Renal dysfunction and heart failure.

The cardiorenal syndrome is a relative frequent complication in patients with advanced heart failure (HF) and left ventricular dysfunction. Its presence is associated with a worse prognosis. The pathophysiology of cardiorenal syndrome may vary according to the specific clinical circumstances and conditions of the patients. Thus, the different factors that take part in this syndrome vary among subjects and in the same patient along the time. These mechanisms are multifactorial and many of them are not well defined. These include hemodynamic factors, systemic neurohormonal factors, drug treatment resistances and anemia. The first step in the treatment of cardiorenal syndrome is the optimization of HF therapy that includes diuretics, renin angiotensin system antagonists and beta blockers. However, despite these treatments, the prognosis of this syndrome remains very poor. There has been a growing interest for cardiorenal syndrome in the last years, its pathophysiology and the multiple interactions between heart and kidney. This has made that new therapies for the treatment of this syndrome have been tested, with encouraging results. In this manuscript, the definition, pathophysiology, clinical management and new therapies are reviewed.

Disnea en un paciente con trasplante hepático / Dypsnea in a patient with liver transplant

No disponible

Efectividad y tolerabilidad de lercanidipino en los pacientes hipertensos de alto riesgo. Datos del estudio LAURA / Effectiveness and tolerability of lercanidipine in very high risk hypertensive patients. Data of the LAURA study

Objetivo. Analizar la efectividad y tolerabilidad de lercanidipino en los pacientes hipertensos de riesgo cardiovascular alto y muy alto en condiciones de práctica clínica habitual. Pacientes y métodos. El estudio LAURA fue un estudio multicéntrico, prospectivo, no comparativo y abierto que incluyó a pacientes con hipertensión arterial esencial leve-moderada. Los pacientes recibieron durante 6 meses lercanidipino 10 mg/ día o 20 mg/día en caso de ausencia de control de presión arterial (PA). Se consideró buen control de PA < 140/90 mmHg (< 130/80 mmHg en diabéticos). Resultados. Del total de 3.175 pacientes hipertensos incluidos en el estudio, 1.542 (66,3 ± 14 años; 48 % mujeres) pertenecían a los grupos de riesgo cardiovascular alto (n = 722) o muy alto (n = 820), según la estratificación de las guías europeas de hipertensión de 2003. En estos pacientes las PA basales fueron: PA sistólica (PAS), 162,1 ± 13,1 mmHg; PA diastólica (PAD), 96,0 ± 8,1 mmHg, y presión de pulso (PP) 66,0 ± 5,0 mmHg. Al final del estudio, se observó un descenso de 26 y 16,8 mmHg en PAS y PAD, y de 9,2 mmHg en PP. Estas reducciones de PAS, PAD y PP fueron significativamente mayores que las detectadas en el subgrupo de riesgo medio-bajo (23, 15,8 y 9,2 mmHg, respectivamente; en todas ellas p < 0,05 frente al subgrupo de riesgo alto-muy alto). Al terminar el seguimiento el 38,2 % de los pacientes de riesgo alto-muy alto estaba con lercanidipino 10 mg, el 23,4 % lercanidipino 20 mg, y el 38,4 % restante con más medicación antihipertensiva añadida. El 53 % de los pacientes alcanzó el objetivo de PA sólo con lercanidipino en monoterapia. La incidencia de efectos adversos en el grupo total de hipertensos fue 11,5 %, siendo más frecuente la presencia de edema maleolar (5,1 %). No hubo diferencias significativas en cuanto a la presencia de efectos secundarios según los diferentes subgrupos de riesgo. Sólo el 1,7 % de los pacientes suspendieron el tratamiento debido a los efectos adversos. Conclusiones. Lercanidipino es un fármaco antihipertensivo eficaz y bien tolerado en los pacientes hipertensos de alto riesgo en condiciones de práctica clínica

