Monitorización ambulatoria de presión arterial y enfermedad renal crónica en pacientes hipertensos diabéticos tipo 2 y en pacientes hipertensos / Ambulatory blood pressure monitoring and chronic kidney disease in type 2 diabetic hypertense patients and hypertense patients

Objetivos. La valoración del perfil circadiano de la presión arterial (PA) y la estimación adecuada de la presencia de enfermedad renal crónica constituyen nuevas aproximaciones en la evaluación del riesgo cardiovascular. En este estudio hemos pretendido conocer las características del patrón circadiano y la enfermedad renal de los pacientes diabéticos tipo 2 e hipertensos con respecto a los pacientes únicamente hipertensos. Pacientes y método. En una unidad especializada de riesgo cardiovascular se estudiaron 180 pacientes, 146 hipertensos y 34 hipertensos diabéticos tipo 2 con edades comprendidas entre 18 y 80 años. Se realizó historia clínica, bioquímica, electrocardiograma y se descartó la existencia de causa secundaria de hipertensión. A todos se les determinó el grado de enfermedad renal y se les realizó monitorización ambulatoria de presión arterial (MAPA) durante 24 horas. Resultados. La edad media del los pacientes hipertensos (H) fue de 47,9 ± 13,6 años, y la de los hipertensos diabéticos (H-D) fue de 57,2 ± 8,5 años. Las PA clínicas fueron más alta en los pacientes H-D que en los pacientes H (165 ± 15,1/99,7 ± 9,4 mmHg frente a 153,4 ± 23,6/96,7 ± 12,0 mmHg), respectivamente. En MAPA la presión arterial sistólica (PAS) de 24 h diurna y nocturna también eran más elevadas en los pacientes H-D que en los H. El 82,4 % de los pacientes H-D fueron non dipper frente al 71,2 % de los H (p = 0,28). El filtrado glomerular (FG) en los pacientes H-D fue de 66,7 ± 10,1 ml/min frente a 74,8 ± 3,2 ml/min (p < 0,0001) de los pacientes H. Conclusiones. Es preciso valorar con atención la enfermedad renal y el patrón circadiano de presión arterial de los pacientes hipertensos diabéticos tipo 2

Objectives. Evaluation of the circadian blood pressure (BP) profile and adequate calculation of the presence of chronic renal disease make up new approaches in evaluation of cardiovascular risk. In this study, we have aimed to know the characteristics of the circadian pattern and kidney disease of type 2 diabetic and hypertense patients in regards to patients who are only hypertense. Patients and methods. In a specialized cardiovascular risk unit, 180 patients were studied, with 146 hypertense and 34 type 2 diabetic hypertense subjects aged 18 and 80 years. A clinical, biochemical and electrocardiogram history was obtained and secondary cause of hypertension ruled out. The degree of kidney disease was determined in all of them and 24 hour ambulatory blood pressure monitoring (ABPM) was performed. Results. Mean age of the hypertense patients (H) was 47.9 ± 13.6 years and of diabetic hypertense (D H) subjects was 57.2 ± 8.5 years. The clinical BPs were higher in D-H patients than in H patients (165 ± 15.1/99.7 ± 9.4 mmHg versus 153.4 ± 23.6/96.7 ± 12.0 mmHg), respectively. In ABPM the daytime, nighttime, and 24 hour SBP were higher in D-H patients than in H ones. A total of 82.4 % of the D-H patients were non dipper versus 71.2 % of the H (p = 0.28). Glomerular filtration (GF) in D-H patients was 66.7 ± 10.1 ml/min versus 74.8 ± 13.2 ml/min (p < 0.0001) of the H patients. Conclusions. Renal disease and the circadian blood pressure pattern of type 2 diabetic hypertense patients must be evaluated carefully

[Clinical characteristics of 47 patients with primary hyperparathyroidism surgically treated]. / Características clínicas de 47 casos de hiperparatiroidismo primario intervenidos quirúrgicamente.

