Short-term atorvastatin therapy improves arterial stiffness of middle-aged systemic lupus erythematosus patients with pathological pulse wave velocity.

Objectives Statins have been proposed as a potential treatment for systemic lupus erythematosus (SLE) due to their immunomodulatory properties, their role restoring endothelial function and preventing atherosclerosis. We evaluate the effect of a short period treatment with a low dose of atorvastatin and its withdrawal on early stage subclinical atherosclerosis. Methods Thirty-seven SLE females received 20 mg/day atorvastatin during eight weeks. At baseline, at the end of treatment and six months after atorvastatin withdrawal, disease activity, subclinical atherosclerosis -assessed by measuring carotid-femoral pulse wave velocity (PWV) - and quantification of circulating endothelial progenitor cells (EPC) - as a surrogate biological marker of subclinical atherosclerosis - were carried out. Results The group of SLE patients with baseline pathological arterial stiffness showed a significant decrease of PWV after atorvastatin therapy (8.43 ± 1.45 m/s vs 7.42 ± 1.06 m/s; p = 0.002) that is maintained six months after treatment finished. Only patients of the middle-aged group showed a nearly significant decrease in the PWV measured along the study (7.16 ± 1.23 m/s vs 6.76 ± 0.82 m/s; p = 0.05). Atorvastatin induced a significant decrease in the circulating EPC percentage (0.65 ± 0.67 vs 0.40 ± 0.31; p = 0.023) as well as a downward trend of disease activity that it is observed by a decrease in SLE disease activity index simultaneously with an increase in C3 complement and significant decrease in serum concentration of vascular endothelial grow factor (VEGF) and sVCAM-1. Conclusions Short-term atorvastatin therapy reduces arterial stiffness of SLE patients with baseline pathological PWV, who are mainly in the group of middle-aged patients. Further studies are needed to determine whether these patients would benefit from statin therapy in preventing cardiovascular events.

Metabolic syndrome is associated with decreased circulating endothelial progenitor cells and increased arterial stiffness in systemic lupus erythematosus.

OBJECTIVES: Metabolic syndrome (MetS) is highly prevalent in patients with systemic lupus erythematosus (SLE) and it has been associated with increased cardiovascular risk. We examined the contribution of MetS to inflammatory markers, arterial stiffness and circulating endothelial progenitor cells (EPCs) as surrogates of subclinical atherosclerosis. METHODS: Cardiovascular risk factors, SLE-specific factors and peripheral blood EPCs were assessed in 50 female SLE patients. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Simultaneously, atherosclerosis was assessed by measuring the carotid-femoral pulse wave velocity (PWV) by doppler velocimetry. RESULTS: Beyond the factors included in the definition, SLE patients with MetS have a significantly higher serum level of uric acid (6.88 ± 2.20 vs 4.45 ± 1.17, p < 0.001) and some inflammatory biomarkers such as homocysteine, IL-8, sICAM-1 or complement molecules. The presence of MetS in our patients was closely linked with a significantly increased patient organ damage score (3.20 ± 1.97 vs 1.60 ± 1.67, p = 0.008), a decreased percentage of circulating EPCs (0.53 ± 0.24 vs 0.85 ± 0.57, p = 0.007) and an increased arterial stiffness (9.89 ± 2.40 vs 7.13 ± 1.51, p < 0.001). CONCLUSIONS: MetS may contribute to the development of atherosclerosis by significantly increasing inflammation levels and arterial stiffness and decreasing circulating EPCs. This finding would justify close monitoring of these patients.

Gammapatías biclonales: estudio retrospectivo de 47 pacientes / Biclonal gammopathies: retrospective study of 47 patients

