Modificación del comportamiento celular bajo el efecto de estatinas en células de pared arterial (II). Alteraciones estructurales del citoesqueleto / Alterations in cell behaviour under the effect of statins in arterial wall cells (II). Changes in cytoskeletal structure

Algunos de los efectos clínicos de los inhibidores de la HMG-CoA-reductasa (estatinas) pueden no ser estrictamente dependientes del descenso de colesterol y del cLDL. Estos efectos, ajenos al propiamente hipocolesterolemiante, se conocen como efectos pleiotrópicos. En trabajos previos se ha demostrado que los efectos pleiotrópicos pueden tener como sustrato cambios en el comportamiento celular, valorando la movilidad y la adherencia celular. Ello, unido a los cambios en la tasa de proliferación celular así como la de apoptosis, obliga a pensar que algunos cambios estructurales pueden estar detrás de los efectos no estrictamente lipídicos. En el presente trabajo se ha intentado valorar los cambios inducidos en el citoesqueleto cuando se incuban células de pared vascular con estatinas. Se han empleado fibroblastos y fibras musculares lisas, y simvastatina y cerivastatina. Nuestros resultados han permitido confirmar que las estatinas inducen modificaciones en las estructuras actínicas de la célula mediante el empleo de tinciones con inmunofluorescencia y empleando anticuerpos anti-actina. Estos cambios podrían explicar las modificaciones celulares que se acompañan de variaciones en el comportamiento celular (AU)

Some of the clinical effects of HMG-CoA-reductase inhibitors (statins) may not bestrictly dependent on the decrease in cholesterols and LDL-cholesterol. These effects, whichare not related to their lipid lowering properties, are known as pleiotropic effects. In previous studies it has been shown that the pleiotropic effects may have changes in cellbehaviour, assessing cell mobility and adhesion as substrate. That, along with the changes in the cell proliferation rate as well as apoptosis, leads to thinking that structural changes maybe behind these not strictly lipid effects. In the present study, an attempt has been made to evaluate the changes induced in the cytoskeleton when vascular wall cells are incubated with statins. Fibroblast and smooth musclefibres, and simvastatin and cerivastatin have been used. Our results have been able to confirm that the statins induce changes in the act in structures of the cell by using stains with immunofluorescence as well as anti-actin antibodies (AU)

Peripheral Arterial Disease study (PERART): prevalence and predictive values of asymptomatic peripheral arterial occlusive disease related to cardiovascular morbidity and mortality / Peripheral Arterial Disease study (PERART): prevalence and predictive values of asymptomatic peripheral arterial occlusive disease related to cardiovascular morbidity and mortality

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[Satellite manifestations of internal diseases]. / Manifestaciones satélites de las enfermedades internas.

AIMS: Define the concept of satellite manifestations (SM) and to determine the number and types of them that appear in the diseases of each one of the subspecialties of the Internal Medicine. METHODS: 290 diseases are reviewed in agreements of Internal Medicine and specialties books and in each one are described the types of SM that they present. RESULTS: The respiratory diseases are the group that more SM presents and the less one the neurological. The most frequent type of SM are dermatological. The diseases that have more variety of types of SM are the endocrinologicals. Analyzing the percentages of every type of SM in relation with the number of diseases of every group, the highest are the dermatological SM in cardiac diseases. CONCLUSIONS: The SM are a very frequent phenomenon in the current medical practice and express the holistic character of the disease. His knowledge is indispensable in the internal medicine and subspecialties, where they can suppose a help in the diagnoses, though a bad knowledge of his reality can mean the opposite.

