[Langerhans cell histiocytosis]. / Histiocitosis de células de Langerhans.

We describe the case of male diagnosed with histiocytosis of Langerhans cells. Histiocytosis X is an interstitial disease with a real incidence and an unknown prevalence that can be suspected due to epidemiological and radiological data. The diagnosis can be realized using BAL and/or anatomo-pathological study of a biopsy. The principal treatment is to give up the tobacco habit. Evolution can be favourable.

Histiocitosis de células de Langerhans / Langerhans cell histiocytosis

Se describe el caso de un varón con diagnóstico de histiocitosis de células de Langerhans. La histiocitosis X es una enfermedad intersticial con una incidencia real y una prevalencia desconocidas que puede sospecharse por datos epidemiológicos y radiológicos. El diagnóstico puede realizarse mediante BAL y/o estudio anatomo-patológico de biopsia. El principal tratamiento consiste en abandonar el hábito tabáquico. La evolución puede ser variable (AU)

We describe the case of male diagnosed with histiocytosis of Langerhans cells. Histiocytosis X is an interstitial disease with a real incidence and an unknown prevalence that can be suspected due to epidemiological and radiological data. The diagnosis can be realized using BAL and/or anatomo-pathological study of a biopsy. The principal treatment is to give up the tobacco habit. Evolution can be favourable (AU)

Estudio anatomopatológico de aislados de Leptospira spp., provenientes de Nicaragua en Mesocricetus auratus como biomodelo / Anatomopathologic study of Leptospira spp., isolated in Nicaragua in Mesocricetus auratus as biomodel

Objetivo. El objetivo de este trabajo fue caracterizar en el biomodelo Mesocricetus auratus la sintomatología y lesiones anatomopatológicas que provocan 5 aislados clínicos de Leptospira spp., provenientes de Nicaragua. Materiales y métodos. Con este fin se inocularon 50 hámster por vía i.p con 1mL del cultivo de cada una de las cepas en fase exponencial teniendo una concentración celular de 7.5 x 106 leptospira/mL (10 animales por cepa), evaluándose signos de la enfermedad, mortalidad durante 14 días, lesiones anatomopatológicas macroscópicas y microscópicas mediante tinción con hematoxilina-eosina y tinción de Warthyn Starryn. Resultados. Todas las cepas presentaron alta mortalidad, mostrando un cuadro tanto clínico, como lesional característico de la infección experimental. Además, causaron la muerte al 100% de los animales entre el tercer y décimo día postinfección. En el estudio anatomopatológico la cepa del serogrupo Ballum y la del serogrupo Pomona produjeron focos de hemorragias específicamente en el riñón y pulmones. De forma similar ocurrió una congestión hepática y renal, mientras que la hemorragia renal fue observada con mayor frecuencia en la cepa del serogrupo Pomona, diferenciándose del resto de las cepas que mostraron esta lesión con menos frecuencia. Conclusiones. Este trabajo permitió una mayor caracterización de estas cepas siendo utilizadas como futuras candidatas vacunales frente a una nueva epidemia de Leptospirosis en Nicaragua.

Objective. The aim of this study was to characterize the symptomatology and anatomopathological lesions caused by 5 clinical isolated Leptospira spp. from Nicaragua in a Mesocricetus auratus biomodel. Materials and methods. 50 hamsters were inoculated via i.p with 1mL of the culture of each strain in exponential phase having a cellular concentration of 7.5 x 106 leptospira/mL, (10 animals per strain). Signs of the disease, mortality during 14 days, and macroscopic and microscopic anatomopathological lesions by haematoxylin-eosin and Warthyn Starryn stain technique were evaluated. Results. All the strains presented high mortality, showing clinical lesions of the experimental infection. Death to 100% of the animals was caused between the third and tenth day post-infection. In the anatomopathologic study, the strains of the Ballum and Pomona serogroup produced haemorrhaging specifically in the kidney and lungs. The animals manifested hepatic and renal congestion, while the renal haemorrhage was observed with more frequency in the strain of the Pomona serogroup, differing from the other strains, which presented this lesion less frequently. Conclusions. This work allowed a better characterization of these strains in order to use them as future vaccine candidates for future Leptospirosis epidemics in Nicaragua.

Co-infection with Ascaris lumbricoides modulates protective immune responses against Giardia duodenalis in school Venezuelan rural children.

