[Macroscopic liver pathology in patients with dissociated cholestasis]. / Lesiones hepáticas macroscópicas en pacientes con colestasis disociada.

OBJECTIVE: To establish the prevalence of liver focal pathology in patients with increase of alkaline phosphatase and gamma-glutamil transpeptidase and normal bilirubin (dissociated cholestasis), and to analyze the related risk factors for such pathology. METHODS: All laboratory studies of patients admitted to an Internal Medicine Department were reviewed prospectively throughout a period of 9 months. For the purpose of detecting focal liver pathology imaging liver studies (echography and/or CT) were carried out in those in which biochemical analyses showed dissociated cholestasis. RESULTS: A dissociated cholestasis pattern was found in 81 patients. In 13 of them (16%) focal liver pathology was demonstrated. The majority of the lesions (10 of 13) were local or metastatic malignant neoplasms. Sex, alcohol consumption, presence of diabetes mellitus, tumor or hepatobiliar disease previously known, or abnormalities in liver physical examination were not risk factors. No liver pathology was found in patients with an alkaline phosphatase level higher than double of gamma-glutamil transpeptidase level (sensitivity: 100%; negative predictive value: 100%). Diagnosis of a non-hepatic malignant neoplasm at discharge was associated to a risk 12 times bigger for the presence of liver lesions (p < 0.01). CONCLUSIONS: It is uncommon to find focal liver pathology in patients with dissociated cholestasis. It is more common to discover focal liver pathology in patients with non-hepatic tumors and less probable when phosphatase alcaline: gamma-glutamil transpeptidase ratio is higher than two.

[Continuing medical education about the use of antilipemic agents in elderly patients aged 65-75 years]. / Formación médica continuada sobre el uso de hipolipemiantes en ancianos de 65-75 años.

OBJECTIVE: The objective is evaluating the efficacy of the educative intervention to primary care physicians, about the accurate dyslipidaemia management in population between 65 and 75 years old with hypercholesterolemia. DESIGN: Simple-blind random clinical trial. SETTING: Area 10 primary care (National Institute of Health of Spain). STUDY SUBJECTS: . Thirty eight primary care physicians of Area 10. Seven hundred and five patients between 65 and 75 years old with dyslipidaemia. INTERVENTIONS: Clinical session to physicians about the dyslipidaemia management, reinforced with the shipment of the accurate management criteria and bibliographic information. Physicians were followed up for one year. RESULTS: The therapeutic management varied (p = 0.03) in the experimental group after educative intervention. The dietetic therapeutic increased 6.56 percent (p = 0.21), the therapeutic with HMG-CoA-reductase inhibitors increased 4.16 percent (p = 0.36), and the therapeutic with fibric-acid derivates decreased 4.22 percent (p = 0.24). The criteria fulfillment rate of accurate dyslipidaemia management did not vary (p = 1.0) in the control group (44.3 percent) and there was hardly any variation (from 49.4 percent to 49.1) in the experimental group (p = 0.96). The fulfillment rate decreased 7,56 percent (p = 0.25) when dyslipidaemia managed with only diet. The fulfillment improved 17,17 percent (p = 0.14) if dyslipidaemia managed with fibric-acid derivates, and it improved 17,58 percent (p = 0.06) if was managed with HMG-CoA-reductase inhibitors. CONCLUSIONS: The educative session to primary care physicians reinforced with the shipment of the received information, is not likely to relieve the criteria fulfillment rate of accurate management of population between 65 and 75 years old with hypercholesterolemia.

Physical exercise and improvement of liver oxidative metabolism in the elderly.

Drug metabolizing capacity is generally reduced in the elderly, and physical exercise has been reported to increase drug oxidative metabolism. The purpose of this investigation was to study the effects of engagement in a program of regular physical exercise on the clearance and metabolite excretion of antipyrine, a marker of oxidative metabolism, in elderly subjects. The saliva clearance of antipyrine and the production clearances of antipyrine metabolites were studied in 37 elderly women (mean age 66 years). Subjects attended 60-min sessions three times a week for 12 weeks. Each session consisted of both aerobic (training of cardiorespiratory capacity) and nonaerobic (training of muscular strength/endurance and flexibility/coordination) exercises performed at 50-75% of maximum oxygen uptake. Antipyrine was administered orally and pharmacokinetic parameters were obtained from saliva and urine samples. After 3 months of participation in the exercise program, salivary antipyrine clearance was significantly increased by 17% mean (SEM) 0.42 (0.02) vs 0.36 (0.02) ml/min/kg; P < 0.05) and the half-life of antipyrine was significantly reduced by 18% (17.9 (1.1) vs 22.3 (1.3) h; P < 0.05). No significant change with exercise was observed in the renal clearance of antipyrine or in the norantipyrine formation clearance, but significant increases were found for hydroxymethylantipyrine [42 (5) vs 32 (4) microl/kg/min; P < 0.05; +31%] and 4-hydroxyantipyrine [243 (18) vs 194 (17) microl/kg/min; P < 0.05; +25%] formation clearances. These findings indicate that regular exercise leads to increased disposition of antipyrine in the elderly and that the main metabolic pathways of the compound are changed differentially.

Field dependence-independence of basketball referees.

This study examined the field dependence-independence of basketball referees. A total of 205 subjects (nonathletes, athletes active in individual or team sports, and referees) completed the Group Embedded Figures Test. Analysis indicated no significant differences among referees due to age, group, or number of years officiating. Statistically significant lower scores were obtained by team-sport players and referees than by nonathletes. Mean scores of team-sport players and referees did not differ significantly.