Control de la hipertensión arterial mediante el esquema de hemodiálisis en días alternos (HDDA o «EODD»: «Every Other Day Dialysis») versus dos esquemas convencionales de 4 y 5 horas por sesión tres veces a la semana con 72 horas de fin de semana sin sesiones / Control of hypertension with different hemodialisis schedules

El aumento de la frecuencia de las sesiones de hemodiálisis garantiza un mejor control del volumen extracelular y de la hipertensión arterial, hechos que pueden reducir la mortalidad relacionada con patología cardiovascular entre la población en hemodiálisis. Describimos la evolución de la hipertensión arterial, en función de las necesidad de administración de fármacos antihipertensivos, en una población prevalente de 38 pacientes que iniciaron el esquema de hemodiálisis en días alternos sin descanso de 72 h de fin de semana, y la comparamos con 140 pacientes asimismo prevalentes que eran tratados en dos esquemas convencionales, previamente utilizados, con descanso de fin de semana y tres sesiones semanales de 4 y de 5 horas respectivamente; todos los pacientes habían permanecido durante más de 6 meses en hemodiálisis. El 68,4% (26/38) de los pacientes del esquema alterno presentaba hipertensión arterial al inicio del esquema alterno y tras 16,1 meses de permanencia media en el esquema solo mantuvieron medicación el 7,9% de ellos (3/38) con reducción en dos de los tres pacientes restantes (p < 0,001). Los 25 pacientes que cesaron o redujeron la medicación antihipertensiva lo hicieron en una media de 100 ± 15 días. La frecuencia final de hipertensión en diálisis alterna fue inferior a la que presentaban los 84 pacientes prevalentes con esquema de 4 horas x 3 sesiones x semana (60,7%) (p < 0,002) y a la de los 56 pacientes prevalentes con esquema de 5 horas x 3 sesiones x semana (25%: p = 0,065). Las diferencias entre las ganancias medias de peso entre sesiones con y sin fin de semana, los descensos medios del peso seco, las medias de tensión arterial y la frecuencia de hipotensiones, entre los pacientes en el esquema alterno y los del esquema con fin de semana y 3 sesiones de 4 horas durante la misma, alcanzaron diferencia significativa (p < 0,05). Estos mismos datos comparados con el mismo esquema pero con sesiones de 5 horas fueron mejores pero sin alcanzar significación estadística. El gasto farmacéutico en medicación antihipertensiva se redujo en un 87%. Nuestros resultados, empleando el esquema de hemodiálisis en días alternos sin descanso de 72 horas, apoyan experiencias previas (Lecce, Columbia) que consiguen controlar el peso seco tras hacer desaparecer el exceso de volumen acumulado en el fin de semana posibilitando unas tasas adecuadas de ultrafiltración, minimizando la aparición de hipertensión y de los síntomas de intolerancia en hemodiálisis, tan frecuentes en el esquema convencional

An increase in the frequency of hemodialysis sessions improves control of extracellular volume and blood hypertension and consequently reduces the mortality related to cardiovascular aetiology in hemodialysis patients. We report the evolution of the blood hypertension depending on the need for antihypertensive drugs in a group of 38 prevalent patients that were included in a every-otherday dialysis schedule (EODD), and compare it with the results in two other groups of prevalent patients that were dialyzed in conventional, previously employed schedules without week-end sessions 4hoursx3xweek and 5hoursx3xweek. All three groups received hemodialysis treatment for more than 6 months. A 68% (26/38) of the patients received antihypertensive treatment at the beginning the EODD schedule and, after 16 months, only 7.9% (3/38) of them required antihypertensive treatment (p < 0.001) with reduction in two of the three remanent patients; hypertension control in those 25 patients took an average of 100 ± 15 days. The final frequency of hypertension in EODD was lower (p < 0.002) than the frequency registered in the 84 prevalent patients in 4hx3xweek schedule, and also lower (p = 0.065) than the frequency of the 56 prevalent patients in 5hx3xweek schedule. There is a significant difference (p < 0,05) between EODD and 4hx3xweek schedule as regards average figures of: increase in weight, decrease in dry-weight, blood pressure levels and hypotension incidence. EODD also produced better results than 5hx3xweek schedule in this regard although statistics did not reflect it. The results using the every-other-day hemodialysis schedule support previous experiences (Lecce, Columbia) which achieved a good control of the dry-weight by means of suppressing the volume overload gained during the weekend and consequently obtaining adequate ultrafiltration rates and high reduction both of the hypertension and of the symptoms of intolerance to hemodialysis, which are so frequent in conventional schedules with 72 hours without hemodialysis sessions

Usefulness of duodenal biopsy during routine upper gastrointestinal endoscopy for diagnosis of celiac disease.

AIM: To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical practice. METHODS: A 15 year-trend (1990 to 2004) in duodenal biopsy performed when undertaking upper gastrointestinal endoscopy was studied. We analysed the prevalence of celiac disease in the overall group, and in the subgroups with anaemia and/or chronic diarrhoea. RESULTS: Duodenal biopsy was performed in 1033 of 13 678 upper gastrointestinal endoscopies (7.6%); an increase in the use of such was observed over the study period (1.9% in 1990-1994, 5% in 1995-1999 and 12.8% in 2000-2004). Celiac disease was diagnosed in 22 patients (2.2%), this being more frequent in women than in men (3% and 1% respectively). Fourteen out of 514 (2.7%) patients with anaemia, 12 out of 141 (8.5%) with chronic diarrhoea and 8 out of 42 (19%) with anaemia plus chronic diarrhoea had celiac disease. A classical clinical presentation was observed in 55% of the cases, 23% of the patients had associated dermatitis herpetiformis and 64% presented anaemia; 9% were diagnosed by familial screening and 5% by cryptogenetic hypertransaminasaemia. CONCLUSION: Duodenal biopsy undertaken during routine upper gastrointestinal endoscopy in adults, has been gradually incorporated into clinical practice, and is a useful tool for the diagnosis of celiac disease in high risk groups such as those with anaemia and/or chronic diarrhoea.

