Reproducibilidad de la MAPA en pacientes con diabetes mellitus 2 / Reproducibility of ABPM in diabetes mellitus

Objetivo. Estudiamos la reproducibilidad de las cifras tensionales y de los trastornos del ritmo nictameral en pacientes afectos de diabetes mellitus 2. Asimismo valoramos la concordancia del estudio tensional con las complicaciones micro y macrovasculares presentes. Pacientes y método. Se estudia a 58 pacientes afectos de diabetes mellitus 2 con dos registros ambulatorios de presión arterial (MAPA) en un período inferior a las 8 semanas sin cambios en la medicación hipotensora. Resultados. La concordancia de las cifras de PA sistólica y PA diastólica tanto de las 24 horas como de día y noche es superior al 73 %. La reproducibilidad para la situación dipper/no dipper es muy baja. Doce de los pacientes se comportan repetidamente como dipper, otros 12 como no dipper y el resto son dipper variables. Sin alcanzar significación estadística los diabéticos repetidamente no dipper tienen una excreción urinaria de albúmina más elevada. Conclusiones. En el diabético tipo 2 las cifras de PA medidas por MAPA tienen una elevada reproducibilidad. Sin embargo, los trastornos del ritmo nictameral la tienen muy baja. La condición no dipper persistente comporta, probablemente, mayor repercusión visceral

Aim. We study the reproducibility of the blood pressure values and circadian pattern in diabetes mellitus 2 patients. We also evaluated the concordance of the blood pressure study with the micro and macrovascular complications present. Material and methods. A total of 58 patients with diabetes mellitus 2 who had two ambulatory blood pressure monitorings (ABPM) in a period less than 8 weeks without changes in their hypotensive medications were studied. Results. Concordance of the 24 hour and day and night time systolic and diastolic BP levels is superior to 73 %. Reproducibility for the dipper/non-dipper situation is very low. Twelve of the patients repeated were dipper, 12 others were non-dipper and the rest were variable dippers. Although not statistically significant, the repeatedly non-dipper diabetics had a very elevated urinary excretion of albumin. Discussion. ABPM blood pressure levels had elevated reproducibility among diabetic 2 patients. However, the circadian pattern reproducibility was very low. Persistent non-dipper condition probably has major visceral repercussion

Information program about organ and tissue transplant-donation process at the secondary schools in the province of Girona (Spain).

We believe that it is important to spread information about the organ and tissue transplant-donation (T-D) process to obtain the participation of all society. We prepared an information program about the T-D process for secondary school students in collaboration with the Education Department. We chose these students because they wish to receive information about life and are already conscious about its possible loss, and because they take risks practicing sports or driving cars. We spoke about the frequency of the T-D process in our hospitals, the organs and tissues that can be transplanted the number of people on the waiting list, as well as the origin and circumstances of potential donors. During the last 3 years we have done more than 200 lessons at 44 secondary schools. We consider our experience to be pleasant and useful. Students have accepted us and 96.5% of them have recommended the T-D lessons to future classmates.

[Evaluation of plasma volume variation during different hemodialysis maneuvers]. / Evaluación de las variaciones de la volemia en las distintas maniobras empleadas durante la hemodiálisis.

UNLABELLED: Intradialytic hypotension is closely linked to hypovolemia and ascribed to the degree of ultrafiltration. Among the maneuvers used to recovery hypotension, we have the Trendelenburg position, the infusion of isotonic saline serum or plasma extenders as well as shutting of the ultrafiltration. The objective of this study is to quantify the influence that the different maneuvers employed for recovery hypovolemia will have on blood volume, employing the Crit-Line system. We have studied 32 hemodialysis patients over 5 consecutive hemodialysis sessions. The different maneuvers evaluated were: administration of saline serum, plasma extenders, Trendelenburg position, shutting off the ultrafiltration and administration of hypertonic saline serum. RESULTS: The administration of saline serum causes an increase of 2.9% in blood volume at the end of the third hour, which is higher than the increase achieved in the first hour (2.6%) and second hour (2.4%). The Trendelenburg position achieves a minimal blood volume increase of 0.4%. The administration of plasma extenders achieves the most significant increase in blood volume of 3.1% and the longer lasting one as well (37 minutes). The cessation of ultrafiltration at the end of the first and third hours, achieves a blood volume increase of 2% and 2.3% respectively. Lastly, the administration of hypertonic saline serum causes a minimal blood volume increase of 0.7%. CONCLUSION: The infusion of isotonic saline serum and plasma extenders, are the quickest, most efficient and long lasting maneuvers for blood volume expansion, followed by the cessation of ultrafiltration. In concerning to quick plasma volume recovery, the Trendelenburg position and the administration of hypertonic saline serum are not very efficient maneuvers.

[Immunonegative necrotizing glomerulonephritis: an atypical case of lupus nephropathy]. / Glomerulonefritis necrotizante inmunonegativa: un caso de nefropatía lúpica atípico.

We report here a case of systemic lupus erythematosus with severe, active pauci-immune necrotizing and crescentic glomerulonephritis. This patient had been diagnosed of a lupus nephritis type III previously and treated with steroids and azathioprine. After a renal symptomless period of nine years, she developed heavy proteinuria and hypertension. A second kidney biopsy was then performed. The pathological study disclosed a pauci-immune necrotizing crescentic and segmental glomerulonephritis. The absence of subendothelial and mesangial deposits was confirmed by both immunofluorescent microscopy and electron microscopy. The simultaneous immunological study showed normal ANCA levels while complement, anti-dsDNA and ANA were altered. The patient was treated with steroids and cyclophosphamide eith good response. This case points out the possibility previously recognized by others of an association between lupus and an pauci-immune necrotizing glomerulonephritis.