BACKGROUND: The primary hyperparathyroidism is usually an asymptomatic disease. Actually, specialists are attempting to consider to what extent it can be necessary to undergo surgery in this disease. In this article, we are going to describe the clinical and biochemical characteristics of our patients with primary hyperparathyroidism as well as the diagnostic procedures and the results after operation. METHODS: Firstly, we have analysed 47 records of patients with primary hyperparathyroidism and intervened in our hospital during the last 5 years. Secondly, we assessed the biochemical results before and after the surgical intervention, the outcome of parathyroid echography, thoracico-cervical tomography, technietium-99-mm-sestamibi gammagraphy and bone densitometry. Finally, we followed up the assessment of the operation of the patients with hyperparathyroidism. RESULTS: 47 patients were intervened of hyperparathyroidism. 89.4% were women and average the age was 61.4 +/- 12.8 years. Most of them were asymptomatic (45.7%). The gammagraphy was the procedure with best sensibility and specificity, 75 and 100%. Bone densitometry showed that there were no patients with diminished calcification of the bones. The principal diagnostic of pathologic anatomy was adenoma (85.1%). Excluding one single case, the rest of patients healed of their illness after intervention. CONCLUSIONS: Primary hyperparathyroidism is asymptomatic in most of the cases. It is mainly an adenoma process. The best diagnostic procedure is technietium-99-mm-sestamibi gammagraphy. The most appropriate and successful treatment is surgery.

[Alterations of nuclear maturity in spermatozoids of males with antecedents of cryptorchidism]. / Alteraciones de la madurez nuclear en espermatozoides de varones con antecedentes de criptorquidia.

The association between infertility and cryptorchidism is an accepted fact, usually attributed to the oligozoosperm, asthenozoosperm or teratozoosperm presented in ejaculation products of males with this antecedent. The nuclear maturity in a sample of men with antecedents of cryptorchidism have been studied and these results have been compared to those of a control group. The results of this work show the deficient transformation of nuclear proteins to protamines in males with antecedents of cryptorchidism compared to the control group, due to the remaining of immature histones. Alterations of nuclear maturity able to contribute to the subfertility of these men were found in spermatozoids of adult males with antecedents of cryptorchidism.

Características clínicas de 47 casos de hiperparatiroidismo primario intervenidos quirúrgicamente / The clinical manifestations of 47 patients with pri mary hyperparathyroidism intervened

Fundamento y objetivo: El hiperparatiroidismo primario (HPTP) en la mayoría de los casos es asintomático. Hoy día, se discute la necesidad de someter a estos enfermos a paratiroidectomía. En el presente estudio, pretendemos describir las características clínicas y bioquímicas de nuestra serie de HPTP, además, de describir las técnicas utilizadas en el diagnóstico y los resultados obtenidos tras la intervención quirúrgica. Material y métodos: Hemos revisado las historias clínicas de 47 pacientes diagnosticados y operados de HPTP en nuestro centro en los últimos cinco años. Primero, recogimos las manifestaciones clínicas; segundo, los resultados bioquímicos anteriores y posteriores a la intervención quirúrgica; tercero, los datos de la ecografía paratiroidea, tomografía computerizada (TC) cervico-torácica, gammagrafía paratiroidea con 99Tc-Sestamibi y densitometría dual de rayos X ( DEXA); y por último, los resultados derivados de la intervención quirúrgica. Resultados: Fueron intervenidos 47 pacientes de HPTP, 89,4 por ciento mujeres, con edad media 61,4 ± 12,8 años. La gran mayoría se encontraban asintomáticos (45,7 por ciento). En cuanto a las técnicas de localización, la gammagrafía con 99mTc-sestamibi fue la que tuvo mayor sensibilidad y especificidad 75 y 100 por ciento, respectivamente. Ninguno de los pacientes presentó osteoporosis mediante densitometría ósea. El principal diagnóstico fue el de adenoma 85,1 por ciento. Todos los pacientes curaron tras la intervención, con la excepción de un solo caso. Conclusión: El HPTP presenta escasos síntomas. Principalmente se trata de adenomas. La técnica de localización preoperatoria más útil es la gammagrafía. El tratamiento definitivo es la extirpación (AU)

[Usefulness of the clonidine test for the diagnosis of pheochromocytoma]. / Utilidad de la prueba de clonidina en el diagnóstico de feocromocitoma.