[Present situation of antibiotic resistances in tonsillar infections]. / Situación actual de las resistencias a antibióticos en infecciones amigdalares.

OBJECTIVE: To obtain the main responsible organisms, its sensitivity and resistances to antibiotics in tonsillitis. MATERIAL AND METHODS: We have studied the post-surgical tonsils, carrying out a microbiologic study, its culture and sensitivity. RESULTS: The most frequent isolated organisms were Staphylococcus aureus (29.3%), followed by Streptococcus pyogenes (23.4%), and Haemophilus influenzae (12.1%). The highest resistances were for the S. aureus (penicillin 91%, erythromycin 18% and 5% to the rest of the beta-lactams), followed by H. influenzae (50% clarithromycin, 30% amoxyciIlin and 2% cephalosporins) and S. pyogenes (28% erytromycin, 10% clindamycin and 3% penicillin). CONCLUSIONS: We noticed the minimal resistance found to cephalosporins, and for this reason they appear to be the safest option, except in children under five years old, in which amoxicillin is still the first line treatment, because the causative agent is S. pyogenes, sensitive to that antibiotic.

Identification of genes involved in imatinib resistance in CML: a gene-expression profiling approach.

The use of the tyrosine kinase inhibitor imatinib, which blocks the enzymatic action of the BCR-ABL fusion protein, has represented a critical advance in chronic myeloid leukemia (CML) treatment. However, a subset of patients initially fails to respond to this treatment. Use of complementary DNA (cDNA) microarray expression profiling allows the identification of genes whose expression is associated with imatinib resistance. Thirty-two CML bone marrow samples, collected before imatinib treatment, were hybridized to a cDNA microarray containing 6500 cancer genes, and analyzed using bootstrap statistics. Patients refractory to interferon-alpha treatment were evaluated for cytogenetic and molecular responses for a minimum of 12 months. A set of 46 genes was differentially expressed in imatinib responders and non-responders. This set includes genes involved in cell adhesion (TNC and SCAM-1), drug metabolism (cyclooxygenase 1), protein tyrosine kinases and phosphatases (BTK and PTPN22). A six-gene prediction model was constructed, which was capable of distinguishing cytogenetic response with an accuracy of 80%. This study identifies a set of genes that may be involved in primary resistance to imatinib, suggesting BCR-ABL-independent mechanisms.

Situación actual de las resistencias a antibióticos en infecciones amigdalares / Present situation of antibiotic resistances in tonsillar infections

Objetivo: Obtener los principales microorganismos y resistencias a antibióticos en infecciones amigdalares. Material y métodos: Realizamos un estudio microbiológico con antibiograma de amígdalas palatinas postquirúrgicas. Resultados: Los microorganismos más aislados han sido el Staphylococcus aureus (29,3%) seguido del Streptococcus pyogenes (23,4%), y del Haemophilus influenzae (12,1%). Las mayores resistencias fueron para el S. aureus (91% a la penicilina, 18% a la eritromicina y un 5% al resto de β-lactámicos), seguido del H. influenzae (50% a la claritromicina, 30% a la amoxicilina y 2% a cefalosporinas) y por último el S. pyogenes (28% a la eritromicina, 10% a la clindamicina y 3% a la penicilina). Conclusiones: Destacamos la mínima resistencia encontrada a las cefalosporinas por lo que parece ser el grupo antibiótico más seguro, excepto en los niños menores de 5 años en los cuales la amoxicilina sigue siendo de primera elección dado que están provocadas por S. pyogenes sensibles a dicho antibiótico

Objective: To obtain the main responsible organisms, its sensitivity and resistances to antibiotics in tonsillitis. Material and methods: We have studied the post-surgical tonsils, carrying out a microbiologic study, its culture and sensitivity. Results: The most frequent isolated organisms were Staphylococcus aureus (29.3%), followed by Streptococcus pyogenes (23.4%), and Haemophilus influenzae (12.1%). The highest resistances were for the S. aureus (penicillin 91%, erythromycin 18% and 5% to the rest of the β-lactams), followed by H. influenzae (50% clarithromycin, 30% amoxycillin and 2% cephalosporins) and S. pyogenes (28% erytromycin, 10% clindamycin and 3% penicillin). Conclusions: We noticed the minimal resistance found to cephalosporins, and for this reason they appear to be the safest option, except in children under five years old, in which amoxicillin is still the first line treatment, because the causative agent is S. pyogenes, sensitive to that antibiotic

[Control of arterial hypertension by means of a regimen of hemodialysis on alternate days (HDAA or EODD: "Every Other Day Dialysis") versus 2 conventional regiments of 4 and 5 hours per session 3 times a week with 72 hours without sessions during the weekends]. / Control de la hipertensión arterial mediante el esquema de hemodiálisis en días alternos (HDDA o EODD: "Every Other Day Dialysis") versus dos esquemas convencionales de 4 y 5 horas por sesión tres veces a la semana con 72 horas de fin de semana sin sesiones.