We evaluated the effect of Ascaris lumbricoides on Giardia duodenalis infection and TH1/TH2 type immune mechanisms toward this parasite in 251 rural parasitized and 70 urban non-parasitized school children. The children were classified according to light (0-5000 eggs/g faeces) or moderate (>5001-50,000 eggs/g faeces) A. lumbricoides infection. Anti G. duodenalis skin hyper-reactivity, IgE, IgG, IL-13, IFN γ, IL6 and IL-10 levels were compared among G. duodenalis infected and non-infected children according to light or moderate A. lumbricoides infection. It was found that 62% of the A. lumbricoides moderately infected children were co-infected by G. duodenalis compared to 45% of the lightly infected group. After treatment, 42% of the A. lumbricoides moderately group were infected with G. duodenalis compared to 11% of their lightly counterparts, being A. lumbricoides IL-10 levels higher (p<0.0001) in the moderately infected group. In the A. lumbricoides lightly parasitized children, G. duodenalis infection was associated to a significant increase (p<0.005) of the levels of G. duodenalis IL-13, IFN-γ, IL-6, IgE, IgG and skin test hyper reactivity. In contrast, there was no effect of G. duodenalis infection in the elevation of these parameters among the A. lumbricoides moderately parasitized group, being those levels similarly lower as those observed in the control group. Inverse correlations were found between the levels of anti G duodenalis antibodies, skin test hyper-reactivity and cytokines with the intensity of A. lumbricoides infection (p>0.0001) and A. lumbricoides IL-10 levels (p>0.0001), suggesting that co-infection with A. lumbricoides may affect both TH1 and TH2 type immunity against G. duodenalis that may play an important role in the susceptibility to the infection after chemotherapy in children from endemic areas.

Proteinuria in the prognosis of IgA nephropathy.

IgA Nephropathy (IgAN) is the most common lesion causing primary glomerulonephritis in the world. The main clinical predictors of progression are: elevated blood pressure, high histological score and proteinuria. Although elevated serum creatinine concentration at diagnosis, increased excretion of cytochines, age at onset, obesity and genetic factors may all influence clinical outcome, it is quite clear that proteinuria is the hallmark of renal damage in IgAN. Patients with IgAN and little or no proteinuria (<500 mg/day) have low risk of progression in the short term, while the rate of decline in renal function is 25-fold faster in those with sustained proteinuria >3 g/day. The product of duration (years) and urinary protein excretion (g/day) at the time of renal biopsy is more significantly correlated with progression. So, this so called proteinuria index may be a useful predictor for glomerular and interstitial histopathological changes and the fate of renal function in IgAN. The progression of IgAN may be slowed by antihypertensive and antiproteinuric therapy, such as angiotensin converting enzyme inhibitors and/or angiotensin II receptor blockers, that can minimize secondary glomerular injury. Proteinuria has been shown to be an adverse prognostic factor in IgAN, with a strong relationship between proteinuria and prognosis and established importance of remission. Consequently, targeting proteinuria may be a valid surrogate for individualized kidney protective therapy.

ID2-VEGF-related pathways in the pathogenesis of Kaposi's sarcoma: a link disrupted by rapamycin.

The Id-proteins are a family of four related proteins implicated in the control of differentiation and cell-cycle progression. Down-regulation of Id-gene expression is essential for the differentiation of several cell types. In addition, deregulated Id2 activity inhibits the Rb tumor suppressor pathway and promotes the expression of vascular endothelial growth factor (VEGF). Several members of VEGF family could be involved in Kaposi's sarcoma (KS) development and progression. Lymphatic vascular endothelial hyaluronan receptor-1 (LYVE-1) is the first marker of lymphatic endothelial competence during development in the mature vasculature, and is also expressed on KS spindle cells. Rapamycin (RAPA), an immunosuppressive drug, has been shown to reverse KS growth and to reduce tumor angiogenesis. We evaluate, in transplantation-associated KS and in cultured KS-cells the RAPA effect on Id2 and on de novo lymphangiogenesis. Markers of lymphatic-endothelial-cells (VEGFR-3, LYVE-1) and Id2, expressed at low levels within the normal skin, were up-regulated in KS and returned to normal levels after RAPA introduction. The association between Id2 and lymphangiogenesis is suggested by co-localization of Id2, VEGFR-3 and LYVE-1. RAPA inhibition on Id2 expression was confirmed in vitro in KS-cells, both in basal conditions and upon stimulation with VEGF. In conclusion, our data would suggest a novel molecular mechanism for the antineoplastic effects of RAPA in posttransplant KS.