Objetivo. Las gammapatías biclonales se caracterizan por una proliferación clonal de cálulas plasmáticas, o sus progenitores linfoides B, con producción de dos inmunoglobulinas anormales (proteínas M o paraproteínas). No conocemos estudios que hayan analizado esta patología en España. Hemos estudiado las enfermedades subyacentes, características de las paraproteínas y evolución de una serie de pacientes con gammapatía biclonal. Material y métodos. Se revisaron las gammapatías clonales del Servicio de Inmunología del Hospital Puerta de Hierro de Madrid, entre los años 1970 y 2011, seleccionando aquellos pacientes con gammapatía biclonal en una determinación. Se recogieron datos epidemiológicos, enfermedad de base, patologías asociadas, terapias recibidas, paraproteína y cuantificación de inmunoglobulinas. Resultados. De los 1.626 casos de gammapatías clonales, 47 eran gammapatía biclonal (2,89%). La mediana de seguimiento fue de 2 años. La principal entidad asociada fue la gammapatía biclonal de significado indeterminado. La composición de paraproteínas más frecuente fue IgG-IgG. En el 81% de los pacientes con una segunda determinación de paraproteína, había desaparecido al menos un componente M. Un tercio de los pacientes no había recibido tratamiento. Conclusiones. Las gammapatías biclonales se asocian fundamentalmente a gammapatía biclonal de significado indeterminado. Ninguna gammapatía biclonal de significado indeterminado evolucionó a patología maligna. En un elevado porcentaje desapareció al menos uno de los dos componentes clonales, a veces de forma espontánea (AU)

Objectives. Biclonal gammopathies are characterized by the clonal proliferation of plasma cells or their B-lymphoid progenitors and are associated with the production of abnormal immunoglobulins (M proteins or paraproteins). There are no known studies that have analyzed this disease in Spain. We studied the underlying diseases, characteristics of paraproteins and the evolution of a series of patients with biclonal gammopathy. Material and methods. We reviewed clonal gammopathies at the Department of Immunology of Hospital Puerta de Hierro in Madrid, between 1970 and 2011, selecting those patients with biclonal gammopathy in one reading. We collected data on the patient's epidemiology, underlying disease, associated diseases, therapies and paraprotein and immunoglobulin levels. Results. Of the 1626 cases of clonal gammapathies, 47 were biclonal gammopathy (2.89%). The median follow-up was 2 years. The main associated condition was biclonal gammopathies of undetermined significance (BGUS). The most common paraprotein combination was IgG-IgG. Upon conducting a second paraprotein reading, 81% of the patients had lost at least 1 monoclonal component. A third of the patients had not undergone treatment. Conclusions. Biclonal gammopathy are fundamentally associated with biclonal gammopathies of undetermined significance. No biclonal gammopathies of undetermined significance evolved to a malignant disease. In a high percentage of patients, at least 1 of the 2 clonal components disappeared, sometimes spontaneously (AU)

Biclonal gammopathies: Retrospective study of 47 patients. / Gammapatías biclonales: estudio retrospectivo de 47 pacientes.

OBJECTIVES: Biclonal gammopathies are characterized by the clonal proliferation of plasma cells or their B-lymphoid progenitors and are associated with the production of abnormal immunoglobulins (M proteins or paraproteins). There are no known studies that have analyzed this disease in Spain. We studied the underlying diseases, characteristics of paraproteins and the evolution of a series of patients with biclonal gammopathy. MATERIAL AND METHODS: We reviewed clonal gammopathies at the Department of Immunology of Hospital Puerta de Hierro in Madrid, between 1970 and 2011, selecting those patients with biclonal gammopathy in one reading. We collected data on the patient's epidemiology, underlying disease, associated diseases, therapies and paraprotein and immunoglobulin levels. RESULTS: Of the 1626 cases of clonal gammapathies, 47 were biclonal gammopathy (2.89%). The median follow-up was 2 years. The main associated condition was biclonal gammopathies of undetermined significance (BGUS). The most common paraprotein combination was IgG-IgG. Upon conducting a second paraprotein reading, 81% of the patients had lost at least 1 monoclonal component. A third of the patients had not undergone treatment. CONCLUSIONS: Biclonal gammopathy are fundamentally associated with biclonal gammopathies of undetermined significance. No biclonal gammopathies of undetermined significance evolved to a malignant disease. In a high percentage of patients, at least 1 of the 2 clonal components disappeared, sometimes spontaneously.

Increased arterial stiffness is independently associated with metabolic syndrome and damage index in systemic lupus erythematosus patients.

