[Cyclic adenosine monophosphate in the cerebrospinal fluid of patients with liver disease (author's transl)]. / Adenosín monofosfórico cíclico en líquido cefalorraquídeo de enfermos hepáticos.

The concentration of adenosine 3':5'-cyclic monophosphate in the spinal fluid of ten patients with liver dysfunction was analyzed. Ages of the patients ranged from 31 to 75 years. The state of consciousness varied between normality and stupor. After a liver biopsy the diagnoses were as follows: cirrhosis in six cases, porphyria cutanea tarda in one case, hepatic metastases in two cases and Wilson's disease in one case. Mean values in these patients (22.91 +/- 4.18 pM/ml) have been significantly greater (p less than 0.0005) than those in ten control individuals (15.55n control individuals (15.44 +/- 3.66 pM/ml). Values corresponding to two patients in coma were still higher (52.62 and 36.50 pM/ml respectively). A previous lumbar puncture carried out in one of these patients when he was conscious showed a figure of 23 pM/ml. These results suggest a progressive rise of cyclic adenosine monophosphate in the spinal fluid in relation to clinical impairment, and may indicate a similar behaviour for this nucleotide to that of tryptophan, as reported by other authors. These findings point toward the role of the alteration of neurotransmitters in the pathogenesis of hepatic coma.

[Renal tubular acidification in patients treated with anticonvulsants (author's transl)]. / Acidificación tubular renal en sujetos tratados con anticonvulsivantes.

Proximal and distal renal tubular acidification function has been studied in ten epileptics treated with phenobarbital and hydantoins. Plasma concentration of 25 OH D3 and urinary excretion of adenosine 3':5'-cyclic phosphate (cAMP) were also determined. Serum parathormone (PTH) was analyzed in five patients. Four of these ten patients showed a decreasing threshold for bicarbonates, suggesting a disturbance of the proximal tubular acidification function. These patients did not show diminishing plasma levels of 25 OH D3, and according to the results of cAMP and PTH determinations a hyperparathyroidism could be ruled out. Anticonvulsants lead to a disturbance of the renal acidification which is not derived from alterations of the phosphocalcic metabolism.

[Ectopic ACTH syndrome in bronchopulmonary tumors (author's transl)]. / Síndrome de ACTH ectópica en los tumores broncopulmonares.

Thirteen cases of bronchopulmonary carcinomas without symptoms of hypercorticoidism, hypopotassemic alkalosis, or intolerance to an overdose of glucose are described. Repeated circadian rhythm and the suppression test with small doses of dexamethasone were practiced on each one. In 7 cases the secretion of cortisol was supressed normally with oral administration of dexametahsone. In the other 6 cases the circadian rhythm was lost and it was imposible to reduce the plasma level of cortisol with dexamethasone. The results help to point out the usefulness of these easy to perform dynamic tests as a means of diagnosing the ectopic production of ACTH by bronchopulmonary tumors. At the same time they show the relatively high incidence of production of this hormone by this type of tumors in patients who have no symptoms of classical hypercorticoidism. The determination of plasma cortisol levels using this test could be valuable in establishing the prognosis and clinical course of the disease. A normalization of the endogenous adrenal secretion of glucocorticoids would indicate a regression of the tumor in response to treatment.

[Idiopathic hemochromatosis: a study of pituitary function in patients and potentially affected relatives (author's transl)]. / Hemocromatosis idiopática: estudio de la función hipofisaria en enfermos y familiares potencialmente hemocromatósicos.

Anterior pituitary function, particularly the hypothalamus-pituitary gonadal axis, has been investigated in four patients with idiopathic hemochromatosis and in two potentially affected family members (sons) of one patient. All the patients presented a hypogonadotrophic hypogonadism. In one patient there was an associated primary testicular failure. Gonadotropin secretion was intact in the family members. The remaining pituitary functions were usually preserved, except a probable decrease of the glandular reserve of TSH in two patients, and of prolactin in one of them.

[Medullary aplasia, sarcoidosis, and malacoplakia. A case report (author's transl)]. / Aplasia medular, sarcoidosis y malacoplaquia. A propósito de un caso.