Objective. To determine the effectiveness and tolerability of lercanidipine in high and very high cardiovascular risk hypertensive patients in conditions of clinical practice. Patients and methods. The LAURA study was a multicenter, prospective, non-comparative, open-label study that included patients with treated or untreated mild-to-moderate essential hypertension. Patients received lercanidipine 10 mg/day or 20 mg/day, when blood pressure (BP) control was not achieved, during 6 months. BP control was defined as systolic BP (SBP) < 140 mmHg and diastolic BP (DBP) < 90 mmHg (< 130 and < 80 mmHg for diabetics). Results. Out of the 3,175 hypertensive patients included in the LAURA study, 1,542 (66.3 ± 14 years; 48 % women) belonged to the high (n = 722) or very high (n = 820) risk groups according to the European guidelines on hypertension 2003. In these patients, baseline BP values were: SBP, 162.1 ± 13.1 mmHg; DBP, 96.0 ± 8.1 mmHg, and pulse pressure (PP), 66.0 ± 5.0 mmHg. At the end of the study, decreases of 26 and 16.8 mmHg in SBP and DBP and of 9.2 mmHg in PP were observed. These reductions in SBP, DBP and PP were significantly bigger than those observed in medium-low risk subgroup (23, 15.8 and 9.2 mmHg, respectively; in all of them p < 0.05 vs high-very high risk subgroup). At the end of the follow-up, 38.2 % of high-very high risk patients were taking lercanidipine 10 mg, 23.4 % lercanidipine 20 mg, and the rest 38.4 % with add-on antihypertensive therapy. A total of 53 % of patients were controlled with only lercanidipine in monotherapy. The incidence of adverse events was 11.5 %, the most frequent being ankle edema (5.1 %). There were no significant differences in the incidence of adverse events according to the different risk subgroups. Only 1.7 % of the patients discontinued the medication due to adverse events. Conclusions. Lercanidipine is an effective and well-tolerated antihypertensive drug in high and very high cardiovascular risk hypertensive patients in conditions of clinical practice

Cardiovascular risk profile and risk stratification of the hypertensive population attended by general practitioners and specialists in Spain. The CONTROLRISK study.

The CONTROLRISK study was designed to determine the cardiovascular risk profile of the hypertensive population attended at primary care and specialist setting in Spain and to investigate whether physicians stratify the risk correctly, according to the 2003 European guidelines. A total of 8920 patients were recruited from primary care (n=4485) and specialist outpatient clinic (n=4435). The age criteria was 62.6+/-11.1 years; 51.6% were women. No differences were observed in the severity of hypertension. More than 85% presented other cardiovascular risk factors, similarly in both groups. Target organ damage (TOD) and associated clinical conditions (ACC) were more frequent in specialist setting (57.6 vs 34.3% and 39 vs 28.7%, both P<0.0001). The most common risk factor was age. The most frequently reported TOD was left ventricular hypertrophy (42.3 and 22.1%; P<0.0001). Ischemic heart disease was the most common ACC (21.5 vs 13.1%; P<0.0001). The risk profile was significantly higher in specialist population (75.1 vs 60.3% of patients belonged to high- or very high-risk groups). Specialists and primary care physicians stratified only 54.6 and 48% of their patients correctly, respectively (P<0.05). Both, specialists and general practitioners (GPs) strongly underestimated the risk. Very high-risk patients were adequately assessed only in 44.9% of cases by specialists and in 25.3% by GPs (P<0.001). More than half of the hypertensive patients attended by GPs in Spain belong to the high- or very high-risk groups. GPs and specialists tend to underestimate the cardiovascular risk in daily clinical practice, mainly in very high-risk patients.

Emigrante oriental con hipertensión arterial y electrocardiograma con alteraciones en la repolarización. Un caso de miocardiopatía hipertrófica apical / An oriental immigrant with high blood pressure and electrocardiogram with alterations in the repolarization. A case of apical hypertrophic cardiomyopathy

La miocardiopatía hipertrófica apical, común en Japón, es una forma infrecuente de miocardiopatía hipertrófica que se caracteriza porque la hipertrofia se localiza predominantemente a nivel del ápex del ventrículo izquierdo. En esta enfermedad es característica la presencia de ondas T negativas gigantes en las derivaciones precordiales del electrocardiograma sin gradiente intraventricular en el ecocardiograma así como la escasa presencia de síntomas. Aunque se ha descrito un curso benigno de la enfermedad en términos de mortalidad cardiovascular, aproximadamente un tercio de los pacientes presenta eventos cardiovasculares serios como el infarto de miocardio o la aparición de arritmias. Presentamos un caso de miocardiopatía hipertrófica apical y a continuación revisamos el conocimiento actual que existe sobre esta enfermedad