[Health-related quality of life in patients with chronic kidney disease]. / Qualita' della vita nei nefropatici.

Assessment of quality of life in patients with different degrees of chronic kidney disease is an important issue because of its impact on clinical decisions and financial resource management in the health-care system. The aim of this study was to assess whether a generic instrument like the SF-36 questionnaire is able to discriminate three different populations of patients with different degrees of renal disease (pre-ESRD, ESRD, TxR). Five hundred sixty-three patients from 12 Italian nephrology units completed the SF-36 scales by themselves. The results from these samples were compared with those from the general population. Univariate analysis and multivariate regression were used. The generic SF-36 questionnaire proved to be a powerful instrument to discriminate populations with different degrees of chronic renal failure. The quality of life of patients on dialysis is significantly worse than that of the normal population and other patients with less severe renal function impairment.

[Nocturnal hemodialysis: an alternative treatment for a better quality of life]. / Emodialisi notturna: un trattamento alternativo per una migliore qualità della vita.

The interest of investigators in intensified dialysis regimens has been growing in recent years, especially since the HEMO Study Group showed that a higher dose of thrice-weekly hemodialysis fails to reduce mortality and morbidity but improves clinical outcomes. Alternative hemodialysis strategies including short daily hemodialysis (SDHD), long hemodialysis (LHD) and nocturnal daily hemodialysis (NDHD) have been developed in the hope to improve patients' outcomes. A growing number of investigators are studying patients on alternative dialysis regimens and most publications in this field have reported significant improvements in clinical outcomes including left ventricular hypertrophy, blood pressure control, anemia, calcium-phosphate metabolism, and fluid and electrolyte balance; all of these parameters can be considered as indirect signs of improvement in quality of life. However, the strength of these results is often limited by shortcomings in study design. Indeed, in most of these studies an adequate control group is missing, the patient groups are not properly matched, and the number of patients enrolled is small. Similarly, most studies have evaluated the effects of NDHD and/or nocturnal LHD on health-related quality of life (HRQoL) by questionnaire administration. Even though better results might be achieved with nocturnal hemodialysis, no conclusive data exist to prove statistically significant differences in HRQoL between conventional and intensive hemodialysis. In conclusion, all of these novel dialysis strategies offer reliable opportunities for uremic patients, but further trials are needed to determine whether alternative hemodialysis can reduce morbidity and mortality in this high-risk population of patients.

Ischemia-reperfusion injury-induced abnormal dendritic cell traffic in the transplanted kidney with delayed graft function.

Delayed graft function (DGF) in kidney transplantation is associated with an increased risk of acute rejection. Myeloid dendritic cells (DCs) are involved in graft rejection, whereas plasmacytoid DCs may play a role in inducing tolerance. We evaluated the presence and phenotype of the DCs in renal graft biopsies of 15 patients with DGF collected before and 7-15 days after transplantation. Biopsies taken from normal patients and from transplant recipients with acute calcineurin inhibitors (CNIs) nephrotoxicity served as a control group. Specific markers of myeloid, plasmacytoid, and mature DCs were imaged by confocal microscopy and immunohistochemistry. In normal kidneys and pre-transplant biopsies, sparse niches of myeloid and plasmacytoid cells were found but these were significantly increased with few mature cells during DGF. This same pattern was seen in acute rejection but with overall higher cell numbers. In CNI nephrotoxicity, myeloid cells were slightly increased but plasmacytoid cells were significantly higher than in DGF. Using a pig model, we found that a short period of warm ischemia followed by reperfusion led to myeloid cell infiltration of the kidney. Our data suggest that ischemia-reperfusion injury may cause an imbalance between intragraft myeloid and plasmacytoid DCs, which might be related to DGF and acute rejection.

[Pro and anti-neoplastic effects of immunosuppressive drug in renal transplantation]. / Effetti pro ed anti-neoplastici dei principali farmaci immunosoppressori usati nella pratica clinica trapiantologica.

