[Pulse wave velocity of the leg minus that of the arm measured with a custom device correlates to the coronary calcium quantification]. / La velocidad de onda de pulso de la pierna menos brazo medida con un dispositivo propio se correlaciona con la cuantificación de calcio coronario.

OBJECTIVE: The pulse wave velocity (PWV) in the great arteries is an indicator of vascular risk. Our objective was to identify the PWV index between the arms and legs that best correlates with the coronary calcium quantification (CCQ) and to compare it with other methods. MATERIAL AND METHODS: Eight-one patients without vascular disease underwent the following measurements: CCQ; carotid intima-media thickness (IMT); carotid-femoral PWV (cfPWV), using COMPLIOR; and PWV in the arms and legs, with our own device (abiPWV, ankle brachial index PWV). RESULTS: The difference in PWVs between the leg and arm (l-a PWV) measured with abiPWV was the index that best correlated with CCQ (r=0.401, P<.001). The correlation between IMT and CCQ and between CF-PWV and CCQ were r=0.366, P=.001; and r=0.385, P=.001, respectively. For a CCQ score higher than 100 as a marker of significant coronary arteriosclerosis, the areas under the curve for l-a PWV, IMT and cfPWV were 0.721 (P=.002), 0.758 (P<.001) and 0.636 (P=.058), respectively. CONCLUSIONS: For patients without vascular disease, the l-a PWV measured with abiPWV appears to be the index that best correlates with the CCQ. This association is comparable to that between IMT and CCQ and between cfPWV and CCQ. The abiPWV is an easy-to-use device that can help improve vascular risk stratification.

[Characteristics of smoking, nicotine dependence and motivation for change in specialists training in health sciences (residents) in Andalusia (Spain)]. / Características del consumo de tabaco, dependencia y motivación para el cambio de los especialistas internos residentes de Andalucía (España).

OBJECTIVE: As there are few studies on the smoking habits of specialists training in health sciences (residents), it is of interest to determine the prevalence of smoking, nicotine dependence and motivation for change, and their relationship with other variables (personal, work and consumption of other drugs). MATERIAL AND METHODS: A multicentre, cross-sectional study using a questionnaire was conducted in 2012. All the residents who were studying in Teaching Health Centres in Andalusia (Spain) completed a questionnaire, which was sent by e-mail, collecting: age, sex, specialty, country of origin, qualitative-quantitative consumption of tobacco, age of onset/cessation, Fagerström test and stage of change (Proschaka). RESULTS: A total of 2667 residents (63% of total) completed the questionnaire. The mean age was 29.1 years (± 5.2), 69% female, 89% Spanish, and 86% physicians. Of the 17% who smoked (daily pattern-47%, intermittently-41%, related to leisure-3%), starting at 17.4 years (±3.5) and mean of 7.5 cigarettes per day (±7.1), higher medical specialties (P=.067 ANOVA), and in men (P=.074, Student-t). More than three-quarters (82%) had a low nicotine dependence, being higher in hospital medical specialties (P=.078 χ(2)). Of the total, 7% were former smokers, and 48% wanted to quit smoking (contemplation 38%, preparation 10%). In the multivariate analysis there was a link between smoking and alcohol consumption (OR 2.84) and illegal drugs (OR 3.57). There were no differences by age or country. CONCLUSIONS: The consumption of tobacco in residents is less than the general population, with a low dependence and better willingness to change. The period of specialised training is a good time to offer tobacco interventions.

[Obstructive uropathy secondary to vesico-ureteral endometriosis: clinical, radiologic and pathologic features]. / Uropatía obstructiva secundaria a endometriosis vésico-ureteral: características clinico-radiológicas y anatomopatológicas.

