Documento de consenso sobre el manejo de la patología renal en pacientes con infección por VIH / Consensus document on the management of renal disease in HIV-infected patients

OBJETIVO: Actualizar las recomendaciones sobre la evaluación y el manejo de la afectación renal en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). MÉTODOS: Este documento ha sido consensuado por un panel de expertos del Grupo de Estudio de Sida (GESIDA) de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), de la Sociedad Española de Nefrología (S.E.N.) y de la Sociedad Española de Química Clínica y Patología Molecular (SEQC). Para la valoración de la calidad de la evidencia y la graduación de las recomendaciones se ha utilizado el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTADOS: La evaluación renal debe incluir la medida de la concentración sérica de creatinina, la estimación del filtrado glomerular (ecuación chronic kidney disease epidemiological collaboration [CKD-EPI]), la medida del cociente proteína/creatinina en orina y un sedimento urinario. El estudio básico de la función tubular ha de incluir la concentración sérica de fosfato y la tira reactiva de orina (glucosuria). En ausencia de alteraciones, el cribado será anual. En pacientes tratados con tenofovir o con factores de riesgo para el desarrollo de enfermedad renal crónica (ERC), se recomienda una evaluación más frecuente. Se debe evitar el uso de antirretrovirales potencialmente nefrotóxicos en pacientes con ERC o factores de riesgo para evitar su progresión. En este documento se revisan las indicaciones de derivación del paciente a Nefrología y las de la biopsia renal, así como las indicaciones y la evaluación y el manejo del paciente en diálisis o del trasplante renal. CONCLUSIONES: La función renal debe monitorizarse en todos los pacientes con infección por el VIH y este documento pretende optimizar la evaluación y el manejo de la afectación renal.(AU)

OBJECTIVE: To update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients. METHODS: This document was approved by a panel of experts from the AIDS Working Group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Nephrology (S.E.N.), and the Spanish Society of Clinical Chemistry and Molecular Pathology (SEQC). The quality of evidence and the level of recommendation were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, Urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document advises on the optimal time for referral of a patient to the nephrologist and provides indications for renal biopsy. The indications for and evaluation and management of dialysis and renal transplantation are also addressed. CONCLUSIONS: Renal function should be monitored in all HIV-infected patients. The information provided in this document should enable clinicians to optimize the evaluation and management of HIV-infected patients with renal disease.(AU)

Asociación de la rigidez peneana nocturna con testosterona, síndrome metabólico y otras variables: un estudio piloto prospectivo transversal / Association of Nocturnal Penile Rigidity with Testosterone, Metabolic Syndrome, and Other Variables: a Prospective Cross-Sectional Pilot Study

Introducción: El objetivo fue estudiar la relación entre la rigidez peneana nocturna (RPN) con el síndrome metabólico (SM) y la testosterona en varones que consultan por trastornos de erección (DE). Material y método: Se incluyeron 234 varones en un estudio piloto prospectivo y transversal. Se midieron los niveles séricos de testosterona total y biodisponible y otros parámetros bioquímicos relacionados con el SM y con las RPN. Los pacientes se agruparon según la rigidez de las erecciones: normales (alta rigidez, componente predominante psicológico de la disfunción) o anormales (baja rigidez, posible componente orgánico o físico de la DE) y por la presencia o ausencia de SM. Resultados: El modelo de regresión logística para la rigidez del pene como variable dependiente demostró que el riesgo de rigidez anormal es menor en individuos con mayor testosterona total (OR=0,96; 95% CI=0,92-0,99) o biodisponible (OR=0,91; 95% CI=0,84-0,99). Pacientes con niveles de testosterona entre 8 y 12 mmol/L presentaron un riesgo cuatro veces mayor de tener rigidez anormal comparados con aquellos con niveles superiores a 12 mmol/L (OR=3,96; 95% CI=1,89, 8,31). Si se consideraban únicamente aquellos varones sin SM, solo la edad y el índice de masa corporal (IMC) aparecían como factores de riesgo asociados a la rigidez anormal. La edad aumentó el riesgo de rigidez anormal en un 8% (OR=1,08; 95% CI=1,03-1,13) y el IMC lo aumentó en un 18% (OR=1,18; 95% CI=1,01-1,38). Conclusión: La asociación de niveles de testosterona con la rigidez del pene fue baja y desaparece si se asocia con SM (AU)