The increased efficiency of immunosuppressive drugs obtained in the last few years has significantly reduced the incidence of acute rejection, prolonging transplant survival rates. The inevitable trade-off was however an increased rate of post-transplant infections and malignancies. Furthermore, this problem might get more and more serious in the next future due to the increasing incidence of cancer in immunosuppressed transplant recipients; the introduction of new immunosuppressive strategies is expected to extend significantly allograft survival. The inclusion of older recipients in transplant programs will also likely increase this problem. Thus, cancer may represent a serious cause of morbidity and mortality in patients otherwise successfully treated by organ transplantation. Nevertheless, effective approaches to deal with malignancies in immunosuppressed patients are still far from the clinical arena. Therefore, once cancer occurs in a transplant recipient, clinicians only have two options: to reduce or withdraw the immunosuppression eventually causing acute or chronic allograft rejection, or to continue the standard immunosuppressive therapy while beginning specific therapy for the malignancy. Several clinical studies suggest that the use of immunosuppressive drugs may result in increased cancer incidence, in transplant as well as autoimmune disease patients. This clinical observation is supported by experimental data showing that these drugs enhance cancer cell growth characteristics and inhibit DNA repair mechanisms, clearly suggesting that the increased incidence of neoplastic disease in patients treated with several immunosuppressive drugs is at least partially independent of their immunosuppressive action. In this scenario it is of particular interest the fact that some immunosuppressive drugs have both an anti-rejection and anti-neoplastic activity. In this review we focus our attention on this potential dual role of immunosuppressive therapy in the development of neoplasia in transplanted patients.

[Malign pleural mesothelioma]. / Mesotelioma pleural maligno.

Malign mesothelioma is a pleural neoplasia related to the occupational exposure to asbestos, although other factors can be involved; its incidence is increasing in Western Europe. Pain in the thorax and dyspnoea are its most frequent clinical manifestations. An important role in the evaluation of the disease is played by imaging techniques, of which CAT is the most widely used, although MR and PET are suggested as techniques that can provide additional information in the diagnosis and prognosis of these patients. Survival is short and there is no consensus in the literature that would orientate treatment of these patients. This is due to a lack of data that would confirm an increase of survival with any therapeutic method, although recent efforts have led to the development of new treatments that could change the present pessimistic view of the disease held by doctors and patients.

[Other obstructive diseases: byssinosis, chronic bronchitis and occupational COPD and eosinophilic bronchitis]. / Otras enfermedades obstructivas: bisinosis, bronquitis crónica y EPOC de origen laboral y bronquitis eosinofílica.

Besides occupational asthma and diseases derived from acute inhalation, other obstructive diseases also have an occupational origin. Although at present byssinosis is a rare disease in Spain, we describe its characteristics because of its historical interest amongst occupational respiratory diseases and because it is still relevant in developing countries. Chronic bronchitis can also be related to exposure at work to dust and smoke, and is often referred to as "industrial bronchitis". Historically, the relation of CPOD to occupation has been subject to controversy, but nowadays this relationship is accepted; we describe the present evidence supporting this relationship. Finally, we describe eosinophilic bronchitis without asthma, an entity that was described for the first time in 1989 and that can sometimes have an occupational origin, sharing aetiological agents with occupational asthma.

[Occupational lung cancer]. / Carcinoma de pulmón de origen laboral.

Bronchopulmonary carcinoma is the first cause of death by cancer in males, its principal cause being tobacco consumption. Nonetheless, different studies have attributed a certain, by no means negligible percent of its aetiology to the occupational exposure to agents considered carcinogenic such as asbestos, with which half of the cases of occupational lung cancer are related. Given the low survival rate of this pathology, preventive measures directed at identifying carcinogenic agents and reducing exposure to them are extremely important. Given that the clinical presentation does not differ from tobacco-related carcinoma, a high level of suspicion, based on a meticulous occupational history, is fundamental to its diagnosis. Due to the synergic effect of tobacco, measures aimed at reducing its consumption continue to be extremely important in the exposed population.

[Registry of occupational respiratory diseases in Navarre]. / Registro de enfermedades respiratorias de origen laboral en Navarra.

