Forma monogénica de hipertensión arterial secundaria / Monogenic form of secondary arterial hypertension

Entre las causas de hipertensión arterial secundaria se incluyen múltiples entidades diagnósticas, por lo que un cribado apropiado es fundamental para diagnosticar aquellas patologías potencialmente tratables. Los síndromes genéticos ocupan un pequeño porcentaje de estas causas. Dentro de este último grupo se incluye el síndrome de Liddle, rara enfermedad genética con herencia autosómica dominante, causado por mutaciones de ganancia de función en los genes que codifican para el canal epitelial de sodio (ENaC), implicados en la reabsorción de sodio en los túbulos renales distales. La presencia de historia familiar de hipertensión arterial con aparición a edad temprana e hipopotasemia en alguno de ellos debería llevar a la sospecha de este trastorno genético, que debe confirmarse con pruebas genéticas. Describimos un caso, confirmado genéticamente, en el cual la hipertensión arterial refractaria a tratamiento convencional es la única manifestación de dicho síndrome, dificultando y retrasando el diagnóstico, hasta la edad adulta.(AU)

Multiple diagnostic entities are included among the causes of secondary arterial hypertension, so an appropriate screening is essential to diagnose potentially treatable pathologies. Genetic syndromes occupy a small percentage of these causes. The latter group includes Liddle syndrome, a rare genetic disease with autosomal dominant inheritance, caused by gain-of-function mutations in the genes that code for the epithelial sodium channel (ENaC), involved in sodium reabsorption in the distal renal tubules. The presence of a family history of arterial hypertension with onset at an early age and hypokalemia in some of them should lead to the suspicion of this genetic disorder, which must be confirmed with genetic tests. We describe a case, genetically confirmed, in which hypertension refractory to conventional treatment is the only manifestation of said syndrome, making diagnosis difficult and delayed until adulthood.(AU)

[Monogenic form of secondary arterial hypertension]. / Forma monogénica de hipertensión arterial secundaria.

Multiple diagnostic entities are included among the causes of secondary arterial hypertension, so an appropriate screening is essential to diagnose potentially treatable pathologies. Genetic syndromes occupy a small percentage of these causes. The latter group includes Liddle syndrome, a rare genetic disease with autosomal dominant inheritance, caused by gain-of-function mutations in the genes that code for the epithelial sodium channel (ENaC), involved in sodium reabsorption in the distal renal tubules. The presence of a family history of arterial hypertension with onset at an early age and hypokalemia in some of them should lead to the suspicion of this genetic disorder, which must be confirmed with genetic tests. We describe a case, genetically confirmed, in which hypertension refractory to conventional treatment is the only manifestation of said syndrome, making diagnosis difficult and delayed until adulthood.

Falso positivo en estudio de tomografía de emisión de positrones con fluorodesoxiglucosa-F18 de un leiomioma de vena cava inferior en paciente con sospecha de paraganglioma / False positive in fluorodeoxyglucose-F18 positron emission tomography computed tomography scan of inferior vena cava leiomyoma in patient with a suspected paraganglioma

Los leiomiomas son tumores benignos derivados de tejido muscular liso que rara vez se presentan fuera del útero. Estos tumores no suelen mostrar captación de FDG. Presentamos el caso de un paciente con hipertensión arterial refractaria al tratamiento y una lesión dependiente de vena cava inferior que muestra una intensa captación de FDG en el estudio PET/TC, sugestivo de paraganglioma, con un diagnóstico histológico final de leiomioma

Leiomyomas are benign tumors derived from smooth muscle tissue that rarely present outside the uterus. These tumors do not usually show FDG uptake. We present the case of a patient with hypertension refractory to treatment and a lesion arising from inferior vena cava, that shows intense FDG uptake in PET/CT scan, suggestive of paraganglioma, with a final histological diagnosis of leiomyoma

False positive in fluorodeoxyglucose-F18 positron emission tomography computed tomography scan of inferior vena cava leiomyoma in patient with a suspected paraganglioma. / Falso positivo en estudio de tomografía de emisión de positrones con fluorodesoxiglucosa-F18 de un leiomioma de vena cava inferior en paciente con sospecha de paraganglioma.

Leiomyomas are benign tumors derived from smooth muscle tissue that rarely present outside the uterus. These tumors do not usually show FDG uptake. We present the case of a patient with hypertension refractory to treatment and a lesion arising from inferior vena cava, that shows intense FDG uptake in PET/CT scan, suggestive of paraganglioma, with a final histological diagnosis of leiomyoma.