An increase in the frequency of hemodialysis sessions improves control of extracellular volume and blood hypertension and consequently reduces the mortality related to cardiovascular aetiology in hemodialysis patients.We report the evolution of the blood hypertension depending on the need for antihypertensive drugs in a group of 38 prevalent patients that were included in a every-other-day dialysis schedule (EODD), and compare it with the results in two other groups of prevalent patients that were dialyzed in conventional, previously employed schedules without week-end sessions 4 hours x 3 x week and 5 hours x 3 x week. All three groups received hemodialysis treatment for more than 6 months.A 68% (26/38) of the patients received antihypertensive treatment at the beginning the EODD schedule and, after 16 months, only 7.9% (3/38) of them required antihypertensive treatment (p < 0.001) with reduction in two of the three remanent patients; hypertension control in those 25 patients took an average of 100 +/- 15 days. The final frequency of hypertension in EODD was lower (p < 0.002) than the frequency registered in the 84 prevalent patients in 4h x 3 x week schedule, and also lower (p = 0.065) than the frequency of the 56 prevalent patients in 5h x 3 x week schedule. There is a significant difference (p < 0,05) between EODD and 4h x 3 x week schedule as regards average figures of: increase in weight, decrease in dry-weight, blood pressure levels and hypotension incidence. EODD also produced better results than 5h x 3 x week schedule in this regard although statistics did not reflect it. The results using the every-other-day hemodialysis schedule support previous experiences(Lecce, Columbia) which achieved a good control of the dry-weight by means of suppressing the volume overload gained during the weekend and consequently obtaining adequate ultrafiltration rates and high reduction both of the hypertension and of the symptoms of intolerance to hemodialysis, which are so frequent in conventional schedules with 72 hours without hemodialysis sessions.

[Systemic arterial hypertension in primary chronic glomerulonephritis: prevalence and its influence on the renal prognosis]. / Hipertensión arterial en las glomerulonefritis primarias crónicas biopsiadas: prevalencia e influencia en el pronóstico renal.

UNLABELLED: Nowadays, glomerulonephritis is one of the most common causes of End-stage Renal Disease and starting point of dialysis in Spain. Several factors may influence negatively in this prognosis; among them, we may show up the systemic arterial hypertension. Though its prevalence in the glomerulonephritis is considered higher than in other nephropathies, with variations among series, probably due to difference in ages, in geographical areas, in histological types, in time on evolution of the nephritis ... and because it is difficult to distinguish if the hypertension is a consequence of the nephritis or a consequence of the renal failure that can be present in several cases. In the same way, its negative influence in the renal prognosis may be influenced more by this renal failure, which can be its cause when it is quite severe, than by the hypertension itself. Our aims were to analyse, on the one hand the prevalence of hypertension in the 394 patients diagnosed of primary glomerulonephritis by means of a renal biopsy during two decades in the Bay of Cadiz, as well as its influence in the renal prognosis since the moment of the diagnosis, even with the absence of severe renal failure. We gathered demographic, clinical, analytical and histological data, as well as the situation of the renal function and the survival period of it at the end of each patient study. For the analysis prognosis and renal survival, Kaplan-Meier curves and the long-rank test were used. Of the 394 patients, 247 are men and 147 are women, with an average age of 36.7 +/- 17.7 years old. The global prevalence of hypertension was 39%, with a higher frequency in older patients. The gathered rate of renal survival for hypertensive patients was 54%, 28%, 20% and 4% at 5, 10, 15 and 20 years respectively; while for non-hypertensive patients, it was 83%, 75%, 66% and 62% for the same periods of time (p < 0.001). This worse tendency for hypertensive patients is observed too in each particular histological type, especially in the IgA nephropathy and membranous nephropathy. These results were the same for the patients who did not have severe renal failure in the moment of the biopsy. CONCLUSIONS: Hypertension is a common fact in the primary glomerulonephritis, which also conditions, in an important way, the renal prognosis itself in a long term, from the moment of diagnosis and even before the existence of a significant renal failure.

[Study of the biopsied nephrotic syndrome for 20 years in the Cadiz Bay Area: histological correspondence, renal prognosis and clinical prognostic factors]. / Estudio del síndrome nefrótico biopsiado durante 20 años en la bahía de Cádiz: correspondencia histológica, pronóstico renal y factores clínicos que influyen en el mismo.

AIMS: To analyse the histological correspondence, the renal survival and the clinical prognostic factors in the nephrotic syndrome for more than 20 years in our environment as well as the influence of the nephrotic proteinuria in the renal survival in the different histological particular types of glomerulonephritis. PATIENTS AND METHODS: Among the 542 primary and secondary glomerulonephritis diagnosed by kidney biopsy for two decades in the Cadiz Bay Area, we selected 242 patients whose clinical presentation and the biopsy indication was the nephrotic syndrome. Statistics methods: means +/- typical deviation, percentiles, percentages, Kaplan-Meier curves, long-rank test, student's t-test, chi-square analysis and Cox proportional hazards model test. RESULTS: 242 patients with nephrotic syndrome (44.66% out of the total of glomerulonephritis), average age of 39.15 +/- 18 years old. Average proteinuria 6.75 +/- 4.53 g/day. ETIOLOGY: membranous nephropathy (33.85%), lupus nephritis (14.46%), minimal change disease (11.57%), focal segmental glomerulosclerosis (10.33%), renal amyloidosis (9.95%). 33%, 45%, 63% and 72% of the patients with nephrotic syndrome developed to the End-stage Renal Disease and starting point of dialysis in 5, 10, 15 and 20 years respectively. After the multivariate model, the age older than 60 years old, the high levels of proteinuria and the coexistence with hypertension or renal failure, in the moment of diagnosis, showed to be independents clinical prognostic factors. The nephrotic proteinuria had a negative influence in the prognosis in the different histological types, especially in the IgA nephropathy and the lupus nephritis. CONCLUSIONS: The nephrotic syndrome is the main indication of the renal biopsy in our environment. In general, as an independent group, its development is slowly progressive to the End-stage Renal Disease, having the possibility of being also conditioned by certain clinical factors present in the moment of the biopsy. The presence of nephrotic proteinuria is also a negative factor in the progression in many of the glomerulonephritis.