Glomerulonefritis necrotizante inmunonegativa: un caso de nefropatía lúpica atípico / Pauci-immune necrotizing lupus nephritis: an atypical case of lupus nephroapathy

Presentamos el caso de una paciente con un lupus eritematoso sistémico (LES) y una glomerulonefritis (GN) proliferativa necrotizante inmunonegativa. Previamente, la paciente había sido diagnosticada de una nefritis lúpica (NL) tipo III y tratada con esteroides y azatioprina. Tras nueve años asintomática en cuanto a manifestaciones renales, la paciente desarrolló proteinuria e hipertensión (HTA). Se practicó una segunda biopsia renal que objetivó una GN proliferativa necrotizante inmunonegativa. La inmunofluorescencia (IF) y el microscopio electrónico (ME) no mostraron depósitos subendoteliales ni mesangiales. El estudio inmunológico fue negativo para los ANCA, mientras el complemento, los antids-DNA y los ANA permanecían alterados. La paciente presentó una buena respuesta al tratamiento con esteroides y ciclofosfamida. Este caso pone de manifiesto la posibilidad previamente descrita por otros de una asociación entre LES y GN necrotizante inmunonegativa (AU)

We report here a case of systemic lupus erythematosus with severe, active pauciimmune necrotizing and crescentic glomerulonephritis. This patient had been diagnosed of a lupus nephritis type III previously and treated with steroids and azathioprine. After a renal symptomless period of nine years, she developped heavy proteinuria and hypertension. A second kidney biopsy was then performed. The pathological study disclosed a pauci-immune necrotizing crescentic and segmental glomerulonephritis. The absence of subendothelial and mesangial deposits was confirmed by both immunofluorescent microscopy and electron microscopy. The simultaneous immunological study showed normal ANCA levels while complement, anti-dsDNA and ANA were altered. The patient was treated with steroids and cyclophosphamide eith good response. This case points out the possibility previously recognized by others of an association between lupus and an pauciimmune necrotizing glomerulonephritis (AU)

[Nephropathy, nycthemeral variability and pulse pressure in patients with type 2 diabetes mellitus]. / Nefropatía, ritmo nictemeral y presión de pulso en la diabetes mellitus tipo 2.

BACKGROUND: The loss of the blood pressure nictemeral rhythm and the elevated pulse pressure are considered independent cardiovascular risk factors that can be related with the microvascular damage of patients with type 2 diabetes mellitus. PATIENTS AND METHOD: We carried out an observational, tranverse study, of a population of patients with type 2 diabetes mellitus. The variables are calculated by means of 24 hour ambulatory registry of blood pressure. The results are compared with the diverse degrees ofnephropathy. RESULTS: A total of 61 patients is studied; 31 have a behavior "non dipper". The "non dipper" proportion increased with the urinary albumin excretion (p = 0.024). The pulse pressure was higher inpatients with macroalbuminuria (p = 0.004). CONCLUSIONS: Theresults demonstrate a more frequent loss of the nictemeral rhythm and higher pulse pressure among the patients with type 2 diabetes mellitus and nephropathy.

[Prevalence of arterial hypertension and other cardiovascular risk factors among hospital workers]. / Prevalencia de hipertensión arterial y otros factores de riesgo cardiovascular en trabajadores de un hospital.

BACKGROUND: The attitude of sanitary workers is essential for the control of arterial hypertension (HT). The aim of the study was to identify the prevalence of HT and some cardiovascular risk factors in both sanitary and non-sanitary hospital workers and the knowledge, therapeutic compliance and control of hypertense individuals. SUBJECTS AND METHODS: Two tensional measurements were obtained by using a manometer of mercury at the beginning and at the end of an epidemiological request. A logistic regression model was obtained to evaluate the association between HT and risk factors. RESULTS: One thousand and one individuals (762 females) with a median age of 37.2 years were studied. Prevalence of HT was 9.7%. Men showed a higher age-related prevalence than women (19.7 vs 6.6%, p < 0.001). Body mass index was higher in HT individuals. Thirty eight per cent of the hospital workers were smokers. HT prevalence increased with alcohol consumption. Sex, mass body index and age were significantly associated with HT. Knowledge, therapeutic compliance and control of HT were 73.2, 19.7 and 28%, respectively, in the total group and 61, 26.3 and 0%, respectively, in the group of physicians and nurses. CONCLUSIONS: Hospital workers showed a high prevalence of cardiovascular risk factors. Inadequate therapeutic and control measures were observed on both nurses and physicians with high blood pressure.

[Early diabetic nephropathy in a patient with agenesis of one kidney]. / Nefropatía diabética temprana sobre riñón único.

A 24 year old male diagnosed of type II diabetes mellitus of 2 years of known clinical evolution discovered by an episode of hyperglycemic decompensation without ketoacidosis is presented. In the study of possible visceral involvement of the disease agenesis of the left kidney with compensating hypertrophy of the right kidney, increase of glomerular filtrate and proteinuria of 1.8 g/24 hours were observed. Renal histologic study demonstrated the existence of diffuse intercapillar glomerulosclerosis compatible with diabetic glomerulopathy. From these data and review of the literature the possibility of the greater risk of individuals with a single kidney to present nephropathy in the case of coexistence of associated diabetes mellitus.