Xantogranuloma necrobiótico asociado a gammapatía monoclonal IgG kappa de significado incierto / Necrobiotic xanthogranuloma associated with monoclonal gammopathy of unknown significance

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The utility of the macro-aggregated albumin lung perfusion scan in the diagnosis and prognosis of hepatopulmonary syndrome in cirrhotic patients candidates for liver transplantation.

BACKGROUND: The macro-aggregated albumin lung perfusion scan (99mTc-MAA) is a diagnostic method for hepatopulmonary syndrome (HPS). GOAL: To determine the sensitivity of 99mTc-MAA in diagnosing HPS, to establish the utility of 99mTc-MAA in determining the influence of HPS on hypoxemia in patients with concomitant pulmonary disease and to determine the correlation between 99mTc-MAA values and other respiratory parameters. METHODS: Data from 115 cirrhotic patients who were eligible for liver transplantation (LT) were prospectively analyzed. A transthoracic contrast echocardiography and 99mTc-MAA were performed in 85 patients, and 74 patients were diagnosed with HPS. RESULTS: The overall sensitivity of 99mTc-MAA for the diagnosis of HPS was 18.9% (14/74) in all of the HPS cases and 66.7% (4/6) in the severe to very severe cases. In HPS patients who did not have lung disease, the degree of brain uptake of 99mTc-MAA was correlated with the alveolar-arterial oxygen gradient (A-a PO2) (r = 0.32, p < 0.05) and estimated oxygen shunt (r = 0.41, p < 0.05) and inversely correlated with partial pressure of arterial oxygen (PaO2) while breathing 100% O2 (r = -0.43, p < 0.05). The 99mTc-MAA was positive in 20.6% (7/36) of the patients with HPS and lung disease. The brain uptake of 99mTc-MAA was not associated with mortality and normalized in all cases six months after LT. CONCLUSIONS: The 99mTc-MAA is a low sensitivity test for the diagnosis of HPS that can be useful in patients who have concomitant lung disease and in severe to very severe cases of HPS. It was not related to mortality, and brain uptake normalized after LT.

[Screening for high blood pressure among hypertensive and metabolic syndrome patients' children]. / Cribado de hipertensión arterial en hijos de pacientes diagnosticados de hipertensión arterial y síndrome metabólico.

BACKGROUND AND OBJECTIVE: Essential arterial hypertension (HTA) and metabolic syndrome (MS) are highly prevalent disorders, with familiar aggregation and important mortality. Late HTA diagnosis is made in a high percentage of people. The aim of this study was to diagnose HTA among hypertensive and MS patients' children. PATIENTS AND METHOD: Hypertensive and MS patients attended at primary and hypertension clinics were studied. Hypertensive patients collaborated to get their children's blood pressure measured. If high blood pressure was detected, the patients' children were referred to their family doctor in order to confirm the diagnosis of HTA. RESULTS: 118 hypertensive patients were studied. Blood pressure was measured in 117 hypertensive patients' children. Thirty-two of them (27.4%) had blood pressure > or = 130/85 mmHg. Eventually, 20 of them (62.5%) were diagnosed of HTA. 17% of the hypertensive patients' children studied were newly diagnosed of HTA. CONCLUSIONS: Screening for HTA among hypertensive and MS patients' children is useful for early diagnosis or HTA and it is cost-effective.

Cribado de hipertensión arterial en hijos de pacientes diagnosticados de hipertensión arterial y síndrome metabólico / Screening for high blood pressure among hypertensive and metabolic syndrome patients' children

Fundamento y objetivo: La hipertensión arterial (HTA) esencial es una enfermedad prevalente que origina una morbimortalidad elevada y tiene una agregación familiar. Un porcentaje importante de pacientes hipertensos se diagnostican tardíamente. El objetivo del estudio es el diagnóstico temprano de pacientes con HTA. Pacientes y método: Estudio de intervención en hijos de pacientes diagnosticados de HTA y síndrome metabólico (SM) que acuden a consultas. Con la colaboración de los padres, se consigue tomar la presión arterial (PA) de sus hijos. Una consulta posterior a su médico de atención primaria permite confirmar o descartar el diagnóstico de HTA en los hijos que presentaron cifras elevadas de PA. Resultados: Seleccionamos a 118 padres hipertensos con SM. Se ha recibido el cuaderno de recogida de datos de 117 hijos. Treinta y dos de ellos (27,4%) presentaban cifras de PA $ 130/85 mmHg y en este grupo se diagnosticó de HTA a 20 pacientes (62,5%). Se ha detectado un 17% de hipertensos no conocidos. Conclusiones: El cribado de hijos de hipertensos con SM que acuden a las consultas es rentable y permite el diagnóstico temprano de la HTA