[Darbepoetin in the treatment of the renal anaemia in the patient undergoing peritoneal dialysis previously treated with epoetin alfa]. / Darbepoetina alfa en el tratamiento de la anemia del paciente en diálisis peritoneal previamente tratado con epoetina alfa.

INTRODUCTION: In 2002, it was contraindicated the use of epoetin alfa by a subcutaneous way to avoid the risk of the pure red cell aplasia in chronic renal failure patients. This forced to change the prescription in the way it was supplied, which was especially problematic in predialysis and peritoneal dialysis, as treating out-patients, that is why it was necessary to change to epoetina beta o darbepoetin, where this contraindication was not established, in order to continue using this way. The darbepoetin has an average lifetime longer than the epoetin. Its efficacy and security have been well studied, especially in pre-dialysis and haemodialysis, but little less in peritoneal dialysis. AIMS: To evaluate our experience about the efficacy and security of darbepoetin alfa, by a subcutaneous way, in our programme of peritoneal dialysis, after the conversion of the patients previously treated with epoetin alfa. PATIENTS AND METHODS: 35 patients. 7 analytical and clinical controls are evaluated, 2 before and 5 after the conversion, with an interval of 6 weeks. Statistics methods: means +/- typical deviation, medians, distribution of frequencies, Wilcoxon test and Friedman test. RESULTS: The change into darbepoetin alfa has been successful in maintaining stable haemoglobin levels in patients in peritoneal dialysis, without meaningful changes in the mean levels of haemoglobin before and after the conversion. The percentage of patients with haemoglobin in the rank 11-13 g/dl (85%) has been higher with the darbepoetin, probably due to the dose increment in the patients with previous levels of haemoglobin less than 11 g/dl. The dosages might have been widely separated (7.5 +/- 3 vs 9.2 +/- 3.2 days). The darbepoetin has been well tolerated, without any important adverse effects. CONCLUSIONS: The conversion of epoetin alfa into darbepoetin alfa in peritoneal dialysis was simple, effective, secure and well tolerated.

Hipertensión arterial en las glomerulonefritis primarias crónicas biopsiadas: prevalencia e influencia en el pronóstico renal / Systemic arterial hypertension in primary chronic glomerulonephritis: prevalence and its influence in the prognosis

Las glomerulonefritis constituyen una causa importante de insuficiencia renal crónicaterminal. Varios factores pueden influir negativamente en su pronóstico; deentre ellos destaca la hipertensión arterial. Su prevalencia en las glomerulonefritises variable según las series, probablemente debido a diferencias demográficas, detipos histológicos, de tiempo de evolución en el momento del análisis o a que esdifícil diferenciar si es secundaria a la propia nefropatía o a la insuficiencia renalque puede producir ésta. Su influencia negativa en el pronóstico renal puede estarmediada más por la propia insuficiencia renal, de la que puede ser a su vez consecuenciacuando es lo suficientemente severa, que por la propia hipertensión.Nuestros objetivos fueron analizar la prevalencia de hipertensión en el momentode la biopsia renal de los 394 pacientes diagnosticados de glomerulonefritis primariaen dos décadas en la Bahía de Cádiz y su influencia en el pronóstico desdeentonces y aún en ausencia de insuficiencia renal severa.La prevalencia global de hipertensión fue del 39%, siendo más frecuente en lospacientes de mayor edad. La tasa acumulada de supervivencia renal para los hipertensosfue del 54%, 28%, 20% y 4% a los 5, 10, 15 y 20 años respectivamente;mientras que para los normotensos fue del 83%, 75%, 66% y 62% paralos mismos períodos (p < 0,001). Esta peor tendencia para los hipertensos se observaen cada tipo histológico, con especial significación en las nefropatías IgA ymembranosa. Esta influencia negativa de la hipertensión se mantuvo igualmentecuando no coexistía insuficiencia renal severa en el momento de la biopsia.Conclusiones: La hipertensión es frecuente en las glomerulonefritis primarias,condicionando el pronóstico renal a largo plazo, desde el momento del diagnósticoe incluso antes de la existencia de insuficiencia renal severa