Introduction: The aim was to study whether nocturnal penile rigidity (NPTR) correlates with metabolic syndrome (MetS) and testosterone in men consulting for erectile dysfunction (ED). Material and methods: 234 men were included in a prospective, cross-sectional pilot study. Serum total and bioavailable testosterone and other biochemical constituents were measured and compared with NPTR. Patients were classified by normal or low/abnormal penile rigidity (abnormal meaning predominant organic component of ED) and presence or absence of MetS to test the hypothesized correlations. Results: Application of the logistic regression model to rigidity as the dependent variable showed the risk of low penile rigidity to be significantly lower for patients with higher total (OR=0.96, 95% CI=0.92-0.99) or bioavailable testosterone (OR=0.91, 95% CI=0.84-0.99). Patients with testosterone levels between 8 and 12 mmol/L had a quadrupled risk of low penile rigidity compared with patients with higher levels (>12 mmol/L) (OR=3.96, 95% CI=1.89-8.31). Considering men without MetS, age and body mass index were associated as significant factors for low penile rigidity: age increased risk by 8% (OR=1.08, 95% CI=1.03-1.13) and BMI increased it by 18% (OR=1.18, 95% CI=1.01-1.38). Conclusion: Testosterone levels are weakly associated with penile rigidity and disappear when associated with MetS (AU)

[Association of nocturnal penile rigidity with testosterone, metabolic syndrome, and other variables: a prospective cross-sectional pilot study]. / Asociación de la rigidez peneana nocturna con testosterona, síndrome metabólico y otras variables: un estudio piloto prospectivo transversal.

INTRODUCTION: The aim was to study whether nocturnal penile rigidity (NPTR) correlates with metabolic syndrome (MetS) and testosterone in men consulting for erectile dysfunction (ED). MATERIAL AND METHODS: 234 men were included in a prospective, cross-sectional pilot study. Serum total and bioavailable testosterone and other biochemical constituents were measured and compared with NPTR. Patients were classified by normal or low/abnormal penile rigidity (abnormal meaning predominant organic component of ED) and presence or absence of MetS to test the hypothesized correlations. RESULTS: Application of the logistic regression model to rigidity as the dependent variable showed the risk of low penile rigidity to be significantly lower for patients with higher total (OR=0.96, 95% CI=0.92-0.99) or bioavailable testosterone (OR=0.91, 95% CI=0.84-0.99). Patients with testosterone levels between 8 and 12 mmol/L had a quadrupled risk of low penile rigidity compared with patients with higher levels (>12 mmol/L) (OR=3.96, 95% CI=1.89-8.31). Considering men without MetS, age and body mass index were associated as significant factors for low penile rigidity: age increased risk by 8% (OR=1.08, 95% CI=1.03-1.13) and BMI increased it by 18% (OR=1.18, 95% CI=1.01-1.38). CONCLUSION: Testosterone levels are weakly associated with penile rigidity and disappear when associated with MetS.

Eritrosedimentación. Revisión de la evidencia científica / Eritrosedimentation. Review of the clinical evidence

La velocidad de sedimentación globular refleja un aumento inespecífico de un grupo heterogéneo de proteínas (reactantes) que se sintetizan el hígado y cuya cantidad en la circulación aumenta rápidamente en presencia de inflamación y necrosis tisular. El gran número de factores que afectan el valor (muchas de ellas no patológicas) ha llevado a la búsqueda de pruebas alternativas. Dada su inespecificidad no debe ser utilizada como prueba de cribado de enfermedad en población asintomática (AU)

The globular sedimentation rate reflects a nonspecific increase of a heterogeneous group of proteins (reactants) which are synthesized in the liver and whose number increases rapidly in the circulation in the presence of inflammation and tisular necrosis. The large number of factors affecting the value (no may pathological) led the research for alternative tests. Known its unspecificity should not be used as a screening test for disease in asymptomatic people (AU)

[Tables estimating glomerular filtration rate from plasma creatinine]. / Tablas para la estimación del filtrado glomerular a partir de la creatinina plasmática.

