Indicación, realización y resultado del cateterismo de venas adrenales en pacientes con hiperaldosteronismo primario / Indication, performance and outcomes of adrenal vein sampling in patients with primary hyperaldosteronism

El hiperaldosteronismo primario (HAP) es una causa importante de hipertensión arterial (HTA) secundaria. El estudio del mismo precisa de una alta sospecha clínica, además de un estudio hormonal que confirme la hipersecreción hormonal. Es importante iniciar el tratamiento adecuado una vez se confirma el diagnóstico, y para ello es preciso demostrar si la hipersecreción hormonal es unilateral (pacientes que podrían ser tributarios a tratamiento quirúrgico) o bilateral (pacientes que son tributarios a tratamiento únicamente farmacológico). En el Hospital del Mar desde el año 2016 existe un equipo de trabajo multidisciplinar en el que participan nefrólogos, endocrinólogos, radiólogos y cirujanos para evaluar los casos con sospecha de hiperaldosteronismo y consensuar el mejor abordaje diagnóstico-terapéutico de estos pacientes, incluyendo la necesidad de cateterismo venoso adrenal, que es una técnica que en los últimos años se ha erigido como gold standard para el estudio del HAP. En el presente estudio recogemos la experiencia de nuestro centro en la realización de cateterismo venoso adrenal y en la utilidad de este para el manejo de tales pacientes (AU)

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 center in performing adrenal vein catheterization and its usefulness for the management of these patients (AU)

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.

Es posible aplicar protocolos de cribado de cáncer de cérvix en la práctica diaria / Cervical screening protocols can be applied in daily clinical practice

Objetivo. Evaluar si podemos aplicar protocolos de cribado de cáncer de cérvix sin retrasar el diagnóstico del cáncer y con buena aceptación por las pacientes. Sujetos y métodos. En 2005 elaboramos un protocolo de diagnóstico precoz del cáncer de cérvix basado en realizar citologías cada 3 años a mujeres mayores de 30 años con 3 citologías previas normales. Estudiamos a 300 pacientes que habían acudido a consulta en 2006 y otras 300 en 2008. Revisamos si les habíamos hecho citología y si estaba indicada, las revisiones recomendadas a los 3 años y si volvían antes. También la adhesión al protocolo en los cánceres diagnosticados desde 2005. Resultados. Las citologías se redujeron en un 32% en 2008 con respecto al 2004, año previo al cribado. En 2008 recomendamos al 21% de las pacientes la próxima revisión en 3 años. Un 3% volvió antes. De 17 cánceres diagnosticados desde 2005, solo una mujer con adenocarcinoma había realizado el cribado. Conclusiones. Evitar el sobreúso de la citología en la práctica diaria es posible (AU)

Objective. To evaluate whether screening protocols for cervical cancer can be implemented without delaying the diagnosis of cancer and whether this practice is well accepted by patients. Subjects and methods. In 2005, we developed a protocol for the early diagnosis of cervical cancer based on carrying out cervical smears every 3 years in women over the age of 30 with three previous normal smears. We studied 300 patients who had attended an appointment in 2006 and another 300 in 2008. We reviewed our records to determine whether we had performed a smear and, if one was indicated, whether we had recommended attendance at a follow-up visit 3 years later, and whether the women had returned earlier. Adherence to the protocol in cancers diagnosed from 2005 was also reviewed. Results. The number of smears decreased by 32% in 2008 compared with 2004, the year prior to screening. In 2008, 21% of women were recommended to attend the next review 3 years later and 3% returned earlier. Of 17 cancers diagnosed since 2005, only one woman with adenocarcinoma had undergone screening. Conclusions. The overuse of cytology/smears in daily clinical practice can be avoided (AU)

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).

Linfoma anaplásico de células grandes asociado a ictiosis adquirida / Anaplastic large-cell lymphoma associated with acquired ichthyosis

El linfoma anaplásico de células grandes (LACG) es un linfoma no-Hodgkin de alto grado caracterizado por su morfología celular y la expresión del marcador CD30. Puede dividirse en dos grandes grupos: primario cutáneo y el ganglionar sistémico, el más frecuente. Presentamos un caso de un paciente que consultó por la aparición de unas lesiones pruriginosas en tronco. En la exploración física se objetivó la presencia de máculas rasposas al tacto en tronco y extremidades y la existencia de una masa a nivel cervical, infiltrada, dura, y recubierta de piel eritematosa. El estudio histológico de ambos procesos reveló: una ictiosis adquirida en la piel y un linfoma anaplásico de células grandes ganglionar con extensión subcutánea, respectivamente. El proceso cutáneo siguió un curso paralelo al linfoma, con una remisión parcial de las lesiones tras la quimioterapia y reaparición de las mismas al extenderse el linfoma ganglionar. La ictiosis adquirida es un síndrome paraneoplásico raro, se ha descrito asociado a procesos linfoproliferativos, aunque sólo en cinco ocasiones a linfoma anaplásico de células grandes (AU)

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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.