Apical hypertrophic cardiomyopathy, common in Japan, is a rare form of hypertrophic cardiomyopathy. It is characterized by the fact that the hypertrophy is mainly located in the left ventricle apex. The presence of giant negative T waves in pre-cordial derivations of the electrocardiogram, without intraventricular gradient in the echocardiogram, and the fact that it has few symptoms is characteristic of this disease. Although a benign course of the disease has been described in terms of cardiovascular mortality, approximately one third of the patients have serious cardiovascular events, such as myocardial infarction or appearance of arrhythmias. We present the case of apical hypertrophic cardiomyopathy and then review the current knowledge existing on this disease

[CA-P control in haemodialysis and K/DOQI guidelines]. / Control del metabolismo calcio-fósforo en hemodiálisis y su adecuación a las guías K/DOQI 2003.

BACKGROUND: The publication in 2003 of the K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease recommended targets levels for serum iPTH, Ca, P, and CaxP product. However, many patients do not achieved these target ranges. It is necessary to known the percentage of patients out of range in order to prevent the development of bone disease and to reduce mortality and morbidity. OBJECTIVES: To know the degree of control of Ca-P metabolism in haemodialysis patients in our haemodilalysis facilities and the achievement of target levels recommended by K/DOQI Guidelines. PATIENTS AND METHODS: We have retrospectively investigated in 190 prevalent haemodialysis patients (males 58.2%, ratio M/F 1.4, mean age 70 years, range 17-87 years, at least 3 months in haemodialysis) the serum levels of Ca, albumin-corrected serum Ca, P, CaxP product and iPTH in all analitycal determinations performed in 2004. In each patient we have obtained the average (and median) of these serum markers. Cut-off levels were carried out following the recommendations of the K/DOQI Guidelines. RESULTS: The average of serum Ca and albumin-corrected serum Ca is normal (means +/- SD = 8.9 +/- 0.6 mg/dL and 9.2 +/- 0.7 mg/dL, respectively); however, 53.7% has normal values, 9.1% hypocalcemia and 37.1% hypercalcemia. The average of serum P is also normal (mean +/- SD = 5.0 +/- 1.3 mg/dL); however, only 57.2% has normal values, and 11.7% has hypophosphoremia and the remaining 31, 1% hyperphosphoremia. The CaxP product is normal (mean +/- SD = 46.3 +/- 13.3 mg2/mL2), 4.9% with low values and 23.4% with high values. The median of serum iPTH is 253 pg/mL, but only 31.1% of them have normal values, 25.1% low range values and 43.7% has hyperparathyroidism; 9.3% with iPTH higher than 800 pg/mL. The percentage of patients with hyperphosphoremia is higher in the group with iPTH higher than 300 pg/mL (23.3% vs. 40%, chi2, p= 0.006). In patients with PTHi in normal range, 3.6% have low CaxP product and the remaining 17.8% high CaxP product. Overall, only 25% of patients falls within recommended ranges for all indicators of mineral metabolism and 17% has all serum markers outside these recommendations. CONCLUSIONS: The degree of control of mineral metabolism in haemodyalisis patients if clearly insufficient and a large percentage of them do not achieved the recommended serum targets recommended by K/DOQI Guidelines. This groups of patients are exposed to a increased risk for oseous and cardiovascular morbimortality. The analysis of adequacy must be performed with percentage of patients out of range in order to apply new therapeutical strategies.

Control del metabolismo calcio-fósforo en hemodiálisis y su adecuación a las guías K/DOQI 2003 / CA-P control in haemodialysis and k/doqi guidelines

