Patients at high risk of cerebrovascular disease: the REACH study.

Cerebrovascular disease is one of the leading causes of morbidity and mortality in developed countries. The identification of at-risk individuals is a high priority so that efficacious preventive measures can be implemented. Subjects with the highest risk of cerebrovascular diseases are those who already have had a stroke or a transient ischemic attack, and those with vascular disease in other territories, either in coronary or peripheral arteries. Other subjects at risk are those with cardiac disease, such as atrial fibrillation, those with hypertension, diabetes and smoking habit, as well as individuals with subclinical vascular disease. Although there is considerable evidence for the efficacy of preventive treatment in this population, the percentage of patients receiving optimum treatment is far from ideal. There is a need to implement strategies in the population directed towards increasing awareness of the need to establish healthy habits and adequate preventive pharmacological treatment that could reduce the incidence of this debilitating disease.

[Carotid intima-media thickness in heterozygous familial hypercholesterolemia: associated factors and changes following 1 year of treatment]. / Grosor de la íntima-media carotídea en la hipercolesterolemia familiar heterocigótica: factores asociados y variación al año de tratamiento.

BACKGROUND AND OBJECTIVE: To evaluate the factors associated with intima-media thickness (IMT) and carotid plaques in patients with familial hypercholesterolemia (FH) and to assess the evolution following 1 year of treatment. PATIENTS AND METHOD: Subjects (n=201) diagnosed as having probable or definite FH according to the MED-PED criteria had a clinical history, physical examination, blood chemistry and lipid profile determined. Ultrasound was used to measure the IMT in both common carotid arteries and to assess the presence of plaques. The measurements were repeated in 123 of the patients after 1 year of treatment. RESULTS: Mean age (standard deviation) was 47.8 (13.2) years; 46.3% were males; 11.4% had a clinical history of cardiovascular disease (CVD); 15.9% were hypertensive; 26.4% were smokers; mean plasma total cholesterol concentration was 362 (49)mg/dL; 66.2% had received previous treatment with statins. In the multivariate analysis, baseline IMT was directly associated with age and history of CVD and inversely related to the years of treatment with statins. The presence of carotid plaques was associated directly with the cholesterol-years index and inversely with years of treatment with statins. The mean LDL-cholesterol reduction at 1 year of treatment was 50%. Neither the IMT nor the percentage of patients with plaques changed significantly following 1 year of treatment. CONCLUSIONS: Intensive hypocholesterolemic treatment in our patients with probable or definite FH did not increase significantly either the carotid IMT or the prevalence of plaques.

Porous Microstructured Surfaces with pH-Triggered Antibacterial Properties.

New antibacterial films are designed with the capability to reversibly regulate their killing and repelling functions in response to variations in environmental pH. These systems consist of porous polystyrene surfaces as the main components and a copolymer bearing pH-sensitive thiazole and triazole groups as the minor components. These pH-sensitive groups, located on the surfaces, can be partially protonated at acidic pH levels, increasing the positive charge density of the surfaces and their antibacterial activity. Similarly, their bacterial adhesion and killing efficiencies in response to changes in pH are evaluated by analyzing the bacterial viability of Staphylococcus aureus bacteria on the surfaces under acidic and neutral pH values. It is demonstrated that after only 1 h of incubation with the bacterial suspension in acidic conditions, the surfaces killed the bacteria, while at pH = 7.4, some of the adhered bacteria are removed. Furthermore, the surface topography exerts an important role by intensifying this response.

Ischaemic related transitory left ventricular dysfunction in 201Tl gated SPECT.

