Urinary beta-glucuronidase in renal cell carcinoma.

The aim of the paper was to study the urinary beta-glucuronidase activity in 30 patients with renal cell carcinoma (RCC), histopathologically proven after surgery, and 32 healthy subjects taken as controls. Classification of patients was done using the TNM system. A statistically significant increase (p < 0.01) in this enzyme was found in RCC patients, without relation to the changes in the urinary sediment (hematuria, pyuria, bacteriuria) or tumor dissemination. Urinary beta-glucuronidase is a useful marker in the diagnosis of malignant renal tumors.

Urinary N-acetyl-beta-glucosaminidase in the prediction of preeclampsia.

The urinary excretion of N-acetyl-beta-glucosaminidase (NAG), a lysosomal enzyme of the renal tubular cells was analyzed in 177 women divided into nonpregnant healthy controls (n = 46), normal pregnant women in their third trimester (n = 49), pregnant women with transient hypertension (n = 43), and women with preeclampsia (n = 39). Urinary activity of NAG was increased in normal pregnant women and in patients with transient hypertension in pregnancy compared to nonpregnant healthy controls. In preeclamptic women, this increase was found to be much higher than that corresponding to their gestational age; this fact is due to the tissue ischemia that precedes glomerular endotheliosis, but also tubular lesions caused by arteriolar vasoconstriction may have an important role.

[Klippel-Feil syndrome and associated malformations. Comments on an unusual case]. / Sindrome di Klippel-Feil e malformazioni associate. Commenti su di una rara osservazione

An unusual association of Klippel-Feil syndrome and other abnormalities (Sprengel's deformity, 1st cervical and 1st dorsal spina bifida, homovertebral bone, scoliosis, plagiocephaly, basilar impression, pterygium colli, nanism, hypogenitalism, etc.) together with neurological signs of amyotrophic lateral sclerosis, in a 36-yr-old woman is reported. The clinical and radiological pictures are examined and the exterior morphology is examined. The three types of Klippel-Feil syndrome are discussed, together with the particular alterations observed in the present case: Sprengel's deformity, spina bifida, craniostenosis, basilar impression, etc.

[Rapid determination of MB fraction of serum creatine kinase in the diagnosis of acute myocardial infarction (author's transl)]. / Diagnóstico del infarto agudo de miocardio por dosificación rápida de la fracción MB de la creatincinasa sérica.

The behaviour of the myocardial fraction of creatine kinase has been studied in a group of 80 patients diagnosed as having an acute myocardial infarction. The method of selective activation with dithiothreitol was employed. This technique enables the isoenzyme quantification in less than 15 minutes, which represents a great advantage in comparison to other complex methods used in the past. According to the time of evolution of the infarction the patients were classified into four groups and comparative statistical studies were carried out between these groups and the group of 20 normal controls. The early increase of the myocardial fraction is stressed, even when creatine kinase is still within normal limits. Literature on this topic is reviewed and a systematic determination of the myocardial fraction of serum creatine kinase in the intensive Coronary Units is recommended in order to certainly diagnose myocardial infarction as soon as possible.

[Study of serum C3 and C4 fractions in patients with glucose-6-phosphate dehydrogenase deficiency (author's transl)]. / Estudio del C3 y C4 en el déficit en glucosa-6-fosfato deshidrogenasa.

Activity of serum C3 and C4 fractions have been measured in 35 individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency and various clinical manifestations. Determination of serum complement was carried out in six cases during an abrupt hemolytic phase; the remaining 29 patients were asymptomatic at the time of laboratory test, but the past history revealed acute hemolytic syndroe in 11 cases. There were no statistical significant differences between C3 and C4 fraction levels of patients with G6PD deficiency and those corresponding to a group of 30 normal controls. Immunoallergic theories causing hemolytic episodes in patients with G6PD deficiency are discussed.

Plasminogen in patients with liver cirrhosis.

BACKGROUND: We studied the plasminogen concentration in patients with alcoholic liver cirrhosis in order to assess its synthesis in the liver and establish correlations with other routine parameters such as the albumin level and prothrombin time. MATERIAL AND METHODS: Plasminogen was determined by radial immunodiffusion albumin by nephelometry and the prothrombin time by Quick's method. The study involved 40 healthy volunteers and 80 patients diagnosed as having alcoholic liver cirrhosis. Histopathological confirmation was achieved in 56 patients, while in the remainder it was based on other instrumental methods and clinical and laboratory findings. RESULTS: The plasminogen level was lower in patients with liver cirrhosis (7.8 +/- 0.3 mg/dl) than in healthy controls (11.7 +/- 0.6 mg/dl). According to the Child-Pugh classification, the concentration in class A was 9.0 +/- 0.3 mg/dl, in class B it was 7.3 +/- 0.4 mg/dl and in class C it was 6.1 +/- 0.2 mg/dl. The differences between the groups were statistically significant. CONCLUSION: The plasminogen level is of diagnostic value in the assessment of liver function and correlates well with the albumin concentration and the prothrombin time.

[Antithrombin III and liver cirrhosis]. / Antitrombina III y cirrosis hepáticas.