BACKGROUND: In January 2002 an occupational respiratory diseases record was established in Navarre so that the number and characteristics of the occupational respiratory pathology could be analysed. METHODS: The cases reported by doctors who collaborated in 2002, 2003 and 2004, were entered in a database for subsequently analysis. This database has several variables: gender, age, tobacco habit, hospital department and notifying doctor, diagnosis, job and causal agent. RESULTS: 125 cases were reported. 97 males (77.6%) and 28 females (22.4%). Average age was 55,4 years old. Eighty-eight were non-smokers (70.4%) and 37 were smokers (29.6%). Pneumology reported 84 cases (67.2%) and Allergology 41 (32.8%). The diagnoses were: 50 bronchial asthma (40%), 31 benign pleural disease (24.8%), 8 extrinsic allergic alveolitis (6.4%), 8 mesothelioma (6.4%), 7 bronchopulmonary cancer (5.6%), 5 acute inhalations (4%), 3 amianthinopsy (2.4%), 2 rhinitis (1.6%), 1 RADS (0.8%) and 1 COPD (0.8%). The most reported jobs were: 13 painting and varnishing (10.4%), 12 spinning asbestos yarn (9.6%) and 8 bakery and confectionery (6.4%). The main causal agents were: 49 cases of asbestos (39.2%), 15 isocyanates (12%) and 8 silica (6.4%). CONCLUSIONS: The most frequent pathology was bronchial asthma, followed by benign pleural disease. The most reported job was painting and varnishing and secondly spinning asbestos yarn. Asbestos was the first substance involved and the second was isocyanates. Most of the patients were males and non-smokers. The Pneumology Service of the Virgen del Camino Hospital reported most of the cases. Ratio contrast analysis showed a certain tendency towards a statistical significance in rhinitis, occupational asthma and amianthinopsy.

[Immunosuppressive drugs and renal transplantation]. / Farmaci immunosoppressori e trapianto renale.

Although the use of new immunosuppressive drugs, and their combination have drastically reduced the incidence of acute rejections, the graft survival is unchanged in the last ten years. The immunosuppressive drugs can be divided in four classes, according to their different site of molecular action: proliferative signal inhibitors, amplification signal inhibitors; STATs inhibitors, DNA synthesis inhibitors. Steroids act on immune system through several mechanisms. Azathioprine is an anti-metabolite that inhibits de-novo synthesis of purins, acting on S-phase of cellular cycle. Mycophenolate-Mofetil (MMF) is also an anti-metabolite, purine synthesis inhibitor that, differently from azathioprine, acts specifically on IMPDH (Inositolmonophosphate-dehydrogenasis) through a non-competitive mechanism. Calcineurin inhibitors (cyclosporin and tacrolimus) act on amplification of intracellular signal. The most important therapeutic side-effect of calcineurin inhibitors is the nephrotoxicity. Other inhibitor agents of the amplification signal are monoclonal antibodies anti-á chain of IL-2 (CD25). Another drug used in the last years, is sirolimus (SRL) or rapamycine, an immunosuppressive agent that act, through the inhibition of T lymphocyte activation.

Mesotelioma pleural maligno / Malign pleural mesothelioma

El mesotelioma maligno es una neoplasia pleuralrelacionada con la exposición laboral a amianto, aunqueotros factores pudieran estar implicados, con unaincidencia en aumento en Europa Occidental. El dolortorácico y la disnea son sus manifestaciones clínicasmás frecuentes. Las técnicas de imagen juegan unpapel importante en la evaluación de la enfermedad,siendo la TAC las más ampliamente utilizada, si bien laRM y el PET se postulan como técnicas que puedenaportar información adicional en el diagnóstico y pronósticode estos pacientes. La supervivencia es corta yno existe un consenso en la literatura que guíe el tratamientode estos pacientes debido a la falta de datosque apoyen un aumento de supervivencia de ningunamodalidad terapéutica, si bien, recientemente losesfuerzos realizados han llevado al desarrollo de nuevostratamientos que podrían cambiar la actual visiónpesimista de la enfermedad por parte de médicos ypacientes

Malign mesothelioma is a pleural neoplasia relatedto the occupational exposure to asbestos, althoughother factors can be involved; its incidence isincreasing in Western Europe. Pain in the thorax anddyspnoea are its most frequent clinical manifestations.An important role in the evaluation of the disease isplayed by imaging techniques, of which CAT is themost widely used, although MR and PET are suggestedas techniques that can provide additional informationin the diagnosis and prognosis of these patients.Survival is short and there is no consensus in theliterature that would orientate treatment of thesepatients. This is due to a lack of data that wouldconfirm an increase of survival with any therapeuticmethod, although recent efforts have led to thedevelopment of new treatments that could change thepresent pessimistic view of the disease held by doctorsand patients