AIM: To report our data concerning the changes in post-stress and at-rest left ventricular ejection fraction and ventricular volumes in patients with thallium gated SPECT. METHODS: Post-stress and at-rest thallium gated SPECT was performed in 629 consecutive patients; left ventricular ejection fraction (LVEF), left ventricular volumes and quantitative perfusion data were obtained. Transitory left ventricular dysfunction was diagnosed when post-stress LVEF did not increase at least 5% from LVEF at-rest. RESULTS: In all patients post-stress LVEF was 64%+/-17 while at-rest LVEF was 66%+/-15 (P=0.6). Post-stress end diastolic volume (EDV) was 142 ml+/-7, at-rest EDV was 141 ml+/-92 (P=0.57), post-stress end systolic volume (ESV) was 54 ml+/-51 and at-rest ESV was 56 ml+/-59 (P=0.38). Data from the perfusion study were used to divide patients into three groups: normal patients (group I), patients with total or partially reversible defects (group II) and patients with fixed defects (group III). In group I and group III patients LVEF at-rest was lower than post-exercise (LVEF 75%+/-11 vs 81%+/-10 (P<0.001) and 57%+/-16 vs 60%+/-18 (P=0.025)), respectively. Patients in group II had a higher at-rest LVEF than post-exercise (LVEF 66%+/-14 vs 64%+/-16 (P=0.003)). While the left ventriuclar volumes in group I and III patients decreased with exercise, group II patients had increased post-stress ESV. CONCLUSIONS: Post-stress and at-rest LVEF are similar when all patients are considered but significant differences appear when patients are divided according to the results of the perfusion study. Normal and fixed defect patients have increased post-exercise LVEF. Patients with reversible defects have decreased LVEF, which is largely due to an increased ESV. Transitory left ventricular dysfunction is related to the presence of reversibility and may benefit from revascularization.

[Prevalence of an abnormal ankle-brachial index in relation to the cardiovascular risk estimated by the Framingham function]. / Prevalencia de un índice tobillo-brazo patológico según el riesgo cardiovascular calculado mediante la función de Framingham.

BACKGROUND AND OBJECTIVE: The measurement of the ankle-brachial index (ABI) is a straightforward method for the detection of atherosclerosis in the lower limbs. An abnormal ABI (< 0.9 or > 1.4) is associated with the development of cardiovascular disease and cardiovascular and all-cause mortality. Despite this, its measurement in clinical practice is underused. The objective of the present study was to evaluate the relation of the ABI with the cardiovascular risk determined by traditional risk functions in a population in primary prevention. PATIENTS AND METHOD: 1001 subjects without known cardiovascular disease attended in primary care were invited to participate in the study. Cardiovascular risk and ABI measurements were calculated in all participants. RESULTS: A low (< 0.9) ABI was found in a 3.8% of the participants, 3.9% females and 3.6% males. An abnormal ABI (< 0.9 or > 1.4) was found in 6.4% of all subjects, 5.2% females and 8.8% males. In a multivariable analysis age (OR = 1.09 for each year; 95% CI 1.03-1.15), smoking habit (OR = 2.96; 95% CI 1.51-5.80), HDL-cholesterol levels (OR = 0.98 for each mg/dl; 95% CI, 0.95-0.99) and hypertension (OR = 1.80; 95% CI, 1.05-3.06) were related with an abnormal ABI. Subjects were divided according to their risk stratification. The percentage of low, moderate and high risk individuals with an abnormal ABI was 2.6%, 8.7% and 14.9% respectively. CONCLUSIONS: In primary prevention, one in ten individuals with moderate risk and one in six individuals with high risk have an abnormal ABI. In these subjects there is an indication for intensive preventive strategies and antiagregation.

[Dilated cardiomyopathy and autoimmunity: an overview of current knowledge and perspectives]. / Autoinmunidad y miocardiopatía dilatada: situación actual y perspectivas.

The diagnosis of idiopathic dilated cardiomyopathy is assigned to patients with left ventricular systolic dysfunction and dilatation in the absence of any other documented cause. Idiopathic dilated cardiomyopathy is presumed to have a multifactorial origin, possibly including autoimmune mechanisms. We reviewed the current state of knowledge of this topic, including a pathophysiological hypothesis postulating a relation between an autoimmune process and sympathetic over-stimulation and systolic dysfunction. The implications for therapy are considered in the light of experience with other autoimmune diseases. The results of immunosuppressant treatment and preliminary experiences with immunoadsorption are reviewed and their future perspectives are discussed.

