False positive in fluorodeoxyglucose-F18 positron emission tomography computed tomography scan of inferior vena cava leiomyoma in patient with a suspected paraganglioma. / Falso positivo en estudio de tomografía de emisión de positrones con fluorodesoxiglucosa-F18 de un leiomioma de vena cava inferior en paciente con sospecha de paraganglioma.

Leiomyomas are benign tumors derived from smooth muscle tissue that rarely present outside the uterus. These tumors do not usually show FDG uptake. We present the case of a patient with hypertension refractory to treatment and a lesion arising from inferior vena cava, that shows intense FDG uptake in PET/CT scan, suggestive of paraganglioma, with a final histological diagnosis of leiomyoma.

[Baroreflex activation therapy: One more step in the treatment of resistant arterial hypertension and chronic heart failure]. / La terapia de activación de barorreceptores, un paso más en el tratamiento de la hipertensión arterial resistente y la insuficiencia cardiaca.

The number of patients who suffer refractory arterial hypertension and chronic heart failure in advanced stages is currently increasing. The case is presented of a patient with an implantable cardioverter defibrillator, and with the dual indication of chronic heart failure and refractory arterial hypertension, who required the implanting of a baroreceptors activation therapy device of the carotid sinus. As far as it is known, it is the first case reported in Spain?

Clinical trials. A pending subject. / Ensayos clínicos. Una asignatura pendiente.

Clinical trials are essential tools for the progress of clinical medicine in its diagnostic and therapeutic aspects. Since the first trial in 1948, which related tobacco use with lung cancer, there have been more than 150,000 clinical trials to date in various areas (paediatrics, cardiology, oncology, endocrinology, etc.). This article highlights the importance for all physicians to participate, over the course of their professional career, in a clinical trial, due to the inherent benefits for patients, the progress of medicine and for curricular prestige. The authors have created a synthesis of their experience with clinical trials on hypertension, diabetes, dyslipidaemia and ischaemic heart disease over the course of almost 3 decades. Furthermore, a brief reference has been made to the characteristics of a phase I unit, as well as to a number of research studies currently underway.

[Study of the circadian blood pressure profile in patient with arterial hypertension]. / Estudio del patrón circadiano de la presión arterial en pacientes hipertensos.

In arterial hypertension besides reducing blood pressure, we should think about the circadian pressure profile that the patient presents, since the patients non depressors (not descent of arterial pressure during the night with regard to the day) (non-dipper) they associate to a worse cardiovascular prognosis. The purpose of the present study was to determine the circadian pressure profile in patient treated arterial hypertension and never previously treated with antihypertensive medication; and its relationship with the organic damage. They were included in the study to 702 patients with clinical indication for 24 hour ambulatory blood pressure monitoring. The 39% was dipper, 2% extreme dipper, 49.6% non-dipper and 9.4% riser. The patient non dipper had bigger levels of 24 hours systolic blood pressure, night blood pressure and bigger organic damage. The main factors associated to this pattern were the clinic systolic blood pressure, obesity and overalls a filtrate smaller glomerular to 60 ml/min.

[Apropos a case of primary meningococcal arthritis in an adult]. / A propósito de un caso de artritis meningocócica primaria en un adulto.

We present the case of a 52-years-old patient which was diagnosed of septic primary meningococcal arthritis, being acute arthritis the only form of presentation without any other manifestations of the meningococcal disease. We want to stress that despite the low frequency of this disease, especially in the adult, it must be taken into account for the assessment of acute mono-oligoarthritis.

[Clinical characteristics of 47 patients with primary hyperparathyroidism surgically treated]. / Características clínicas de 47 casos de hiperparatiroidismo primario intervenidos quirúrgicamente.

BACKGROUND: The primary hyperparathyroidism is usually an asymptomatic disease. Actually, specialists are attempting to consider to what extent it can be necessary to undergo surgery in this disease. In this article, we are going to describe the clinical and biochemical characteristics of our patients with primary hyperparathyroidism as well as the diagnostic procedures and the results after operation. METHODS: Firstly, we have analysed 47 records of patients with primary hyperparathyroidism and intervened in our hospital during the last 5 years. Secondly, we assessed the biochemical results before and after the surgical intervention, the outcome of parathyroid echography, thoracico-cervical tomography, technietium-99-mm-sestamibi gammagraphy and bone densitometry. Finally, we followed up the assessment of the operation of the patients with hyperparathyroidism. RESULTS: 47 patients were intervened of hyperparathyroidism. 89.4% were women and average the age was 61.4 +/- 12.8 years. Most of them were asymptomatic (45.7%). The gammagraphy was the procedure with best sensibility and specificity, 75 and 100%. Bone densitometry showed that there were no patients with diminished calcification of the bones. The principal diagnostic of pathologic anatomy was adenoma (85.1%). Excluding one single case, the rest of patients healed of their illness after intervention. CONCLUSIONS: Primary hyperparathyroidism is asymptomatic in most of the cases. It is mainly an adenoma process. The best diagnostic procedure is technietium-99-mm-sestamibi gammagraphy. The most appropriate and successful treatment is surgery.

[Clinical manifestations and level of blood pressure in patients evaluated for the first time in a Hypertension Clinic]. / Características clínicas y grado de presión arterial de los pacientes atendidos por primera vez en una unidad hospitalaria específica de hipertensión arterial.

OBJECTIVE: To analyze the clinical manifestations, blood pressure level, and determinants of the degree of hypertension (HT) control in the patients referred by the Primary Care physicians and evaluated for the first time in a Hypertension Clinic. METHOD: The participants were 1,317 consecutively referred patients for the first time to the Hypertension Clinic by their Primary Care physician, between January 1997 and November 2000. The following initial study protocol was applied: case history and physical exploration, blood and urine biochemistry, chest and abdomen x-rays, fundus oculi and electrocardiogram. According to the initial clinical orientation and the results of the complementary tests described, the study was supplemented or not with other complementary studies. Results were registered in a computer dabatase and subsequently were analyzed with the statistical program SPSS 9.0. RESULTS. 741 (56.3%) of the 1,317 patients were women. The average age was 54.58 14.4 years (range: 14-91 years). Average systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 152.6 22.7 mmHg and 94.2 11.6 mmHg, respectively. 71.6% (943 patients) presented at least two cardiovascular risk factors (CVRF), 50.5% (665 patients) three CVRF and 10.4% (137 patients) four CVRF. 43.6% (575 patients) presented a degree I, 33.2% (438 patients) a degree II and 23.1% (304 patients) a degree III HT. The degree of HT was associated with the age, the time elapsed from the beginning of the HT, the body mass index (BMI) and the levels of blood glucose, total cholesterol and LDL cholesterol. A model of logistic regression to classify the patients as HT degrees I or II-III identified as independent variables the age, the time elapsed from the beginning of HTA, the BMI, the presence of diabetes mellitus (DM) and the plasma LDL cholesterol level greater of 160 mg/dl. CONCLUSIONS: Half of the patients sent for the first time by its Primary Care physician to our Hypertension Clinic presented at least three CVRF. Furthermore, 56.4% presented a moderate-severe HTA (degrees II-III). Finally, the degree of HTA of the patients was related to the age, the time elapsed from the beginning of the HTA, the Quetelet's index, and the existence of DM and hypercholesterolemia (HC).