Otras enfermedades obstructivas: bisinosis, bronquitis crónica y EPOC de origen laboral y bronquitis eosinofílica / Other obstructive diseases: byssinosis, chronic bronchitis and occupational COPD and eosinophilic bronchitis

Además del asma ocupacional y las enfermedadesderivadas de la inhalación aguda, otras enfermedadesobstructivas también reconocen un origen laboral.Aunque en la actualidad la bisinosis es una enfermedadrara en España, describimos las características de lamisma por su interés histórico dentro de las enfermedadesrespiratorias de origen laboral y porque todavíasigue vigente en los países en vías de desarrollo. Labronquitis crónica también puede estar relacionadacon la exposición laboral a polvos y humos, con frecuenciadenominada “bronquitis industrial”. La relaciónocupacional de la EPOC ha sido más controvertidaa lo largo de la historia, pero en la actualidad estarelación está aceptada; describimos la evidencia actualque sustenta esta relación. En último lugar, describimosla bronquitis eosinofílica sin asma, entidad descritapor primera vez en 1989 y que en ocasiones tambiénpuede tener un origen laboral, compartiendo agentesetiológicos con el asma ocupacional

Besides occupational asthma and diseases derivedfrom acute inhalation, other obstructive diseases alsohave an occupational origin. Although at presentbyssinosis is a rare disease in Spain, we describe itscharacteristics because of its historical interestamongst occupational respiratory diseases andbecause it is still relevant in developing countries.Chronic bronchitis can also be related to exposure atwork to dust and smoke, and is often referred to as“industrial bronchitis”. Historically, the relation ofCPOD to occupation has been subject to controversy,but nowadays this relationship is accepted; wedescribe the present evidence supporting thisrelationship. Finally, we describe eosinophilicbronchitis without asthma, an entity that wasdescribed for the first time in 1989 and that cansometimes have an occupational origin, sharingaetiological agents with occupational asthma

Carcinoma de pulmón de origen laboral / Occupational lung cancer

El carcinoma broncopulmonar es la primera causade muerte por cáncer en varones, siendo su principalcausa el consumo de tabaco; no obstante, diversosestudios han atribuido un tanto por ciento no despreciablede su etiología a la exposición laboral a agentesconsiderados cancerígenos como el asbesto, con elque tiene relación la mitad de los casos de cáncer pulmonarde origen laboral. Dada la baja supervivencia deesta patología, son de suma importancia las medidasde prevención encaminadas a identificar los agentescancerígenos y a la disminución de su exposición.Puesto que la presentación clínica no difiere del carcinomarelacionado con el tabaco, un alto grado de sospecha,basado en una cuidadosa historia laboral, esfundamental para su diagnóstico. Debido el efectosinérgico del tabaco, medidas destinadas a disminuirsu consumo, continúan siendo de suma importancia enla población expuesta

Bronchopulmonary carcinoma is the first cause ofdeath by cancer in males, its principal cause beingtobacco consumption. Nonetheless, different studieshave attributed a certain, by no means negligiblepercent of its aetiology to the occupational exposure toagents considered carcinogenic such as asbestos, withwhich half of the cases of occupational lung cancer arerelated. Given the low survival rate of this pathology,preventive measures directed at identifyingcarcinogenic agents and reducing exposure to them areextremely important. Given that the clinicalpresentation does not differ from tobacco-relatedcarcinoma, a high level of suspicion, based on ameticulous occupational history, is fundamental to itsdiagnosis. Due to the synergic effect of tobacco,measures aimed at reducing its consumption continueto be extremely important in the exposed population

Registro de enfermedades respiratorias de origen laboral en Navarra / Registry of occupational respiratory diseases in Navarre