OBJECTIVES: We evaluated whether traditional or non-traditional cardiovascular (CV) risk factors and systemic lupus erythematosus (SLE)-related risk factors were associated with pathological arterial stiffness measured by pulse wave velocity (PWV) adjusted for patients' age and blood pressure. METHOD: CV risk factors were measured in the 46 SLE female patients studied. Activity and organ damage were assessed by the SLE Disease Activity Index (SLEDAI) and the Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) Damage Index, respectively. Other lupus-related parameters and information concerning treatment were recorded. Subclinical atherosclerosis was assessed by PWV calculated from pulse wave recording by Doppler, a non-invasive method to measure arterial stiffness. Multivariate logistic regression analysis was used to identify independent determinants of increased PWV. RESULTS: PWV was categorized as normal or pathological arterial stiffness following the reference values adjusted by age and blood pressure recently published by the European Society of Cardiology. Pathological PWV was associated with CV risk factors including homocysteine (p = 0.01), high-sensitivity C-reactive protein (hs-CRP; p = 0.03), uric acid (p = 0.01), and metabolic syndrome (p = 0.007). With regard to SLE-specific risk factors, a significant association was found between PWV and SLICC/ACR score (p = 0.006). Multivariate analysis showed that increased PWV was independently associated with metabolic syndrome [odds ratio (OR) 6.6, 95% confidence interval (CI) 1.2-38, p = 0.03] and SLICC/ACR score (OR 1.5, 95% CI 1-2.32, p = 0.05). CONCLUSIONS: We have found a close link between metabolic syndrome and SLICC/ACR score with increased aortic stiffness. These variables might be an indicator of subclinical atherosclerosis in SLE women without clinical evidence of atherosclerotic cardiovascular disease (CVD).

Young systemic lupus erythematosus patients with no hearing involvement: 10-year follow up.

OBJECTIVE: To evaluate patients with systemic lupus erythematosus and normal hearing over 10 years, compared with healthy controls. METHODS: Thirty patients diagnosed with systemic lupus erythematosus were evaluated in a prospective, descriptive study. Eight patients fulfilled the inclusion criteria, i.e. normal otoscopy, normal hearing, normal imaging and disease duration of less than one year. Eleven healthy companions of ENT patients were recruited as controls. RESULTS: At study commencement, the mean patient age was 32.75 years (range, 15-49 years) and there were no statistically significant audiometric differences between patients and controls. No statistically significant audiometric changes were found either within or between the patient and control groups at 10-year follow up. CONCLUSION: These results supply no evidence for progressive hearing loss in systemic lupus erythematosus patients with no hearing involvement at study commencement. Therefore, we recommend audiometric tests only for systemic lupus erythematosus patients complaining of hearing loss, or for other clinical purposes. It is conceivable that asymptomatic hearing loss could be observed over a more extended follow-up period (i.e. more than 10 years).

[Cardiac myxoma: an analysis of 30 patients]. / Mixoma cardíaco: serie de 30 pacientes.

INTRODUCTION: Myxomas are the most common type of benign heart tumors. The aim of this study was to correlate the clinical forms of presentation of cardiac myxoma and complementary laboratory results with the morphological features of the tumor. MATERIALS AND METHODS: We reviewed retrospectively a total of 30 cardiac myxomas seen in 2 institutions after a period of 22 years. In the same period 5 cardiac sarcomas were identified. The Chi-Square test and Fischer's exact test were used to compare the variables. In one patient the IL-6 production by peripherals blood cells before and after surgical tumor resection was evaluated. RESULTS: The patients were evenly distributed between genders. The mean age of this group was 60 years. The most prevalent clinical manifestations were cardiac symptoms (73,3%), constitutional symptoms (30%) and embolisms (26,7%). All cases were diagnosed by transthoracic echocardiography and the most frequent location of the tumor was the left atrium. Larger-diameter myxomas were observed in older patients and correlated with cardiac symptoms, radiological and electrocardiographical abnormalities. Smaller-diameter myxomas presented more frequently embolic phenomenons. There were no deaths during the postoperative period and the principal postoperative complication was transient arrhytmias. There was no evidence of recurrence of the disease. In one patient with systemic manifestations monocytes were observed to contribute to the increased serum levels of IL-6. CONCLUSIONS: Myxomas are the most frequent tumors of the heart. The most common initial manifestations were cardiac symptoms. Diagnosis was achieved in all patients by transthoracic echocardiography. The size and macroscopic appearance of the tumor correlated with the age of the patients and some clinical symptoms and laboratory RESULTS: Surgical excision was a safe and effective procedure. (c) 2009 Elsevier España, S.L. All rights reserved.

