[Strategies for the detection of dyslipemias in primary care in La Rioja]. / Estrategias de detección de dislipemias en atención primaria de La Rioja.

We was carried out a survey between all primary care physicians (PCP) of La Rioja on their social and demographic data, anamnesis on their factors of cardiovascular risk and behavior in the strategies of hypercholesterolemia detection. The 65% of the PCP ask to their patient on knowledge of their cholesterol; this proportion increases between the physicians that know the recommendations of the Spanish Atherosclerosis Society (SAS) (p < 0.002). The 100% of the PCP determine some lipid parameter when they specify a blood sample for another reason or in presence of arterial hypertension, coronary heart disease, dyslipidemias or diabetes mellitus. In presence af smoking habit or oral contraceptive use, PCP that know the SAS or that they work in the rural environment, respectively, they solicit lipid parameters with a greater frequency (p < 0.04 and p < 0.03). Only a 23% of the PCP carry out electrocardiogram in case of a hyperlipidemia, percentage that is incremented between those that works in primary health centers ar in the urban medium (p < 0.03 and p < 0.03). A quarter af the PCP don't refer to the specialized attention to their patients with uncontrolled dyslipidemia and almost the 10% they would not send them under no circumstance. Although in general seem us adequate the behavior in opportunist detection of the PCP, this improves up on knowing the normative of national consensus.

[Treatment of hyperlipemia: opinions of primary care physicians of the La Rioja region]. / Opiniones de los médicos de atención primaria de La Rioja sobre el tratamiento de las hiperlipemias.

BACKGROUND: Primary health care physicians (PHCP) play a fundamental role in the detection and treatment of hyperlipemias in a general population. The aim of this study was to estimate the opinion of the PHCP in the Autonomic Community of La Rioja, Spain, regarding desirable lipemic values and treatment of hyperlipemias. METHODS: A survey with personal interview was carried out to all the PHCP in the Spanish National Health Care (INSALUD) in La Rioja in May and June 1994. RESULTS: Of the 177 PHCP included 97% completed the questionnaire. The main coronary risk factor for 46% of physicians was high blood pressure followed by serum cholesterol (30%). Fifty-six percent of the physicians believed that the desired populational cholesterolemia should be less than 200 mg/dl and this percentage rose if the physician worked in an urban environment (p < 0.01). Sixty-six percent considered 200 mg/dl as the desired triglyceridemia. For treatment and follow-up of hyperlipemia, 78% of physicians use cholesterol linked to low density lipoproteins (cLDL). This use of cLDL increased among those who were familiar with the recommendations of the Spanish Society of Arteriosclerosis (p < 0.002) or who worked in health care centers (p < 0.02). Regarding initiation of dietetic treatment most chose cholesterolemia between 200-250 mg/dl, a cLDL value between 150-185 mg/dl and triglyceridemia between 200-250 mg/dl. For the use of pharmacologic treatment these levels were 250-300 mg/dl, 150-185 mg/dl and 250-300 mg/dl, respectively. Ninety-nine percent of physicians indicated diet as the first therapeutic measure. In isolated hypercholesterolemia the resins were most used by the Family Medicine specialists (p < 0.002) and fibrates (p < 0.03) and statins (p < 0.02) the least used. The use of statins was lower in the physicians working in health care centers (p < 0.03). CONCLUSIONS: Knowledge of theshold values of serum cholesterol and triglicerides levels and the use of drugs among the primary health care physicians from La Rioja, Spain, are generally correct. The physicians with good knowledge of the National Consensus Guides on hyperlipemias had the most adequate opinion.

[Limited reserve of corticotropic hormone (ACTH)]. / Reserva limitada de hormona corticotropa (ACTH).

Chronic deterioration of the glucocorticoid function may result from a primary disorder of the suprarenal glands; from a deficit of the corticotropic hormone (ACTH) due in most cases to an extended hypophyseal affection with reduced secretion of other hypophyseal hormones and from the lack of corticotropin releasing hormone (CRH) at the hypothalamic level. Isolated ACTH deficiency is a rare clinical entity. A subgroup within this pathology is the limited reserve of ACTH which would constitute a mild form of dysfunction in the corticotropic cells, with enough secretion of ACTH to maintain a normal adrenal function in the absence of stress-inducing situations, but unable to show an appropriate reaction in such situations. The difference between these two entities lies in the normal levels of 17-OH-corticosteroids in the limited reserve of ACTH. We describe the case of a patient with acute severe hyponatremia in whom this rare affection was diagnosed and we make some considerations regarding this entity.

[Pulmonary cryptosporidiosis and AIDS. Presentation of a case and review of the literature]. / Criptosporidiasis pulmonar y SIDA. Presentación de un caso y revisiónde la literatura.

Pulmonary cryptosporidiasis is a rare disease. However, following the advent of the acquired immunodeficiency syndrome (AIDS), this rare pathology infection by Cryptosporidium and we conduct a literature review. The Cryptosporidium can be detected with the routine technique used for the identification of mycobacterias in sputum: Zichl-Neelsen, auramine O, Kinyoun, etc. The most frequent sympthomatology includes chronic cough (91%), fever (59%) and dyspnea (64%). In 78% of cases, several respiratory infectious agents coexist, mainly P. carinii (47%) and Cytomegalovirus (41%). In 76% of cases, the infection is followed by diarrhea, detecting Cryptosporidium in the feces of 80% of these patients. The most frequent cause of death is respiratory failure. The radiologic evidences are not specific. The OKT4+/OKT8+ ratio has an average value of 0.3 (0.05-0.9). There is not any treatment truly effective.

[Sclerosing cholangitis in a patient with acquired immunodeficiency syndrome]. / Colangitis esclerosante en un paciente con síndrome de inmunodeficiencia adquirida.

The case of a man with the acquired immunodeficiency syndrome who had been intravenous drug abuser is reported. He was investigated because of the presence of both severe upper abdominal pain and raised levels of serum alkaline phosphatase and gamma-glutamyltransferase. The endoscopic retrograde cholangiopancreatography show stenosis of the major duodenal papilla associated with thickening and dilatation of intrahepatic bile ducts. The sclerosing cholangitis (SC) diagnostic was made with histological confirmation. Cryptosporidium oocysts were identified in sputum and bronchial lavage. We discuss his SC implication and we review the literature. We highlight the need to suspect this pathology in both positive serology human immunodeficiency patients or AIDS with abdominal pain and biochemical cholestasis.