Antithrombin III (AT III) levels in 37 healthy people and in 103 patients diagnosed of hepatic cirrhosis (75 due to ethylism, 26 cryptogenic and 7 post-hepatitis) have been studied. Forty seven patients presented a compensation in their cirrhosis and 56 an unbalance. AT III concentration was decreased in cirrhotic patients (14.9 + 1.09 mg/dl), being p less than 0.0005 in relation to healthy patients (24.3 + 0.87 mg/dl). Concentration resulted lesser in patients with unbalance (13.9 + 1.8 mg/dl) than in patients with compensation (18.1 + 1.6 mg/dl). Moreover, statistical study between them showed significant results. AT III, though is a protein whose hepatic synthesis is not clear, decreases in diffuse hepatic disease and so much as more severe is the hepatic damage. Cirrhotic patients did not present thromboembolic phenomena, perhaps because of depression of coagulation factors.

[Clinical value of urinary excretion of N-acetyl-beta-glucosaminidase in diabetic retinopathy]. / Valor clínico de la excreción urinaria de N-acetil-betaglucosaminidasa en la retinopatía diabética.

PURPOSE: To test N-acetyl-beta-glucosaminidase (NAG) urinary excretion, early renal damage biochemical marker, in patients with non-insulin-dependent diabetes mellitus grouped according to the degree of retinopathy, establishing its relationships to retinal involvement. METHODS: We make a prospective study of 144 type 2 diabetic patients and 94 healthy subjects. We realized an ocular exploration that included fluorescein angiography and a biochemical study that included the determination of NAG urinary excretion in all of them. The patients were grouped depending on their retinal disease. 76 subjects without retinal abnormalities (40 men and 36 women), 30 with early nonproliferative diabetic retinopathy (13 men and 17 women) and 21 subjects with proliferative diabetic retinopathy (10 men and 11 women). Results were analyzed by using statistical analyses. RESULTS: Our results showed that there exist an increase in the urinary excretion of NAG according to the degree of diabetic retinopathy advance. We also highlight the biggest urinary excretion of NAG in the diabetic patients without retinal involvement regarding healthy subjects. CONCLUSION: There is a parallelism between renal and retinal complications in type 2 diabetes mellitus as other authors had demonstrated previously for the type 1 diabetes mellitus.

[Heat syndrome: the first 7 cases in Granada]. / Golpe de calor: primeras siete observaciones en Granada.

We present the seven first cases with heatstroke in Granada provinces. Six patients were elderly man with passive heatstroke, the other was a young adult with active heatstroke. The clinic picture was evident: fever, hiperpnea, anhidrosis and mental impairment; there was not peculiar biochemic sign though the prognosis depended of the development of tubular kidney failure. We expose the main phisiopathologic therapeutic measure.

[Inappropriate ADH secretion syndrome]. / Síndrome de secreción inadecuada de ADH.

Six patients are with inappropriate secretion of antidiuretic hormone syndrome are reported (two with bacterial acute meningitis, two with bacterial pneumonia, one with oat cell lung carcinoma, other with mediterranean fever boutonneuse) and the clinical manifestations were: mind changes (four cases) nausea-vomiting (two cases) and inappetence (six cases). All patients presented hyponatremia criteria, serum decreased osmolarity, urinary sodium and osmolarity increased, without edemas, renal disease endocrine (hypophysis, thyroids, adrenal) without diuretic treatment. Treatment was, effective water restriction in three patients and hydrochloride of demeclocycline in other three patients.

[Idiopathic hemochromatosis, analysis of 19 cases]. / Hemocromatosis idiopática (análisis de 19 casos).

We studied 19 patients with idiopathic haemochromatosis between 12,000 patients by the Department of Internal Medicine. By 17 the diagnosis was made very late with severe state of chronic liver disease, only two went to consult because transaminases were increased without exploration in routinary examination. Hepatomegalie was constant exploratory feature (100%) followed by impaired hydrocarbonated metabolism (52%). The biochemical usual pattern was: hipersideremie, decreased transferrin and increased transaminases activities in all the patients. Increased iron urinary excretion (more than 8 g/24 h) with desferroxiamine administration is a useful biochemical feature if because severe liver disease the biopsy punction was not indicated due to impaired hemostasia. Because the serious illness with late diagnosis and the normal survival if the diagnosis is early the iron metabolism would be useful screening as in another countries.

[Rendu-Osler-Weber disease. Contribution of ten cases]. / Enfermedad de Rendu-Osler-Weber. Aportación de diez observaciones.

Ten new cases of hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber's disease) are presented. Five of them were detected among 30,000 patients attending a Service of Internal Medicine; the remainder five, were detected while conducting the family study. Epistaxis (5 cases) and hidden (2 cases) and evident (1 case) digestive hemorrhage were the most frequent clinical signs. All patients presented telangiectasia affecting lips. We observed edemas in nasal fossas (5 cases), hand fingers (6 cases), tongue (2 cases) and face (1 case), as well as in gastroduodenal mucosa in the three patients undergoing endoscopic study. We did not observed hemostasis disorders, except for moderate thrombocytosis in two patients and microcytic anemia in three patients. The relevance of clinical evaluation is stressed, because all patients presented oral-facial telangiectasia.

[Imported malaria: 6 cases, 2 of them with an erythrocyte glucose-6-phosphate dehydrogenase deficiency]. / Paludismo importado: seis observaciones, dos con déficit en glucosa-6-fosfato deshidrogenasa eritrocitaria.

We present six cases of imported malaria in Spanish and foreign patients who had visited or lived in areas of malaria endemic. Two patients presented deficit of erythrocytic glucose-6-phosphate dehydrogenase. The main aspects of these two pathologies are analyzed, stressing their similar geographic distribution and the mechanisms by which such deficit protects against the malaria infection. In addition, we describe the problems that may arise with the use of anti-malaria in carriers of this enzymatic deficit; in our patients, the use of chloroquine did not raise any problem.