OBJECTIVES: To report the case of a 37 year-old woman suffering from endometriosis of the urinary tract, that presented with lumbar and pelvic pain associated to cyclic recurrent haematuria. METHODS: Following history, physical examination, abdomino-pelvic ultrasound (USS), CT scan and cystoscopy with biopsies, surgical treatment was indicated RESULTS: Imaging (USS-CT ) revealed a protrusion of the left bladder hemi-trigone with a nodular, irregular thickening and ipsilateral grade II-III/IV uretero-hydronefrosis. Cistoscopy confirmed a swollen and oedematous lesion in left hemi-trigone that seemed extrinsic in origin. With the clinical diagnosis of a possible neoplasia of gynaecological origin, the patient underwent surgical treatment consisting in radical hysterectomy with bilateral oophorectomy, partial cystectomy and left ureteroneocystostomy. CONCLUSIONS: The frequency of endometriosis in the urinary tract is relatively low and therefore, endometriosis presenting with ureteral obstruction (uretero-hydronephrosis) has been rarely reported in the literature and should be part of the differential diagnosis in young women, especially if symptoms are cyclic. The treatment is surgery and the final diagnosis by pathology report.

Application of the McCluskey Index to predict blood product requirements during liver transplantation.

BACKGROUND: A recent study proposed a risk index (McCluskey index) based on 7 parameters to identify the transfusion needs of patients during surgery and in the first 24 hours postoperation. The initial objective of our study was to validate this predictor for blood product transfusions. PATIENTS AND METHODS: We undertook a retrospective, observational study of all liver transplant patients between January 1, 2005 and December 31, 2006. The following variables were recorded for each patient: age, gender, patient comorbidity, biochemical values prior to liver transplantation, and transfusion needs. RESULTS: Comparing the transfusion needs of those patients with scores <5 with those of scores >/=5, we observed significant differences in terms of the use of red blood cell concentrates, plasma, and platelets, both during the first 24 hours and in the total number. The index sensitivity was 80% (95% confidence interval [CI]: 71.23-88.76), with a specificity of 84.21% (95% CI: 67.81-100), where the positive predictive value was 95.52% (95% CI: 90.57-100.4) and the negative predictive value was 50% (95% CI: 32.67-67.32). CONCLUSION: The McCluskey index showed sufficient sensitivity and specificity to predict which patients will require a massive transfusion.

Comparison between two drugs on the hemodynamic evaluation of pulmonary hypertension prior to heart transplantation.

INTRODUCTION: Invasive estimation of pulmonary pressure is part of the usual protocol prior to heart transplantation. The aim of this study was to compare the results of 2 different vasodilators, nitric oxide (NO) and prostacyclin, in an acute vasodilator test (AVT) for patients with pulmonary venous hypertension. MATERIALS AND METHODS: From January 2000 to December 2006, 94 right-sided heart catheterizations were performed in our center within pretransplantation evaluations. AVT was performed if the mean pulmonary artery pressure (mPAP) >35 mm Hg or if the pulmonary vascular resistance (PVR) was >4 Wood units (WU). Epoprostenol was administered to 40 patients, NO to 6 patients, and both agents to 8 patients. RESULTS: A significant decrease in both mPAP and PVR was shown with maximum doses of epoprostenol, with an average variation of 8.96 mm Hg in mPAP (P < .001) and 3.26 WU in PVR (P < .001). An increased cardiac output (CO) was observed with epoprostenol, with a mean difference of 1.9 L/min (P < .001) at maximum compared with baseline doses. A tendency for the mPAP and PVR to decrease was also observed with maximum NO doses, with mean decreases of mPAP and PVR of 5.62 mm Hg and 1.14 WU, respectively. A tendency for CO to decrease was observed with NO (0.75 L/min; P = .039). CONCLUSIONS: In our experience, NO is the best drug for AVT due to its pulmonary tree selectivity. A study with epoprostenol was complementary; both drugs can be used in these patients prior to heart transplantation.

Correlation of echocardiographic and hemodynamic parameters in pulmonary hypertension assessment prior to heart transplantation.