BACKGROUND: The clonidine test has been proposed as diagnostic biochemical test for patients with clinical suspicion of pheochromocytoma. METHODS: The clonidine test was used in 80 patients with suspicion of pheochromocytoma (on account of suggestive clinical findings, increased levels of metanephrines, increased plasma or urinary levels of catecholamines, or suggestive images by ultrasonography or CT). RESULTS: Surgery confirmed the diagnosis of pheochromocytoma in 16 patients. The highest sensitivity (62%) and specificity (46%) of the clonidine test corresponded to a brake degree of 5%, with a predictive negative value of 83%. The test was most useful in patients with increased basal plasma values of catecholamines (sensitivity, 62%; specificity, 66%). CONCLUSIONS: The clonidine test can be useful for the diagnosis of pheochromocytoma in patients with increased basal plasma levels of catecholamines and a brake degree lower than 5% at 180 minutes.

Alteraciones de la madurez nuclear en espermatozoides de varones con antecedentes de criptorquidia / Alterations of nuclear maturity in spermatozoids of males with antecedents of cryptorchidism

La asociación de infertilidad y criptorquidia es un hecho aceptado. Casi siempre se ha atribuido a la oligozoosperrmia, astenozoospermia o teratozoospermia que presentan los eyaculados de los varones con este antecedente. Hemos estudiado la madurez nuclear de los espermatozoides de un grupo de varones con antecedentes de criptorquidia y la hemos comparado con la de un grupo control. Los resultados de este estudio demuestran la deficiente transformación de las proteínas nucleares en protaminas en los varones con antecedentes de criptorquidia respecto al grupo control, permaneciendo en su estado inmaduro de historias. En los espermatozoides del eyaculado de varones adultos con antecedentes ele criptorquidia encontramos alteraciones de la madurez nuclear que pueden contribuir a la subfertilidad de los mismos (AU)

Utilidad de la prueba de clonidina en el diagnóstico de feocromocitoma / Utility of the clonidine test for the diagnosis of pheochromocytoma

Fundamento. La prueba de clonidina se ha propuesto como prueba bioquímica diagnóstica en pacientes con sospecha clínica de feocromocitoma. Método. Hemos realizado dicha prueba a 80 pacientes con sospecha de feocromocitoma (por datos clínicos sugestivos, metanefrinas elevadas, catecolaminas plasmáticas o urinarias elevadas, imágenes en eco o tomografía axial computarizada sugerentes del mismo).Resultados. Se confirmó quirúrgicamente el diagnóstico de feocromocitoma en 16 pacientes. La prueba de clonidina mostró la mayor sensibilidad (S = 62 por ciento) y especificidad (E = 46 por ciento) para un punto de corte de frenación del 5 por ciento, con un valor predictivo negativo del 83 por ciento. La prueba mostró mayor utilidad en los pacientes con valores plasmáticos basales elevados de catecolaminas (S, 62 por ciento; E, 66 por ciento).Conclusiones. La prueba de clonidina puede ser útil en el diagnóstico de feocromocitoma en pacientes que presentan catecolaminas plasmáticas basales elevadas y una frenación a los 180 minutos menor del 5 por ciento (AU)

Calidad de vida relacionada con la salud y obesidad / Health related quality of life (HRQoL) and obesity

