Hipertensión maligna y feocromocitoma: reporte de un caso / Malignant hypertension and pheochromocytoma: a case report

La hipertensión arterial maligna se define por cifras extremadamente altas de presión arterial asociadas a daño orgánico. Constituye una causa de emergencia hipertensiva donde coexisten cifras elevadas de presión arterial, con hemorragia y exudados bilaterales retinianas (retinopatía hipertensiva grado III), con o sin papiledema (retinopatía hipertensiva grado IV), asociada usualmente a lesión renal o cardíaca. En un 1% de los casos es secundaria a causas endocrinológicas, entre ellas, la más frecuente: el feocromocitoma, que clásicamente se ha caracterizado por la tríada cefalea, sudoración y palpitaciones. Sin embargo, no existe un hallazgo clínico único que tenga un valor significativo en su diagnóstico. A continuación, presentamos el caso de una paciente de 23 años con emergencia hipertensiva y masa suprarrenal asociado a retinopatía hipertensiva grado IV. (AU)

Malignant arterial hypertension is defined by extremely high levels of pressure associated with organ damage. It is a cause of hypertensive emergency and is defined by the coexistence of high blood pressure and bilateral retinal haemorrhage or exudates (grade III hypertensive retinopathy), with or without papilloedema (grade IV hypertensive retinopathy) currently associated with organ damage such as renal or cardiac failure. Around 1% of malignant arterial hypertension is secondary to endocrinological causes, including the most common: pheochromocytoma, which is classically characterized by the triad: headache, sweating and palpitations. However, there is no single clinical finding that is of significant value in its diagnosis. We now present the case of a 23-year-old patient with a hypertensive emergency, an adrenal mass associated with grade IV hypertensive retinopathy. (AU)

[Malignant hypertension and pheochromocytoma: a case report]. / Hipertensión maligna y feocromocitoma: reporte de un caso.

Malignant arterial hypertension is defined by extremely high levels of pressure associated with organ damage. It is a cause of hypertensive emergency and is defined by the coexistence of high blood pressure and bilateral retinal haemorrhage or exudates (grade III hypertensive retinopathy), with or without papilloedema (grade IV hypertensive retinopathy) currently associated with organ damage such as renal or cardiac failure. Around 1% of malignant arterial hypertension is secondary to endocrinological causes, including the most common: pheochromocytoma, which is classically characterized by the triad: headache, sweating and palpitations. However, there is no single clinical finding that is of significant value in its diagnosis. We now present the case of a 23-year-old patient with a hypertensive emergency, an adrenal mass associated with grade IV hypertensive retinopathy.

[Trends in resident positions offered in nephrology (1985-2008)]. / Evolución de las plazas asignadas a nefrología en las convocatorias MIR (1985-2008).

This article reviews the trends in positions of internal medicine resident (IMR) assigned to nephrology in Spain from 1985 to 2008. We analyse the number of positions, the changes of average points received (435 to 377), and the average position for nephrology (253 to 3457). We also observed the distribution by sex for the candidates (from 42% to 72% feminisation) over the 24 years examined. Nephrology is positioned 29th of the 47 specialities offered on Spanish IMR training programmes. These data should be an indication to all nephrologists that change is needed. We must examine which factors are involved in the lessening interest in Nephrology as a career among medical graduates and then strive to resolve the problems.

HIV y diálisis: optimismo infundado o cambios reales / No disponible

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[Renal infarction and acute renal failure induced by cocaine]. / Infarto renal e insuficiencia renal aguda por consumo de cocaína.

We describe the case of a 36 year old man, habitual consumer of cocaine, who after the inhaled cocaine consumption develops acute renal failure secondary to massive left and segmental right renal infarction. Although the most frequent complications associated to cocaine consumption are of cardiovascular and neurological nature, the kidney can be frequently affected.