Nowadays, glomerulonephritis are one of the most common causes of End-stageRenal Disease and starting point of dialysis in Spain. Several factors may influencenegatively in this prognosis; among them, we may show up the systemic arterialhypertension. Though its prevalence in the glomerulonephritis is consideredhigher than in other nephropathies, with variations among series, probably due todifference in ages, in geographical areas, in histological types, in time on evolutionof the nephritis… and because it is difficult to distinguish if the hypertensionis a consequence of the nephritis or a consequence of the renal failure that canbe present in several cases. In the same way, its negative influence in the renalprognosis may be influenced more by this renal failure, which can be its causewhen it is quite severe, than by the hypertension itself. Our aims were to analyse,on the one hand the prevalence of hypertension in the 394 patients diagnosedof primary glomurolonephritis by means of a renal biopsy during two decadesin the Bay of Cadiz, as well as its influence in the renal prognosis since themoment of the diagnosis, even with the absence of severe renal failure. We gathereddemographic, clinical, analytical and histological data, as well as the situationof the renal function and the survival period of it at the end of each patientstudy. For the analysis prognosis and renal survival, Kaplan-Meier curves and thelong-rank test were used.Of the 394 patients, 247 are men and 147 are women, with an average age of36.7 ± 17.7 years old. The global prevalence of hypertension was 39%, with ahigher frequency in older patients. The gathered rate of renal survival for hypertensivepatients was 54%, 28%, 20% and 4% at 5, 10, 15 and 20 years respectively;while for non-hypertensive patients, it was 83%, 75%, 66% and 62% forthe same periods of time (p < 0,001). This worse tendency for hypertensive patientsis observed too in each particular histological type, especially in the IgAnephropathy and membranous nephropathy. These results were the same for thepatients who did not have severe renal failure in the moment of the biopsy.Conclusions: Hypertension is a common fact in the primary glomerulonephritis,which also conditions, in an important way, the renal prognosis itself in a longterm, from the moment of diagnosis and even before the existence of a significantrenal failure

[Benefits of every other day dialysis (EODD) without rest for 72 hours in patients with symptomatic cardiovascular disease]. / Beneficios de la hemodiálisis en días alternos sin descanso de 72 horas (EODD: every other day dialysis) en pacientes con enfermedad cardiovascular sintomática.

With the purpose to improve the clinical situation of nine hemodialysis patients who suffer from severe cardiovascular disease and are highly symptomatic after weekends without dialysis because of fluid overload, their dialysis schedule was changed from 5 hours in 3 sessions per week to 4 hours every other day sessions (EODD), avoiding 72 hours of interdialitic weekend period. In each patient, during 38 sessions previous to starting the EODD (stage 1: 3 months) and the 38 sessions in EODD, which followed the first month of this dialysis regime (stage 2), the frequency of the next incidences was registered (ratio in 348 sessions, in every stage, of this patients group): presence of dysnea and/or hypertension pre dialysis session, pre or intra dialysis angor, emergency sessions with hypotension and sessions without achieving predetermined dry-weight. During the EODD stage, sessions, with dysena, hypertension and pre or intra dialysis angor were reduced in 80% (p < 0.001); the incidence of sessions with hypotensive episode or sessions without achieving dry-weight decreased in a third. All patients experimented a considerable improvement in their clinical situation. In addition, the whole group reduced dry-weight and later regained it without presenting symptoms which had motivated EODD schedule. EODD schedule improves the clinical situation in patients with cardiopathy who would not do so when following previous schedule (which includes 48 hours without dialysis).

Estudio del síndrome nefrótico biopsiado durante 20 años en la bahía de Cádiz: correspondencia histológica, pronóstico renal y factores clínicos que influyen en el mismo / Study of the biopsied nephrotic syndrome for 20 years in the Cadiz bay area: histological correspondence, renal prognosis and clinical prognostic factors

Objetivos: Analizar la correspondencia histológica, la supervivencia renal y losfactores pronósticos clínicos en el síndrome nefrótico, a la vez que estudiar la influenciade la proteinuria nefrótica en la supervivencia renal de los distintos tiposhistológicos de glomerulonefritis crónicas.Pacientes y métodos: 542 pacientes diagnosticados de glomerulonefritis primariaso secundarias mediante biopsia renal durante dos décadas en la Bahía de Cádiz, delos que en 242 la presentación clínica e indicación de biopsia fue el síndrome nefrótico.Estadística: Medias,medianas, percentiles, porcentajes, curvas de Kaplan-Meier,test de long-rank, t de student, chi-cuadrado, modelo de riesgo proporcional de Cox.Resultados: De los 542 pacientes con glomerulonefritis 242 presentaban síndromenefrótico (44,66%). Edad media 39,15 ± 18 años. Proteinuria media 6,75 ±4,53 g/día. Etiología: nefropatía membranosa (33,85%), lúpica (14,46%), cambiosmínimos (11,57%), focal y segmentaria (10,33%), amiloidosis renal (9,95%). El33%, 45%, 63% y 72% de los pacientes con síndrome nefrótico evolucionaron ala IRCT a los 5, 10, 15 y 20 años respectivamente (media de supervivencia renalde 10,6 años). Mediante análisis multivariante, los factores pronósticos clínicos independientesfueron la edad mayor de 60 años, los niveles elevados de proteinuriay la presencia de HTA o insuficiencia renal en el momento del diagnóstico. Laproteinuria nefrótica condicionó negativamente el pronóstico en las distintas formashistológicas, fundamentalmente en las nefropatías IgA y lúpica.Conclusiones: El síndrome nefrótico es la principal indicación de biopsia renalen nuestro medio. En general, y como grupo único, independiente de su etiologíaconcreta, su evolución es lentamente progresiva hacia la IRCT, pudiendo sercondicionada además por determinados factores clínicos presentes en el momentode la biopsia. La proteinuria nefrótica es, además, un factor de progresión enmuchas de las glomerulonefritis