A 49-year-old man presented medullary aplasia, sarcoidosis, and malacoplakia as evidenced by biopsy. This is apparently the first case of this association to be described in the literature. Medullary aplasia is basically an aplasia of the erythroid series, though it may be a pure aplasia of the red cells alone. A histologic study of the left testicle removed because of an infectious orchiepidydimitis led to the discovery of malacoplakia. Skin nodules appeared later; two of them were extirpated and revealed the existence of sarcoidosis. There was no evidence of sarcoidosis at any other level. The immune mechanism involved in pure red cell aplasia with or without thymoma are well known. The association of malacoplakia and sarcoidosis, two similar conditions, is closely related to alterations in cell immunity. The possibility that common immune factors were present in this patient. After eliminating different therapeutic approaches used in other cases, an immunosuppresive therapy was applied.

[Study of the acidification capacity of the urine in polyclonal hypergammaglobulinemia (author's transl)]. / Estudio de la capacidad de acidificación de la orina en las hipergammaglobulinemias policionales.

The renal capacity of acidification of urine was studied in 21 patients with hypergammaglobulinemia (polyclonal gammapathies) secondary to several conditions. The reabsorption threshold of bicarbonate was determined by Rodriguez-Soriano's technique; the acid and ammonium production was measured using Wrong and Davies' technique. Values for the bicarbonate threshold ranged from 18.5 to 29 mmol/liter of plasma bicarbonate with a mean value of 25 +/- 2.29; they were not significantly different from the control values. Urinary pH ranged from 4.6 to 5.8; ammonium excretion ranged from 18.4 to 114.5 microEq/min (mean value 63.01 +/- 25.36). Acidity values ranged from 13 to 65.05 microEq/min (mean value 33.61 +/- 19.36). Thhre was no statistical difference between these values and those obtained from the controls. We found no evidence that the acidification function of urine was limited in patients with hypergammaglobulinemia secondary to several conditions as compared with normal subjects. In the two cases in which this function was altered there was no reason why it should be attributed to hypergammaglobulinemia.

[A study of the urinary acidifying capacity of patients chronically treated with anticonvulsants (author's transl)]. / Estudio de la capacidad de acidificación de la orina en enfermos con ingestón crónica de anticonvulsivantes.

The subjects of this study were 18 patients with essential or secondary epilepsy under treatment with anticonvulsant drugs (hydantoins and phenobarbital) for periods of time varying between 8 months and 22 years. In all of them the serum levels of calcium, phosphorus, alkaline phosphatase, and the renal tubular capacity to acidify the urine were measured. Mean serum calcium and phosphorus levels were normal, while alkaline phosphatase was significantly elevated (p less than 0.0005). The renal threshold for bicarbonate was lowered to a mean of 23.01 +/- 2.86 (p less than 0.01). Distal tubular function was normal in all cases. When the patients are divided into two groups according to the duration of treatment (more or less than 100 months), the group with longest therapy shows an elevation of alkaline phosphatase (p less than 0.0005), a lowering of serum calcium (p less than 0.025) and a reduction of the renal threshold for bicarbonate (p less than 0.005) when compared to the group with shortest therapy.

[Sepsis: clinical course study of 126 patients in an internal medicine department]. / Sepsis: estudio clínico-evolutivo de 126 pacientes en un Servicio de Medicina Interna.

126 cases of sepsis were retrospectively studied in an Internal Medicine Department, giving special attention to the clinical evolution. 67 males and 59 females with a median age of 65 years old were discovered. 92% had one or more diseases, mainly COLD (30%) and diabetes mellitus (28%). The septic sources were urinary (37%) and respiratory (31%). 84% of the germs were gram (-), mainly E. Coli and Proteus sp. A mortality rate of 36% was found, the primary rates being: eighth decade (52%), patients with neoplastic disease (46%), biliary tract diseases (64%), endocarditis (66%), infection by Serratia (60%), Pseudomonas (50%), shock (55%) and DIC (50%). These last two complications were analysed and found to be the more frequent (35% and 6.3% respectively), also being those with higher mortality rate. Finally, the prognostic factors are established based on the results obtained.