Background and objective: Essential arterial hypertension (HTA) and metabolic syndrome (MS) are highly prevalent disorders, with familiar aggregation and important mortality. Late HTA diagnosis is made in a high percentage of people. The aim of this study was to diagnose HTA among hypertensive and MS patients' children. Patients and method: Hypertensive and MS patients attended at primary and hypertension clinics were studied. Hypertensive patients collaborated to get their children's blood pressure measured. If high blood pressure was detected, the patients' children were referred to their family doctor in order to confirm the diagnosis of HTA. Results: 118 hypertensive patients were studied. Blood pressure was measured in 117 hypertensive patients' children. Twirty-two of them (27.4%) had blood pressure $ 130/85 mmHg. Eventually, 20 of them (62.5%) were diagnosed of HTA. A 17% of the hypertensive patients' children studied were newly diagnosed of HTA. Conclusions: Screening for HTA among hypertensive and MS patients' children is useful for early diagnosis or HTA and it is cost-effective

Long-term effect of continuous positive airway pressure on BP in patients with hypertension and sleep apnea.

OBJECTIVE: To analyze the long-term effect of continuous positive airway pressure (CPAP) on ambulatory BP in patients with obstructive sleep apnea (OSA) and hypertension, and to identify subgroups of patients for whom CPAP could be more effective. METHODS: We conducted a prospective, long-term follow-up trial (24 months) in 55 patients with OSA and hypertension (mean CPAP use, 5.3 +/- 1.9 h/d [+/- SD]). Twenty-four-hour ambulatory BP monitoring (ABPM) was measured at baseline and after intervention with CPAP on an intention-to-treat basis. In addition, the correlation between the changes in 24-h mean arterial pressure (24hMAP) and CPAP compliance, OSA severity, and baseline ABPM was assessed. RESULTS: At the end of follow-up, a significant decrease was shown only in diastolic BP (- 2.2 mm Hg; 95% confidence interval [CI], - 4.2 to - 0.1; p = 0.03) but not in 24hMAP or other ABPM parameters. However, a correlation between changes in 24hMAP and baseline systolic BP (r = - 0.43, p = 0.001), diastolic BP (r = - 0.38, p = 0.004), and hours of use of CPAP (r = - 0.30, p = 0.02) was observed. A significant decrease in the 24hMAP was achieved in a subgroup of patients with incompletely controlled hypertension at entry (- 4.4 mm Hg; 95% CI, - 7.9 to - 0.9 mm Hg; p = 0.01), as well as in those with CPAP compliance > 5.3 h/d (- 5.3 mm Hg; 95% CI, - 9.5 to - 1.2 mm Hg; p = 0.01). Linear regression analysis showed that baseline systolic BP and hours of CPAP were independent predictors of reductions in BP with CPAP. CONCLUSION: Long-term CPAP reduced BP modestly in the whole sample. However, patients with higher BP at entry and good CPAP compliance achieved significant reductions in BP.

Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for arterial hypertension. Several controlled trials have investigated the effect of continuous positive airway pressure (CPAP) on BP in patients with OSAS, but its effect on hypertensive patients has not been analyzed specifically. OBJECTIVE: To analyze the effect of CPAP on ambulatory BP in patients with OSAS and hypertension who were undergoing antihypertensive treatment. DESIGN AND PATIENTS: We conducted a parallel, randomized, placebo-controlled trial in 68 patients with OSAS and hypertension, who were receiving treatment with antihypertensive medication. Patients were randomly allocated to either therapeutic or subtherapeutic CPAP for 4 weeks. Ambulatory BP was registered at baseline and after treatment. Antihypertensive treatment was not changed during the study. Changes in BP were assessed on an intention-to-treat basis. RESULTS: There were no baseline differences in the apnea-hypopnea index, comorbidities, or ambulatory BP between groups. Objective compliance with CPAP was similar in both the therapeutic and subtherapeutic groups (5.0 +/- 1.4 h/d vs 4.4 +/- 1.9 h/d, respectively; p = 0.13 [mean +/- SD]). There was a small and statistically nonsignificant decrease (- 0.3 +/- 6.3 mm Hg vs - 1.1 +/- 7.9 mm Hg; difference, - 0.8 mm Hg [95% confidence interval, - 2.7 to 4.3]; p = 0.65) in 24-h mean BP (24hMBP) in both subtherapeutic and therapeutic groups after 4 weeks of treatment. No significant changes in systolic, diastolic, daytime, or nighttime BP were observed. The normal circadian dipper pattern was restored in a higher proportion of patients in the therapeutic group compared to the subtherapeutic CPAP group, although differences were not significant (11 of 32 patients vs 3 of 25 patients; odds ratio, 3.84; 95% confidence interval, 0.82 to 20.30; p = 0.10). There was no correlation between the magnitude of change in 24hMBP and CPAP compliance, OSAS severity, or number of antihypertensive drugs used. CONCLUSION: Four weeks of CPAP did not reduce BP in patients with OSAS and hypertension who were treated with antihypertensive medication, compared to placebo group.