Enfermedad de Kikuchi-Fujimoto / Kikuchi-Fujimoto disease

Resumen: La enfermedad de Kikuchi-Fujimoto es poco común, de curso natural con alivio espontáneo, de causa desconocida, que se manifiesta por linfadenopatías, fiebre y síntomas menos específicos como diaforesis nocturna, pérdida de peso, cefalea, fatiga, náusea y artralgias. La única forma de establecer el diagnóstico es mediante los hallazgos histopatológicos, caracterizados por necrosis coagulativa con abundantes restos de cariorrexis en zonas paracorticales. El tratamiento es sintomático y debe realizarse diagnóstico diferencial con procesos infecciosos y neoplasias. Se comunica el caso de una mujer de 37 años de edad en la que se integró el diagnóstico de enfermedad de Kikuchi-Fujimoto y se realiza una revisión de la bibliografía.

Abstract: Kikuchi-Fujimoto disease is a rare, self-limiting disease of unknown etiology, manifested by lymphadenopathy, fever and less specific symptoms such as nocturnal diaphoresis, weight loss, headache, fatigue, nausea and arthralgias. The only way to establish the diagnosis is through the histopathological findings, characterized by coagulative necrosis with abundant remains of karyorrhexis in paracortical zones. The treatment is symptomatic, and a differential diagnosis must be made with infectious and neoplastic processes. We present the case of a 37-year-old woman in whom the diagnosis of Kikuchi-Fujimoto disease was integrated, and a review of the literature is made.

Does the antihypertensive therapy with calcium-channel blockers improve the cognitive funtion?: a review of evidences

Los bloqueantes de los canales de calcio (BCC) son un grupo de drogas con estructuras químicas heterógeneas, entre ellas verapamil, ditiazen y dihidropiridinas. Introducidas en la medicina clínica en el año de 1960, son drogas de prescripción frecuente en el tratamiento de los desordenes cardiovasculares. Los bloqueantes de los canales de calcio son ampliamente utilizados en clínica en razón de que inducen vasodilatación arterial inhibiendo los canales voltaje dependientes del calcio del músculo cardíaco y del músculo liso vascular, modificando así la concentración de calcio intracelular fomentando de esa forma la relajación muscular. Hipertensión, diabetes, fibrilación auricular, demencia multiinfarto, enfermedad de alzehimer y la isquémia cerebral son algunas nuevas indicaciones en investigación para el uso de bloqueantes de los canales de calcio. De nuestra revisión se desprende que los efectos atribuidos a los BCC en la función aognitiva se ubican todavía en el terreno de la investigación. Trabajos futuros aportarán claridad sobre el tema

Semipersonalized psychological evaluation of quality of life in hypertensive patients during a trial with two calcium antagonists: a multicenter Latin-American Study (LASTLHY).

OBJECTIVE: The main objective of this study was to evaluate well-being and physical activity of 248 hypertensive patients, including 177 females, who had previously been included in the Latin-American Study on Lacidipine in Hypertension (LASTLHY). SUBJECTS, MATERIALS AND METHODS: This open study was carried out in 12 clinical centers in Argentina, Brazil, Colombia, Mexico and Venezuela, to compare, over a period of 16 weeks, the antihypertensive action of a fixed-dose, once daily of 4 mg lacidipine administered orally to 120 patients and 30 mg nifedipine GITS (Gastro-Intestinal Therapeutic System) administered to 128 patients, aged between 40 and 65 years. All patients had mild to moderate hypertension and treatment was begun at the end of a one-week placebo run-in period (end of week -1). Well-being and physical activity were assessed by means of single questionnaire, which reflected the physical and cultural diversities amongst the clinical centers and patients. The questionnaire included 13 multiple-choice and 8 contingent open questions. The score of each question was multiplied by a coefficient related to the importance of each question to the patient (semipersonalization); the coefficient was obtained from cultural and socioeconomic data collected at the time of enrollment. The semipersonalization was carried out by a blind psychological study with respect to the medication and had a high repeatability in the assignment of personalized coefficients to the score of each question. The scores of each question were added to obtain an overall well-being and activity scoring. The possible theoretical range for the overall scoring in this study was 10 - 124. RESULTS: See Table 1. CONCLUSION: The study revealed that the administration of calcium channel blockers such as lacidipine and nifedipine GITS, and lacidipine in particular, produced low incidence of side effects, and lacidipine in particular induced significant improvement in the quality of life.

Pharmacological modulation of the cardiovascular response to hypertonic NaCl injection in the anteroventral area of the rat brain third ventricle.

The anteroventral area of the rat brain third ventricle (AV3V) was stimulated by stereotaxically placed microinjections (1 microliter) of hypertonic 1.5 mol/l NaCl and the responses of mean arterial pressure (MAP) and heart rate (HR) were recorded. Previous injection of terazosin or propranolol (5.0 micrograms) into AV3V, 15 min before 1.5 mol/l NaCl microinjection, did not alter the cardiovascular response pattern induced by 1.5 mol/l NaCl. Prior AV3V treatment with ketanserin (1.0 microgram) significantly reduced (p < 0.01) the MAP and HR increase induced by 1.0 microliter of 1.5 mol/l NaCl without changing basal cardiovascular parameters. Prior AV3V treatment with losartan (10.0 micrograms) significantly reduced (p < 0.01) the hypertension and tachycardia induced by hypertonic NaCl administration. Thus, AV3V serotonin and angiotensin II-sensitive neurons may exert an excitatory role on blood pressure and HR involved with the sympathetic discharge produced by hypertonic NaCl stimulation.