Introducción: Desde la publicación de las Guías K/DOQI en 2003 sobre metabolismomineral en la enfermedad renal crónica se ha observado que algunospacientes no alcanzan en la práctica clínica un adecuado control y es necesarioconocer el porcentaje de ellos que están fuera de rango normal, para evitar complicacionesmetabólicas y cardiovasculares.Objetivos: Conocer el grado de control del metabolismo Ca-P en pacientes tratadoscon hemodiálisis en nuestra provincia, estudiando los valores de tendenciacentral y el porcentaje de casos que se encuentran dentro y fuera de rango.Pacientes y métodos: Estudio retrospectivo realizado en 190 pacientes (58,2%varones, V/H 1,4, mediana de edad 70 años, rango de edad 17-87 años) incluidosen hemodiálisis durante al menos 3 meses, durante todo el año 2004. Decada paciente se obtiene la media (y mediana) de los valores de Ca, Ca corregidocon albúmina, P, producto CaxP y PTHi. Los niveles de corte se establecensegún las recomendaciones de las Guías K/DOQI de 2003.Resultados: Las medias de Ca total y corregido con albúmina están en rangonormal (medias ± DE = 8,9 ± 0,6 mg/dL y 9,2 ± 0,7 mg/dL, respectivamente);no obstante el 53,7% de ellos tienen valores de normocalcemia, mientras que el9,1% tiene hipocalcemia y el 37,1% hipercalcemia. La media de P también seencuentra en rango normal (media ± DE = 5,0 ± 1,3 mg/dL); no obstante sóloel 57,1% de ellos tienen valores en rango normal, mientras que el 11,7% tienehipofosforemia y el 31,1% hiperfosforemia. El producto CaxP se encuentra enrango normal (media ± DE = 46,3 ± 13,3 mg2/mL2, pero un 4,9% tiene valoresdisminuidos y un 23,4% valores elevados. La mediana de PTHi es 253 pg/mL,pero sólo el 31,1% se encuentra en el rango normal mientras que el 25,1% tienevalores disminuidos y un 43,7% en rango de hiperparatiroidismo, entre ellos un9,3% con niveles por encima de 800 pg/mL. El porcentaje de casos con hiperfosforemiaes superior en el grupo de pacientes con niveles de PTHi superiores a300 pg/mL (23,3% vs 40%, chi2, p = 0,006). Entre los pacientes con valores dePTHi en rango normal, un 78,6% tienen un producto CaxP normal, un 3,6% disminuidoy el 17,8% restante elevado. Al analizar los resultados globales, sólo lacuarta parte de los pacientes presenta un perfil completo en rango normal y un17% tiene todos los parámetros fuera de rango. Conclusiones: El control del metabolismo Ca-P es insuficiente y muchos pacientesno se encuentran en los rangos recomendados por las Guías K/DOQI de2003, por lo que están expuestos un mayor riesgo de complicaciones óseas y cardiovasculares.El análisis de la adecuación de los parámetros del metabolismo Calcio-Fósforo debe realizarse mediante porcentajes para conocer el grupo de pacientesque requieren nuevas estrategias terapéuticas

Backgroung: The publication in 2003 of the K/DOQI Clinical Practice Guidelinesfor Bone Metabolism and Disease in Chronic Kidney Disease recommendedtargets levels for serum iPTH, Ca, P, and CaxP product. However, many patientsdo not achieved these target ranges. It is necessary to known the percentage ofpatients out of range in order to prevent the development of bone disease and toreduce mortality and morbidity.Objectives: To know the degree of control of Ca-P metabolism in haemodialysispatients in our haemodilalysis facilities and the achievement of target levels recommendedby K/DOQI Guidelines.Patients and methods: We have retrospectively investigated in 190 prevalenthaemodialysis patients (males 58,2%, ratio M/F 1,4, mean age 70 years, range 17-87 years, at least 3 months in haemodialysis) the serum levels of Ca, albumin-correctedserum Ca, P, CaxP product and iPTH in all analitycal determinations performedin 2004. In each patient we have obtained the average (and median) ofthese serum markers. Cut-off levels were carried out following the recommendationsof the K/DOQI Guidelines.Results: The average of serum Ca and albumin-corrected serum Ca is normal(means ± SD = 8,9 ± 0,6 mg/dL and 9,2 ± 0,7 mg/dL, respectively); however,53,7% has normal values, 9,1% hypocalcemia and 37,1% hypercalcemia. Theaverage of serum P is also normal (mean ± SD = 5,0 ± 1,3 mg/dL); however, only57,2% has normal values, and 11,7% has hypophosphoremia and the remaining31,1% hyperphosphoremia. The CaxP product is normal (mean ± SD = 46,3 ±13,3 mg2/mL2) , 4,9% with low values and 23,4% with high values. The medianof serum iPTH is 253 pg/mL, but only 31,1% of them have normal values, 25,1%low range values and 43,7% has hyperparathyroidism; 9,3% with iPTH higherthan 800 pg/mL. The percentage of patients with hyperphosphoremia is higher inthe group with iPTH higher than 300 pg/mL (23,3% vs 40%, chi2, p= 0,006). Inpatients with PTHi in normal range, 3,6% have low CaxP product and the remaining17,8% high CaxP product. Overall, only 25% of patients falls within recommendedranges for all indicators of mineral metabolism and 17% has all serummarkers outside these recommendations.Conclusions: The degree of control of mineral metabolism in haemodyalisis patientsif clearly insufficient and a large percentage of them do not achieved therecommended serum targets recommended by K/DOQI Guidelines. This groupsof patients are exposed to a increased risk for oseous and cardiovascular morbimortality.The analysis of adequacy must be performed with percentage of patientsout of range in order to apply new therapeutical strategies