Mixoma cardíaco: serie de 30 pacientes / Cardiac myxoma: an analysis of 30 patients

Introducción y objetivos: El mixoma es la neoplasia benigna cardíaca más frecuente. El objetivo de este estudio es relacionar los síntomas y los hallazgos en las pruebas complementarias de los pacientes diagnosticados de mixoma con las características macroscópicas del tumor. Material y métodos: Se analizaron de forma retrospectiva en dos hospitales de tercer nivel un total de 30 mixomas cardíacos en los últimos 22 años. En el mismo período se identificaron 5 sarcomas cardíacos. Para las comparaciones se utilizó el test de la ji cuadrado y el test exacto de Fischer. En un paciente con síntomas sistémicos e inflamatorios se determinó la producción de interleucina 6 (IL-6) en células mononucleares de sangre periférica antes y después de la cirugía. Resultados: La distribución de los enfermos fue equitativa para ambos sexos. La edad media fue de 60 años. Las manifestaciones clínicas más prevalentes fueron los síntomas cardíacos (73,3%), seguidos de los síntomas generales (30%) y las manifestaciones embólicas (26,7%). El diagnóstico se realizó mediante ecocardiograma, siendo la localización predominante la aurícula izquierda. Los tumores de mayor tamaño se presentaron en edades avanzadas y se relacionaron más frecuentemente con manifestaciones cardíacas y con más alteraciones radiológicas y electrocardiográficas. Por el contrario, los tumores de menor tamaño y pediculados tuvieron manifestaciones embólicas con mayor asiduidad. No hubo mortalidad postoperatoria aunque sí arritmias transitorias. No se describieron recidivas locales. Se comprobó que los monocitos de sangre periférica contribuyen de forma mayoritaria a la producción de IL-6 en un paciente con síntomas sistémicos. Conclusiones: El mixoma es la neoplasia cardíaca más frecuente. Los síntomas cardíacos son la forma de presentación más común de los mixomas. El diagnóstico se realizó mediante ecocardiografía. El tamaño y la morfología del tumor se relacionan con la edad del paciente y con algunas manifestaciones clínicas y hallazgos de las pruebas complementarias. El tratamiento es quirúrgico y suele ser seguro y curativo (AU)

Introduction: Myxomas are the most common type of benign heart tumors. The aim of this study was to correlate the clinical forms of presentation of cardiac myxoma and complementary laboratory results with the morphological features of the tumor. Materials and methods: We reviewed retrospectively a total of 30 cardiac myxomas seen in 2 institutions after a period of 22 years. In the same period 5 cardiac sarcomas were identified. The Chi-Square test and Fischer's exact test were used to compare the variables. In one patient the IL-6 production by peripherals blood cells before and after surgical tumor resection was evaluated. Results: The patients were evenly distributed between genders. The mean age of this group was 60 years. The most prevalent clinical manifestations were cardiac symptoms (73,3%), constitutional symptoms (30%) and embolisms (26,7%). All cases were diagnosed by transthoracic echocardiography and the most frequent location of the tumor was the left atrium. Larger-diameter myxomas were observed in older patients and correlated with cardiac symptoms, radiological and electrocardiographical abnormalities. Smallerdiameter myxomas presented more frequently embolic phenomenons. There were no deaths during the postoperative period and the principal postoperative complication was transient arrhytmias. There was no evidence of recurrence of the disease. In one patient with systemic manifestations monocytes were observed to contribute to the increased serum levels of IL-6. Conclusions: Myxomas are the most frequent tumors of the heart. The most common initial manifestations were cardiac symptoms. Diagnosis was achieved in all patients by transthoracic echocardiography. The size and macroscopic appearance of the tumor correlated with the age of the patients and some clinical symptoms and laboratory results. Surgical excision was a safe and effective procedure (AU)

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Mujer de 36 años con tumoración quística pancreática y trombopenia / 36-year old woman with cystic pancreatic tumor and thrombopenia

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