Nefropatía inducida por contrastes iodados radiológicos / Radiological iodinated contrast-induced nephropathy

El uso de contrastes iodados puede causar nefrotoxicidad. Actualmente se cuestiona que los contrastes sean los responsables exclusivos del daño renal, ya que en la mayoría de los casos coexisten otras causas potenciales de fracaso renal. Con los contrastes actuales de baja osmolaridad e isoosmolares, la incidencia de nefropatía por contraste se estima que es inferior al 1% en la población de bajo riesgo; pero puede incrementarse hasta el 37% en pacientes que reciben contraste por vía intraarterial y/o que presentan insuficiencia renal con filtrado glomerular estimado inferior a 30ml/min/1,73m2. Para minimizar el riesgo de nefrotoxicidad se recomienda administrar la menor cantidad posible de contraste y asegurar una adecuada expansión de volumen mediante la infusión de solución salina 0,9%

The use of iodinated contrast media can cause renal toxicity. Whether contrast media are exclusively responsible for kidney damage is currently the subject of debate, given that in most cases, other potential causes of the renal failure are present. With current low-osmolar and iso-osmolar contrast media, the incidence rate of contrast-induced nephropathy is estimated to be <1% in the low-risk population but can increase to 37% in patients who are administered contrast by an intra-arterial administration and/or who have renal failure with an estimated glomerular filtration rate (eGFR) <30mL/min/1.73m2. To minimize the risk of renal toxicity, the recommendation is to administer the least amount of contrast possible and ensure appropriate volume expansion by infusing 0.9% saline solution

Radiological iodinated contrast-induced nephropathy. / Nefropatía inducida por contrastes iodados radiológicos.

The use of iodinated contrast media can cause renal toxicity. Whether contrast media are exclusively responsible for kidney damage is currently the subject of debate, given that in most cases, other potential causes of the renal failure are present. With current low-osmolar and iso-osmolar contrast media, the incidence rate of contrast-induced nephropathy is estimated to be <1% in the low-risk population but can increase to 37% in patients who are administered contrast by an intra-arterial administration and/or who have renal failure with an estimated glomerular filtration rate (eGFR) <30mL/min/1.73m2. To minimize the risk of renal toxicity, the recommendation is to administer the least amount of contrast possible and ensure appropriate volume expansion by infusing 0.9% saline solution.

Tularemia pulmonar / Pulmonary tularemia

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N-terminal pro-brain natriuretic peptide as a potential non-invasive marker of cardiac transplantation rejection.

BACKGROUND: Transplantation is the main palliative treatment for patients with heart failure. Clinical signs of cardiac rejection can be very non-specific or even absent. Thus, successful management relies on early diagnosis, ideally before the onset of clinical features of cardiac dysfunction. Although endomyocardial biopsy (EMB) is the reference diagnostic method, several non-invasive methods have been proposed to reduce the number of EMB performed during the follow-up of the transplanted patient. The aim of the present work was to study the potential relationship between rejection and serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) as well as cardiac troponin T (cTnT) in post-transplantation patients. METHODS: Twenty-three consecutive orthotopic heart transplantation recipients with a mean age of 51 years (range 22-66) were prospectively recruited from the cardiac transplantation programme at the Hospital Universitario Central de Asturias. Serum NT-proBNP and cTnT were measured during the follow-up of these patients (ranging from 9-13 months post-transplantation) and compared with the results of EMB. RESULTS: Serum NT-proBNP concentrations progressively decrease during the first year post-transplantation, reaching concentrations slightly higher than the reference values. NT-proBNP concentrations increase significantly in those patients with a rejection episode graded >or=3A on the basis of the EMB (P<0.001, Mann-Whitney U-test). No relation between cTnT and rejection was observed. CONCLUSIONS: The potential of NT-proBNP as a non-invasive marker of transplantation rejection shows promising results, since NT-proBNP concentrations increase whenever a significant rejection event takes place in the first year of follow-up.