[Recommendations of the Study Group for Metabolic Alterations/Secretariat for the National AIDS Plan (GEAM/SPNS) on the management of metabolic and morphologic alterations in patients with HIV infection]. / Recomendaciones de GEAM/SPNS sobre el tratamiento de las alteraciones metabólicas y morfológicas en el paciente con infección por VIH.

OBJECTIVE: To provide an update of the metabolic and morphologic alterations in patients infected with HIV with an in-depth analysis of their clinical management and treatment. METHODS: These recommendations were agreed by consensus by a committee of experts in metabolic alterations and HIV patient care, under the auspices of the Secretariat for the National AIDS Plan. To do this, the latest clinical, epidemiological and physiopathological advances described in studies published in the scientific literature and/or presented in congresses were reviewed. RESULTS: The most frequent metabolic alterations in HIV patients and in antiretroviral treatment (ART) are dyslipidemia with an atherogenic profile and alterations in carbohydrate metabolism/insulin resistance. A high prevalence of cardiovascular risk factors, especially smoking, has been described. The same criteria for their management as those used in the general population have been employed, with specific nuances. Diet and exercise should be the first therapeutic recommendation. In patients with dyslipidemia who require drug treatment, statins and/or fibrates are indicated. Glitazones have demonstrated efficacy in the treatment of insulin resistance. The approach to anomalous fat distribution continues to be controversial. The main approaches at present are a switch of ART, reparative surgery, psychological support and lifestyle changes. Lactic acidosis is an infrequent but highly serious complication, and the first step is withdrawal of ART. In bone metabolism alterations, prevention and early detection are essential, especially in children and perimenopausal women. Sexual dysfunction is a frequent problem in both men and women; because the causes are highly varied, treatment should be individualized. CONCLUSIONS: The prevalence of metabolic and morphologic alterations has increased since the introduction of highly active antiretroviral treatment (HAART). Knowledge of the various aspects involved in their diagnosis and treatment is essential for the appropriate care of patients with HIV infection.

Ureterorrenoscopía: problemas y complicaciones / Ureterorenoscopy: problems and complications

Se presenta la casuística compuesta por 114 ureterorrenoscopías realizadas entre 1984 y octubre de 1986, haciendo especial énfasis en los problemas y complicaciones encontrados. En 105 casos se pudo ver el uréter. En 20 de estos pacientes hubo complicaciones

Experiencia con catéter ureteral doble pig tail Ureteofix (R) / Experience with double ureteral catheter pig tail Ureterofix (R)

Los autores presentan su experiencia en el empleo de 20 catéteres ureterales doble pig-tail, en 17 pacientes. Este sistema fue utilizado en pacientes portadores de una uropatía obstructiva ureteral y en cirugía plástica del uréter. Se demostró la buena tolerancia al catéter por parte del paciente y su utilidad como sistema de derivación urinaria interna definitiva o transitoria

Estudio y diagnóstico de la incontinencia de orina / Study and diagnosis of the urinary incontinence

Se presenta el esquema de estudio y diagnóstico de 202 pacientes con incontinencia de orina evaluadas en el Servicio de Ginecología, con la colaboración del Servicio de Urología de­ Hospital Clínico San Borja Arriarán. Con el esquema descrito se excluyen de­ tratamiento quirúrgico el 22,3 por ciento de ellas. Se enfatiza la necesidad de estudio y diagnóstico preoperatorio, para no efectuar indicaciones quirúrgicas injustificadas con desmedro de técnicas útiles y el consiguiente desprestigio de los cirujanos que las efectúan. Se analizan los fundamentos de los esquemas utilizados y los elementos de diagnóstico diferencial para aquellas incontinencias que son de tratamiento médico