Chronic kidney disease (CKD) and its related complications have become an important health and social problem. Very expensive resources are required in end-stage renal disease, and both complications of CKD as well as the important associated cardiovascular risk demand for interventions long before renal substitution therapies are needed. Thus, early diagnosis of CKD is currently considered of paramount importance, and it is based essentially upon the estimation of the glomerular filtration rate by formulae such as the abbreviated equation of the MDRD study. Nevertheless, in spite of international published recommendations, an automatic calculation to estimate the glomerular filtration rate (GFR) from serum creatinine is not reported by most laboratories yet and the need for creatinine assay standardisation is far from being implemented. Thus, we have designed some tables to show the creatinine value corresponding to different GFR for ages between 20 and 90 y/o, at 5 years intervals and in both sexes with both the MDRD-4 and MDRD-IDMS equations (Modification of Diet in Renal Disease-Isotope Dilution Mass Spectrometry). Moreover, we have created a global table including an estimation of GFR from plasma creatinine, age and sex by the MDRD-IDMS formula, the recommended for those laboratories which measure serum creatinine with assays aligned to the reference method. These tables aim to increase the awareness of the different assays for serum creatinine and to facilitate the diagnosis of CKD converting serum creatinine into GFR. This action should allow not only the early detection but also the possibility to establish the appropriate medical actions recommended after CKD detection.

Tablas para la estimación del filtrado glomerular a partir de la creatinina plasmática / Tables for estimating glomerular filtration rate from plasma creatinine

La enfermedad renal crónica (ERC) y las complicaciones que de ella se derivan se ha convertido en un importante problema social y sanitario, tanto por los recursos que se requieren en los estadios finales de la enfermedad como por las complicaciones secundarias a la propia ERC y a su elevado riesgo cardiovascular asociado. Hoy se considera de gran valor el diagnóstico precoz, basándose la definición y la clasificación actuales fundamentalmente en la estimación del filtrado glomerular (FG) por medio de fórmulas como la ecuación abreviada del estudio MDRD. No obstante, a pesar de las recomendaciones internacionales, no en todos los laboratorios es posible el cálculo automático del FG a partir de la creatinina plasmática ni se ha enfatizado la necesidad de estandarización de los métodos de medición de la misma. Es por ello que hemos diseñado unas tablas en las que se ha calculado el valor de creatinina correspondiente a los diferentes FG con significación clínica para cada una de las edades comprendidas entre 20y 90 años y a intervalos de 5 años en ambos sexos con lasfórmulas MDRD-4 y MDRD-IDMS (Modification of Diet in Renal Disease-Isotope Dilution Mass Spectrometry). Además hemos creado una tabla que integra de forma global una estimación del FG a partir de la creatinina plasmática por el método MDRD-IDMS que es el recomendado para aquellos laboratorios que utilizan un método de medición de la creatinina con trazabilidad respecto al método de referencia de espectrometría de masas por dilución isotópica. Estas tablas pretenden, no sólo incrementar la conciencia de la existencia de distintos ensayos en la medida de la creatinina sérica que influyen sobre la estimación del FG, sino también el facilitar el diagnóstico de la ERC a partir de la conversión de la creatinina plasmática en FG, para permitirá sí el diagnóstico precoz y el establecimiento de las acciones precisas que se recomiendan tras su detección (AU)

Chronic kidney disease (CKD) and its related complications have become an important health and social problem. Very expensive resources are required in end-stage renal disease, and both complications of CKD as well as the important associated cardiovascular risk demand for interventions long before renal substitution therapies are needed. Thus, early diagnosis of CKD is currently considered of paramount importance, and it is based essentially upon the estimation of the glomerular filtration rate by formulae such as the abbreviated equation of the MDRD study. Nevertheless, in spite of international published recommendations, an automatic calculation to estimate the glomerular filtration rate (GFR) from serum creatinine is not reported by most laboratories yet and the need for creatinine as say standardisation is far from being implemented. Thus, we have designed some tables to show the creatinine value corresponding to different GFR for ages between 20 and 90 y/o, at 5years intervals and in both sexes with both the MDRD-4 and MDRD-IDMS equations (Modification of Diet in Renal Disease-Isotope Dilution Mass Spectrometry). Moreover, we have created a global table including an estimation of GFR from plasma creatinine, age and sex by the MDRD-IDMS formula, the recommended for those laboratories which measure serum creatinine with assays aligned to the reference method. These tables aim to increase the awareness of the different assays for serum creatinine and to facilitate the diagnosis of CKD converting serum creatinine into GFR. This action should allow not only the early detection but also the possibility to establish the appropriate medical actions recommended after CKD detection (AU)

