Silent Ischemic Heart Disease in a Patient with Necrotizing Glomerulonephritis due to Wegener's Granulomatosis.

OBJECTIVE: Wegener's granulomatosis (WG) is a necrotizing vasculitis that mainly affects the respiratory tract and kidneys, but can also affect other systems such as the eye, joints, skin, muscles, nerves, and gastrointestinal tract. Cardiac involvement is traditionally believed to be rare. We report a patient with silent myocardial infarction (MI) and review previously reported cases showing this association. METHODS: A Medline database search of cases published between January 1978 and July 2008 both in English and Spanish, reporting silent MI complicating WG, was conducted. RESULTS: We describe a typical patient with WG who had both respiratory and renal involvement and died unexpectedly following a silent MI after a period of clinical improvement induced by treatment with prednisone and cyclophosphamide. We report necropsy findings and the association with 5 additional cases of WG with silent MI reported in the literature. CONCLUSIONS: Clinicians should be aware of potential cardiac involvement due to WG. Careful evaluation of each patient, with or without cardiac symptoms, using ECG, echocardiogram, and myocardial enzymes is prudent.

[Leptin and its influence on the main gynecoobstetric diseases]. / Leptina y su influencia en los principales padecimientos ginecoobstétricos.

Leptin is a protein hormone synthesized and secreted by adipose tissue and also probably in other organs and systems in human body. It has multiple functions such as to regulate feed intake and energy balance, gonadal regulation, action in the hypothalamo-pituitary-gonadal axis, regulates the metabolism of the fetal-placental unit in the pregnancy, fertility and reproductive systems, actions in the endometrium, mammary gland with corresponding influences on important physiologic processes such as menstruation, pregnancy and lactation. In the gynecologic surgery the serum leptin concentration is also modified. The knowledge of serum leptin concentration in the oncological diseases is going-up. Leptin is modified in the choriocarcinoma, Meigs' syndrome and other tumors. A better understanding of regulatory mechanisms will have direct clinical significance, as leptin has been proposed to impact on those causes of human perinatal morbidity and mortality that are associated with abnormalities of fetal maturity and development, general concept growth, trophoblast endocrinology, and placental sufficiency. Further investigations in this area will be necessary to improve new knowledge and a better understanding of the actions about this hormone.

Pentoxifylline in the treatment of refractory nephrotic syndrome secondary to lupus nephritis.

OBJECTIVE: To evaluate the efficacy of pentoxifylline in the treatment of refractory nephrotic syndrome secondary to lupus nephritis. METHODS: We studied 11 patients who met the following inclusion criteria: (1) systemic lupus erythematosus (SLE) according to the American College of Rheumatology criteria; (2) lupus nephritis class III, IV, or V according to the World Health Organization; (3) proteinuria in the nephrotic range (> or = 3 g/24 h) for at least 6 months despite treatment. All patients received pentoxifylline 800-1600 mg/day. Clinical and laboratory data, including creatinine, urine test, creatinine clearance, and 24-h urinary protein, were collected monthly for 6 months. No changes in treatment were allowed, except for alterations in the dose of prednisone. RESULTS: All patients had received corticosteroids and immunosuppressants for at least 6 months. All patients showed a decrease in proteinuria concentrations after use of pentoxifylline from a median of 5.5 to 2.0 (p = 0.003). No patient discontinued the drug due to side effects. One patient had nausea and one had anxiety that disappeared after decreasing the dosage. CONCLUSION: Pentoxifylline seems to be effective in the treatment of refractory nephrotic syndrome secondary to lupus nephritis.

[Analysis of Bcr-abl type transcript and its relationship with platelet count in Mexican patients with chronic myeloid leukemia]. / Análisis del tipo de transcrito bcr-abl y su relación con la cuenta plaquetaria en pacientes mexicanos con leucemia mieloide crónica.

PROBLEM: It has been suggested that type of chimeric mRNA is associated with differences in the clinical and hematologic characteristics of chronic myeloid leukemia (CML). However, prognostic value of type of chimeric mRNA bcr-xabl (b3a2 or b2a2) is still controversial. METHODS: We analyzed 97 cases of Philadelphia-positive CML to determine mRNA type by reverse-polymerase chain reaction (RT-PCR) and its relationship with clinical features. RESULTS: We detected b3a2 bcr-abl transcripts in 27 (28%) cases, b2a2 in 57 (59%) cases, and 13 (13%) with both mRNA transcripts b3a2/b2a2. These frequencies were the total reverse of other reports. Age, sex, hemoglobin, and white-cell counts showed no significant difference for those with either b3a2 or b2a2 bcr-abl transcripts. However, platelet counts of b3a2 patients were significantly higher than those of b2a2 patients (743.3 vs 477.3 x 109/L; p = 0.01). In addition, in the subgroup of patients whose white-cell count at diagnosis was < 100 x 10(9)/L, those with b3a2 transcript had a significantly higher platelet count (679.1 vs. 352.2 x 10(9)/L; p = 0.001). CONCLUSIONS: We observed reversed frequency of bcr-abl transcripts in this population, but agreement with other Latin-American reports. In addition, our data suggested that there is different CML biological behavior in our population and that there is a subpopulation of CML patients in whom b3a2 is associated witH higher thrombopoietic activity.

Insuficiencia renal aguda en la preeclampsia-eclampsia / Acute ranla failure in preeclampsia-eclampsia

INTRODUCCION. La fisiopatología de la preeclampsia-eclampsia tiene como sustrato común lesión a endotelio vascular, microangiopatía, fuga capilar y conflicto hemorreológico-hemodinámico con daño a órgano blanco como el riñón, clínicamente manifestado por hipertensión arterial y disminución de la función renal. OBJETIVO. Presentar los resultados obtenidos en nuestra unidad en las pacientes con preeclampsia-eclampsia que desarrollaron insuficiencia renal aguda. PACIENTES Y METODO. Hicimos una revisión de expedientes clínicos de pacientes que ingresaron a cuidados intensivos con diagnóstico de preeclampsia-eclampsia y además se documentó insuficiencia renal aguda, describiendo su evolución clínica, el manejo establecido y su morbi-mortalidad.RESULTADOS. Durante 36 meses ingresaron a la Unidad de Cuidados Intensivos (UCI) 220 pacientes con preeclampsia-eclampsia y en 26 pacientes ( 11.8 por ciento) se documentó IRA; de éstas el 19 por ciento requirió diálisis peritoneal, el resto tratamiento médico. El síndrome de Hellp se asoció en 42 por ciento con IRA.Observamos en este estudio una mortalidad fetal del 19 por ciento y la materna en 7.6 por ciento. Las demás pacientes se recuperaron íntegramente y egresaron de UCI con una estancia promedio de once días.CONCLUSIONES. La preeclampsia-eclampsia continúa teniendo en nuestro medio un gran impacto social, sobre todo cuando se asocia a disfunción orgánica como la falla renal aguda, la cual requiere de diagnóstico y manejo temprano y oportuno.