Lumbar bone mineral density after kidney transplantation: a three-year prospective study.

Osteopenia is a common complication after transplantation. However, prospective long-term studies are scarce and most were performed in patients on cyclosporine and high-dose steroids. In 65 patients with functioning grafts, 41 males and 24 females, 50 on tacrolimus-based immunosuppression and 15 on cyclosporine-based immunosuppression, bone mineral density (BMD) was measured in the lumbar spine (L2-L4) and femoral neck (FN) using dual X-ray absorptiometry (DEXA) in the first month after transplantation (baseline) and at 1, 2, and 3 years. At baseline, BMD was similar to the control population both in L2-L4 (z score = -0.421) and in FN (z score = -0.518). During the follow-up, 3 types of patterns were identified: BMD increased in L2-L4 in 25 patients (38.5%), remained stable in 20 patients (30.8%), and decreased in 20 patients (30.8%). BMD losses appeared mainly during the first year (0.964 +/- 0.162 baseline; 0.904 +/- 0.161 at 1 year, 0.886 +/- 0.140 at 3 years; analysis of variance [ANOVA] P < .001). However, the improvement was maintained throughout the follow-up (0.860 +/- 0.176 g/cm2 at baseline; 0.901 +/- 0.161 at 1 year; 0.954 +/- 0.178 at 3 years; ANOVA P < .001) and there was a parallel increase of BMD in FN (0.712 +/- 0.144 at baseline; 0.744 +/- 0.249 at 1 year; 0.826 +/- 0.184 at 3 years; ANOVA P < .01). There were no differences between both groups in graft function, intact parathyroid hormone (iPTH) levels, number of postmenopausal women, or steroid doses. About one third of patients had bone loss during the first year after transplantation. We were unable to identify any risk factor for this complication in patients on low-dose steroids.

[Colitis due to cytomegalovirus in a dialysis patient]. / Colitis por citomegalovirus asociada a insuficiencia renal crónica tratada con hemodiálisis.

Cytomegalovirus (CMV) is an ubiquitous agent and a pathogen in all age groups. Although CMV disease in normal adults is not very usual, the virus is well known to produce severe symptoms, mostly in immunocompromised patients. Chronic hemodialysed patients constitute a risk population for developing CMV infection, nevertheless, clinical manifestations are not usual. One chronic renal failure patient who developed acute and severe colitis due to CMV infection is presented. Of interest are, the rarity of this case, the favorable clinical course after the treatment and the differential diagnosis with other gastrointestinal disorders frequently found in renal patients.

[Therapy with interferon plus ribavirin in hemodialysis patient with PCR-positive viral hepatitis C]. / Tratamiento con interferón a y ribavirina en un paciente de hemodiálisis virus C, PCR positivo.

Traditionally, the treatment of viral hepatitis C (positive Polymerase Chain Reaction -PCR-) was with Interferon. A combination of Interferon plus Ribavirin has been producing better results in last years. Currently, Ribavirin is not indicated for patients with Chronic Kidney Disease because of a high risk of severe anaemia. In a few cases, this treatment is producing good results with previous dose adjustment. We show a case of a 28-year-old man with Chronic Kidney Disease on treatment with periodical hemodialysis and chronic hepatopathy HCV Positive RNA HCV (> 1,000,000 copies/ml) and persistent transaminase elevation. Before kidney transplantation, we decided to use Interferon (3,000,000 IU/48 hours) and Ribavirin (200 mg/24 hours) treatment. After 15 days, we saw normal transaminase values and HCV RNA was negative. The patient required temporary suspension of Ribavirin and two red blood cell transfusions due to severe anaemia. Ribavirin was reintroduced 200 mg/48 h posthemodialysis. The patient did not present any complication again, and could be treated for 14 months. After next 11 months of evolution the patient has normal rates of liver function and negative HCV RNA values.