Documento de consenso: Recomendaciones sobre la utilización de ecuaciones para la estimación del filtrado glomerular en adultos / Recommendations for the use of equations to estimate glomerular filtration rate in adults

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Prognostic parameters other than Gleason score for the daily evaluation of prostate cancer in needle biopsy.

OBJECTIVE: To evaluate in prostate needle biopsies the usefulness and the efficacy of not time-consuming morphologic parameters in order to predict whether prostate cancer is organ-confined or it is not, that could contribute additional information to pre-surgical serum PSA and Gleason score, both of them parameters already accepted as clinically significant. METHODS: Three hundred and two consecutive patients were evaluated, of whom a diagnostic needle biopsy and the radical prostatectomy specimen with no pre-surgical hormone therapy were available. Bilateral or unilateral extension, number of positive cores, percentage of positive cores, intraprostatic perineural invasion (IPNI) and the presence of high-grade prostatic intraepithelial neoplasia (HGPIN) in any of the biopsy cores were evaluated in the needle biopsy. RESULTS: The median of cores is 6. The IPNI, the presence of bilateral tumour, and the percentage of positive cores, higher than 37.5% (ROC curve), show significant crude OR (4.0, 2.8, 6.9 respectively). The regression model discloses that only the percentage of positive cores shows a significant OR (5.8) adjusting for bilaterality, IPNI, HGPIN and age. CONCLUSIONS: The percentage of cores with cancer and the bilateral involvement are another two parameters predictive of cancer with extraprostatic extension. (p<0.0005 in both). IPNI has statistical significance too (p<0.002), but it is related to the tumour volume expressed through the two mentioned parameters.

Interpretación de las pruebas de laboratorio (II). Valores de referencia / Interpretation of laboratorial analysis (II). Reference values

Existen diversos factores, no relacionados con la existencia de enfermedad, que deben ser tenidos en cuenta para interpretar correctamente los resultados producidos en el laboratorio clínico. Estos factores pueden clasificarse en tres tipos: (I) fuentes de variabilidad de los resultados, (II) los valores de referencia y (III) los índices de rendimiento de las pruebas diagnósticas. En un artículo anterior se trató sobre las fuentes de variabilidad en los resultados. El segundo artículo de esta serie trata sobre el concepto y utilización de valores de referencia, su representatividad e idoneidad, poniendo especial énfasis en sus limitaciones

Different factors, not related to disease, should be taken into account for an accuratet interpretation of laboratory tests. Tbese factors could be classified as: (I) sources of variability in test results, (II the reference values and (III) the diagnostic accuracy of laboratory tests. Our previous article refered to the sources of variability in laboratory test results. This second article is focused on the concept and utilization of reference values, their representativity and suitability with special emphasis in their limitations

Determining factors of the response to hyperhomocysteinemia treatment in renal transplant patients.

Hyperhomocysteinemia (hyperHcy) is a risk factor for cardiovascular disease. The benefits of lowering homocysteinemia (Hcy) in renal transplant recipients through vitamin treatment are not clearly understood. The objective of this study was to establish the demographic, renal, Hcy metabolism, and microinflammation factors that determined the response to folic acid and vitamin B complex treatment in stable patients with renal transplants and hyperHcy. We studied 65 renal transplant patients with baseline hyperHcy. The mean baseline Hcy level of these patients was 22.5 micromol/L. Following treatment it fell to 14.5 micromol/L, an overall reduction of 35.5%. Forty-one patients (63%) were classified as responders; the remainder (37%), nonresponders. A bivariance analysis suggested the only significant differences between responding and nonresponding patients were the pre-treatment Hcy level and the renal function level.

Factors involved in baseline hyperhomocysteinemia in renal transplantation.