INTRODUCTION: Invasive assessment of pulmonary artery pressure (PAP), via right heart catheterization, is part of the usual protocol prior to heart transplantation. Echocardiography is considered a valuable technique to evaluate PAP. We sought to determine the reliability of measurements of PAP via a noninvasive technique, echocardiography, in relation to the estimated PAP via right catheterization. We also determined its safety when invasive procedures are restricted to just patients with pulmonary hypertension (PHT) according to echocardiographic parameters. MATERIALS AND METHODS: We performed a retrospective study of 67 right catheterizations performed in our hospital, within the heart transplant study protocol, from January 2000 to December 2006. PAP parameters were estimated by echocardiography and right catheterization. RESULTS: Hemodynamically, 57.1% of the patients had severe PHT (more than 45 mm Hg mean PAP); 13.2% moderate PHT (between 35 and 45 mm Hg mean PAP); 12.1% had mild PHT (between 25 and 35 mm Hg mean PAP); and 17.6% of patients showed no PHT. Pearson correlation index with systolic PAP (estimated via echocardiography) and mean PAP (calculated via invasive method) was 0.69 (P < .001). PHT was considered significant when systolic PAP estimated via echocardiography reached more than 40 mm Hg and mean PAP estimated via right catheterization reached more than 35 mm Hg, the value from which the vasodilator test was carried out. According to these parameters, echocardiography showed a sensitivity of 89% to diagnose significant PHT and 46% specificity, with positive and negative predictive values of 70% and 76%, respectively.

Incidence and importance of de novo diabetes mellitus after heart transplantation.

INTRODUCTION: Diabetes mellitus is one of the main metabolic complications after heart transplantation. The aims of our study were to determine the incidence and factors that determine the appearance of posttransplantation diabetes mellitus (PTDM) and its prognostic value. MATERIALS AND METHODS: We performed a retrospective study of all heart transplant recipients in our hospital from January 1993 to December 2005, including 116 patients with prolonged monitoring with 59-month median follow-up. We divided the patients into two groups, according to whether they had de novo diabetes (group 1) or no diabetes (group 2). RESULTS: Patients with PTDM were significantly older, with a median difference (MD) of 5.4 years (95% confidence interval [CI], 1.53-9.28) and a greater body mass index (MD, 3.37 kg/m(2); 95% CI, 1.68-5.06). Moreover, a greater percentage of patients in group 1 had ischemia compared to other etiologies. However, no significant differences were observed regarding other cardiovascular risk factors. PTDM was associated with a greater incidence of posttransplant hypertension (51.6% in group 1 vs 48.4% in group 2, P = .08) and posttransplant renal failure (59.5% in group 1 vs 40.5% in group 2, P = .001). However, no differences were observed in overall survival. CONCLUSIONS: Age, overweight, and ischemic origin of cardiopathy were the main risk factors for the development of PTDM in our population. Although no differences were observed in survival rates, PTDM was associated with a greater incidence of hypertension and renal insufficiency, which may have long-term influences on patient survival.

Safety and efficacy of ezetimibe in a sample of cardiac transplant patients.

OBJECTIVE: To evaluate the safety and efficacy of ezetimibe in a sample of transplanted cardiac patients. MATERIALS AND METHODS: We undertook a descriptive retrospective observational study of 19 transplanted cardiac patients in whom treatment with ezetimibe was initiated at doses of 10 mg/d between 2004 and 2006, assessing tolerability and changes in lipid levels (total cholesterol and triglycerides), doses of immunosuppressive drugs, and the hepatic profile after 12 months of treatment. RESULTS: There was no effect on the doses required of any immunosuppressive drugs. We observed a reduction in cholesterol levels, with a normal distribution (mean +/- standard deviation 26.84 +/- 14 mg/dL) among patients with ezetimibe addition, despite no change in the statin doses. There were no changes in the levels of triglycerides, transaminases, or bilirubin, and no cases of rhabdomyolysis or myalgia. All patients continued to take the drug after 1 year of treatment. CONCLUSIONS: In our sample, the administration of ezetimibe to transplanted cardiac patients for 1 year was associated with a reduction in cholesterol levels by 26.8%. No substantial changes in the doses of immunosuppressive drugs could be attributed to the use of ezetimibe. Tolerance was good, with no need for drug withdrawal in any case.