Fundamento. Con objeto de analizar la incidenciay características de la patología respiratoria ocupacionalen Navarra, se implantó en enero de 2002 el Registrode Enfermedades Respiratorias de Origen Laboral.Métodos. Los casos notificados por los médicoscolaboradores durante los años 2002, 2003 y 2004, seintrodujeron en una base de datos diseñada para suanálisis posterior, que constaba de distintas variables:sexo, edad, tabaco, servicio y médico declarante, diagnóstico,profesión y agente causal.Resultados. Se notificaron 125 casos. 97 varones(77,6%) y 28 mujeres (22,4%). La media de edad fue 55,4años. Ochenta y ocho pacientes no fumaban (70,4%) y37 eran fumadores (29,6%). Neumología declaró 84casos (67,2%) y Alergología 41 (32,8%). Los diagnósticosfueron: 50 casos de asma bronquial (40%), 31 deenfermedad pleural benigna (24,8%), 8 alveolitis alérgicaextrínseca (6,4%), 8 mesotelioma (6,4%), 7 cáncerbroncopulmonar (5,6%), 5 inhalaciones agudas (4%), 3asbestosis (2,4%), 2 rinitis (1,6%), 1 RADS (0,8%) y 1EPOC (0,8%). Las profesiones más declaradas: 13 pintura/barnizado (10,4%), 12 hilado de ovillos de amianto(9,6%) y 8 panadería/pastelería (6,4%). Como agentescausales principales: 49 casos de asbesto (39,2%),15 isocianatos (12%) y 8 sílice (6,4%).Conclusiones. La patología más frecuente fue elasma bronquial, seguida de la enfermedad pleuralbenigna. La profesión más notificada era pintura/barnizadoy en segundo lugar hilado de ovillos. El asbestofue la primera sustancia implicada seguida de los isocianatos.La mayoría de pacientes eran varones y nofumadores. El Servicio de Neumología del Hospital Virgendel Camino notificó el mayor número de casos. Elanálisis de contraste de proporciones mostró ciertatendencia a la significación en rinitis, asma bronquial yasbestosis

Background. In January 2002 an occupationalrespiratory diseases record was established in Navarreso that the number and characteristics of theoccupational respiratory pathology could be analysed.Methods. The cases reported by doctors whocollaborated in 2002, 2003 and 2004, were entered in adatabase for subsequently analysis. This database hasseveral variables: gender, age, tobacco habit, hospitaldepartment and notifying doctor, diagnosis, job andcausal agent.Results. 125 cases were reported. 97 males (77.6%)and 28 females (22.4%). Average age was 55,4 years old.Eighty-eight were non-smokers (70.4%) and 37 weresmokers (29.6%). Pneumology reported 84 cases(67.2%) and Allergology 41 (32.8%). The diagnoseswere: 50 bronchial asthma (40%), 31 benign pleuraldisease (24.8%), 8 extrinsic allergic alveolitis (6.4%), 8mesothelioma (6.4%), 7 bronchopulmonary cancer(5.6%), 5 acute inhalations (4%), 3 amianthinopsy(2.4%), 2 rhinitis (1.6%), 1 RADS (0.8%) and 1 COPD(0.8%). The most reported jobs were: 13 painting andvarnishing (10.4%), 12 spinning asbestos yarn (9.6%)and 8 bakery and confectionery (6.4%). The maincausal agents were: 49 cases of asbestos (39.2%), 15isocyanates (12%) and 8 silica (6.4%).Conclusions. The most frequent pathology wasbronchial asthma, followed by benign pleural disease.The most reported job was painting and varnishing andsecondly spinning asbestos yarn. Asbestos was thefirst substance involved and the second wasisocyanates. Most of the patients were males and nonsmokers.The Pneumology Service of the Virgen delCamino Hospital reported most of the cases. Ratiocontrast analysis showed a certain tendency towards astatistical significance in rhinitis, occupational asthmaand amianthinopsy

[Cardiovascular risk and renal transplantation]. / Il rischio cardiovascolare nel paziente con trapianto renale.

Cardiovascular disease after renal transplantation is often the expression of a disease process that first started with the onset of renal dysfunction many years before, and its prevention starts with the early predialysis phase of chronic renal failure and with the aggressive treatment of hypertension and dyslipidemia. The evidence that dialysis treatment itself accelerates arterial damage is poor. After transplantation, however, many patients are restored to a state not of normal renal function but of chronic renal impairment and have drug-induced hypertension and dyslipidemia, resulting in a vastly increased risk of atherosclerosis. Further research is required on optimal strategies to prevent or ameliorate cardiovascular disease, to establish the roles of lipid-lowering and antihypertensive therapies after transplantation and to define immunosuppressive ad hoc treatments for each kind of patient.