Hyperhomocysteinemia (hyperHcy) is one cardiovascular risk. The objective of this study was to establish the prevalence demographic, and clinical and analytical factors related to hyperhomocysteinemia among renal transplant patients. The mean Hcy level was 17.3 micromol/L; the prevalence of hyperHcy was 61.2%. The population was categorized as hyperHcy and normal-homocysteinemia (Hcy) patients. Those subjects with hyperHcy were mostly men, with lower intraerythrocyte folate and vitamin B(12) levels, higher fibrinogen levels, and poorer renal function. Multivariate evaluation showed that creatinine clearance, plasma intraerythrocyte folate and vitamin B(12) levels, and plasma fibrinogen levels were independently associated with Hcy levels. Even though the Hcy level was slightly higher among patients who suffered a posttransplantation cardiovascular event, this was statistically significant.

Nuevos conceptos sobre la enfermedad renal crónica y sus implicaciones / No disponible

La National Kidney Foundation americana ha definido recientemente criterios que definen un nuevo concepto denominado enfermedad renal crónica. Más o menos discutibles, suponen un importante método de estandarización de rápida aceptación internacional. En este artículo se revisa la nueva definición y estadios, los métodos de diagnóstico y evaluación, sus complicaciones y asociaciones, así como sus factores de progresión a estadios terminales con necesidad de tratamiento sustitutivo. Asimismo se establece el importante nuevo vínculo de la enfermedad renal crónica como factor de riesgo cardiovascular (AU)

The American National Kidney Foundation has recently defined new criteria to define the concept of chronic Kidney disease (CKD). Althougt they are partially under discussion, they have become a very helpful way of standarization and widely internationally accepted. In this article, we review the new definition and stages, the diagnostic and evaluation methods, complications and associations, as well as progression factors to end stage renal disease. It is also underlined the important newly recognized link between chronic kidney disease and cardiovascular risk (AU)

Interpretación de las pruebas de laboratorio. (I) Fuentes de variabilidad en los resultados / No disponible

Existen diversos factores, no relacionados con la existencia de enfermedad, que deben ser tenidos en cuenta para interpretar correctamente los resultados obtenidos en el laboratorio clínico. Estos factores pueden clasificarse en tres tipos: (I) fuentes de variabilidad de los resultados, (II) los valores de referencia y (III) los índices de rendimiento de las pruebas diagnósticas. El conocimiento de estos factores contribuirá, sin lugar a dudas, a una mejora en la interpretación de los resultados producidos en el laboratorio, a una disminución del uso inapropiado del mismo y por lo tanto a una utilización más coste-efectiva del laboratorio clínico. Este artículo trata sobre las fuentes de variabilidad de los resultados: la variabilidad preanalítica, la variabilidad biológica y la variabilidad analítica. Se muestra con la ayuda de un ejemplo como las distintas fuentes de variabilidad pueden afectar al resultado final de una prueba de laboratorio. En próximos artículos de la serie se tratarán los valores de referencia y los índices de rendimiento de las pruebas diagnósticas (AU)

The aim of this article is to describe factors, not related to disease, to take into account in the interpretation of laboratory test. These factors could be classified as: (I) sources of variability in test results, (II) the reference values and (III) the diagnostic accuracy of laboratory test. The knowledge of these factors is an important tool to improve the interpretation of laboratory results, to decrease the misure of laboratory services and to promote a more cost-effective laboratory utilization. This article deals with the sources of variability in laboratory test results: the preanalytical variability, the biological variability, and the analytical variability. It shows, using an exemple, bow the different sorts of variability affect the test results. Next articles will deal with the reference values and the diagnostic accuracy of laboratory test (AU)

Assessment of cyclosporine therapeutic monitoring with C2 concentrations in stable renal allograft recipients.