Aims: To analyse the histological correspondence, the renal survival and the clinicalprognostic factors in the nephrotic syndrome for more than 20 years in ourenvironment as well as the influence of the nephrotic proteinuria in the renal survivalin the different histological particular types of glomerulonephritis.Patients and methods: Among the 542 primary and secondary glomerulonephritisdiagnosed by kidney biopsy for two decades in the Cadiz Bay Area, we selected242 patients whose clinical presentation and the biopsy indication was thenephrotic syndrome. Statistics methods: means ± typical deviation, percentiles, percentages,Kaplan-Meier curves, long-rank test, student’s t-test, chi-square analysisand Cox proportional hazards model test.Results: 242 patients with nephrotic syndrome (44.66% out of the total of glomerulonephritis),average age of 39.15 ± 18 years old. Average proteinuria 6.75± 4,53 g/day. Etiology: membranous nephropathy (33.85%), lupus nephritis(14.46%), minimal change disease (11.57%), focal segmental glomerulosclerosis(10.33%), renal amyloidosis (9.95%). 33%, 45%, 63% and 72% of the patientswith nephrotic syndrome developed to the End-stage Renal Disease and startingpoint of dialysis in 5, 10, 15 and 20 years respectively. After the multivariate model,the age older than 60 years old, the high levels of proteinuria and the coexistencewith hypertension or renal failure, in the moment of diagnosis, showed to beindependents clinical prognostic factors. The nephrotic proteinuria had a negativeinfluence in the prognosis in the different histological types, especially in the IgAnephropathy and the lupus nephritis.Conclusions: The nephrotic syndrome is the main indication of the renal biopsyin our environment. In general, as an independent group, its development is slowlyprogressive to the End-stage Renal Disease, having the possibility of being alsoconditioned by certain clinical factors present in the moment of the biopsy. Thepresence of nephrotic proteinuria is also a negative factor in the progression inmany of the glomerulonephritis

Darbepoetina alfa en el tratamiento de la anemia del paciente en diálisis peritoneal previamente tratado con epoetina alfa / Darbepoetin in the treatment of the renal anaemia in the patient undergoing peritoneal dialysis previously treated with epoetin alfa

Introducción: En el año 2002 se contraindicó el empleo de epoetina alfa víasubcutánea para minimizar el riesgo de aplasia pura de células rojas. Esto obligóa un cambio de prescripción en su vía de administración, lo que fue especialmenteproblemático en prediálisis y diálisis peritoneal, por tratarse de pacientesambulatorios, siendo necesario cambiar a epoetina beta o darbepoetina, en lasque no se estableció esta contraindicación. La darbepoetina tiene una vida mediasuperior a la epoetina. Su eficacia y seguridad han sido bien estudiadas, sobretodo en prediálisis y hemodiálisis, pero menos en diálisis peritoneal.Objetivos: Analizar nuestra experiencia en cuanto a la eficacia y seguridad deltratamiento con darbepoetina alfa por vía subcutánea para la corrección de laanemia renal en los pacientes del programa de diálisis peritoneal tratados previamentecon epoetina alfa.Material y métodos: Treinta y cinco pacientes en diálisis peritoneal. Se analizanlos parámetros analíticos y los acontecimientos clínicos en 7 controles, 2 antes y5 después de la conversión a darbepoetina, con intervalos de 6 semanas. Estadística:Medias ± ds, medianas, frecuencias, tests de Wilcoxon y Friedman.Resultados: El cambio a darbepoetina alfa ha sido efectivo para mantener valoresde hemoglobina estables en los pacientes en diálisis peritoneal, sin cambiossignificativos en los niveles medios de hemoglobina antes y después de la conversión.El porcentaje de pacientes con hemoglobina en el rango 11-13 g/dl (85%)ha sido mayor con la darbepoetina, probablemente como consecuencia del incrementode la dosis en aquellos pacientes con niveles de hemoglobina previosmenores de 11 g/dl. Aunque no fue objetivo inicial, las dosis han podido ser distanciadas(7,5 ± 3 vs 9,2 ± 3,2 días). La darbepoetina ha sido bien tolerada, sinefectos adversos importantes.Conclusiones: La conversión de epoetina alfa a darbepoetina alfa en diálisis peritonealfue sencilla, eficaz y segura

Introduction: In 2002, it was contraindicated the use of epoetin alfa by a subcutaneousway to avoid the risk of the pure red cell aplasia in chronic renal failurepatients. This forced to change the prescription in the way it was supplied,which was especially problematic in predialysis and peritoneal dialysis, as treatingout-patients, that is why it was necessary to change to epoetina beta o darbepoetin,where this contraindication was not established, in order to continue using thisway. The darbepoetin has an average lifetime longer than the epoetin. Its efficacyand security have been well studied, especially in pre-dialysis and haemodialysis,but little less in peritoneal dialysis.Aims: To evaluate our experience about the efficacy and security of darbepoetinalfa, by a subcutaneous way, in our programme of peritoneal dialysis, after theconversion of the patients previously treated with epoetin alfa.Patients and methods: 35 patients. 7 analytical and clinical controls are evaluated,2 before and 5 after the conversion, with an interval of 6 weeks. Statisticsmethods: means ± typical deviation, medians, distribution of frequencies, Wilcoxontest and Friedman test.Results: The change into darbepoetin alfa has been successful in maintainingstable haemoglobin levels in patients in peritoneal dialysis, without meaningfulchanges in the mean levels of haemoglobin before and after the conversion. Thepercentage of patients with haemoglobin in the rank 11-13 g/dl (85%) has beenhigher with the darbepoetin, probably due to the dose increment in the patientswith previous levels of haemoglobin less than 11 g/dl. The dosages might havebeen widely separated (7.5 ± 3 vs 9.2 ± 3.2 days). The darbepoetin has beenwell tolerated, without any important adverse effects.Conclusions: The conversion of epoetin alfa into darbepoetin alfa in peritonealdialysis was simple, effective, secure and well tolerated

