Hipertensión arterial en pacientes infectados por el virus de la inmunodeficiencia humana / Arterial hypertension in HIV-infected patients

El advenimiento de la terapia antirretroviral de gran actividad (TARGA) ha incidido de forma radical en el manejo de la infección por el virus de la inmunodeficiencia humana (VIH). De ser una enfermedad con una elevada letalidad a corto plazo se ha pasado a una situación de cronificación del proceso. Ello se ha acompañado de la aparición de problemas previamente no descritos en este tipo de paciente, muchos de ellos relacionados con la propia TARGA. El efecto que sobre el endotelio ejerce la infección junto a la frecuente asociación de alteraciones lipídicas y del metabolismo hidrocarbonado ha despertado la preocupación en el impacto que sobre la morbimortalidad cardiovascular pudieran ejercer estas alteraciones a largo plazo en el paciente infectado por el VIH. Además de estos factores de riesgo metabólicos, en los últimos años existen evidencias crecientes sobre el papel que la elevación tensional podría desempeñar. Si bien la información con que actualmente se cuenta es escasa, parece que los enfermos con antecedentes personales o familiares de hipertensión arterial (HTA) presentan una incidencia aumentada de elevación tensional, sobre todo en relación con la toma de regímenes TARGA con inhibidores de proteasa (IP). El manejo actual del paciente infectado por el VIH exige la valoración del riesgo cardiovascular individual y su consideración a la hora del diseño individualizado de la TARGA. De otro lado, las numerosas interacciones farmacológicas de los fármacos antirretrovirales son elementos fundamentales a tener en cuenta a la hora de la elección de antihipertensivos (AU)

[Reflex sympathetic dystrophy syndrome associated with phenobarbital]. / Síndrome de distrofia simpático refleja asociado a fenobarbital.

Reflex sympathetic dystrophy syndrome (RSDS) is clinically characterized by pain and edema of one or more extremities, trophic skin changes and vasomotor instability. Although the pathogenesis is unknown, it could be caused by an abnormal reflex of the sympathetic nervous system. Different studies haven't yet confirmed the classical division in three clinical phases (warm, of vasomotor instability and cold). Barbiturates are the precipitating event in 10-30% of cases. We describe the clinical features of a patient with RSDS associated with phenobarbital who needed corticosteroid treatment. The Technetium diphosphate bone scan (Tc 99m DPD) is very useful because there is an increased radionuclide uptake in the involved areas during the early phases of the disease and precedes in some weeks the radiologic signs. The Magnetic Resonance Imaging (MRI) may be useful because of the early signs it shows. The patient may develop contractures and atrophy of the involved extremities in spite of the indispensable withdrawal of the drug.

[Clinical and subclinical hyperthyroidism: two faces of the coin?]. / Hipotiroidismo clínico y subclínico: dos caras de una moneda?

We have made a prospective study of 23 patients diagnosed of subclinical hypothyroidism and 45 of overt hypothyroidism, aged 68.3-70.3 years and with a mean illness of 4.5 and 6.5 years respectively. It has been proved a higher prevalence of females in both groups. The most frequent clinical symptoms, similar in both groups, were fatigue, constipation and dyspnea. The most repeated initial diagnosis at the entry were prymary hypothyroidism, heart failure, hypertensive urgencies and stroke. We have found differences of statistical significance between the Free Thyroxine (fT4), triiodothyronine (T3), total serum cholesterol (CT), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and thyrotropin (TSH) initial and ending serum levels in patients with overt hypothyroidism (p < 0.05). We only have found significant differences in TSH serum levels in patients with subclinical hypothyroidism. The antithyroglobulin and antimicrobial antibodies, have been both positive in two and one patient respectively. Both are more useful as a predictor than their diagnostic value. The levothyroxine (L-T4) daily dose needed to normalize the TSH serum concentration, was lesser in subclinical hypothyroidism (71.8 micrograms opposite 107 micrograms-p < 0.001). We didn't find significant differences between the different groups in the time necessary for normalizing TSH. It seems that the L-T4 therapy should be started in all patients with subclinical hypothyroidism and TSH > or = 10 microU/ml or with TSH > 5 and goiter or with thyroid antibodies. The aim to reach is to normalize the TSH serum levels. The mean daily necessary L-T4 dose is 50-100 micrograms.

[The correlation of the isotopic liver/spleen ratio with the tissue damage in chronic diffuse hepatopathies]. / Correlación del cociente hígado/bazo isotópico con el daño hístico en hepatopatías crónicas difusas.

The purpose of the study was to determine whether a correlation between the radioisotopic "spleen-to-liver" ratio and the hepatic damage (according to Knodell's Index) exists in patients with chronic liver disease, in order to ascertain whether hepatic biopsy should be performed under visual (laparoscopic) control or not (blind liver biopsy). Thirty patients with inflammatory chronic hepatic disease were studied (9 chronic persistent hepatitis, 14 active chronic hepatitis and 7 hepatic cirrhosis). An inverse correlation was found between Knodell's Index and the "spleen-to-liver" ratio with moderate statistical significance (r = -0.46). In conclusion, the isotopic "spleen-to-liver" ratio correlates moderately well with the degree of hepatic damage and consequently it can only be used as orientation about the preferable way for obtaining a liver biopsy (laparoscopically or not).