Comparación de la eficacia preventiva de programas de intervención psicosocial sobre las actitudes hacia el consumo juvenil de sustancias psicoactivas / Comparison of the preventive efficacy of psychosocial intervention programs on attitudes towards the young consumption of psychoactives substances

Objetivo: Con la intervención psicosocial de carácter educativo-preventivo, implementada en 4 centros de enseñanza secundaria del Principado de Asturias, el objetivo prioritario que se ha perseguido es promover cambios en las actitudes hacia el consumo de sustancias psicoactivas del colectivo de adolescentes que han participado en el estudio longitudinal llevado a cabo. Material y métodos: Se ha procedido a comprobar la eficacia preventiva de 4 programas de intervención psicosocial calificados como de intervención familiar, experto, informativo y de sensibilización básica. En la primera encuesta participaron 755 alumnos, y posteriormente se seleccionaron 4 grupos experimentales y un grupo control, integrados por 141 adolescentes. Se han analizado las actitudes permisivas y contrarias hacia las drogas ilegales y hacia drogas institucionalizadas (tabaco y alcohol) y la percepción valorativa de sus consumidores, entre otros factores. Resultados: De acuerdo con los resultados obtenidos, se confirma la eficacia preventiva de las sesiones educativo-preventivas implementadas en promover cambios en la actitud ante el consumo de drogas, en la dirección predicha relativa a un fortalecimiento de las actitudes opuestas al consumo de sustancias psicoactivas, así como una disminución significativa de actitudes previas permisivas. Conclusiones: A partir del análisis longitudinal de los resultados hallados en las comparaciones de las sucesivas evaluaciones del programa (7, 12 y 18 meses), y en función del programa preventivo empleado, ha de concluirse que la eficacia preventiva del programa de intervención psicosocial se mantiene a medio plazo (AU)

Evaluation of new surfactant expanded zirconium and titanium phosphates for polycyclic aromatic hydrocarbons extraction from waters.

A newly synthesized family of materials prepared with surfactant as organic template were tested for the extraction of polycyclic aromatic hydrocarbons (PAHs) from water, using pyrene (Pyr) and benzo[a]pyrene (B[a]P) as PAHs representatives. Particular attention was paid to the evaluation of the recovery factors with dichloromethane as eluent in order to estimate their potential as adsorbing solid phases for PAH remediation or analysis. Eleven lamellar MCM-50 type materials incorporating n-alkyl- (n = 12, 16, 18) trimethylammonium bromide molecules with different concentrations and chain lengths and two hexagonal MCM-41 type materials incorporating octadecyl-trimethyl ammonium bromide were tested. Best results were obtained by preparing lamellar MCM-50 zirconium and titanium phosphates in the presence of n-dodecyl-trimethylammonium at a relative molar concentration (surfactant/phosphate) of 1.

[Localized Castleman's disease: description of a case and review of the literature]. / Enfermedad de Castleman localizada: descripción de un caso y revisión de la literatura.

Castleman's disease is a rare entity which is caracterized by its histological features: hyperplasia of lymph nodes and capillary proliferation. Two histological patterns has been described: hyaline vascular type and plasma cell type. From a clinical viewpoint has been identified two different clinical course: a localized type (ECL) usually of benign clinical course and a multicentric type (ECM) of worst prognosis. We present a case of Castleman"s disease localized in the neck region in which the excision was both diagnostic and therapeutic. The variety histological was hyaline-vascular type.

Transmission of trans effects in dinuclear complexes.