Manifestaciones satélites de las enfermedades internas / Satellite manifestations of internal diseases

Objetivos. Definir el concepto de manifestaciones satélites (MS) y determinar que número y tipos de ellas aparecen en las enfermedades de cada una de las subespecialidades de la Medicina Interna. Método: Se revisan 290 enfermedades en tratados de Medicina Interna y de especialidades y en cada una de ellas se describen los tipos de MS que presentan. Resultados: Las enfermedades respiratorias son las que mas MS presentan y las que menos las neurológicas. El tipo mas frecuente de MS es dermatológico. Las enfermedades que más variedad tienen de tipos de MS son las endocrinas. Analizando los porcentajes de cada tipo de MS en relación con el número de enfermedades de cada grupo, los mas altos son de MS dermatológicas en enfermedades cardiacas. Conclusiones: Las MS son un fenómeno muy frecuente en la clínica médica actual y expresan el carácter holístico de la enfermedad. Su conocimiento es imprescindible en la clínica internista y subespecializada, donde pueden suponer una ayuda diagnostica, aunque un mal conocimiento de su realidad pueden significar lo contrario

Aims: Define the concept of satellite manifestations (SM) and to determine the number and types of them that appear in the diseases of each one of the subspecialities of the Internal Medicine. Methods: 290 diseases are reviewed in agreements of Internal Medicine and specialities books and in each one are described the types of SM that they present. Results: The respiratory diseases are the group that more SM presents and the less one the neurological. The most frequent type of SM are dermatological. The diseases that have more variety of types of SM are the endocrinologicals. Analyzing the percentages of every type of SM in relation with the number of diseases of every group, the highest are the dermatological SM in cardiac diseases. Conclusions: The SM are a very frequent phenomenon in the current medical practice and express the holistic character of the disease. His knowledge is indispensable in the internal medicine and subspecialities, where they can suppose a help in the diagnoses, though a bad knowledge of his reality can mean the opposite

[Subcutaneous panniculitis at a third level hospital retrospective study of 113 cases]. / Paniculitis subcutáneas en un hospital de tercer nivel: estudio retrospectivo de 113 casos.

INTRODUCTION: The panniculitides or hypodermitis are a wide and heterogeneous group of diseases characterized by the presence of subcutaneous inflammatory nodules located generally in low limbs. OBJECTIVES: Show the clinicopathologic characteristics of the cases diagnosed as panniculitis for a 5 years period; their epidemiology, etiopathogenic factors, evolution and treatment. MATERIAL AND METHODS: A retrospective study of 113 patients diagnosed as panniculitis by histopathologic report of cutaneous biopsy since 1997 to 2001 were performed. RESULTS: The sex proportion was of 4.65 women to every man. The mean age of these patients was 49 +/- 20 years old. 100% had legs affectation, 7.1% in arms, 5.9% in trunk and 0.9% in face. 9.7% presented fever and arthromyialgias, especially in young people (p < 0.05). The etiopathogenic factors implied were tuberculosis, streptococcic pharyngoamygdalitis, sarcoidosis and different drugs. The most frequent histological pattern was septal panniculitis without vasculitis. 24.8% did not realize any treatment; 32.5% took nonsteroideal anti-inflammatory drugs; 31.6% potassium iodide; 16% systemic corticosteroids and 7.1% tuberculostatic drugs. Evolution of the patients was good and independently from the treatment performed. CONCLUSIONS: Panniculitides are a group of diseases with similar clinic, but very heterogeneous in their etiology and histopathologic findings. They are more frequent in women and with more expressive clinic in young people. Up to in the 59.3% of the studied cases a causal etiologic agent was identified. These factors are compatible with the published ones in other previous panniculitis series. When a paniculitis is suspected, the most efficient tool is the clinical diagnosis. Histological confirmation by cutaneous biopsy it must be done when it is possible.

