Indication, performance and outcomes of adrenal vein sampling in patients with primary hyperaldosteronism.

Primary hyperaldosteronism (PAH) is an important cause of secondary hypertension (HTN). The study of the same requires a high clinical suspicion in addition to a hormonal study that confirms hormonal hypersecretion. It is important to start the appropriate treatment once the diagnosis is confirmed, and for this is necessary to demonstrate whether the hormonal hypersecretion is unilateral (patients who could be candidates for surgical treatment) or bilateral (patients who are candidates for pharmacological treatment only). At the Hospital del Mar since 2016 there has been a multidisciplinary work team in which Nephrologists, Endocrinologists, Radiologists and Surgeons participate to evaluate cases with suspected hyperaldosteronism and agree on the best diagnostic-therapeutic approach for these patients, including the need for adrenal vein sampling, which is a technique that in recent years has become the gold standard for the study of PAH. In the present study we collect the experience of our centre in performing AVC and its usefulness for the management of these patients.

Podocytopathy in patients with monoclonal gammopathy: three patients and literature review.

BACKGROUND: Renal manifestations of monoclonal gammopathies are of increasing interest among nephrologists. Typical manifestations include light chain cast nephropathy, amyloidosis or renal damage mediated by monoclonal immunoglobulin deposition. Podocytopathies in the setting of an underlying monoclonal gammopathy constitute a rare manifestation of these diseases and, although being described in the literature, remain a challenge since most data derive from case reports. METHODS: A retrospective review of the clinical data of Hospital del Mar and Hospital Vall d'Hebron was performed to identify patients with minimal change disease (MCD) or focal and segmental glomerulosclerosis (FSGS) in the setting of neoplasms that produce monoclonal (M) protein. Additionally, a literature review on this topic was performed. This study aims to describe the clinical characteristics and outcomes of these patients. RESULTS: Three patients were identified to have podocytopathy and monoclonal gammopathy between the years 2013 and 2020. All three were males and  >65 years of age. Two patients were diagnosed with MCD and one patient was diagnosed with FSGS. All patients underwent a kidney biopsy and light and electron microscopic studies were performed. The underlying causes of monoclonal gammopathy were multiple myeloma in two cases and Waldeström macroglobulinemia in one case. Two patients developed nephrotic syndrome during the follow-up. All patients were under active hematological treatment. One patient presented a complete remission of proteinuria whereas the other two presented a partial remission. CONCLUSIONS: Podocytopathies may infrequently be found in patients with monoclonal gammopathies. Patients with overt glomerular proteinuria and hematological disorders with M protein should undergo a kidney biopsy for prompt diagnosis and to specify a prognosis. In addition, further study on this matter must be done to understand the pathophysiology and treat these patients appropriately.

Protozoal forms in house-dust mites and respiratory allergy.

The presence of mites in sputum smears has been described with possible implications through direct action of dust mites inside the lungs and of the possibility of them being a causal factor in asthma. Because of the impact and frequency of allergic respiratory diseases associated with exposure to dust mites, we examine extracts of the intestinal content of dust mites to find a special factor to link the allergic respiratory diseases and the dust mites. We examined 600 slides of household dust with an average of 5 (3-8 mites) mites being observed on each, approximately 3000 mites in all. Among the remains of intestinal contents of the mites, the presence was observed of various protozoal forms with filiform projections. These forms were very similar in morphology to those previously observed by us, under the same conditions of phase contrast, in the sputa of asthmatic patients and the nasal extrusions of patients with allergic rhinosinusitis. The discovery of these protozoal forms may be the nexus necessary to connect these diseases with the arthropods mentioned.

Protozoal forms in the sputum of immunocompromized patients.

The aim of this study is to determine whether, in situations of marked immunological deficit, principally among patients with AIDS, there is a greater frequency of protozoal forms. Comparative study was of 2 group of patients, 1 an immunocompromized group, main HIV+, and the other a non-immunocompromized group with different respiratory disorders (control group). A cytological study was carried out using 295 sputum smears, obtained between 1994 and 2003, from patients at the Central University Hospital of Asturias, Spain. Smears were valid for 106 patients, 83 of whom presented HIV infection. Protozoa were detected in 72 of this group. Our findings indicate a greater number of protozoal forms in the sputa of patients with AIDS than among the other 2 groups analysed (patients without AIDS and control group).

Vulval squamous cell carcinoma arising in localized Darier's disease.

Darier's disease (keratosis follicularis) is a rare vulval lesion and it has been associated with squamous and non-squamous tumors from different origin. A vulval squamous cell carcinoma (SCC) arising in a localized Darier's disease is presented. To our knowledge, this is the first case to report the association of a vulval SCC and a localized Darier's disease. The possibility of delaying or overlooking the diagnosis of a vulval carcinoma is also illustrated. It is suggested to resect the whole lesion of Darier's disease localized to the vulva or take multiple biopsies.