The substitution of a terminal hydride ligand in the complexes [Ir(2)(mu-H)(mu-Pz)(2)H(3)(L)P(i)Pr(3))(2)] (L = NCCH(3) (1) or pyrazole (3)) by chloride provokes a significant change in the lability of the L ligand, despite the fact that the substituted hydride and the L ligand lie in opposite extremes of the diiridium(III) complexes. Detailed structural studies of complex 3 and its chloro-trihydride analogue [Ir(2)(mu-H)(mu-Pz)(2)H(2)Cl(HPz)(P(i)Pr(3))(2)] (4) have shown that this behavior is a consequence of the transmission of ligand trans effects from one extreme of the molecule to the other, with the participation of the bridging hydride. Extended Hückel calculations on model diiridium complexes have suggested that such trans effect transmissions are due to the formation of molecular orbitals of sigma symmetry extended along the backbones of the complexes. This is also an expected feature for metal-metal bonded complexes. The feasibility of the transmission of ligand trans effects and trans influences through metal-metal bonds and its relevance to the understanding of both the reactivity and structures of metal-metal bonded dinuclear compounds have been substantiated through structural studies and selected reactions of the diiridium(II) complexes [Ir(2)(mu-1,8-(NH)(2)naphth)I(CH(3))(CO)(2)(P(i)Pr(3))(2)] (isomers 6 and 7) and their cationic derivatives [Ir(2)(mu-1,8-(NH)(2)naphth)(CH(3))(CO)(2)(P(i)Pr(3))(2)](CF(3)SO(3)) (isomers 8 and 9).

[Paratesticular recurrence of renal carcinoma]. / Recidiva paratesticular de carcinoma renal.

OBJECTIVE: To describe the clinical and histological findings of a case of renal cell carcinoma metastatic to the testes, an uncommon site of metastasis of this tumor type that can cause difficulty in making the differential diagnosis and consequently, in the staging and treatment of the disease. METHODS/RESULTS: A 65-year-old patient diagnosed of renal cell carcinoma presented a paratesticular mass. Histopathological examination of the orchidectomy specimen showed proliferation of clear cells arranged in a diffuse pattern, with intimate intertwining with vascular structures. Tumor cells were strongly positive for vimentin, CAM5.2 and EMA. CONCLUSIONS: Although renal cell carcinoma rarely metastasizes to the testes, it should be considered in the differential diagnosis of testicular masses. Histological examination is essential to diagnosis and correct management.

Key factors determining the course of methyl iodide oxidative addition to diamidonaphthalene-bridged diiridium(I) and dirhodium(I) complexes.

The course of methyl iodide oxidative addition to various nucleophilic complexes, [Ir2(mu-1,8-(NH)2naphth)(CO)2(PiPr3)2] (1), [IrRh(mu-1,8-(NH)2naphth)(CO)2(PiPr3)2] (2), and [Rh2(mu-1,8-(NH)2naphth)(CO)2(PR3)2] (R = iPr, 3; Ph, 4; p-tolyl, 5; Me, 6), has been investigated. The CH3I addition to complex 1 readily affords the diiridium(II) complex [Ir2(mu-1,8-(NH)2naphth)I(CH3)(CO)2(PiPr3)2] (7), which undergoes slow rearrangement to give a thermodynamically stable stereoisomer, 8. The reaction of the Ir-Rh complex 2 gives the ionic compound [IrRh(mu-1,8-(NH)2naphth)(CH3)(CO)2(PiPr3)2]I (10). The dirhodium compounds, 3-5, undergo one-center additions to yield acyl complexes of the formula (Rh2(mu-1,8-(NH)2naphth)I(COCH3)(CO)(PR3)2] (R = iPr, 12; Ph, 13; p-tolyl, 14). The structure of 12 has been determined by X-ray diffraction. Further reactions of these Rh(III)-Rh(I) acyl derivatives with CH3I are productive only for the p-tolylphosphine derivative, which affords the bis-acyl complex [Rh2(mu-1,8-(NH)2naphth)(CH3CO)2I2(P(p-tolyl)3)2] (15). The reaction of the PMe3 derivative, 6, allows the isolation of the bis-methyl complex [Rh2(mu-1,8-(NH)2naphth)(mu-I)(CH3)2(CO)2(PMe3)2]I (16a), which emanates from a double one-center addition. Upon reaction with methyl triflate, the starting materials, 1, 2, 3, and 6, give the isostructural cationic methyl complexes 9, 11, 17, and 18, respectively. The behavior of these cationic methyl compounds toward CH3I, CH3OSO2CF3, and tetrabutylamonium iodide is consistent with the role of these species as intermediates in the SN2 addition of CH3I. Compounds 18 and 17 react with an excess of methyl triflate to give [Rh2(mu-1,8-(NH)2naphth)(mu-OSO2CF3)(CH3)2(CO)2(PMe3)2][CF3SO3] (19) and [Rh2(mu-1,8-(NH)2naphth)(OSO2CF3)(COCH3)(CH3)(CO)(PiPr3)2][CF3SO3] (20), respectively. Upon treatment with acetonitrile, complexes 17 and 18 give the isostructural cationic acyl complexes [Rh2(mu-1,8-(NH)2naphth)(COCH3)(NCCH3)(CO)(PR3)2][CF3SO3] (R = iPr, 21; Me, 22). A kinetic study of the reaction leading to 21 shows that formation of these complexes involves a slow insertion step followed by the fast coordination of the acetonitrile. The variety of reactions found in this system can be rationalized in terms of three alternative reaction pathways, which are determined by the effectiveness of the interactions between the two metal centers of the dinuclear complex and by the steric constraints due to the phosphine ligands.