Paniculitis subcutáneas en un hospital de tercer nivel: estudio retrospectivo de 113 casos / Subcutaneous panniculitis at a third level hospital: retrospective study of 113 cases

Introducción: Las paniculitis o hipodermitis son un amplio y heterogéneo grupo de enfermedades caracterizadas por la presencia de nódulos subcutáneos inflamatorios localizados habitualmente en miembros inferiores. Objetivos: Reflejar las características clínicopatológicas de los casos diagnosticados como paniculitis durante un periodo de 5 años; estudio epidemiológico de los pacientes, factores etiopatogénicos, evolución y tratamiento. Material y métodos: Obtuvimos de forma retrospectiva los datos de 113 pacientes diagnosticados de paniculitis mediante informe histopatológico de biopsia cutánea realizadas entre los años 1997 y 2001. Resultados: La proporción entre sexos fue de 4,65 mujeres por cada hombre. La edad media de los pacientes estudiados fue de 49 ± 20 años. El 100 por ciento tuvieron afectación en piernas, el 7,1 por ciento en brazos, el 5,9 por ciento en tronco y el 0,9 por ciento en cara. El 9,7 por ciento presentó fiebre y artromialgias, sobre todo en gente joven (p<0,05). Los factores etiopatogénicos implicados fueron la tuberculosis, la faringoamigdalitis estreptocócica, la sarcoidosis y diversos fármacos. La forma histológica más frecuente fue la paniculitis septal sin vasculitis. El 24,8 por ciento no realizaron tratamiento; el 32,5 por ciento tomaron antiinflamatorios no esteroideos; el 31,6 por ciento yoduro potásico; el 16 por ciento corticoesteroides orales y el 7,1 por ciento tuberculoestáticos. La evolución de los pacientes fue buena en general e independiente del tratamiento realizado. Conclusiones: Las paniculitis son un conjunto de enfermedades con clínica similar, pero muy heterogéneas en cuanto su etiología y hallazgos histopatológicos. Es más frecuente en mujeres y con clínica más expresiva en gente joven. Hasta en el 59,3 por ciento de los casos se halló un agente etiológico causal. Estos factores coinciden con los publicados en otras series anteriores. Ante una sospecha de paniculitis, lo más eficiente es el diagnóstico clínico. Se debe realizar confirmación histológica mediante la realización de biopsia cutánea siempre que sea posible (AU)

Síndrome de Klippel-Trenàunay en el adulto / Klippel-Trenáunay syndrome: and a adult case report

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Púrpura de Schönlein-Henoch y esclerosis tuberosa en el adulto / Adult´s Schölein-Henonch purple and tuberous sclerosis in adults

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Características del sarcoma de Kaposi. Estudio retrospectivo en un hospital de Tercer Nivel / Characteristics of kaposi´s sarcoma. A retrospective study in a reference hospital

El angiosarcoma de Kaposi (SK) es un tumor vascular que afecta a piel y otros órganos. Actualmente se piensa que en su génesis intervienen factores relacionados con la inmunosupresión. Objetivos: Reflejar los datos correspondientes a la distribución del SK, proporción de subtipos, evolución y terapéutica empleada. Material y métodos: Estudio retrospectivo de 28 casos. Obtuvimos los datos personales, hábitos, origen del VIH cuando el SK estaba asociado a SIDA, y tratamiento realizado. Tipo de SK y localización, presentación cutánea, complicaciones y síntomas B. Tratamiento realizado, respuesta y efectos indeseables del mismo. Progresión de la enfermedad, tiempo medio de recidiva, supervivencia media y presencia del SK al fallecer. Resultados: 64 por ciento epidémicos, 21 por ciento tipo clásico y 14 por ciento asociado a trasplantes. En el 48 por ciento de los casos epidémicos, se atribuyó el VIH a hábitos homosexuales y el 18 por ciento a ser ADVP. En todos hubo afectación cutánea, el 46 por ciento tuvo afectación de mucosas, 11 por ciento adenopatías y 14 por ciento extensión visceral. El 71 por ciento recibió tratamiento: 40 por ciento quimioterapia, 35 por ciento radioterapia y 18 por ciento crioterapia. Progresión: el 11 por ciento se estabilizó, en el 50 por ciento hubo extensión local y sistémica en el 17 por ciento. La supervivencia media fue de 4,16 ñ 3 años. Conclusiones: Hay menor incidencia de SK en la población homosexual. La elevada proporción del clásico y asociado a trasplantes apoya un estado de inmunodepresión como factor predisponente. Hubo numerosas complicaciones locales que se asociaron a síntomas B. La crioterapia se utilizó como primera opción en las formas localizadas y en las generalizadas la quimioterapia (AU)

