[The role of intestinal absorption blockade in hypercholesterolemia treatment]. / El papel del bloqueo de la absorción intestinal del colesterol en el tratamiento de la hipercolesterolemia.

Mechanisms of biliary and diet cholesterol absorption are reviewed, and the characteristics of a new specific intestinal cholesterol absorption inhibitor (ezetimibe) are discussed. Ezetimibe is absorbed well by oral route, shows glucuronization in the liver and enters in enterohepatic circulation; thus, half-life is long, around 22 hours. Dose is 10 mg administered once a day. Ezetimibe works through both cholesterol sources: the production of cholesterol by hepatocytes and the absorption of cholesterol by enterocytes, giving rise in this way to an additive hypolipemic effect. The administration of lower dose of statin besides 10 mg of ezetimibe amounts to the administration of highest dose of statin. In patients who take statins whose LDL cholesterol levels are higher than normal, adding ezetimibe increase from 27% to 75% the percentage of those who reach the therapeutic objective. In addition to increasing the effectiveness, side effects are also avoided since the tolerability to ezetimibe is similar to placebo. The average maximum reduction of the plasma level of cholesterol with 10 mg of ezetimibe and 80 mg of simvastatin or atorvastatin is higher 60%.

El papel del bloqueo de la absorción intestinal del colesterol en el tratamiento de la hipercolesterolemia / The role of intestinal absorption blockade in hypercolesterolemia treatment

Se revisan los mecanismos de absorción de colesterol biliar y de la dieta y se comentan las características de un nuevo inhibidor específico de la absorción del colesterol en el intestino: la ezetimiba. La variablidad de la capacidad absortiva en distintos individuos hace que la eficacia de las estatinas se vea limitada. La ezetimiba se absorbe bien por víal oral, se glucuroniza en el hígado y entra en la circulación enterohepática, por ello su vida media es larga, alrededor de 22 horas. La dosis más efectiva es 10 mg administrados una vez al día. Actuando sobre las dos fuentes: la producción de colesterol hepatocitario y la absorción en el enterocito, se obtiene efecto sinérgico. La dosis más baja de estatina acompañada de 10 mg de ezetimiba equivale a dar la dosis más alta de estatina. En pacientes que toman estatinas al añadir ezetimiba el porcentaje de los que alcanzan el objetivo se incrementa de un 27 por ciento a un 75 por ciento. Además de aumentar la eficacia también se evitan efectos secundarios, ya que la tolerancia de ezetimiba es similar al placebo. La reducción máxima promedio de la cifra de colesterol plasmático con 10 mg de ezetimiba y 80 mg de simvastatina o atorvastatina oscila entre el 60 por ciento-65 por ciento (AU)

Factors predicting a hospital stay of over 3 days in patients with acute exacerbation of chronic obstructive pulmonary disease.

OBJECTIVE: To investigate the factors predicting a hospital stay of over 3 days in patients who required hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD). DESIGN AND SETTING: A cross-sectional study was done at a tertiary hospital serving an area of 500 000 inhabitants. SUBJECTS: A total of 273 patients (alpha=0.05; accuracy=5.94%) who had been admitted consecutively to the Short Stay Medical Unit at the Juan Canalejo Hospital in A Coruña, from February 1998 to March 1999, with a diagnosis focusing on exacerbation of COPD. Methods. Demographic variables, past medical history, symptoms, arterial blood gases, functional tests, treatment and the cause of exacerbation were studied in each patient. The hospital stay was dichotomized into 3 days. The prognostic factors of a hospital stay were determined by log regression. Results. The mean stay was 4.6 +/- 5.1 days (range: 1-64). After monitoring the associated covariables, the following were found to have an independent effect on the prediction of a hospital stay of over 3 days: weekend admissions (OR=4.17; 95% CI: 2.42-7.18), the presence of cor pulmonale (OR=2.19; 95% CI: 1.27-3.78), and the respiratory rate on admission (OR=1.09; 95% CI: 1.03-1.14). Arterial blood gases and functional tests showed no independent effect. Conclusions. The factors having an independent prognostic value in determining the length of hospital stays in patients with COPD are weekend admission, cor pulmonale and respiratory rate. Additional studies are required to validate these findings.

[Bilateral adrenal hemorrhage secondary to heparin treatment: a case report]. / Hemorragia suprarrenal bilateral, secundaria a tratamiento con heparina: descripción de un caso.

Bilateral suprarenal haemorrhage (BSH) has not been often described as a cause of chronic suprarenal insufficiency. The diagnosis before death is difficult and it was rare until the CAT scan became a routine diagnostic tool. Of 25 cases reported since 1981, 23 were diagnosed by CAT scan. We report a case of a patient that developed bilateral suprarenal haemorrhage (BSH) during heparin therapy for pulmonary embolism. The early clinical picture resembled a septic shock, and the diagnosis of Addison disease was made later. We reviewed the medical literature and we emphasized the clinical problems in which we should suspect the diagnosis of BSH, where early therapy with steroids may be critical to save the patient's life.

[Miliary tuberculosis in adults. Study of 67 patients]. / Tuberculosis miliar en adultos. Estudio en 67 pacientes.

67 patients with miliary TB diagnosed over a 15 year period (1973-1987) have been retrospectively studied. The clinical and analysis data were evaluated, highlighting different factors associated to higher mortality. 53 patients diagnoses were made premortem and 14 had the diagnosis made post-mortem. The age of the patients was of 48 +/- 21 (mean +/- DE) years, inferior to other series, this showing a higher prevalence and early age of infection in the area. 63% had miliary radiological features; the most frequent tests performed were liver biopsy with profitability of 80% and bronchoscopy which, together with transbronchial biopsy and bacterial analysis of the bronchoalveolar lavage, showed a positive diagnosis of 60%. The factors which were associated with bad prognosis were cavitated or chronic lesions (P less than 0.01), chronic diseases and immunosuppression factors associated, this not being statistically significant.