Cardiopatía isquémica como forma de presentación de feocromocitoma / Ischemic cardiomyopathy as a presentation of pheocromocytoma

El feocromocitoma es una causa poco frecuente de cardiopatía isquémica. Presentamos el caso de una paciente en la que se diagnostica de un feocromocitoma a raíz de una cardiopatía isquémica con ausencia de lesiones coronarias, demostrando la importancia de tenerlo en cuenta en el diagnóstico diferencial en estos casos, sobre todo teniendo en cuenta que disponemos de un tratamiento curativo. (AU)

Pheochromocytoma is a rare cause of ischaemic heart disease. We present the case of a patient in whom pheochromocytoma was diagnosed following ischaemic heart disease with absence of coronary lesions, demonstrating the importance of taking it into account in the differential diagnosis in these cases, especially considering that curative treatment is available. (AU)

[Ischemic cardiomyopathy as a presentation of pheocromocytoma]. / Cardiopatía isquémica como forma de presentación de feocromocitoma.

Pheochromocytoma is a rare cause of ischaemic heart disease. We present the case of a patient in whom pheochromocytoma was diagnosed following ischaemic heart disease with absence of coronary lesions, demonstrating the importance of taking it into account in the differential diagnosis in these cases, especially considering that curative treatment is available.

Síndrome de Fahr / Fahr's syndrome

No disponible

Relationship between plasma bilirubin level and oxidative stress markers in HIV-infected patients on atazanavir- vs. efavirenz-based antiretroviral therapy.

OBJECTIVES: Chronic oxidative stress (OS) may play a role in cardiovascular disease in HIV-infected patients, and increased bilirubin levels may have a beneficial role in counteracting OS. Atazanavir (ATV) inhibits UDP-glucuronosyl-transferase 1A1 (UGT1A1), thus increasing unconjugated bilirubin levels. We aimed to compare changes in OS markers in patients on ATV/ritonavir (ATV/r)- vs. efavirenz (EFV)-based first-line antiretroviral therapy (ART). METHODS: A multicentre, prospective cohort study of HIV-infected patients who started first-line ART with either ATV/r or EFV was conducted. Lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO) and oxidized low-density lipoprotein (oxLDL) were measured for 145 patients in samples obtained at baseline and after at least 9 months of ART during which the initial regimen was maintained and the patient was virologically suppressed. The change in OS markers was modelled using multiple linear regressions adjusting for baseline values and confounders. RESULTS: After adjustment for baseline variables, patients on ATV/r had a significantly greater decrease in Lp-PLA2 [estimated difference -16.3; 95% confidence interval (CI) -31.4, -1.25; P = 0.03] and a significantly smaller increase in OxLDL (estimated difference -21.8; 95% CI -38.0, -5.6; P < 0.01) relative to those on EFV, whereas changes in MPO were not significantly different (estimated difference 1.2; 95% CI -14.3, 16.7; P = 0.88). Adjusted changes in bilirubin were significantly greater for the ATV/r group than for the EFV group (estimated difference 1.33 mg/dL; 95% CI 1.03, 1.52 mg/dL; P < 0.01). Changes in bilirubin and changes in OS markers were significantly correlated. CONCLUSIONS: When compared with EFV, ATV/r-based therapy was associated with lower levels of oxidative stress biomarkers, which was in part attributable to increased bilirubin levels.

Enfermedad de Behçet asociada a déficit de corticotropina / Behçet disease with isolated acth deficiency

Presentamos un paciente con enfermedad de Behçet de larga evolución, con predominio de manifestaciones neurológicas, que ingresó por insuficiencia suprarrenal, en el que se demostró déficit aislado de corticotropina (DAACTH). El DAACTH es una característica típica de las hipofisitis y se ha descrito en asociación con múltiples enfermedades autoinmunitarias; sin embargo, la afección hipotálamo-hipofisaria en la enfermedad de Behçet es excepcional. Revisamos los casos publicados y los posibles mecanismos patogénicos de esta asociación hasta ahora no descrita (AU)

We report a case of a patient with longstanding Behçet disease, with neurological symptoms predominantly, who became hospitalized for adrenal insufficiency, caused by isolated deficiency of corticotropin (DAACTH). DAACTH is a typical characteristic of hypophysitis, reported in association with many autoimmune diseases. Nevertheless, hypothalamic-pituitary injury in Behçet disease is exceptional. We review the literature and possible mechanisms of this association until now not reported (AU)

[Present situation and future perspectives of the epidemic of HIV and AIDS in Spain]. / Situación actual y perspectivas futuras de la epidemia de VIH y sida en España.

