Rhabdomyolysis after initial session of indoor cycling: analysis of 11 patients.

AIM: The aim of this paper was to highlight the special frequency of cases of rhabdomyolysis related to the practice of indoor cycling and to define the characteristics, course, and outcome of this disease. METHODS: Retrospective review of clinical histories of patients diagnosed with rhabdomyolysis after indoor cycling in our unit from January 2012 to April 2013. RESULTS: Eleven patients were analyzed. All patients, regardless of the degree of previous physical training, were diagnosed after a first session of indoor cycling. Mean age was 27.63 years (SD=5.74). Fifty-four percent were women. Creatine kinase (CK) levels gradually decreased in response to rest and intensive intravenous hydration. Only in two cases was renal failure observed, and in none were electrolyte disorders, disseminated intravascular coagulation (DIC) or compartmental syndrome detected. CONCLUSION: A first session of indoor cycling has become a common cause of rhabdomyolysis secondary to the physical exercise in recent years, which should alert those responsible for teaching this sport of the need for a gradual start under adequate hydration and environmental conditions, because although the condition has a benign course with adequate treatment and the complication rate is low, there are patients with increased susceptibility to very high CK blood levels requiring hospitalization for treatment and follow-up of possible complications.

[Evaluation of a combination of a diuretic and nifedipine retard for the treatment of hypertensive patients refractory to nifedipine retard]. / Evaluación de la asociación de un diurético a nifedipina retard como terapia en pacientes hipertensos refractarios a nifedipina retard.

This study assessed the effectivity of the association between a diuretic, chlorthalidone, and retard nifedipine in the treatment of patients above 50 years of age with Arterial Hypertension refractory to retard nifedipine. A prospective study of a 3-month controlled intervention was designed, in which the patients were treated with retard nifedipine for 2 months and, if they did not respond to the treatment, chlorthalidone was associated for 1 month. Out of 235 patients selected at the beginning of the study, 28 dropped out voluntarily, 24 were excluded because they did not adhere to the protocol and 30 dropped out due to side effects. After the first two months of therapy, hypertension was controlled in 60.2% of the 181 patients, whereas in the third month, only in 20% of the 44 patients considered could be controlled. Significant differences were observed between the two treatments (p < 0.001) with a 95% CI in the percentage differences of 54% versus 26.4%. These results suggest that the association of chlorthalidone and retard nifedipine does not improve the treatment of Arterial Hypertension refractory to retard nifedipine.

[Treatment of arterial hypertension with captopril in lupus nephropathy]. / Tratamiento con captopril de la hipertensión arterial en la nefropatía lúpica.

We present a non-controlled prospective study of 10 hypertensive patients with systemic erythematous lupus and nephropathy, treated with captopril exclusively or combined with other drugs, in order to assess its effectivity and potential side effects. Four of these 10 patients had mild hypertension; 3, moderate hypertension and 3, severe hypertension. In 5 of them, arterial pressures was controlled with just captopril; in other 3, we added furosemide and in one patient, we added furosemide and nifedipine. In one case, hypertension was not controlled. Renal function remained stable and proteinuria improved in six patients. Three patients presented reversible agranulocytosis, during or immediately after treatment. One of them was treated two years after with enalapril, without observing hematologic recurrence. We conclude that captopril is useful in treating arterial hypertension associated to lupous nephropathy, but frequent leukocyte counting controls must be done during the first months.

[Parinaud's oculo-glandular syndrome secondary to cat-scratch disease]. / Síndrome oculo-glandular de Parinaud secundario a enfermedad por arañazo de gato.

A 56 year old patient with an oculo-glandular syndrome of Parinaud, secondary to a cat scratch disease, is presented. The biopsy of the palpebral conjunctiva and parotid gland showed a non-caseous granulomatosis. The patient met the diagnosis criteria for cat scratch disease and, after treatment with a low dosage of steroids, showed a good evolution.

[Arthritis, endophthalmitis and endocarditis caused by Escherichia coli]. / Artritis, endoftalmitis y endocarditis por Escherichia coli.

A female diabetic patient of 66 years old with acute pyelonephritis, caused by escherichia coli, was further complicated by bacteremia and a rare septic metastasis such as arthritis of the knee and coxa-femoral, unilateral purulent endophthalmitis with a loss of sight and aortic endocarditis which required a surgical change of valves, the posterior evolution being favourable.

[Usefulness of captopril as monotherapy and combination therapy in the treatment of arterial hypertension]. / Utilidad del captopril como monoterapia y en terapia de combinación en el tratamiento de la hipertensión arterial.

The efficacy and tolerance of captopril was prospectively studied as monotherapy for blood hypertension (BH), as well as combined modality with thiazides diuretic and nifedipine as a third drug. 95 cases of BH were followed up for a period of 6 months. 43.15% of the patients who received monotherapy with captopril were controlled (diastolic BP less than 95 mmHg). Those patients who had a diuretic added showed a response of 71.75% and those administered 3 drugs showed a response of 81.25%. The decrease of BH was significant in all groups (p less than 0.01). There was a significant correlation (p less than 0.01) between the response to monotherapy and severity of BH (mild BH 67.50% and severe BH 35.20%). 6.5% of patients abandoned the treatment because of secondary effects. No alterations were noted in the blood test. Monotherapy with captopril is effective in control of mild and moderate BH. In resistant patients, the addition of a diuretic and nifedipine retard as a third drug is useful and well-tolerated in any type of BH severity.

[Thoracic and retroperitoneal dissemination of multiple myeloma. 2 cases]. / Diseminación torácica y retroperitoneal del mieloma múltiple. Dos observaciones.

The dissemination of multiple myeloma out of the bone marrow is very rare, even though the observation of plasmacytosis in the bodies of patients having died of this disease is not rare. We present 2 patients affected by multiple myeloma and with extra-bone marrow plasmacytomas at the diagnosis, localized at posterior mediastinum and retroperitoneum, discovered by tomography.