La terapia de activación de barorreceptores, un paso más en el tratamiento de la hipertensión arterial resistente y la insuficiencia cardiaca / Baroreflex activation therapy: One more step in the treatment of resistant arterial hypertension and chronic heart failure

En la actualidad son cada vez más los pacientes con hipertensión arterial refractaria (HTAR) que sufren insuficiencia cardiaca (IC) en fases avanzadas y que precisan dispositivos implantables para su tratamiento. Presentamos el caso de un paciente con un desfibrilador automático implantable (DAI) que precisó la colocación de un dispositivo de terapia de activación de barorreceptores (TAB) del seno carotídeo con la doble indicación de IC y HTAR. Hasta donde sabemos, se trata del primer caso realizado en nuestro país

The number of patients who suffer refractory arterial hypertension and chronic heart failure in advanced stages is currently increasing. The case is presented of a patient with an implantable cardioverter defibrillator, and with the dual indication of chronic heart failure and refractory arterial hypertension, who required the implanting of a baroreceptors activation therapy device of the carotid sinus. As far as it is known, it is the first case reported in Spain?

[Baroreflex activation therapy: One more step in the treatment of resistant arterial hypertension and chronic heart failure]. / La terapia de activación de barorreceptores, un paso más en el tratamiento de la hipertensión arterial resistente y la insuficiencia cardiaca.

The number of patients who suffer refractory arterial hypertension and chronic heart failure in advanced stages is currently increasing. The case is presented of a patient with an implantable cardioverter defibrillator, and with the dual indication of chronic heart failure and refractory arterial hypertension, who required the implanting of a baroreceptors activation therapy device of the carotid sinus. As far as it is known, it is the first case reported in Spain?

Estudio urodinámico en mujeres con síntomas de incontinencia urinaria de esfuerzo pura / Urodynamic study in women with pure stress urinary incontinence

Objetivo: Describir los resultados del estudio urodinámico en mujeres con síntomas de incontinencia urinaria de esfuerzo pura, incluyendo las características del detrusor hiperactivo, sin conocer otras evaluaciones clínicas. Material y métodos: Estudio retrospectivo de mujeres con incontinencia urinaria evaluadas con estudio urodinámico de forma consecutiva. De 710 mujeres evaluadas, se seleccionaron 108 con síntomas de incontinencia urinaria de esfuerzo pura (15%), excluyendo aquellas con cirugía de incontinencia urinaria previa, prolapso de órganos pélvicos en estadio ≥ iii, radioterapia pelviana, uso de fármacos uroselectivos y enfermedades neurológicas. La velocidad de infusión fue de 70 ml/min. La tos fue el único método utilizado para provocar la hiperactividad del detrusor. La prueba de esfuerzo se hizo estandarizada, con uso de tos de intensidad progresiva. Resultados: Se describen valores de referencia de las diferentes etapas del estudio urodinámico. Se demostró incontinencia urinaria de esfuerzo urodinámica en 79 mujeres (73,1%), detrusor hiperactivo en 4 (3,7%) y diagnóstico urodinámico mixto en 15 (13,8%). En 10 pacientes el examen no fue concluyente (9,2%). Dos mujeres presentaron incontinencia urinaria por detrusor hiperactivo (1,9%). Una paciente presentó detrusor hiperactivo inducido por tos sin incontinencia urinaria de esfuerzo urodinámica (0,9%). Hubo asociación entre detrusor hiperactivo y nicturia ≥ 2 (p = 0,002; odds ratio: 3,74; intervalo de confianza del 95%: 1,22-11,39). Una mujer presentó obstrucción de la salida de la vejiga (0,9%). Conclusiones: En mujeres con incontinencia urinaria de esfuerzo pura, sin conocer el resultado de otras evaluaciones clínicas, el estudio urodinámico puede proporcionar información útil para definir el tratamiento

