Síndrome de Paget-Schroetter asociado a hiperhomocisteinemia / Paget-Schroetter síndrome associated with hyperhomocsyteinemia

La enfermedad tromboembólica venosa (ETEV) en extremidades superiores es una entidad poco frecuente, si bien su incidencia ha aumentado en relación con el empleo de catéteres venosos centrales. La etiología puede ser primaria (idiopática, espontánea, de esfuerzo o traumática) o secundaria (relacionada con tumores, catéteres venosos centrales, etc.). Presentamos un caso de trombosis venosa primaria de extremidad superior derecha, también llamada síndrome de Paget- Schroetter. Este cuadro suele asociarse a ejercicios o esfuerzos intensos y/o repetitivos de la extremidad afecta, alteraciones anatómicas en la zona, o bien puede ser la primera manifestación de un estado trombofílico desconocido hasta ese momento, como en el caso que nos ocupa. La clínica suele consistir en dolor en extremidad afecta, acompañado frecuentemente de edema y circulación colateral. La ecografía-doppler presenta con frecuencia falsos negativos, recomendando la realización de TAC por su mayor especificidad y para valoración de las estructuras vecinas, aunque la flebografía continúa siendo la prueba oro para el diagnóstico de este cuadro. No existe unanimidad acerca del tratamiento, recomendándose individualizar de acuerdo con las características propias de cada caso

Venous thromboembolic disease (VTED) in the upper extremities is an infrequent entity, although its incidence has increased in relation to the use of central venous catheters. Its etiology can be primary (idiopathic, spontaneous, due to effort or traumatic) or secondary (related to tumours, central venous catheters, etc.). We present a case of primary venous thrombosis of the upper right extremity, also called the Paget-Schroetter syndrome. This clinical picture is usually associated with intensive and/or repetitive exercise or effort of the affected extremity, anatomical alterations in the zone, or it can be the first manifestation of a previously unknown thrombophilic state, as in the case that concerns us. The clinical picture usually consists of pain in the affected extremity, frequently accompanied by edema and collateral circulation. Echography-Doppler frequently presents false negatives, and it is recommendable to carry out CAT, due to its greater specificity and for evaluating the neighbouring structures, although flebography continues to be the cardinal test for diagnosing this picture. There is no unanimity of opinion concerning treatment, and it is recommendable that this should be individualised in accordance with the characteristics of each case

[Paget-Schroetter síndrome associated with hyperhomocsyteinemia]. / Síndrome de Paget-Schroetter asociado a hiperhomocisteinemia.

Venous thromboembolic disease (VTED) in the upper extremities is an infrequent entity, although its incidence has increased in relation to the use of central venous catheters. Its etiology can be primary (idiopathic, spontaneous, due to effort or traumatic) or secondary (related to tumours, central venous catheters, etc.). We present a case of primary venous thrombosis of the upper right extremity, also called the Paget-Schroetter syndrome. This clinical picture is usually associated with intensive and/or repetitive exercise or effort of the affected extremity, anatomical alterations in the zone, or it can be the first manifestation of a previously unknown thrombophilic state, as in the case that concerns us. The clinical picture usually consists of pain in the affected extremity, frequently accompanied by edema and collateral circulation. Echography-Doppler frequently presents false negatives, and it is recommendable to carry out CAT, due to its greater specificity and for evaluating the neighbouring structures, although flebography continues to be the cardinal test for diagnosing this picture. There is no unanimity of opinion concerning treatment, and it is recommendable that this should be individualised in accordance with the characteristics of each case.

[Abdominal tuberculosis]. / Tuberculosis abdominal.

Abdominal tuberculosis develops according to a non-specific clinical picture, with a difficult differential diagnosis with respect to other entities of similar semiology. We present the case of a male who was admitted because of abdominal pain, progressive and notable loss of body weight and a fever of two months evolution. The culture from the colon biopsy showed the presence of Koch bacilli.

[Mechanisms of hypertension in obesity]. / Mecanismos de hipertensión en obesidad.

Obesity is a chronic disease, considered to be an important risk factor in the development of coronary disease, hypertension, renal insufficiency and failure. Obesity contributes to hypertension by mechanisms such as: insulinic resistance and hyperinsulinaemia, increase of adrenergic activity and of concentrations of aldosterone, retention of sodium and water and increase of cardiac wear, alteration of the endothelial function, through molecules such as leptin and adiponectin and genetic factors. Many paths of research remain open. The angiotensin-converting-enzyme inhibitors (ACEI) and/or the angiotensin II receptor antagonists (ARA II) are first choice medicines because of their beneficial effect on insulinic resistance and sympathetic activity.

Mecanismos de hipertensión en obesidad / Mechanisms of hypertension in obesity

La obesidad es una enfermedad crónica, considerada un factor de riesgo importante en el desarrollo de enfermedad coronaria, hipertensión, insuficiencia y fallo renal. La obesidad contribuye a la hipertensión por mecanismos tales como: resistencia insulínica e hiperinsulinemia, aumento de la actividad adrenérgica y de las concentraciones de aldosterona, retención de sodio y agua e incremento del gasto cardíaco, alteración de la función endotelial, a través de moléculas como leptina y adiponectina y factores genéticos. Quedan aún abiertas muchas vías de investigación.Los IECA y/o los ARA II son fármacos de primera elección por su efecto beneficioso sobre la resistencia insulínica y actividad simpática (AU)