Búsqueda activa de casos entre familiares de primer grado de niños celíacos / Case finding study among first degree relatives of coeliac children

Objetivo. Conocer la prevalencia de la enfermedad celíaca entre familiares de primer grado de niños afectos de celiaquía. Estudiar el comportamiento del HLA DQ2 entre los niños y sus familiares. Material y Métodos. Estudio descriptivo transversal de serología de celíaca y de HLA DQ2 entre los familiares de primer grado de niños diagnosticados de enfermedad celíaca en nuestro Área Sanitaria entre 1992 y 2003.Resultados. Se diagnosticaron 54 casos nuevos de enfermedad celíaca en el periodo de estudio (17 varones y 37 mujeres), con una mediana de edad en la biopsia yeyunal de 24 meses. De ellos, el 89 por ciento presentaban clínica digestiva, el 46 por ciento hipocrecimiento/fallo de medro y el 2 por ciento eran asintomáticos. Todos presentaron serología y biopsia yeyunal típica de enfermedad celíaca. El 85 por ciento eran HLA DQ2 positivos. Se pudieron estudiar 44 familias de las 54 iniciales. Se realizó la serología de celíaca en 115 familiares, detectándose cuatro nuevos casos (dos hermanos, una hermana y una madre) (3,5 por ciento de los familiares estudiados). El HLA DQ2 se estudió en 110 familiares, siendo positivo en el 64 por ciento de los mismos (74 por ciento de los padres, 59 por ciento de las madres y 60 por ciento de los hermanos). Los cuatro nuevos casos eran HLA DQ2 positivos. Conclusión. El 3,5 por ciento de los familiares de primer grado de nuestros niños celíacos presentaban marcadores serológicos de celíaca. El HLA DQ2 fue positivo en el 85 por ciento de los niños celíacos y en el 64 por ciento de los familiares estudiados. Los cuatro nuevos casos detectados eran HLA DQ2 positivos (AU)

Effect of prenatal stress on the hormonal response to acute and chronic stress and on immune parameters in the offspring.

The effect of prenatal stress on the time course of the corticosterone response to acute and chronic stress and on hematological and immunological parameters in the offspring were analized in the present study. Pregnant Sprague-Dawley rats were stressed daily for 2 hours during the last week of gestation, and female and male off-spring were studied during adulthood. Corticosterone response to acute immobilization stress was not significantly different in either control or prenatally stressed rats. However, after 10 days of immobilization stress the corticosterone response completely disappeared in the control animals but not in the prenatally stressed group: high levels of corticosterone were found during the first hour of stress, although they were lower than those found in acutely stressed rats. Adrenal hypertrophy in response to prenatal stress was observed in females but not in male offspring, and chronic stress only increased adrenal weights in the male control group. Prenatal stress decreased the total peripheral leukocyte count, altered its diferential count decreasing lymphocytes and increasing neutrophil and eosinhophil counts, and significantly reduced the percentage of peripheral lymphocyte T CD8+ subset in male offspring. Chronic stress also reduced the percentage of the peripheral T CD8+ lymphocyte subset in the control group but not in the prenatally stressed group. These results suggest that the exposure to stress during pregnancy alters the adaptative response of the hypothalamus-pituitary-adrenocortical axis to chronic stress and presumably the immune competence in the offspring.

Nitric oxide inhibits tyrosine hydroxylase of rat median eminence.

Tyrosine hydroxylase (TH) is the rate-limiting enzyme in the biosynthesis of catecholamines. In a previous report we found that intracerebroventricular administration of nitric oxide (NO) generator sodium nitroprusside (SNP) to conscious male rats inhibited dose-dependently the TH activity of the median eminence (ME). In the present study we have tested the in vitro effects of SNP on TH activity, its possible mediator and action mechanism. Exposure of the ME TH to SNP (50, 100 and 500 microM) caused concentration-dependent inhibition of its enzyme activity. Addition of; reduced hemoglobin Hb (10 microM), a NO scavenger, superoxide dismutase SOD (1000 units/ml), a superoxide scavenger enzyme, or uric acid UA (300 microM), a peroxynitrite scavenger, did not affect the enzyme activity by themselves, but prevented the inhibitory effect of SNP 500 microM. However, the presence of methylene blue MB (100 microM), a guanylyl cyclase inhibitor, did not alter either basal enzyme activity or the inhibitory action of SNP 500 microM. These results suggest that this action of SNP on TH of the ME would be mediated by peroxynitrite generated by the reaction of NO with superoxide.