Objective: To describe the results of urodynamic study in women with pure stress urinary incontinence symptoms, including the characteristics of the overactive detrusor. No other clinical assessments were taken into account. Material and methods: A retrospective study in women with urinary incontinence consecutively evaluated by urodynamic study. From a total of 710 women, only 108 (15%) with pure stress urinary incontinence symptoms were selected. Women with prior urinary incontinence surgery, pelvic organ prolapse (stage ≥ iii), pelvic radiotherapy, using medication active on the lower urinary tract and neurological diseases were excluded. Infusion rate was 70 ml/min. Detrusor overactivity was induced only by cough. A standardized cough stress test with progressive cough intensity was carried out. Results: Reference urodynamic values for stress incontinent women are described. Urodynamic stress incontinence was observed in 79 women (73.1%), detrusor overactivity in 4 (3.7%) and mixed urodynamic diagnosis in 15 (13.8%). Test was inconclusive in 10 patients (9.2%). Two women had detrusor overactivity incontinence (1.9%). One patient had detrusor overactivity induced by cough without urodynamic stress incontinence (0.9%). There was an association between detrusor overactivity and nocturia ≥ 2 (P = .002; odds ratio: 3.74; 95% confidence interval: 1.22-11.39). One woman had a bladder outlet obstruction (0.9%). Conclusions: In women with pure stress urinary incontinence, without knowing the outcome of other clinical assessments, urodynamic study can provide useful information to define the proper therapy

Urodynamic study in women with pure stress urinary incontinence.

OBJECTIVE: To describe the results of urodynamic study in women with pure stress urinary incontinence symptoms, including the characteristics of the overactive detrusor. No other clinical assessments were taken into account. MATERIAL AND METHODS: A retrospective study in women with urinary incontinence consecutively evaluated by urodynamic study. From a total of 710 women, only 108 (15%) with pure stress urinary incontinence symptoms were selected. Women with prior urinary incontinence surgery, pelvic organ prolapse (stage ≥iii), pelvic radiotherapy, using medication active on the lower urinary tract and neurological diseases were excluded. Infusion rate was 70 ml/min. Detrusor overactivity was induced only by cough. A standardized cough stress test with progressive cough intensity was carried out. RESULTS: Reference urodynamic values for stress incontinent women are described. Urodynamic stress incontinence was observed in 79 women (73.1%), detrusor overactivity in 4 (3.7%) and mixed urodynamic diagnosis in 15 (13.8%). Test was inconclusive in 10 patients (9.2%). Two women had detrusor overactivity incontinence (1.9%). One patient had detrusor overactivity induced by cough without urodynamic stress incontinence (0.9%). There was an association between detrusor overactivity and nocturia ≥2 (P=.002; odds ratio: 3.74; 95% confidence interval: 1.22-11.39). One woman had a bladder outlet obstruction (0.9%). CONCLUSIONS: In women with pure stress urinary incontinence, without knowing the outcome of other clinical assessments, urodynamic study can provide useful information to define the proper therapy.

Ansiedad, depresión y su implicación en la hipertensión arterial resistente / Anxiety, depression and their involvement in resistant arterial hypertension

La hipertensión arterial (HTA) esencial tiene un origen multifactorial en el que están implicadas al menos 2 categorías de factores. Los factores biológicos clásicos de riesgo y los factores psicológicos, incluyendo los efectos del estrés crónico, los cuales tienen una cierta influencia tanto en el origen como en la persistencia de la HTA. En este estudio nos planteamos conocer el grado de influencia de la ansiedad y la depresión como manifestaciones de un proceso de estrés crónico, en pacientes con HTA resistente

The origin of essential arterial hypertension is multifactorial in which at least2 different categories of factors are involved. These categories are classical biological risk factors and the psychological factors, including the effects of chronic stress, which also seem to play a significant role in its origin and maintenance. In this study we aim to know the degree of the relationship between anxiety and depression and chronic stress in patients with resistant arterial hypertension

Esteroides androgénicos anabolizantes: consecuencias en el hombre / Anabolic androgenic steroids: consequences in the man

El abuso de Esteroides Androgénicos Anabolizantes (EAA) se ha convertido en una práctica frecuente en hombres. Deportistas de alto rendimiento y fisicoculturistas eran los usuarios más frecuentes de este tipo de fármacos, sin embargo, en los últimos 10 años se ha observado una preocupante prevalencia de abuso en hombres jóvenes y usuarios de gimnasios con el fin simplemente de mejorar su aspecto físico. Muchas veces este tipo de fármacos son adquiridos al margen de la legalidad, promocionados en internet, sin la supervisión médica, necesaria al sostener una terapia hormonal. La autoadministración de EAA en altas dosis guarda implicancias negativas poco conocidas o inadvertidas por lo usuarios. Dentro de estas destacan las consecuencias andrológicas propias del abuso de estas sustancias como son la disfunción sexual, alteraciones reproductivas, metabólicas y psicógenas. El objetivo de esta revisión es acercar el conocimiento actual sobre los riesgos e implicancias en el hombre del abuso de los EAA.