Infarto renal e insuficiencia renal aguda por consumo de cocaína / Renal infarction and acute renal failure due to cocaine use

Describimos el caso de un varón de 36 años, consumidor habitual de cocaína, que desarrolla un cuadro de insuficiencia renal aguda, secundario a infarto isquémico masivo en riñón izquierdo y segmentario en el riñón derecho. Las complicaciones más frecuentemente asociadas al uso de cocaína son de índole cardiovascular y neurológica, sin embargo, la afectación renal es frecuente (AU)

We describe the case of a 36 year old man, habitual consumer of cocaine, who after the inhaled cocaine consumption develops acute renal failure secondary to massive left and segmental right renal infarction. Although the most frequent complications associated to cocaine consumption are of cardiovascular and neurological nature, the kidney can be frequently affected (AU)

An in-use microbiological comparison of two surgical hand disinfection techniques in cardiothoracic surgery: hand rubbing versus hand scrubbing.

Surgical site infection after heart surgery increases morbidity and mortality. The method of presurgical hand disinfection could influence the infection risk. From February to April 2003, we compared the microbiological efficacy of hand-rubbing (R) and hand-scrubbing (S) procedures. The surgical team alternately used hand-scrubbing or hand-rubbing techniques every two weeks. Fingertip impressions were taken before and immediately after hand disinfection, every 2h and at the end of the operation. Acceptability of hand rubbing was assessed by a questionnaire. Mean durations of surgical procedures were 259+/-68 and 244+/-69min for groups S and R respectively (P=0.43). Bacterial counts immediately after hand disinfection were comparable with the two techniques, but significantly lower in group R at the end of surgery. No differences were observed between the percentages of negative samples taken after 2h, 4h and at the end of surgery between the two groups. Bacterial skin flora reduction immediately after hand disinfection, after 2h and 4h of operating time and at the end of surgery was better in group R, but the difference was not statistically significant. Before surgery, the hand-rubbing method with alcohol solution preceded by hand washing with mild neutral soap is as effective as hand scrubbing to reduce bacterial counts on hands. It decreased the bacterial counts both immediately after hand disinfection and at the end of long cardiothoracic surgical procedures. The acceptability of hand rubbing was excellent and it can be considered to be a valid alternative to the conventional hand-scrubbing protocol.

Prevención de la nefropatía por contraste (NC) / Prevention of contrast-induced nephropathy (CN)

Los pacientes con función renal normal y sin factores de riesgo reconocidos no requieren cuidados especiales con motivo de la exposición a contrastes. En el paciente con posible reducción de la función renal y/o factores de riesgo (edad, diabetes, enfermedad cardiovascular) se debe realizar cr basal y estimar Ccr mediante fórmula. Siempre que exista Ccr 30 ml/m por el riesgo de inducir Dermopatia Fibrosante Nefrogénica. La nefropatía por contraste se define como un aumento de la creatinina respecto a la basal bien absoluto, de al menos 0,5 mg/dl, bien porcentual de al menos un 25%. Los AINES y los diuréticos deben suspenderse las 24 h antes y después. La menformina debe suspenderse 24 h antes y 48 después proporcionando un tratamiento adecuado de la diabetes. La profilaxis mejor es la administración de líquidos. La administración IV es más eficaz que la oral. El salino isotónico se ha demostrado más eficaz que el hipotónico. Aunque las pautas varían la más utilizada y evaluada es la administración de salino a dosis pequeñas 1 mL/kg/h desde 12 h antes a 12 h después. Recientemente la administración de bicarbonato (154 Na) a 3 mL/h desde 1 hora antes de la exploración seguida de 1 mL/h 6 horas después se ha demostrado muy eficaz y mejor que el salino a la misma dosis. No obstante es el único estudio controlado disponible y la hidratación enérgica a 3 mL/h en la primera hora puede no ser adecuada en algunos pacientes. La profilaxis farmacológica con diuréticos, dopa, factor natriurético, fenoldopan, antagonistas de la endotelina esta contraindicada. El ac ascórbico, la teofilina, la PGE no se han demostrado claramente eficaces. Con la NAC existen resultados contradictorios en los ensayos y en los meta-análisis, si bien el último publicado encontró un efecto protector. Dado su bajo coste y los nulos efectos secundarios se aconseja para los pacientes en riesgo la administración de 600 mg/12 h el día previo y el siguiente a la exploración. La diálisis profiláctica no debe utilizarse. La hemofiltración continua periprocedimiento puede ser útil en pacientes de alto riesgo en UCI, pero precisa ser confirmada por nuevos estudios

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Intra-aortic balloon counterpulsation: outcome in cardiac surgical patients.