Tratamiento con interferón y ribavirina en un paciente de hemodiálisis virus C, PCR positivo / Therapy with interferón plus ribavirin in hemodialysis patient with virus C hepatitis

Tradicionalmente el tratamiento de la hepatopatía virus hepatitis C (VHC), Reacción en Cadena de la Polimerasa (PCR) positivo, era con Interferón. En los últimos años se están viendo unos mejores resultados con la combinación de Interferón y Ribavirina. Inicialmente en pacientes con Insuficiencia Renal Crónica la Ribavirina no está indicada por riesgo elevado de anemia severa. En casos aislados se está empezando a usar, ajustando dosis a función renal, observando buenos resultados. Exponemos el caso de un varón de 28 años con insuficiencia renal crónica en tratamiento con hemodiálisis periódicas y hepatopatía crónica por VHC. RNA VHC positivo (> 1.000.000 copias/ml) y elevación mantenida de transaminasas. Previo a trasplante renal, se decide tratamiento del VHC con Interferón (3.000.000 UI/ 48 horas) y Ribavirina (200 mg/24 horas). A los 15 días de iniciar tratamiento se objetiva normalización de los valores de transaminasas y negativización del PCR VHC. Requirió suspensión temporal de Ribavirina y transfusión de dos concentrados de hematíes por anemia severa, siendo reintroducida posteriormente a dosis de 200 mg/48 horas posthemodiálisis. No volvió a presentar ninguna complicación con el tratamiento manteniéndolo durante 14 meses. En 11 meses de seguimiento desde la finalización del mismo el paciente mantiene parámetros de función hepática dentro de límites normales y PCR VHC negativa (AU)

Traditionally, the treatment of virical hepatitis C (positive Polymerase Chain Reaccion –RCP–) was with Interferon. A combination of Interferon plus Ribavirin are producing better results on last years. Currently, Ribavirin is not indicated for patients with Chronic Kidney Disease because exist high risk of several anaemia. In a few cases, this treatment is producing good results with previously dosifications adjust. We show a case of a 28 years old man with Chronic Kidney Disease on treatment with periodical hemodialysis and chronic hepatopathy HCV. Positive RNA HCV (> 1,000,000 copies/ml) and persistent transaminase elevation. Before kidney transplantation, we decided to use Interferon (3,000,000 IU/ 48 hours) and Rivavirin (200 mg/24 hours) treatment. After 15 days, exists normal transaminase values and HCV RNA was negative. The patient required temporally suspension of Rivavirin and two red blood cells transfusions due to several anaemic; and was reintroduced 200 mg/48 h posthemodialysis. The patient did not present any complication again, and could be treated for 14 months. After next 11 months of evolution the patient have normal rates of liver function and negative HCV RNA values (AU)

[Ionic dialysance to control the dose of dialysis. One year experience]. / Utilidad de la dialisancia iónica para control de la dosis de diálisis. Experiencia de un año.

