Association of HLA-DRB3*0202 and serum IgG antibodies to Chlamydia pneumoniae with essential hypertension in a highly homogeneous population from Majorca (Balearic Islands, Spain).

Separate studies investigating the relationship of essential hypertension (EH) with the HLA system and with Chlamydia pneumoniae (C. pneumoniae) infection have given conflicting results. Our aim was to clarify these relationships and determine whether the HLA system and C. pneumoniae infection interact with respect to the risk for EH. An association study (110 essential hypertensives and 107 controls) was conducted in a highly homogeneous population in the Balearic Island of Majorca (Spain). Molecular typing of HLA-B and HLA-DRB and quantification of serum levels of IgG antibodies to C. pneumoniae (sIgGa-Cp) were determined. Student's t-test, chi(2)-statistics, logistic regression analysis, and general linear model ANOVA were used for statistical analysis. The results showed that EH was related with HLA-DRB3*0202 in the whole study population, and with levels of sIgGa-Cp>63.5 BU/ml in the group of individuals with sIgGa-Cp>30 BU/ml (OR (95% CI) adjusted for obesity, familial history of EH and diabetes=2.06 (1.07-3.97), P=0.03, and =4.60 (1.06-19.90), P=0.04, respectively). The association between EH and sIgGa-Cp was observed in the DRB3*0202(+) individuals, but not in the DRB3*0202(-) subgroup (OR (95% CI)=11.14 (1.92-64.54), P=0.004, and =0.98 (0.22-4.43), P=0.64, respectively (P of the Mantel-Haenszel test for homogeneity of OR=0.06)). In our population, EH was positively associated with HLA-DRB3*0202 and with high levels of sIgGa-Cp. Moreover, a significant interaction of DRB3*0202 on the effect of sIgGa-Cp was observed, as the association of EH with these antibodies depended on the presence of DRB*0202.

[Angiotensinogen gene T174M polymorphism: opposite relationships with essential hypertension and obesity in a homogeneous population from Majorca (Baleric Islands, Spain)]. / Polimorfismo T174M del gen del angiotensinógeno: relaciones opuestas con la hipertensión arterial esencial y con la obesidad en una población homogénea de Mallorca (Islas Baleares).

Numerous association studies have been performed to evaluate the relationship between the angiotensinogen gene and the essential hypertension, but their results are conflicting. The conflicting results may be explained by methodological reasons, particularly genetic differences in the population samples, phenotypic differences in the hypertensive populations analyzed, lack of appropriate control for other hypertension risk factors in some studies, or limited statistical power among many studies. Furthermore, hypertension is a public health issue of great relevance in Baleric Islands (Spain). For these reasons we performed an association study about the relationship between the M235T, T174M and G-6A diallelic polymorphisms of the angiotensinogen gene and hypertension in a population from Majorca (Balearic Islands), in which a considerable homogeneity with respect to ethnicity and environmental factors could be documented. This population was composed of 109 patients and 107 controls. Alleles of the angiotensinogen gene were determined by PCR and restriction site polymorphism analysis. The different genotypes were tested for association with dependent variables by univariate and multivariate logistic regression analysis. In the univariate analysis we found no evidence of association between the angiotensinogen gene genotypes and hypertension. This lack of association was independent of obesity, familial history of hypertension and diabetes for the genotypes of the polymorphisms M235T and G-6A; however, in the multivariate analysis the T174T174 genotype showed an almost significant positive association with hypertension [OR = 2.76 (95% confidence interval: 1.00-7.65, p = 0.05)]. The T174T174 genotype also showed a significant negative association with obesity [OR = 0.41 (95% confidence interval: 0.18-0.90, p = 0.03)] that remained after adjustment by sex, hypertension and diabetes [OR = 0.26 (95% confidence interval: 0.10-0.65, p = 0.004)]. Our results: a) are in contrast with the results from most previous studies that found a relationship of the T174M polymorphism with hypertension, as in those studies the M174 allele was responsible for the association; b) emphasize the need for rigorous control for obsesity in the studies of association between the angiotensinogen gene and hypertension; c) underscore the importance and the utility of using concrete populations to carry out studies on the genetic dissection of hypertension.

[Silent ischemic heart disease in patient with Wegener's necrotizing glomerulonephritis]. / Cardiopatía isquémica silente en paciente con glomerulonefritis necrotizante por enfermedad de Wegener.

Wegener's granulomatosis is a necrotizing vasculitis disorder that usually presents with clinical involvement of the upper and lower respiratory tract in association with renal disease. Although Wegener's granulomatosis can affect other systems, such as the eye, skin, joints, muscle, nerves, gastrointestinal tract and heart, cardiac involvement is traditionally believed to be rare, even though coronary vasculitis can be demonstrated at postmortem examination. We report a patient who has both respiratory and renal involvement who died unexpectedly following a silent myocardial infarct after a period of clinical improve induced by treatment with cyclophosphamide and prednisone.