¿Cómo medir el beneficio que un obeso percibe cuando pierde peso en aspectos tan subjetivos como la vitalidad, las relaciones sociales o la salud mental? El concepto de calidad de vida relacionada con la salud (CVRS) es un parámetro de gran utilidad para intentar aproximarse al impacto que la obesidad puede tener en la vida cotidiana de un obeso. Este concepto hace referencia a aspectos de la vida que en principio parecen insignificantes, pero que influyen sobremanera en la experiencia personal y pueden impedir llevar la vida que se quiere. La medida de la salud, no en cantidad, sino en calidad, con distintos tests genéricos (NHP, SIP, SF-36, etc.) o específicos (IWQoL, SOS, etc.), que nos permitan conocer a qué facetas afecta más la obesidad y cómo evolucionan a medida que se normaliza el peso, además de realizar comparaciones entre distintos grupos o en el mismo individuo, ayuda a comprender por qué se producen las recidivas, a encontrar una motivación válida para el paciente, a establecer objetivos realistas que, apoyados en mejoras concretas de la CVRS, sirvan para afianzar cambios en el estilo de vida y lograr el éxito a largo plazo. A su vez son medidas útiles para seleccionar tratamientos y monitorizar su eficacia, así como para la toma de decisiones sociopolítico-sanitarias. Hasta ahora su aplicación se ha limitado casi exclusivamente a obesos mórbidos sometidos a cirugía bariátrica y con seguimientos relativamente cortos, lo que condiciona que sus resultados sean poco generalizables (AU)

[Obesity and quality of life]. / Obesidad y calidad de vida.

The health status from the patient's own perspective is being given more importance every day, both with regard to his or her physical aspect and the mental and social aspects, this is the so-called Health Related Quality of Life. In order to evaluate this, tools are being developed that permit a quantification of this qualitative concept, using generic and specific tools which, if adequately validated, will lead to an understanding of the impact of the obesity on the individual, its change over time, enable comparisons with other individuals, with the quality of life of other diseases, with that of a healthy population, or with the general population. They will also allow the patients to be grouped and they will facilitate the study of the mechanisms that have led to the patient being obese and the consequences thereof. The QoL tests will serve to select the treatments and to monitor the efficacy thereof. Although there is no evidence of major psychiatric disease in obese patients considered globally, those with a greater degree of obesity, are more prone to suffering from these. The latter also show an alteration in most of the dimensions explored by the QoL tests and if they subject to a radical weight loss, these improve from the first months on, but it has yet to be determined whether these improvements are maintained over time and whether they are equally manifest in patients with moderate weight losses, and as yet the frustration that the frequent relapses of this disease imply, have not been properly quantified. The rapid development of valid tools to assess the Health Related Quality of Life in obesity, require their use as yet another part of the clinical evaluation of any obese individual.

[A comparative study of 9 cases of adrenal pheochromocytoma and 11 cases of extra-adrenal pheochromocytoma]. / Estudio comparativo de nueve casos con feocromocitoma adrenal y once casos con feocromocitoma extraadrenal.

Twenty patients with the diagnosis of pheochromocytoma were studied from January 1990 to January 1998. Nineteen patients had a pathologic investigation performed. The mean age of patients was 49 +/- 16 years (range: 24-71 years), 8 males and 12 females. Nine cases corresponded to adrenal and eleven to extra-adrenal (paragangliomas) pheochromocytomas. The anatomic location was similar in both adrenal glands and for paragangliomas the cervical location predominated. The most consistent clinical finding in our patients was maintained arterial hypertension, followed by headache, palpitations and flushing. Biochemically, an increase in urine catecholamine levels or their metabolites was found in 82.2%. The clonidine test was very useful, particularly for cases where biochemical results were discrepant. CT, NMR and gammagraphy with 123I-MIBG have a high sensitivity for locating pheochromocytomas. NMR and gammagraphy with 111In-pentetreotide located cases in which CT or 123I-MIBG were negative. Preoperative treatment with adrenergic alpha-blockers allowed to surgery with no arterial tension complications. Only one patient with multiple abdominal paragangliomas relapsed. No differences regarding clinical manifestations, biochemical parameters or imaging studies were found between pheochromocytomas and paragangliomas, except their location.