The Diascan equipment (Hospal) measures ionic dialysane which it derives the K and the Kt. If we divide the Kt obtained with Diascan between the Kt/V obtained by a simplified formula, it result a value of V for every patient. Entering this V in the Diascan software we can obtain a Kt/V (Diascan Kt/V), similar in theory to the simplified Kt/V. In the year 2002 we have controlled the delivered dialysis in our unit with the Diascan Kt/V. The aim of the present study was to study the agreement between de Diascan Kt/V and the Lowrie Kt/V. During the year 2002, 63 patients have been dialyzed in monitors with Diascan equipment. We calculated the V of each patient by dividing the Kt Diascan between the Lowrie Kt/V in the same dialysis session. The mea of the two consecutive measurements was considered the V value. Throughout the year 2002, 7 agreement studies were realized. The inter-method variability was assessed by the relative difference (absolute difference Diascan Kt/V-Lowrie Kt/V, divided by the average of both tests). A good agreement was considered when the relative difference was equal or lower than 10%. In the 7 agreement studies realized, the mean of the relative difference oscilled between 5.2 and 6.6%, and the percentage of patients with a relative difference equal or lower than 10% oscilled between 83 and 91%. During a month, the Diascan Kt/V was controlled in all dialysis sessions in 41 patients (554 sessions in total). Failure in the lecture of Kt/V Diascan was observed in 41 sessions (7%). A Diascan Kt/V greater than 1 (the minimum delivered dialysis considered in our unit) was obtained in 93% of the valid sessions. 38 of 41 patients had a mean monthly Diascan Kt/V greater than 1. The coefficient of variability of any patient oscilled between 2.1 and 12.4% (mean 5.1%). Diascan Kt/V is good procedure for the monitoring the delivered dialysis without blood sampling or any additional costs.

Utilidad de la dialisancia iónica para control de la dosis de diálisis. Experiencia de un año / Ionic dialysante to control the dosis of dialysis. One year experience

Introducción: Mediante el cálculo de la dialisancia iónica, el monitor Diascan (Hospal) permite obtener el valor del aclaramiento de urea (K) y del Kt en cada sesión de hemodiálisis. Si dividimos el Kt así obtenido por el Kt/V calculado por cualquiera de las fórmulas al uso, obtendremos para cada enfermo un valor de V acorde al método utilizado para calcular el Kt/V. Introduciendo el valor V de cada enfermo, el programa Diascan proporciona un valor Kt/V de forma automática y sin precisar reactivo. Objetivo: Durante el año 2002 hemos controlado la dosis de diálisis de los enfermos de nuestra unidad mediante el Kt/V del Diascan (Kt/V Diascan). El objetivo del presente trabajo ha sido estudiar la concordancia entre el Kt/V Diascan y el Kt/V calculado por el método de Lowrie de 1983 (Kt/V Lowrie83).Material y métodos: El estudio ha sido realizado en los 63 enfermos crónicos que a lo largo del año 2002 se han dializado en un monitor Integra (Hospal) equipado con el sistema Diascan. En cada enfermo se calculó V dividiendo el Kt Diascan entre el KtV Lowrie83. El cálculo se hizo en dos sesiones de diálisis consecutivas, utilizando como V la media de las dos medidas. El valor V de cada enfermo fue introducido en su programa Diascan y de esta forma obtuvimos un valor Kt/V Diascan en todas las sesiones de hemodiálisis. A lo largo del año 2002 hemos realizado 7 estudios de concordancia entre Kt/V" Diascan y Kt/V Lowrie83. La concordancia entre ambos procedimientos (variabilidad intermétodo) se ha estudiado mediante su diferencia relativa = 100 × (diferencia absoluta Kt/V Lowrie83-Lt/V Diascan)/media de ambos Kt/V. Se consideró que la concordancia entre ambos métodos era aceptable cuando la variabilidad intermétodo era igual o inferior al 10 por ciento.Para valorar la utilidad del Kt/V Diascan en el control diario de la dosis de diálisis, se analizó su valor en todas las sesiones de diálisis realizadas en un mes elegido de forma arbitraria (julio de 2002). Durante todo ese mes se dializaron 41 enfermos en un monitor Integra con control Diascan. El número total de se siones analizadas fue de 554. En cada enfermo se estudió la variabilidad de la dosis de diálisis que recibió en todas las sesiones de ese mes. Resultados: En los 7 estudios de concordancia realizados no se objetivó una diferencia estadísticamente significativa entre ambos procedimientos, la variabilidad intermétodo media osciló entre el 5,2 y el 6,6 por ciento y el porcentaje de casos con variabilidad intermétodo igual o inferior al 10 por ciento estuvo comprendido entre el 83 y el 91 por ciento. En 11 de los 63 enfermos hubo que reajustar el valor de V durante el período de seguimiento. De las 554 sesiones realizadas con control Diascan durante un mes, en 41 (7 por ciento) se produjo fallo de lectura. En el 93 por ciento de las 513 sesiones válidas, el Kt/V Diascan fue superior a 1. De los 41 enfermos analizados durante ese mes, en 38 (93 por ciento) el Kt/V medio del mes fue superior a 1. El coeficiente de variación de la dosis de diálisis de cada enfermo en todas las sesiones recibidas en el mes, osciló entre 2,1 por ciento y 12,4 por ciento siendo la media de 5,1 por ciento. Conclusiones: Nuestra experiencia a lo largo de un año indica que el Kt/V Diascan mantiene una buena correlación con el Kt/V simplificado que ha sido utilizado como referencia. De forma periódica es necesario realizar estudios de concordancia para detectar posibles variaciones en el volumen de distribución de la urea de cada enfermo. El Kt/V Diascan un dato bastante fidedigno de la dosis de diálisis administrada a cada enfermo al final de cada sesión (AU)