Protección del orificio de salida del Catéter en las actividades acuáticas / Protection of the catheter output in water sports

No disponible

[Persistence of the left superior vena cava discovered during the implantation of a hemodialysis catheter]. / Persistencia de la vena cava superior izquierda descubierta durante la implantación de catéter para hemodiálisis.

A persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly. It is a persistent remnant of the left anterior cardinal vein that usually disappears in early embryological development as a result of compression between the left atrium and the hilum of the left lung. If it is not associated with other congenital cardiac anomalies it is usually asymptomatic but has important clinical implications in some situations. In this article, we describe a patient with bilateral SVC identified on a chest radiograph by a haemodialysis central venous catheter passing through it.

Profilaxis con fluconazol de las peritonitis fúngicas en diálisis peritoneal / No disponible

No disponible

A propósito de un caso de lesiones cutáneas y calcifilaxis / No disponible

La calcifilaxis es una inusual complicación de la insuficiencia renal crónica asociada a una elevada morbi-mortalidad. El caso clínico que presentamos, describeuna paciente paratiroidectomizada en 1997, que en abril de 1999 es diagnosticada de calcifilaxis tras sospecha clínica y confirmación mediante biopsia cutánea. La persistencia de niveles de PTH superiores a 400 pg/mI, junto con unas imágenes gammagráficas sospechosas de nódulos paratiroideos, determinan una nueva intervención quirúrgica (extirpándose dos nódulos), tras la cual, remite por completo la sintomatología, a pesar de que los nódulos extraídos fueron identificados como tejido tiroideo. Corroboramos el hecho de que la patogenia de la calcifilaxis es multifactorial, adquiriendo especial relevancia el uso de quelantes cálcicos (con un riesgo elevado de presentar hipercalcemia) en el tratamiento de la insuficiencia renal crónica (AU)

Calciphylaxis is an unusual complication of chronic renal failure associted with increased morbidity and mortality. This presentation is a clinical case describinga patient parathyreidectomized in 1997, followed by the condition was clinically suspected and then confirmed by skin biopsy. PTHi levels above 400 pg/ml together with scintigraphyc images suggesting parathyroid nodules resulted in the decision to try a new surgical procedure, which yielded two nodules of thyroideal tissue. After the surgery and in spite of this pathology result, the patient recovered completely from her symptoms. This corroborates the theory that the etiology of calciphylaxis is multifactorial, acquiring special relevance the use of calcium-containing phospa ¡the binders (representing a high risk of hypercalcemia)in the treatment of Chronic Renal Disease (AU)

[Report of a case with skin lesions and calciphylaxis]. / A propósito de un caso de lesiones cutáneas y calcifilaxis.

Calciphylaxis is an unusual complication of chronic renal failure associated with increased morbidity and mortality. This presentation is a clinical case describing a patient parathyreidectomized in 1997, followed by the condition was clinically suspected and then confirmed by skin biopsy. PTHi levels above 400 pg/ml together with scintigraphic images suggesting parathyroid nodules resulted in the decision to try a new surgical procedure, which yielded two nodules of thyroideal tissue. After the surgery and in spite of this pathology result, the patient recovered completely from her symptoms. This corroborates the theory that the etiology of calciphylaxis is multifactorial, acquiring special relevance the use of calcium-containing phosphathe binders (representing a high risk of hypercalcemia) in the treatment of Chronic Renal Disease.

La enfermedad por citomegalovirus en el trasplante renal / Cytomegalovirus infection in renal transplant patients

El citomegalovirus (CMV) es el mayor patógeno viral después de un trasplante renal. Se estima que el CMV causa enfermedad sintomática en un porcentaje que varía según los trabajos desde un 8-35 por ciento y ocasiona la muerte en el 2 por ciento de los pacientes. Los factores de riesgo de la infección por CMV son el estado serológico del donante y receptor, el tratamiento inmunosupresor y la carga viral. La prevención de la infección y/o enfermedad por CMV en el trasplante renal se puede plantear mediante tres estrategias: profilaxis universal, profilaxis dirigida o tratamiento precoz.Hay tres tipos de medidas profilácticas para prevenir la infección y enfermedad por CMV en los pacientes trasplantados que deben utilizarse de forma combinada: la disminución en el riesgo de adquisición o reactivación del virus, la inducción de protección inmunológica (vacunación e inmunoprofilaxis pasiva con inmunoglobulinas inespecíficas o hiperinmunes) y ¡a utilización de fármacos antivirales; los fármacos utilizados en la profilaxis han sido: aciclovir oral, ganciclovir i.v., oral y valaciclovir. En base a la evidencia disponible se recomienda realizar profilaxis en los siguientes grupos, dependiendo del estado serológico del donante y receptor: - Donante CMV+ y receptor CMV-- (D+/R-): profilaxis recomendada.-- Donante CMV- y receptor CMV+ (D-/R+): depende.- Donante CMV+ y receptor CMV+ (D+/R+): depende de la inmunosupresión.-- Donante CMV- y receptor CMV'- (D-/R-): no hacer profilaxis (AU)