immunodeficiency the existence of secondary PA should be discarded as occurred in 7 out of 8 cases with no history of immunodeficiency in this series of patients.