Pharmacological study of atypical beta-adrenoceptors in rat esophageal smooth muscle.

The chemical specificity for the beta-adrenoceptor mediated relaxation of rat esophageal smooth muscle was evaluated using selective and non-selective beta-adrenoceptor agonists and antagonists. Pindolol, ICI 89,406, ICI 118551 [erythro-1-(7-methylindan-4-yloxy)-3-(isopropylamine)-but an-2-ol] and the beta-adrenoceptor alkylating agent, pindobind, produced only small rightward shifts in the concentration-response curves of (-)-isoprenaline and (-)-trimetoquinol in this preparation. Rank order potency (pD2 values) of agonists was: (+/-)-trimetoquinol [1-(3',4',5'-trimethoxybenzyl)-6,7-dihydroxy-1,2,3, 4-tetrahydroisoquinoline] (8.34) = (-)-trimetoquinol (8.26) = BRL 37344 [(R* R*)-(+/-)-4-[2'-2-hydroxy 2-(3-chlorophenyl)ethylamino]propyl] phenoxyacetic acid] (8.16) = ICID7114 [(S)-4-(2-hydroxy- 3-phenoxy-propylamino-ethoxy)-N-(2-methoxyethyl) phenoxyacetamide] (8.03) > or = (-)-isoprenaline (7.82) > 3',5'-diiodotrimetoquinol [1-(3',5'-diiodo-4'-methoxybenzyl)-6, 7-dihydroxy-1,2,3,4-tetrahydroisoquinoline] (7.28) > 3'-iodotrimetoquinol [1-(3'-iodo-4',5'-dimethoxybenzyl)-6, 7-dihydroxy-1,2,3,4-tetrahydroisoquinoline] (7.04) > ractopamine (6.84) = 5,8-difluorotrimetoquinol [5,8-difluoro-6,7-dihydroxy-1- (3',4',5'-trimethoxybenzyl)-1,2,3,4-tetrahydroisoquinoline] (6.82) > 8-fluorotrimetoquinol [6,7-dihydroxy-8-fluoro-1-(3',4',5'- trimethoxybenzyl)-1,2,3,4-tetrahydroisoquinoline] (6.56) > or = (-)-noradrenaline (6.46) > or = (-)-adrenaline (6.36) > (+/-)-noradrenaline (6.24) > (+/-)-adrenaline (6.00) > clenbuterol (5.83) > (-)-1-benzyl-6, 7-dihydroxy-1,2,3,4-tetrahydroisoquinoline (5.75). Isomeric activity ratios of trimetoquinol isomers [(-)-(S)- > > (+)-(R)-] in esophageal smooth muscle in the presence and absence of 1 microM pindolol were 1995- and 2951-fold, respectively; and were much greater than those in rat atria (282-fold) and rat trachea (107-fold). The atypical beta/beta 3-adrenoceptor partial agonist, ICI D7114, produced concentration-dependent rightward shifts of the concentration-response curves of (-)-isoprenaline, (-)-trimetoquinol and the reference atypical beta/beta 3-adrenoceptor agonist, BRL 37344. Schild plot analysis of ICI D7114 against trimetoquinol gave slope and pA2 values of 0.91 and of 7.9, respectively. These results clearly demonstrate that the relaxant effects of these agonists in rat esophageal smooth muscle are primarily mediated through the activation of atypical beta/beta 3-adrenoceptors. (-)-Trimetoquinol was as potent as (-)- isoprenaline and BRL 37344, and was the most stereoselective agonist evaluated in this tissue system.

Isomeric-activity ratios of trimetoquinol enantiomers on beta-adrenergic receptor subtypes: functional and biochemical studies.

Trimetoquinol [1-(3',4',5'-trimethoxybenzyl)-6,7-dihydroxy-1,2,3,4- tetrahydroisoquinoline , TMQ] exists as two enantiomers, and the (-)-(S)-isomer is a potent beta-adrenergic receptor (beta-AR) agonist. Experiments were conducted to examine the functional and biochemical potencies of the (S)-and (R)-enantiomers of TMQ for interaction with beta-AR subtypes in tissues, membrane fractions, and cell systems. The isomeric-activity ratios (IARs) of the TMQ isomers [(S)-isomer > > (R)-isomer] for stimulation of beta 1- and beta 2-AR of guinea pig right atria and trachea were 224 and 1585, respectively; these IARs were similar to those observed on atypical beta-AR systems of rat distal colon (575), rat brown adipocytes (398), but differed from that of rat esophageal smooth muscle (2884) in the presence of pindolol. In the absence of pindolol, the potencies for the TMQ enantiomers were slightly increased; however, the IARs remained unchanged in rat distal colon, rat brown adipocytes, and rat esophageal smooth muscle. Similarly, radioligand binding studies demonstrated that the TMQ isomer beta-AR affinities were stereoselective for the (-)-(S)-isomer in membranes of guinea pig left ventricle (beta 1) and lung (beta 2) giving IARs of 115 and 389, respectively; and in E. coli expressing human beta 1- and beta 2-AR giving IARs of 661 and 724, respectively. Corresponding IARs of receptor affinities and stimulation of cAMP accumulation in Chinese hamster ovary cells expressing human beta 2-AR and rat beta 3-AR were 331 and 282, and 118 and 4678, respectively. These results indicate that the (-)-(S)-isomer of TMQ exhibits high affinity, and is a potent and highly stereoselective agonist for each beta-AR subtype, that the isomers generally fail to differentiate between the beta-AR subtypes, and that, based upon differences in IAR within beta 3-AR containing systems, subtypes of atypical beta (or beta 3)-AR may exist in adipose tissue and smooth muscle.