Anabolic Androgenic Steroid (EAA) Abuse has turned into a common practice upon men. High performance sportsmen and body builders were the most common users of these drugs, but in the last 10 years there has been a worrying prevalence of abuse in young men and fitness studio users with the aim of obtaining better physical aspect. Many times these drugs are bought at the margins of legality, promoted in Internet, without the medical supervision needed for hormonal therapy. Self-administration of EAA in high doses has negative effects that may be not known or unnoticed by users. Some of them are Sexual Dysfunction, reproductive, metabolic or psychological alterations. The purpose of this revision is to come closer to today’s knowledge of the risks of abuse of EAA in men.

Aplasia pura de serie roja como primera manifestación de síndrome de Sjögren primario / No disponible

No disponible

Patrón no reductor de presión arterial y enfermedad renal crónica en pacientes hipertensos / Non-reducing pattern of blood pressure and chronic kidney disease in hypertensive patients

Introducción. La monitorización ambulatoria de la presión arterial (MAPA) se correlaciona mejor con el daño orgánico que la presión arterial (PA) casual. La MAPA también ha permitido dividir a los pacientes en dipper y non-dipper. Los pacientes non-dipper parecen tener un peor pronóstico en morbimortalidad cardiovascular. Nosotros presentamos los datos del patrón circadiano de PA y la afectación renal en pacientes hipertensos. Pacientes y método. Se incluyeron en el estudio 702 pacientes con criterio para realizar MAPA. A todos ellos se les midió el filtrado glomerular (FG) según la ecuación MDRD (Modification of Diet in Renal Disease) corregida para el sexo. Todos los resultados se registraron en base de datos ACCESS y se realizó estudio estadístico mediante el programa SPSS versión 12.0. Resultados. Los pacientes con FG menor de 60 ml/ min/m2 eran varones, de mayor edad, diabéticos y con niveles más elevados de colesterol, triglicéridos y ácido úrico. Las PA clínicas y de la MAPA fueron significativamente más elevadas en los pacientes con FG menor de 60 ml/min/m2. Un FG menor de 60 ml supone un riesgo estimado de 2,86 (IC al 95 %: 1,29-6,36) para presentar un patrón non-dipper. Conclusiones. En nuestro estudio el 15,8 % de los pacientes presenta un FG menor de 60 ml/min/m2. Los pacientes con FG reducido tienen más edad, son varones, diabéticos y con cifras de PA más elevadas. Un FG reducido se asocia a patrón non-dipper

Introduction. Ambulatory blood pressure monitoring (ABPM) correlates better with body damage than with casual blood pressure (BP). The ABPM has also made it possible to divide the patients into dipper and non-dipper. Non-dipper patients seem to have a worse prognosis in cardiovascular morbidity-mortality. We present the data of the circadian pattern of BP and kidney involvement in hypertensive patients. Patients and methods. A total of 702 patients with criterion to perform ABPM were included in the study. Glomerular filtration (GF) rate was measured in all of them according to the MDRD (Modification of Diet in Renal Disease) equation corrected for gender. All the results were recorded in the ACCESS database and statistical study was done with the SPSS version 12.0 program. Results. Patients with GF < 60 ml/min/m2 were male, of greater age, diabetics and with higher levels of cholesterol, triglycerides and uric acid. Clinical BP and those of ABPM were significantly higher in patients with GF < 60 ml/min/m2. A GF under 60 ml meant an estimated risk of 2.86 (95 % CI: 1.29-6.6) to have a NRP. Conclusions. In our study, 15.8 % of the patients showed a glomerular filtration less than 60 ml/m2. Patients with reduced GF are older, males, diabetics and with higher blood pressure values. A reduced GF is associated to a non-dipper pattern

Forward-backward asymmetries of lepton pairs in events with a large-transverse-momentum jet at hadron colliders.

We discuss forward-backward charge asymmetries for lepton-pair production in association with a large-transverse-momentum jet at hadron colliders. The lepton charge asymmetry relative to the jet direction A(j)(FB) gives a new determination of the effective weak mixing angle sin((2)theta(lept)(eff)(M(2)(Z)) with a statistical precision after cuts of approximately 10(-3) (8x10(-3)) at LHC (Tevatron). This is to be compared with the current uncertainty at LEP and SLD from the asymmetries alone, 2x10(-4). The identification of b jets also allows for the measurement of the bottom-quark-Z asymmetry A(b)(FB) at hadron colliders, the resulting statistical precision for sin((2)theta(lept)(eff)(M(2)(Z)) being approximately 9x10(-4) (2x10(-2) at Tevatron), also lower than the reported precision at e(+)e(-) colliders, 3x10(-4).