Rifabutin as salvage therapy for cases of chronic multidrug-resistant pulmonary tuberculosis in Taiwan.

This study was aimed at assessing the efficacy and tolerability of rifabutin for the re-treatment of cases of chronic, multidrug-resistant pulmonary tuberculosis. The study design was self-controlled, single center. Rifabutin was administered as part of an individual-tailored multidrug regimen. In-patients suffering from pulmonary tuberculosis, infected with Mycobacterium tuberculosis bacilli resistant to isoniazid, rifampicin and other drugs with progressive disease unresponsive to prior courses with standard anti-tuberculosis medications were treated. Overall, 43 patients were enrolled and treated with rifabutin at 300 or 450mg/day according to body weight in conjunction with available anti-tuberculous drugs for a mean time of 353 days (range 42-678). Of these, 36 met all eligibility criteria (i.e. positive baseline culture of sputum with bacilli resistant to rifampicin at least) and were retained for the analysis of efficacy. Seventeen patients (47%) achieved a sustained conversion to a negative culture of sputum in a mean time of 47.7 days with a range of 14-120 days. Treatment prevented deterioration in most patients and resulted in clinical and radiological cure or marked improvement in more than half of cases. No correlation was found between treatment outcome and use of medication concomitant to rifabutin or susceptibility of bacilli to the drugs used. Four deaths occurred due to disease progression, in no case being related to study drugs. Ten patients reported a total of 18 adverse events that led to treatment discontinuation in 5 cases. Rifabutin should be considered for inclusion in regimens for cases of pulmonary multidrug-resistant tuberculosis which fail to respond to previous therapy.

Oral plus intramuscular medroxyprogesterone acetate (high dose Farlutal) in advanced breast cancer.

The efficacy and tolerability of the combined scheme of administering high dose medroxyprogesterone acetate in advanced breast cancer is evaluated.

Cis-platinum-adriamycin-cyclophosphamide in the treatment of advanced-recurrent cervical cancer.

Twenty-two patients with advanced or recurrent cancer of the cervix treated with cis-platinum, adriamycin and cyclophosphamide were evaluated. Nine of 22 (41% achieved objective response (2 CR + 7PR), 9/22 (41%) stable disease, 4/22 (18%) progressive disease. The mean duration of response was 24.6 weeks, with a range of 18-28 weeks. Patients with poorly differentiated histologic grade and without previous treatment had better response rates. Responders had longer survival (mean 63.5 + weeks) than nonresponders (mean 30.5 weeks). Commonly encountered toxicities were alopecia, nausea and vomiting, and leucopenia, which were all tolerable.