The optimal long-term C2 target to minimize the risk of chronic allograft nephropathy (CAN) has not yet been established in a prospective study. Furthermore, it is not known whether the target is the same in patients who also receive mycophenolate mofetil (MMF). We determined the 2-hour postdose concentration (C2) in a cohort of 65 maintenance renal transplant patients. The mean C0 level was 0.12 microg/mL and the C2 was 0.62 microg/mL. The overexposed patients are 14%. There was a good correlation between C0 and C2, and between C2 and the cyclosporine (CsA) dose. Patients receiving MMF display lower levels of C0 and C2, lower dosages of CsA, and higher levels of plasma creatinines. We did not observe significant differences on relating the level of absorption to patient age and sex, creatinine level, CsA dose, or coadministration of MMF. In conclusion, there is a low incidence of overexposed patients. C2 levels of approximately 0.6 microg/mL (and possibly may be sufficient in renal transplant patients. somewhat lower [0.5 microg/mL] in patients receiving MMF) Patients who display slow or fast absorption of CsA do not have any apparent characteristic.

Complicaciones cardiovasculares del trasplantado añoso / Cardiovascular complications of the elderly transplanted patient

En los últimos años, la muerte con riñón funcionante (sobre todo de origen cardiovascular) junto a la nefropatía crónica del trasplante son las causas más frecuente de pérdida de injerto renal según múltiples estudios practicados Aunque después del trasplante mejora el pronóstico desde el punto de vista cardiovascular, el riesgo de muerte por causa cardiovascular sigue siendo muy alto si lo comparamos con la población general. Tanto los factores bien determinados de riesgo cardiovascular (diabetes, hipertensión arterial, tabaquismo, dislipemia) como los ahora emergentes en la población general también afectan a la población de pacientes trasplantados que tiene sobreañadidos otros factores inherentes a la disfunción del injerto. El aumento progresivo de la mortalidad cardiovascular en trasplante renal se debe a factores demográficos, a la disminución de la mortalidad en el post-trasplante inmediato y al efecto del tratamiento inmunosupresor. Ante las evidencias científicas de que la patología cardiovascular en el trasplantado renal añoso es un importante problema, que además aumenta con los años, deben plantearse estrategias para intentar paliar el problema. Debe practicarse un screening pre-trasplante renal para seleccionara-los pacientes que pueden beneficiarse del mismo o corregir aquellas patologías cardiovasculares que ya existen pretrasplante, y intervenir sobre los factores de riesgo cardiovascular conocidos en la población general (colesterol, presión arterial diabetes y tabaquismo), dado que éstos son mucho más prevalentes en la población trasplantada. El manejo de algunos de los factores de riesgo pueden tener un efecto positivo en la enfermedad cardiovascular del trasplantado, tales como el uso de fármacos antihipertensivos e hipolipemiantes, el control de la glucosa, la profilaxis con aspirina y la abstinencia tabdquica. Sin embargo hay menos evidencia sobre el impacto real de la reducción de peso, el uso de antioxidantes, los agentes que disminuyen la homocisteína, la terapia substitutiva hormonal con estrógenos o la profilaxis de determinadas infecciones (AU)

Evolución en la procedencia de los pacientes remitidos a un centro de salud mental privado en el ámbito rural en la comunidad autónoma aragonesa / Source of patients derived to a private mental health service in a country setting from the Aragon autonomous community

Introducción Basándonos en el principio del compromiso con la comunidad, el objetivo del presente estudio es analizar la evolución que ha sufrido la procedencia de los pacientes psiquiátricos remitidos a nuestro Centro de Salud Mental de Casetas-Utebo desde su inicio en 1994, tras haber aplicado nuestro método de implantación. Material y métodos Se estudian los datos sociodemográficos y diagnósticos de las 700 primeras historias vistas en nuestro Centro de Salud Mental, así como su procedencia (remitidos por médicos de atención primaria, familiares u otros).Resultados 1. Se confirma la captación de 1/3 de la patología psiquiátrica potencial de nuestra zona. 2. Se observa un incremento estadísticamente significativo de pacientes remitidos por parte de profesionales sanitarios en los cinco años de existencia de nuestro centro (alcanzando el 90 por ciento), así como una progresiva disminución de los remitidos por otras fuentes, con diferencias estadísticamente significativas. Conclusiones Consideramos cumplidos nuestros objetivos iniciales de implantación del CSM en la zona de Utebo-Casetas. Consideramos asimismo imprescindible mantener evaluaciones periódicas de nuestros resultados para ajustarlos a nuevas demandas dentro de la Salud Mental Comunitaria (AU)

Pharmacological properties of quinoxaline derivatives as a new class of 5-HT3 receptor antagonists.

