Parathyroid hormone, calcidiol, calcitriol and adverse events in the acute coronary syndrome. / Hormona paratiroidea, calcidiol, calcitriol y riesgo de eventos adversos en pacientes con síndrome coronario agudo.

OBJECTIVE: To know the clinical profile as well as the prognostic significance of elevated levels of parathyroid hormone (PTH) in patients admitted for acute coronary syndrome (ACS). DESIGN AND SETTING: Observational and prospective study of patients admitted for ACS in a single Spanish center during a period of six months. INTERVENTION AND VARIABLES OF INTEREST: The circulating concentrations of PTH, calcidiol, calcitriol, NT-proBNP, C-reactive protein, cystatinC and fibrinogen were determined within the first 48h at admission. We performed adjusted models to predict death or re-entry for ACS after hospital discharge. RESULTS: A total of 161 patients were recruited (age 67±14 years, 75.2% were men). Forty-one (25.5%) patients had elevated PTH values. During follow-up for a period of 275 person-years, 50 adverse events were recorded. Patients with elevated PTH levels were proportionally more women (21.2 vs. 39.0%) and older (63.3 vs. 77.8 years, both P<.05). Likewise, they presented significantly more cardiovascular risk and a worse prognosis during follow-up (incidence rate ratio 2.64 CI 95%: 1.5-4.6). However, in an adjusted model by the GRACE score, PTH levels were not shown to be an independent risk factor (hazard ratio=1.1; 95% CI: 0.6-2.2), neither other components of the panel. CONCLUSIONS: The proportion of patients with elevated levels of PTH admitted for ACS was high. The presence of high PTH levels was associated with an unfavorable clinical profile and a worse outcome during the follow-up, although it was not an independent predictor of poor prognosis.

[Analysis of our series of kidney transplants: urologic complications and survival]. / Análisis de nuestra serie de trasplantes renales: complicaciones urológicas y supervivencia.

PURPOSE: To review our series of 416 renal transplants, with special reference to the surgical complications and their management. METHODS: From June, 1986 to October 1997, we are performed 416 heterotopic renal transplants, harvested from cadavers. Reconstruction of the urinary tract reconstruction was by ureteroneocystostomy in practically all the cases. RESULTS: There were some urological complications in 80 patients (19.2%). The most common urological complication was obstruction of the urinary tract arising from stenosis (3.3%), lymphocele (4.3%) and clotting (1.2%). 78.1% of these urological complications were resolved by endourological techniques. Urinary fistula was observed in 12 cases (2.8%). Vascular complications in 22 (6.9%), lithiasis in 5 (1.2%), and eventrations in 11 (2.6%). The treatment of these complications is described. The actuarial survival rates were 87.8% and 77.3% at one and five years respectively for the graft, and 92.4% and 83.5% for the patients. CONCLUSIONS: Our surgical complication rate in patients undergoing renal transplantation was 19.2%. The most common complication was urinary tract obstruction from stenosis (3.3%), lymphocele (4.3%) and clotting (1.6%); 78.1% of these obstructive complications were resolved by endourologic techniques. Percutaneous drainage and esclerotherapy of the lymphoceles resolved 66.6% of them. Renal biopsy performed with a 14G needle caused 5 severe hemorrhagic complications. There were no complications when an 18G needle was utilized.

[Utilization and effectiveness of the flu vaccination in the prevention of the hospitalization induced by cardiorespiratory decompensation in high-risk patients in Cáceres]. / Utilización y eficacia de la vacunación antigripal en la prevención de ingresos hospitalarios por descompensación cardiorrespiratoria en pacientes de alto riesgo en Cáceres.

INTRODUCTION: Despite the recommendations to vaccinate annually against the flu to all the elderly and people with various chronic diseases, these recommendations are not comon to fulfill. In this case-control study performed in the service of Internal Medicine of the Hospital of Cáceres we have analyzed the degree of utilization of the flu vaccination in the season 2000/2001 in patients over 65 years of age with high-risk chronic diseases, as well as the effectiveness of this vaccination to avoid the hospitalization induced by cardiorespiratory decompensation, in order to reduce the number of consultations to the primary care physician and in order to reduce the issue of days of hospitalization. PATIENTS OF METHOD: 227 patients over 65 years of age with chronic cardiorespiratory disease, diabetes, chronic renal insufficiency, hepatopathy, previous pneumonia, or other causes of immunosuppression were studied. Of them, 116 were admitted because of cadiac or respiratory decompensation (cases); the control group was made up of 99 patients who went to outpatient consultations, with clinical manifestations similar to the cases and they were not hospitalized during the year of study. All the participants filled a questionnaire that included demographic characteristics and data about the underlying disease; the participants were grouped according to the number of underlying disease (one, two or more), according to if had received correctly the flu vaccination, according to the number of consultations to its Family doctor during the year of the study because of respiratory infections, according to the hospitalizations during the previous year and in the patients that were hospitalized acording to the number of days of the hospitalization. RESULTS: The average age was 71 years and 63% patients had been hospitalized the previous year. The percentage of vaccinated was of 60% and the vaccination was applied most frequently to the patients older than 75 years (p < 0.001), with EPOC (p < 0.005), and with cardiac insufficiency (p < 0.01), as well as to the patients with 2 or more risk factors (p < 0.001). Differences were not observed among the cases and the controls with regard to the age, to the incidence of ICC, to the incidence of DM, nor to the presence of 2 or more risk factors; however, the patients who were hospitalized presented a greater incidence of chronic obstructive pulmonary disease (COPD) (OR: 3.6; IC: 2.01-6.45) and of previous pneumonía (OR: 5.24: CI: 2.4-11-14): The factors most influencing the possibility of hospitalization were: EPOC (OR: 3.67; CI: 1.90-7.13); previous pneumonía (OR: 3.88: CI: 1.69-8.95). The estimate of hospitalizations avoided by the vaccination was of 59 (OR: 0.41; IC: 0.22-0.79). The vaccination did not decrease the number of consultations to the physician nor the days of the hospitalization. CONCLUSIONS: The flu vaccination looks underused in patients over 65 years of age with multiple diseases in the hospital environment. The vaccination seems to be effective in order to diminish the number of hospital admissions because of cardiorespiratory decompensation, even in non-epidemic seasons. We should insist on the use of the flu vaccination in these high-risk patients.