Implantación de un programa para la detección precoz de hipoacusia neonatal / Implementing an universal newborn hearing screening program

La hipoacusia neonatal es un problema de salud pública importante sobre el que se puede incidir mediante programas de detección precoz. Estos programas cumplen los criterios de la OMS para la realización de screening de forma eficaz. En este artículo se expone la implantación de un plan de screening universal de hipoacusia neonatal, mediante detección de otoemisiones acústicas transitorias evocadas, en un hospital con una media de 1200 nacimientos anuales. Discutimos los recursos materiales y humanos requeridos, los resultados en el primer año y la necesidad de la generalización de estos programas (AU)

Permanent childhood hearing impairment is a serious public health problem. Identification by screening in the first few months of life has the potential to improve affected children development. Neonatal hearing screening programs endorse the WHO requirement for a cost efficient screening. This paper shows the implementation of a medium-size hospital-based universal newborn hearing screening program using transient evoked otoacoustic emissions. Operational procedures and requirements are discussed. Quality control and results are showed (AU)

Shifting of localization planes in optical testing: application to a shearing interferometer.

An amplitude-division two-beam interferometer illuminated by a quasi-monochromatic, spatially incoherent, and periodic source yields multiple localization planes of interference fringes. If a thick transmission sample with a few localized phase disturbances in various layers is placed in the interferometer, the disturbances in a layer can be detected, making its images through the two arms coincide with a chosen localization plane. Different layers can be analyzed by means of shifting the localization plane by a variation of the source period without any other changes in the device. Here we illustrate this method by applying it to a shearing interferometer, a classical Wollaston prism placed between crossed polarizers. Experimental images of different observation planes are obtained, and they are in good agreement with the theoretical expectations.

[Implantation of a program for the early detection of neonatal hearing loss]. / Implantación de un programa para la detección precoz de hipoacusia neonatal.

Permanent childhood hearing impairment is a serious public health problem. Identification by screening in the first few months of life has the potential to improve affected children development. Neonatal hearing screening programs endorse the WHO requirement for a cost efficient screening. This paper shows the implementation of a medium-size hospital-based universal newborn hearing screening program using transient evoked otoacoustic emissions. Operational procedures and requirements are discussed. Quality control and results are showed.

[Correlation of clinical, radiologic, and histopathologic findings in laryngeal, hypopharyngeal, and oropharyngeal cancer]. / Correlación entre los hallazgos clínicos, radiológicos e histopatológicos en el cáncer de laringe, hipofaringe y orofaringe.

The correct staging of the tumors has important consequences in the planning of the treatment in the patients with cancer of larynx, hypopharynx and oropharynx. The objective of this paper is to study the correlation of the clinical, radiologic and pathologic staging with the purpose to evaluate if the computed tomography (CT) is effective in the diagnostic of the stage in the different tumoral findings. We did a retrospective study in 34 patients with pharynx and larynx cancer in the "Hospital Universitario Príncipe de Asturias" between the years 1994-1998. The method was: 1. Clinical history and ENT examination. 2. Head and neck CT. 3. Direct laryngoscopy and biopsy. 4. Surgical treatment and posterior pathologic staging of the removed specimen. The lesions were studied according the TNM-UICC classification with the T and N stage. The first thing to do was the clinical stage then the radiologic stage and at last compare it with the pathologic stage after surgical removal. The results are presented in percentages and confirm that the clinical and radiologic combined information improve the correlation between clinical and pathologic staging in the cancer of larynx, hypopharynx and oropharynx.