Beneficios de la hemodiálisis en días alternos sin descanso de 72 horas (EODD: Every other day dialysis) en pacientes con enfermedad cardiovascular sintomática / Benefits of every other day dialysis (eodd) on dialysis patients with symptomatic cardiovascular disease

Con el objetivo de mejorar la situación clínica de un grupo de nueve pacientes enhemodiálisis con patología cardiovascular severa, que mantenía síntomas causadospor expansión de volumen con mala tolerancia al fin de semana sin diálisis, cambiamosla pauta de tres sesiones semanales de 5 horas con descanso de fin de semanapor el régimen de hemodiálisis en días alternos con sesiones de 4 horas sin descansode 72 horas en el fin de semana.En cada paciente, durante las 38 sesiones del esquema primitivo previas al inicio dela diálisis alterna (fase 1: 3 meses) y en las 38 sesiones del esquema alterno (fase 2)que siguieron al primer mes de su inicio se registraron las frecuencias por sesión de lasincidencias siguientes: presencia de disnea y/o hipertensión arterial antes de la sesión,angor pre o intradiálisis, sesiones urgentes no programadas, sesiones con hipotensióny sesiones sin lograr el peso seco.Los resultados se expresan en porcentaje de incidencias en 348 sesiones del grupode pacientes en cada fase de los dos esquemas de diálisis.En la fase de hemodiálisis en días alternos las sesiones del grupo con disnea, hipertensióno angor se redujo en un 80% (p < 0,001); las sesiones con al menos una hipotensióny aquellas en las que no se alcanzó el peso seco disminuyeron en un tercio.Todos los pacientes experimentaron una mejoría clínica importante y bajaron elpeso seco para recuperarlo posteriormente sin reaparición de los síntomas que motivaronel cambio de esquema.La hemodiálisis en días alternos es un sistema que mejora la clínica de los pacientescon patología cardiovascular respecto al esquema de 5 horas en 3 sesiones semanalescon dos días sin diálisis

With the purpose to improve the clinical situation of nine hemodialysis patients whosuffer from severe cardiovascular disease and are highly symptomatic after weekendswithout dialysis because of fluid overload, their dialysis schedule was changed from5 hours in 3 sessions per week to 4 hours every other day sessions (EODD), avoiding72 hours of interdialitic weekend period.In each patient, during 38 sessions previous to starting the EODD (stage 1: 3months) and the 38 sessions in EODD, which followed the first month of this dialysisregime (stage 2), the frequency of the next incidences was registered (ratio in 348 sessions,in every stage, of this patients group): presence of dysnea and/or hypertensionpre dialysis session, pre or intra dialysis angor, emergency sessions with hypotensionand sessions without achieving predetermined dry-weight.During the EODD stage, sessions, with dysena, hypertension and pre or intra dialysisangor were reduced in 80% (p < 0.001); the incidence of sessions with hypotensiveepisode or sessions without achieving dry-weight decreased in a third.All patients experimented a considerable improvement in their clinical situation. Inaddition, the whole group reduced dry-weight and later regained it without presentingsymptoms which had motivated EODD schedule.EODD schedule improves the clinical situation in patients with cardiopathy whowould not do so when following previous schedule (which includes 48 hours withoutdialysis)

Eficacia de la monoterapia con piperacilina-tazobactam en infecciones del área maxilofacial / Efficacy of single drug therapy with piperacillin-tazobactam in infections of the maxillofacial area

Objetivo: Las infecciones del área maxilofacial representan un motivo habitual de consulta para los cirujanos maxilofaciales, siendo las más frecuentes las de origen dental. Estas infecciones son frecuentemente polimicrobianas, por lo que el objetivo del presente estudio ha sido evaluar la eficacia clínica y seguridad de piperacilina-tazobactam en el tratamiento de las infecciones del área maxilofacial. Diseño del estudio: Estudio multicéntrico y prospectivo en donde 79 pacientes con infecciones del área maxilofacial recibieron piperacilina-tazobactam como tratamiento antibiótico. Resultados: La evolución clínica de los pacientes fue favorable en un 97,5 por ciento de los pacientes y la eficacia microbiológica obtenida al final del tratamiento fue del 96,2 por ciento. Se presentaron reacciones adversas en 5 pacientes (6,3 por ciento): 2 casos de mareo, 2 de dispepsia y un caso de flebitis. En ningún caso se precisó la discontinuación del fármaco. Conclusiones: La eficacia clínica y microbiológica junto con la escasez de efectos adversos presentados, hace de piperacilina-tazobactam una alternativa eficaz en el manejo de estas infecciones (AU)

[Localized Castleman's disease: description of a case and review of the literature]. / Enfermedad de Castleman localizada: descripción de un caso y revisión de la literatura.

Castleman's disease is a rare entity which is caracterized by its histological features: hyperplasia of lymph nodes and capillary proliferation. Two histological patterns has been described: hyaline vascular type and plasma cell type. From a clinical viewpoint has been identified two different clinical course: a localized type (ECL) usually of benign clinical course and a multicentric type (ECM) of worst prognosis. We present a case of Castleman"s disease localized in the neck region in which the excision was both diagnostic and therapeutic. The variety histological was hyaline-vascular type.