Until 1997 Spain was the European country with the highest incidence of AIDS, due mainly to transmission between users of injected drugs. Since early 1990 there has been a fall in the rate of diagnoses of HIV infection in the Spanish autonomous communities where this information is available, and in 2004 this rate was situated below that of several western European countries. New infections in users of intravenous drugs have declined, and although heterosexual transmission has not undergone significant changes, it has become the prime cause of new HIV infections. The rate of diagnoses of HIV has fallen in both the indigenous population and immigrants; however, demographic changes have meant an increase in the percentage of HIV diagnoses in immigrants. In homosexual men there have been descriptions of a recent increase in the incidence of syphilis and gonococcus, which are a warning of possible increases in the transmission of HIV in this group. The number of people who live with HIV in Spain remains between 100,000 and 150,000 (2.4 to 3.6 per 1,000 inhabitants). In spite of the improvement in prognosis due to antiretroviral treatments, there are annually in Spain over 2,000 cases of AIDS (4.8 per 100,000 inhabitants) and over 1,600 deaths from AIDS (3.8 per 100,000). One third of the people who developed AIDS in 2004 had not until then been diagnosed with HIV, which prevented starting the antiretroviral treatment in time.

Situación actual y perspectivas futuras de la epidemia de VIH y sida en España / Present situation and future perspectives of the epidemic of HIV and AIDS in Spain

España fue hasta 1997 el país europeo con mayor incidencia de sida, debido principalmente a la transmisión entre usuarios de drogas inyectadas. Desde principios de 1990 ha disminuido la tasa de diagnósticos de infección por el VIH en las comunidades autónomas españolas que disponen de esta información, y en 2004 esta tasa se situó por debajo de la de varios países de Europa occidental. Han disminuido las nuevas infecciones en usuarios de drogas por vía parenteral, y aunque la transmisión heterosexual no ha sufrido cambios importantes, ha pasado a ser la primera causa de las nuevas infecciones por VIH. La tasa de diagnósticos de VIH ha disminuido tanto en población autóctona como en inmigrantes; no obstante, los cambios demográficos hacen que crezca el porcentaje de diagnósticos de VIH de inmigrantes. En hombres homosexuales se han descrito aumentos recientes en la incidencia de sífilis y gonococia que alertan sobre posibles ascensos en la transmisión del VIH en este colectivo. El número de personas que viven con el VIH en España se mantiene entre 100.000 y 150.000 (2,4 a 3,6 por 1.000 habitantes). A pesar de la mejora en el pronóstico debida a los tratamientos antirretrovirales, en España se producen todavía más de 2.000 casos de sida (4,8 por 100.000 habitantes) y más de 1.600 muertes por sida anuales (3,8 por 100.000 habitantes). Un tercio de las personas que debutaron con sida en 2004 no habían sido diagnosticadas de VIH hasta entonces, lo que impidió iniciar el tratamiento antirretroviral a tiempo

Until 1997 Spain was the European country with the highest incidence of AIDS, due mainly to transmission between users of injected drugs. Since early 1990 there has been a fall in the rate of diagnoses of HIV infection in the Spanish autonomous communities where this information is available, and in 2004 this rate was situated below that of several western European countries. New infections in users of intravenous drugs have declined, and although heterosexual transmission has not undergone significant changes, it has become the prime cause of new HIV infections. The rate of diagnoses of HIV has fallen in both the indigenous population and immigrants; however, demographic changes have meant an increase in the percentage of HIV diagnoses in immigrants. In homosexual men there have been descriptions of a recent increase in the incidence of syphilis and gonococcus, which are a warning of possible increases in the transmission of HIV in this group. ;;The number of people who live with HIV in Spain remains between 100,000 and 150,000 (2.4 to 3.6 per 1,000 inhabitants). In spite of the improvement in prognosis due to antiretroviral treatments, there are annually in Spain over 2,000 cases of AIDS (4.8 per 100,000 inhabitants) and over 1,600 deaths from AIDS (3.8 per 100,000). One third of the people who developed AIDS in 2004 had not until then been diagnosed with HIV, which prevented starting the antiretroviral treatment in time

[Guidelines for quality management of dialysis solutions]. / Guías de gestión de calidad del líquido de diálisis (LD).