[Gonadal, hormonal and spermatic function in patients treated for cryptorchidism]. / Función gonadal hormonal y espermática en pacientes tratados por criptorquidia.

This paper studies the gonadal-hormonal and spermatic function of 48 adults (over 18 years old) who were treated in childhood for cryptorchidism by medical, surgical or both treatments. We measure plasmatic levels of FSH, LH, testosterone and prolactin of 34 patients and sperm samples of 31 patients. The testicular hormonal function was not disturbed except in four patients with high levels of prolactin (> 20 ng/ml) without symptoms. The spermatic function was disturbed in bilateral cryptorchidism mainly. The better sperm quality and testicular volume were at patients treated with hormonal treatment before surgical treatment.

[Pituitary apoplexy in 2 hypophyseal tumors]. / Apoplejía hipofisaria en dos tumores hipofisarios.

Hypophyseal apoplexy is not always easy to confirm morphologically or analytically. We present a patient with Cushing's syndrome due to hypophyseal apoplexy and optochiasmic pachyarachnoiditis which produced serious visual alterations. The adenoma necrotized behind an area of hypophyseal apoplexy which cured the patient's Cushing's disease. The second case was admitted with hypophyseal apoplexy, presenting hypophyseal tumoration with signs of hemorrhage and subsequent panhypopituitarism.

[Suprarenal carcinoma of an unusual size]. / Carcinoma suprarrenal de tamaño inusual.

Suprarenal carcinoma is an unusual entity, rarely surpassing 4,000 gr. In general, tumors of such big size are not functional. We present a case of a 31-years-old woman with a suprarenal carcinoma weighting 5,200 gr, in which hormonal production was clinically and biochemically demonstrated.

[Relations between Sheehan's syndrome and empty sella turcica. A functional study apropos of 6 cases]. / Relación entre síndrome de Sheehan y silla turca vacía. Estudio funcional a propósito de 6 casos.

We evaluated six patients in whom a diagnosis of Sheehan's syndrome had been made. The plasma levels of the following hormones were measured: basal thyroxine (T4), estradiol and cortisol; and also follicle-stimulating hormone (FSH), luteinizing hormone (LH), growth hormone (GH), thyrotropin (TSH), prolactin (PRL) and adrenocorticotropic hormone (ACTH), basally and after acute challenge with LH releasing hormone (LHRH), GRF (1-29)NH2 or insulin hypoglycemia, TSH releasing hormone (TRH) and lysine-8-vasopressin, respectively. Two patients underwent chronic LHRH stimulation by pulsatile subcutaneous administration with infusion pump. In 4 cases, computed tomography (CT) was performed although cranial X-ray study was normal. A severe and generalized pituitary involvement was found in all patients, 3 of whom had diabetes mellitus. Probably, more insidious cases go unnoticed. The presence of asymptomatic partial empty sella (ES) in all the CTs that were carried out raises the possibility that it is another evolutive feature of SS.

[MEN I (multiple endocrine neoplasia): patient screening and new tumor markers]. / MEN I: Screening de pacientes y nuevos marcadores tumorales.

Multiple endocrine neoplasia type I (men I) associates hyperparathyroidism with pancreatic tumors. The evaluation included the patient and its family, periodically. A good patient medical history, biochemical blood tests, carried out regularly and in an organised fashion, brings to the fore the diagnosis without difficulties. Tumoral markers are now being considered an important test for diagnosis and follow-up (gastrin, pancreatic peptid, prolactin...). The newest chromogranin is a polypeptidic group which increases in the blood of patients with endocrine neoplasias (including hyperparathyroidism and tumors of pancreatic islet cells). The specific neural enolase is increase in pancreatic islet cells tumor. The evaluation of S-100 substance, 7-B2 protein, neurotensin, alpha sub-unit of chorionic gonadothrophin and other markers will soon be of help in the diagnosis of men I.