[Evolution of epilepsy in successive pregnancies]. / Evolución de la epilepsia en gestaciones sucesivas.

INTRODUCTION: Hormonal and metabolic factors related to pregnancy itself are considered to increase the likelihood of seizure recurrence. If so, we should expect a similar evolution of epilepsy in a subsequent pregnancy. We investigated differences in evolution of non-gestational epilepsy in each pregnancy of women suffering from epilepsy. METHODS: A prospective study was conducted in order to compare seizure frequency in two successive pregnancies of more than 36 weeks duration in 12 patients. Improvement/worsening is defined as a change of +/- 50 % in the number of seizures regarding that which occurred within the previous eleven months. RESULTS: Twelve epileptic women were studied during two subsequent pregnancies. Eight of them took the same antiepileptic treatment for both pregnancies and one took no antiepileptic drug. Three worsened in the first pregnancy and two in the second. Seven patients had the same seizure frequency during both pregnancies. The total plasma antiepileptic concentrations tended to decline with the same proportion in both pregnancies if the dose remained unchanged. We observed no differences in mean hormone plasma concentrations for each quarter, within subsequent pregnancies. CONCLUSION: Except for one case with drug-resistant epilepsy, we found that the reason for the discrepancy in the frequency of the seizure between two successive pregnancies in the same patient was a sharp or rapid change in antiepileptic drug dose or non-compliance. In well controlled epileptic women a consistent evolution of epilepsy should be expected in a subsequent pregnancy, if adequate treatment is maintained.

[Leptin in the endocrinology of obesity]. / Leptina en la endocrinología de la obesidad.

The article summarizes the endocrinology axis in relation to leptin in the obesity. There is a glucocorticoid hypothesis in the obesity origin. Human plasma leptin levels are elevated in Cushing's syndrome and there is a robust leptin secretory responses to dexamethasone. Obesity impacts on reproductive function in man and women. Leptin levels are higher in women than in men and a critical blood leptin level is necessary to trigger reproductive ability in women. The relationship between body mass index and circulating leptin varies during the course of spontaneous cycles in women, the best correlation occurring during the luteal phase when progesterone and leptin concentrations are highest. Obesity is associated with a decrease in growth hormone (GH) and reversible with weight loss. The influence of body composition on GH secretion in the obesity may be mediated through leptin, acting as a peripheral signal from adipose tissue. Thyroid dysfunction appear not associated with alterations in serum leptin levels. There is a significant relationship between insulin and leptin, but it is not immediate, since type 2 diabetics show similar leptin levels to those of nondiabetic humans of the same body mass index.

Leptina en la endocrinología de la obesidad / Leptin in the endocrinology of obesity

El artículo revisa los diferentes ejes endocrinológicos en relación con los niveles plasmáticos de leptina del paciente obeso. Existe una hipótesis glucocorticoidea como causa de obesidad. Los niveles plasmáticos en humanos de leptina están elevados en el síndrome de Cushing y hay una respuesta secretora franca de leptina a la dexametasona. La obesidad altera la función reproductora tanto en el hombre como en la mujer. Los niveles de leptina son mayores en la mujer que en el hombre y se requiere un nivel crítico de leptina en plasma para desarrollar la capacidad reproductora femenina. La interrelación entre el índice de masa corporal y los niveles circulantes de leptina varían en el curso de los ciclos ováricos, la mejor correlación aparece en la fase luteal, cuando los niveles de leptina y progesterona están mas altos. La obesidad se asocia a disminución de los niveles plasmáticos de GH, situación que revierte con la pérdida de peso. La infuliencia de la composición corporal sobre la secreción de GH en la obesidad puede estar relacionada con la leptina, que acutaría como una señal periférica del tejido adiposo. La disfución tiroidea no parece producir alteraciones en los niveles de leptina. Existe una interrelación significativa entre los niveles de insulina y leptina, pero ésta no está clara ya que en el paciente con diabetes tipo 2 encontramos niveles similares de leptina a los de los controles con similar indice de masa corporal (AU)

[Molecular forms of PSA and differentiating between benign hypertrophy,carcinoma, and disseminated prostatic carcinoma. Correlation between two determination technics]. / Formas moleculares de PSA en la discriminación entre hipertrofia benigna, carcinoma y carcinoma diseminado de próstata. Correlación entre dos diferentes técnicas de determinación.

OBJECTIVE: To determine the correlation between two methods of measurement of total PSA (PSA-T) and free PSA (PSA-F) and the utility of the PSA-F/PSA-T ratio in patients with PSA-T between 4 and 10 ng/ml suspected as having prostate cancer. METHODS: Determinations of both PSA-T and PSA-F were performed using two different techniques in 91 patients suspected as having prostate cancer. Diagnosis was made on the findings of biopsy and the complementary tests. RESULTS: The following correlation was found for the two techniques: R = 0.99 and p < 0.05 for PSA-T, and R = 0.85 and p < 0.05 for PSA-F. For PSA-T values of 4-10 ng/ml and PSA-F greater than 25%, we found two patients with prostate cancer. For a PSA-F/PSA-T ratio less than 9%, all cases had prostate cancer. Three cases with bone metastasis had PSA-T values less than 10 ng/ml. CONCLUSIONS: A PSA-F/PSA-T ratio greater than 25% does not exclude malignancy in patients with a total PSA of 4-10 ng/ml; values less than 9% correspond to prostate cancer. Bone metastasis was found with both methods in patients with total PSA values less than 10 ng/ml.

[Biochemical evaluation of renal lesions produced by electrohydraulic shock waves]. / Evaluation biochimique des lésions rénales produites par les ondes de choc électrohydrauliques.

The authors present a biochemical study of the renal lesions produced during extracorporeal electrohydraulic shock wave lithotripsy (ESWL). The sequential variation (before and after ESWL) of various biochemical parameters of the blood and 24-hour urine was analysed in 50 patients. A significant increase of urinary N-Acetyl-Glucosaminidase (NAG), urinary NAG/urinary creatinine quotient, proteinuria, serum creatinine and potassium was detected during the 24 hours following ESWL. A significant fall in creatinine clearance, urinary osmolarity and uric acid clearance was also detected. A positive correlation was observed between these alterations, the number of shocks and the kilovoltage used. On the 7th and 15th days, no significant difference was observed compared to the baseline values before ESWL. This can be explained by the fact that the lesions caused by shock waves are already in the repair phase.