Kaposi's angiosarcoma (SK) is a vascular tumour that affects skin and other organs. Nowadays there is thought that immunosuppression is one of the factors related with its genesis. Objectives: Show the information corresponding to the distribution of the SK, proportion of subtypes, evolution and therapeutic used. Material and methods: A 28 cases retrospective study. We obtained the personal background, habits, origin of the VIH when the SK was associated with AIDS, and treatment carry out. Type of SK and location, coetaneous presentation, complications and B symptoms. Treatment, response and adverse effects. Progression of the disease, average time of relapse and survival, and presence of the SK at death. Results: 64% epidemic, 21% classic type and 14% associated with transplants. In 48% of the epidemic cases, the VIH assumed to homosexual habits and 18% to being ADVP. In all there was coetaneous affectation, 46% had affectation of mucouses, 11% adenophaties and 14% visceral extension. 71% received treatment: 40% chemotherapy, 35% radiotherapy and 18% criotherapy. Progression: 11% became stable, in 50% there was local extension and systemic in 17%. The average survival was of 4,16±3 years. Conclusions: SK has a minor incidence in the homosexual population. The high proportion of classic and transplants associated affirm the role of inmunosuppression as a predisposing factor. There were numerous local complications that were associated with B symptoms. The criotherapy was used as the first option in the located forms and in the widespread ones was the chemotherapy (AU)

[Community-acquired pneumonia in the aged: prognostic factors]. / Neumonía comunitaria en el anciano: factores pronósticos.

We studied the clinical characteristics and the initial supplementary test available in the emergency service, in aged patients with community-acquired pneumonia, as well as their mortality prognosis value. We assessed 190 patients attended consecutively during one year. Clinical, analytical and radiological data were registered. The parameters associated to a higher mortality were: age, absence of thoracic pain, reduction in the level of consciousness, leukocytosis, increased urea levels, aminotransferases, lactate dehydrogenase and reduction in prothrombin activity and pH. The data associated to a greater relative risk were: age above 80 years, absence of thoracic pain, prothrombin activity lower than 70% and ALT < 40 U/l. The presence of three to four of these variables had a sensitivity of 62% and a specificity of 94% in the prediction of mortality. In the multivariable analysis, the following variables remained significative: age, obnubilation and decrease of prothrombin. We stress the relevance of a high clinical suspicion, given the frequency of these cases with little symptomatology, in order to allow for an early treatment and the identification of right risk patients at the initial assessment.

[Magnesium: therapeutic usefulness in emergency situations]. / El magnesio: utilidad terapéutica en situaciones de urgencia.

Magnesium has been a forgotten cation from the therapeutical point of view, given that, although its properties began to be known more than a century ago, its use has been always empirical or isolated. With respect to its use in emergency situations, in addition to correcting its deficit and using it for the treatment of hypercalcemia and hypopotassemia, it is currently recommended as the therapy of choice for the treatment and prevention of several arrhythmias. It can also be used to prevent its deficit, when such deficit is pathological or associated to the ingestion or certain drugs. Given the multiple properties of magnesium, controlled studies are required in order to define its potential therapeutical applications.

[Pleural empyema due to group-A beta-hemolytic Streptococcus]. / Empiema pleural por streptococcus beta-hemolítico grupo A.

We present the case of a parenteral drug addict with pleural overflow (empyema), in which hemolytic Streptococcus group A was isolated. The absence of an early diagnosis and an effective empirical treatment caused the development of septic shock and the patient died in spite of the therapeutical measures implanted in the emergency unit.