OBJECTIVE: To identify the major determinants of survival and nonsurvival for patients in need of intra-aortic balloon pump (IABP) support after cardiac surgery and to define the role of ventilator-associated pneumonia. DESIGN: Retrospective study. SETTING: University and general hospital. PARTICIPANTS: A total of 105 consecutive patients undergoing cardiac surgery requiring IABP support and prolonged mechanical ventilation for >24 hours. INTERVENTION: All patients were assigned into 1 of 2 groups: survival (n = 69) and nonsurvival (n = 36). MEASUREMENTS AND MAIN RESULTS: Differences between the survival and nonsurvival groups were tested with the Student's t-test, chi-square test, and frequency analysis. The overall survival rate was 65.7%. Nonsurvivors (34.3%) had higher rates of acute myocardial infarction (27.7% v 4.3%; p < 0.002), Canadian Cardiovascular Society functional class III and IV (44.4% and 13.8%; p < 0.001), and depressed left ventricular ejection fraction (31.3 +/- 6.4% v 42.4 +/- 7.2%; p < 0.001). The nonsurvival group had longer duration of cardiopulmonary bypass (165 +/- 74.3 minutes v 135 +/- 36 minutes; p < 0.006) and aortic occlusion (81.8 +/- 9 minutes v 68.6 +/- 25.7 minutes; p < 0.004). In the nonsurvival group, 21 patients were not weaned from the IABP, and 15 patients were weaned from the IABP but died from renal failure (26.6%), multiorgan failure (13.3%), infection, and respiratory failure (66.6%). In the nonsurvival group, mechanical ventilation time was longer in patients weaned from the IABP. CONCLUSION: These data suggest that for patients not weaned from the IABP, the major determinants of death are low cardiac output (33.3%) and multiorgan failure (47.6%). Patients with a left ventricular ejection fraction of <30% have a poorer outcome. In patients weaned from the IABP, ventilator-associated pneumonia (66.6%) was the major cause of death.

Myocardial revascularization with multiple arterial grafts: comparison between the radial artery and the right internal thoracic artery.

BACKGROUND: Bilateral internal thoracic artery (ITA) harvesting is significantly underused, whereas the radial artery is being used with increasing frequency. We have retrospectively analyzed perioperative and short-term outcomes of patients receiving a radial artery versus those receiving a right ITA as a second arterial graft. METHODS: Between February 1999 and May 2000, 250 patients underwent coronary artery bypass grafting using the radial artery (156 patients) or the right ITA (94 patients) in combination with the left ITA and, when required, the saphenous vein. RESULTS: There was a higher prevalence of risk factors in the radial artery group. More coronary artery bypass graftings (p < 0.001) were performed with the radial artery. Operative mortality was not different (p = not significant). In the right ITA group there was more bleeding (p < 0.001) and a longer hospital stay (p < 0.001). Mean follow-up was 8.1 +/- 3.9 months. The probability of survival was similar (p = not significant). CONCLUSIONS: The radial artery can extend the benefits of multiple arterial grafting to those patients who are usually excluded from bilateral ITA harvesting because of multiple risk factors. Perioperative and short-term results are good.

Efectividad, estrategias y éxitos en la pérdida de peso en función de parámetros antropométricos / Effectiveness, strategies and successes in weight loss as a function of anthropometric parameters