Enfermedad de Castleman localizada: descripción de un caso y revisión de la literatura / Localized castleman's disease: description of a case and review of the literature

La enfermedad de Castleman (EC) es una entidad rara definida por sus hallazgos anatomopatológicos: hiperplasia de las células dendríticas de los ganglios linfáticos y marcada proliferación capilar. Se han descrito dos tipos histológicos: la variedad hialinovascular y la plasmocelular. Desde el punto de vista clínico se han identificado dos cuadros bien diferenciados: la forma localizada (ECL), de curso clínico benigno, y la forma multicéntrica (ECM) de peor pronóstico. Presentamos un caso de EC localizada en la región cervical, en la que la resección quirúrgica de la adenopatía resultó ser diagnóstica y terapéutica. La variedad histológica fue del tipo hialinovascular (AU)

Castleman’s disease is a rare entity which is caracterized by its histological features: hyperplasia of lymph nodes and capillary proliferation. Two histological patterns has been described: hyaline vascular type and plasma cell type. From a clinical viewpoint has been identified two different clinical course: a localized type (ECL) usually of benign clinical course and a multicentric type (ECM) of worst prognosis. We present a case of Castleman´s disease localized in the neck region in which the excision was both diagnostic and therapeutic. The variety histological was hyaline-vascular type (AU)

[Intra-laryngeal ectopic thyroid tissue. Report of one case and review of the literature]. / Tejido tiroideo ectópico intralaríngeo. Presentación de un caso clínico y revisión de la literatura.

A Ectopic thyroid is any thyroid tissue not located in his normal anatomic situation. There have been described four general groups within the upper aerodigestive tract: lingual, sublingual, thyroglossal and intralaryngotracheal. Intralaryngotracheal thyroid tissue is rare and constitute 7 per cent of all intratracheal tumours, and it represents a problem of diagnosis and management. The controversy about the genesis of this tumours remains. There are two established theories: "the malformation theory" and "the ingrowth theory". These tumours affect more frequently adult female. Intralaryngotracheal thyroid have been mainly reported on the posterior-left wall of the trachea. The most common clinical feature is stridor due to progressive upper airway obstruction. Up to 75% of the intralaryngotracheal goiters are associated with and external goiter. This paper reports a case of ectopic subglotic thyroid in a 42 year-old-female. The embryology, diagnosis and management of this tumours are discussed.

Tejido tiroideo ectópico intralaríngeo. Presentación de un caso clínico y revisión de la literatura / Intralaryngeal ectopic thyroid tissue. Report of one case and review of the literature

El tiroides ectópico es un tejido tiroideo que no se localiza en su posición anatómica normal. Se han descrito cuatro grupos de tiroides ectópico a nivel del tracto aereodigestivo superior: lingual, sublingual, tirogloso e intralaringotraqueal, siendo el lingual la localización más frecuente. El tiroides intralaringotraqueal es un trastorno raro, constituyendo el 7 por ciento de todos los tumores intratraqueales. Es la forma de tiroides ectópico que más frecuentemente pasa desapercibido y origina la clínica más severa. Su etiopatogenia no es bien conocida, existiendo dos teorías que tratan de explicar la aparición de tejido tiroideo aberrante en el interior de la luz traqueal: "la teoría de la malformación" y "la teoría invasiva". Su mayor incidencia se da en mujeres de mediana edad. A nivel intralaringotraqueal la localización más frecuente es la pared posterolateral izquierda. La clínica de presentación habitual es la disnea progresiva alta, destacando la asociación con un cuadro bociógeno en el 75 por ciento de los casos. Presentamos el caso clínico de una paciente de 42 años con un tiroides ectópico subglótico. Discutimos los aspectos más relevantes con relación a la embriología, diagnóstico y tratamiento de estas lesiones (AU)

A Ectopic thyroid is any thyroid tissue not located in his normal anatomic situation. There have been described four general groups within the upper aerodigestive tract: lingual, sublingual, thyroglossal and intralaryngotracheal. Intralaryngotracheal thyroid tissue is rare and constitute 7 per cent of all intratracheal tumours, and it represents a problem of diagnosis and management. The controversy about the genesis of this tumours remains. There are two established theories: "the malformation theory" and "the ingrowth theory". These tumours affect more frequently adult female. Intralaryngotracheal thyroid have been mainly reported on the posterior-left wall of the trachea. The most common clinical feature is stridor due to progressive upper airway obstruction. Up to 75% of the intralaryngotracheal goiters are associated with and external goiter. This paper reports a case of ectopic subglotic thyroid in a 42 year-old-female. The embryology, diagnosis and management of this tumours are discussed (AU)

Molecular and genomic characterization of human DLEC, a novel member of the C-type lectin receptor gene family preferentially expressed on monocyte-derived dendritic cells.

We have identified a novel gene encoding a protein designated DLEC (dendritic cell lectin), which is a type II membrane glycoprotein of 213 amino acids and belongs to the human calcium-dependent (C-type) lectin family. The cytoplasmic tail of DLEC lacks consensus signaling motifs and its extracellular region shows a single carbohydrate recognition domain (CRD), closest in homology to the dendritic cell immunoreceptor (DCIR) CRD. The DLEC gene has been localized linked to DCIR on the telomeric region of the NK gene complex. RT-PCR and Northern blot analyses show that DLEC mRNA is preferentially expressed in monocyte-derived dendritic cells.