A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: [table: see text] Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (Anexos). For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org

Consumo crónico de benzodiacepinas en ancianos / Chronic consumption of Benzodiazepine by the Elderly

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[HIV prevalence among homosexual and bisexual men in Spain, 1992-2000]. / Prevalencia del virus de la inmunodeficiencia humana en varones homosexuales y bisexuales, 1992-2000.

BACKGROUND: Our purpose was to describe the time trend in HIV seroprevalence among homo/ bisexual men. SUBJECTS AND METHOD: We analyzed 9,383 homo/ bisexual men who had a first voluntary test for HIV in 10 Spanish clinics from 1992 to 2000. RESULTS: HIV prevalence decreased from 20.3% in 1992 to 8.4% in 2000. In the multivariate analysis this decline appeared independently associated with the testing year and the birth cohort. CONCLUSIONS: New generations of voluntarily tested homo/bisexual men are less infected by HIV, but it is yet necessary to intensify the prevention programs.

Cholesterol levels in untreated Spanish hypertensive patients. The Compas Study Group, Spanish Hypertension Society.

In daily practice, arterial hypertension (AHT) and hypercholesterolaemia are frequently associated with the existence of multiple common etiopathogenic interrelationships. This situation leads to an exponential increase in cardiovascular risk for these patients, so it is essential to know the prevalence and therapeutic management of hypercholesterolaemia in the hypertensive patient. This national study analyses the distribution of total cholesterol levels and low-density lipoprotein cholesterol as well as hypercholesterolaemia prevalence and its therapeutic management in the uncontrolled hypertensive Spanish population. We observed mean total cholesterol levels of 227+/-41 mg/dl with a high prevalence of hypercholesterolaemia (34.2%) among hypertensive patients, and the percentage of those patients with "desirable" total cholesterol levels (<200 mg/dl) was <25%. The treated hypertensive patients presented both significantly higher mean cholesterol levels and greater hypercholesterolaemia prevalence than the untreated hypertensive patients. It appears that total cholesterol levels are scarcely related to the presence or non-presence of obesity, diabetes or smoking. Regarding treatment, only 14.6% of the hypercholesterolaemic hypertensive patients received hypolipaemic treatment with statins. These results support the need to introduce measures for better diagnostic and therapeutic management of hypercholesterolaemic hypertensive patients that will lead to a much higher reduction in cardiovascular risk for these patients.

Role of interferon alfa-2b in the induction and maintenance treatment of low-grade non-Hodgkin's lymphoma: results from a prospective, multicenter trial with double randomization.

PURPOSE: To evaluate the effectiveness of adding interferon (IFN) alfa-2b to chemotherapy in the induction treatment of low-grade non-Hodgkin's lymphoma (NHL), and to assess the role of maintenance IFN. PATIENTS AND METHODS: A multicenter, two-phase controlled trial with double randomization was conducted in 155 patients with low-grade NHL. In the first randomization, 78 patients received cyclophosphamide, vincristine, and prednisone (CVP) and IFN, 3 MU/m2 three times a week for 3 months, and 77 patients received CVP alone. Responding patients were randomized to receive IFN for 1 year versus observation. RESULTS: Of 144 assessable patients, 73 received CVP + IFN and 71 received CVP. Responses were similar: CVP + IFN 79% versus CVP 76% (P = .62). The number of patients who did not complete the treatment was higher in the CVP + IFN group than in the CVP group (18% v 4%; P = .009), although the received dose-intensity of chemotherapy was comparable. Duration of response and progression-free survival (PFS) were significantly higher in the CVP + IFN group than in the CVP group (P = .0004). However, we observed no differences in overall survival (OS) (P = .30), with a median follow-up for the surviving patients of 3 years. Grade 3/4 granulocytopenia was the most frequent toxicity and was similar in both groups (33% v32%). Eighty-three (74%) of the 112 responding patients were randomized to maintenance IFN or observation. The duration of response was similar between 42 patients that received IFN compared with 41 control patients (P = .83), independently of treatment previously administered. CONCLUSION: Adding IFN alfa-2b to induction CVP in low-grade NHL did not induce a higher response rate, but it significantly increased the duration of the responses. We found significant differences in PFS that favored the patients who received CVP + IFN, but not in OS. To date, no additional benefit has been seen from the administration of IFN for maintenance.