Objetivos. Conocer la variabilidad del aspecto de las mujeres en tres momentos diferentes del ciclo vital y su relación con las prácticas encaminadas a la pérdida de peso, analizando la eficacia de tales comportamientos. Diseño. Transversal. Emplazamiento. Mujeres de la Comunidad de Madrid que forman parte de una investigación de la Unidad de Antropología del Departamento de Biología de la UAM sobre percepción de la imagen y comportamientos asociados en función de la edad, el índice de masa corporal y las condiciones socioeconómicas. Participantes. Un total de 535 mujeres de 3 grupos de edad formados por 200 adolescentes pertenecientes a 2 centros de enseñanza secundaria de Madrid; 202 universitarias de la Facultad de Biología de la Universidad Autónoma de Madrid y 135 mujeres de 45-65 años residentes en la localidad madrileña de Alcobendas que participan en un programa de salud de la mujer del ayuntamiento de dicha localidad. Material y métodos. Se recogió información sobre antropometría, autopercepción y valoración de la imagen, contrastando indicadores de percepción con indicadores de composición corporal. Resultados. Existe una alta frecuencia de intentos de pérdida de peso entre las adolescentes y las mujeres mayores de 45 años, con una edad de inicio de este tipo de prácticas mucho más temprana entre las primeras y el grupo de universitarias. Es especialmente llamativo que un 44 por ciento de las adolescentes dentro de la categoría delgada haya intentado perder peso; entre las universitarias y las mujeres mayores de 45 años este porcentaje es más elevado cuanto mayor es el grado de sobrepeso. Las mujeres de mayor edad son más eficaces a la hora de perder peso, en cambio les cuesta mucho mantener esa pérdida. La velocidad de pérdida de peso es superior en las mujeres con valores más elevados de índice de masa corporal. Conclusiones. El aspecto físico varía en mujeres jóvenes y mayores de 45 años, de manera que las primeras son más altas, delgadas y longilíneas. A pesar de ello, las mujeres jóvenes desarrollan comportamientos encaminados a la pérdida de peso mucho más frecuentemente que las mujeres mayores, con una edad de inicio más temprana y de manera muy rápida, lo cual puede tener graves consecuencias para la salud (AU)

[Effectiveness, strategies and successes in weight loss in function of anthropometric parameters]. / Efectividad, estrategias y éxitos en la pérdida de peso en función de parámetros antropométricos.

OBJECTIVES: To find the variability in women's appearance at three moments of their life cycle and its relationship with practices aiming at weight loss, analysing the efficacy of this behaviour. DESIGN: Cross-sectional. SETTING: Women from the Community of Madrid who formed part of an investigation by the Unit of Anthropology of the Department of Biology of the Autonomous University of Madrid (UAM) into perception of image and associated behaviour as a function of age, body mass index, and social and economic conditions. PARTICIPANTS: 535 women in three age groups: 200 adolescents belonging to two secondary schools in Madrid; 202 university students from the Biology Faculty of the UAM, and 135 women aged between 45 and 65 and living in the Madrid area of Alcobendas, who were taking part in a women's health programme run by the Alcobendas town council. MATERIAL AND METHODS: Information was collected on body measurements, self-perception and image assessment, with perception indicators and body form indicators contrasted. RESULTS: There were a great many attempts to lose weight by adolescents and women over 45, with the starting age for such practices much earlier in the adolescents' and students' groups. It was particularly striking that 44% of the adolescents within the thin category had tried to lose weight. Among the students and women over 45 this percentage rose in consonance with their overweight. The older women were more effective at losing weight, but it was very difficult for them to maintain this loss. The speed of weight loss was higher in women with higher body mass index. CONCLUSIONS: Physical appearance varies between young women and women over 45, in that the former are taller, thinner and with a straighter figure. Despite this, young women develop behaviour designed to lose weight much more often than older women, with an earlier starting age and more rapidly, which can have serious health consequences.

[Right pleural effusion in aortic dissecting aneurysm]. / Il versamento pleurico destro nell'aneurisma dissecante dell'aorta.

Right hemorrhagic pleural effusion may be a presenting sign of thoracic aortic dissecting aneurysm. We describe 2 cases of massive right hemorrhagic pleural effusion and dissection of the descending aorta (type B) detected at tomographic scan. Transesophageal echocardiography ruled out a retrograde dissection of the ascending aorta. Right hemorrhagic pleural effusion is an unusual clinical presentation in thoracic aorta dissection and, up to now, the underling pathophysiology of this sign has not been defined yet.

[Food habits of women: frequency of food consumption and evaluation of changes in dietary behavior]. / Hábitos alimentarios en mujeres: frecuencia de consumo de alimentos y valoración del cambio en el comportamiento alimentario.