The pharmacological profile of five quinoxaline derivatives, a new class of 5HT3 receptor antagonists, is reported in the present study. All of the new compounds antagonized the effect of the selective 5-HT3 receptor agonist 2-methyl-5-HT in the isolated longitudinal muscle-myenteric plexus preparation (LMMP) of guinea-pig ileum. One of them, VC-605) was approximately three orders of magnitude more potent than ondansetron. In binding studies to 5-HT3 receptors from rat cerebral cortex membranes only VC-605 showed an affinity comparable to ondansetron. In the isolated rat oesophageal tunica muscularis mucosae preparation the new compounds, like 2-methyl-5-HT, only produced relaxation of the contraction induced by carbachol at high concentrations. In vivo, the quinoxaline derivatives were weak antagonists of the bradycardia response to 5-HT in the anesthetized rat. The quinoxaline derivatives, in particular VC-501 and VC-603, prevented retches and vomiting induced by 2-methyl-5-HT and cis-platinum in the ferret. The new compounds also enhanced the gastric emptying of solids in rats. The results obtained are probably indicative of the suggested species- and tissue-dependent differences in 5-HT3 receptor subtypes. The high potency and selectivity of one of the new quinoxaline derivatives, VC-605, at 5-HT3 receptors of guinea-pig ileum is remarkable. VC-605 may be a useful tool for further characterizing this possible 5-HT3 receptor subtype.

Experimental study of the efficacy of the endoluminal prosthesis in colonic anastomoses.

Colorectal surgery is still associated with a significant morbidity and mortality rate, mostly related to suture failure. We have carried out a randomized experimental study in dogs on colonic anastomoses exposed to a number of anastomotic risk situations. A total of 42 dogs was used. They were divided into three study groups (control, occlusion and diverticulitis), with and without an endoluminal tube. The aim was to assess the efficacy of the endoluminal prosthesis using clinical and radiological assessment of anastomotic healing. Pre- and post-anastomotic intraluminal pressures were also measured to determine whether these might be a factor in suture failure. There were significant differences in suture failure in animals in which the endoluminal tube was used. Mean duration of placement was 10.5 days. In the colon healing study, no significant differences were found between the groups in the pathological examination or in the assay of hydroxyproline content. The presence of the endoluminal tube may increase the maximum pressure applied on the colon wall. No significant differences were found in the intracolonic pressure differentials between the different groups or after the inclusion of the endoluminal prosthesis. The results obtained establish the efficacy of the endoluminal prosthesis in protecting the colonic anastomosis, and could be a valuable technique in colonic anastomoses with a high risk of suture dehiscence.

[Usefulness of the determination of saliva cortisol in the study of adrenal gland glucocorticoid function]. / Utilidad de la medida de cortisol salival en el estudio de la función glucocorticoide suprarrenal.

To validate the adequacy of saliva as a biological specimen for the study of glucocorticoid adrenal function, the concentrations of salivary cortisol (SC) and serum total cortisol (TC) were measured by radioimmunoassay (RIA) in several groups of individuals in baseline state and during stimulation tests. The study of diurnal variations of SC in the reference population (n = 29) showed a nyctohemeral rhythm similar to that of TC, with maximal concentrations at 08.00-09.00 h (18 +/- 9 nmol/L) and 61% and 80% decreases at 15.30 and 23.00 h, respectively. After the administration of 1 mg of dexamethasone, SC was reduced in a 95% of its baseline value (n = 18). In all patients with Cushing's syndrome (n = 8) SC was increased whereas TC was normal in 3. All patients with adrenal failure (n = 11) had subnormal SC levels, while TC was normal in 4. The SC response to stimulation with intravenous synthetic adrenocorticotropin (Nuvacthen) (with and without previous suppression with 1 mg dexamethasone), insulin hypoglycemia and glucagon were qualitatively similar to those of TC, although more marked in proportion. These results, together with the practical advantages of saliva as a biological sample (easy obtention of specimen, absence of stress during its collection, and stability of cortisol in it), indicate that SC represents a more reliable measurement than TC as a useful clinical test to detect glucocorticoid dysfunction.