OBJECTIVE: To describe present day dietary habits, and how and why they may have changed over the lifetimes. DESIGN: Cross-sectional. PARTICIPANTS: 1037 lower middle-class women, resident in Alcobendas (Autonomous Community of Madrid, Spain), and born between 1933 and 1953. All the women participating in a Women Health Program organized by the Alcobendas Municipality. RESULTS: 21.9% of the women followed some special type of diet, of whom 53.74% did so because of illness and 28.63% did so in order to slim. The type of diet adopted differed significantly according to age (chi 2 = 11.52, d.f. = 3, p = 0.009). Women under 55 years of age chose their diets fundamentally in order to slim, while the over-55s followed special diets (e.g., low cholesterol, salt-free, and diabetic) for reasons of health. 48.78% of the women in the sample had changed their dietary habits for distinct reasons: migration, marriage, illness, menopause, weight gain, etc. CONCLUSIONS: The change in dietary habits has followed the pattern observed in other industrialized countries, including Spain. Within this general pattern there has also be a trend towards a decrease in the consumption of proteins and simple carbohydrates associated with age and nutrition-related diseases.

Left ventricular volume reduction for end-stage heart disease.

Partial left ventriculectomy (PLV) was recently introduced for end-stage dilated cardiomyopathy to improve ventricular function. Since November 1996 we have performed PLV in 14 patients; preoperatively 4 patients had idiopathic dilated cardiomyopathy and 10 had ischemic dilated cardiomyopathy. 57.1% of patients were in New York Heart Association functional Class IV. The mitral valve was replaced in 11 patients. Postoperative echocardiography showed a reduction of left end-diastolic diameter (55.4 +/- 5.4 mm) and an increase in forward ejection (cardiac index from 2.19 +/- 0.571 min/m2 to 2.67 +/- 0.931/min/m2). The 30-day mortality was 28.6% and 20-month survival was 57.2%. Only one patient was not in NYHA functional class due to postoperative progressive mitral incompetence. Prognostic factors should be identified to avoid early failure. However, even if the mortality rate for PLV high, this operation is a valid choice for the treatment of end-stage dilated cardiomyopathy.

Isolation and characterization of the KlHEM1 gene in Kluyveromyces lactis.

The KlHEM1 gene from Kluyveromyces lactis encodes a functional 5-aminolevulinate synthase (deltaALA synthase), as confirmed by complementation of a hem1 mutant Saccharomyces cerevisiae strain, homology search, and detection of a 2.3 kb transcript. The gene is highly homologous to the ScHEM1 gene, and the sequence of the promoter region contains a complex combination of putative regulatory signals. Some of them are related to phospholipid biosynthesis, glycolytic metabolism, and regulation by carbon source. Transcription of KlHEM1 increased significantly in response to limited oxygen, and only slightly with the change from repressed (glucose) to derepressed conditions (glycerol). The deltaALA synthase from K. lactis contains, in the amino-terminal region, two heme-responsive elements that are not present in the protein from Saccharomyces cerevisiae.

[Effect of family environment on adaptation to the hemodialysis program in patients with chronic renal insufficiency]. / Influencia del clima familiar en la adaptación al programa de hemodiálisis en pacientes con insuficiencia renal crónica.

In our study we have analyzed the influence of family environment on adjustment of renal patients to the HD as well as on the attitude towards kidney transplantation. The study included 57 patients (34 M, 23 F), mean age 52.3 years, and they had been on dialysis for an average of 34.5 months. We obtained information about adaptation and behavior in the care unit, and attitude and motivation towards renal transplantation. Biochemical variables were used to register disruption of medical compliance or dietetic transgression (K, PRC, BUN, weight gain, etc.). The patient's family climate was assessed through use of the Family Environment Scale (FES, Moos and Moos, 1981). The results showed that patients with aggressiveness and noncompliance during HD sessions tended to have high family conflict in family members. The most positive attitudes towards renal transplantation were found in the patients that came from families with the greatest degree of cohesion and expressiveness. In summary, family social climate is a variable influencing outcome of these patients. Its routine assessment would permit the prediction of adaptation to the therapeutic program as much as better efficacy of HD treatment.