Basalioma terebrante retroauricular con extensión a huesos temporal y occipital / Retroauricular terebranting basalioma with extension to temporal and occipital bones

Presentamos el caso de un paciente con carcinoma basocelular retroauricular de larga evolución y amplia extensión a pabellón auricular, conducto auditivo externo, oído medio, mastoides, llegando hasta temporal y hueso occipital, considerando esta patología inusual en nuestro medio. Aportamos el tratamiento quirúrgico realizado con un colgajo miocutáneo para reconstruir la zona (AU)

[Predictive value of the Müller maneuver in obstructive sleep apnea syndrome]. / Valor predictivo de la maniobra de Müller en el síndrome de apnea obstructiva del sueño.

Dynamic changes in the upper airway during sleep have been identified in patients with obstructive sleep apnea syndrome (OSAS). Fiberoptic nasopharyngoscopy with the Müller maneuver (FNMM) has been advocated as a practical, clinically useful, preoperative dynamic diagnostic method for assessing the site of collapse. The value of FNMM in predicting response to uvulopalatopharyngoplasty (UPPP) was assessed in patients with obstructive sleep apnea syndrome. Results indicate that preoperative FNMM can reliably enhance surgical success.

Valor predictivo de la maniobra de Müller en el síndrome de apnea obstructiva del sueño / Predictive value of the Müller maneuver in obstructive sleep apnea syndrome

En el síndrome de apnea obstructiva del sueño (SAOS) se producen cambios dinámicos en el calibre de la vía aérea superior (VAS). La maniobra de Miiller es un método de fácil aplicación clínica, que puede utilizarse preoperatoriamente para evaluar las zonas de colapso. El objetivo de nuestro estudio es valorar el rendimiento de dicha maniobra para predecir la respuesta a la cirugía (uvulopa-latofaringoplastia, UPPP) en pacientes con síndrome de apnea obstructiva del sueño. Los resultados indican que la realización de esta maniobra preoperatoriamente puede utilizarse para predecir dichos resultados (AU)

Dynamic changes in the upper airway during sleep have been identified in patients with obstructive sleep apnea syndrome (OSAS). Fiberoptic nasopharyngoscopy with the Müller maneuver (FNMM) has been advocated as a practical, clinically useful, preoperative dynamic diagnostic method for assessing the site of collapse. The value of FNMM in predicting response to uvulopalatopharyngoplasty (UPPP) was assessed in patients with obstructive sleep apnea syndrome. Results indicate that preoperative FNMM can reliably enhance surgical success (AU)

Methylene blue inhibits stimulatory effect of sodium nitroprusside but not of 3-morpholino sydnonimine on prolactin secretion in freely moving male rats.

Previously we reported that intracerebroventricular (i.c.v.) administration of nitric oxide (NO) donors, sodium nitroprusside (SNP) (1-10 microg), and 3-morpholino-sydnonimine (SIN-1) (10-100 microg), induced dose-dependent increases in plasma prolactin levels of freely moving male rats, suggesting a role of NO in the control of prolactin secretion. The present results show that i.c.v. pretreatment with methylene blue (MB) (30 microg), a guanylyl cyclase inhibitor, significantly reduced the effects of microinjections of SNP (3 and 5 microg), however, this did not modify the stimulatory action of SIN-1 (30 microg) on plasma prolactin levels of conscious male rats. Alone, MB did not modify basal prolactin levels. These results suggest different mechanisms of action of SNP and SIN-1 to stimulate prolactin secretion in vivo. Activation of soluble guanylyl cyclase seems to mediate the neuroendocrine action of NO released from SNP but not of SIN-1. Different cellular distribution of NO generating activity from these donors as well as the possible generation of other radicals simultaneously with NO from SIN-1 could explain these differences.

Sodium nitroprusside inhibits the tyrosine hydroxylase activity of the median eminence in the rat.

Nitric oxide (NO) has been involved in the modulation of various neuroendocrine responses. This work is a study of dose-response and time-course of the effect of intracerebroventricular (i.c.v.) administration of (NO) generator sodium nitroprusside (SNP), on tyrosine hydroxylase (TH) activity of the median eminence (ME) and serum prolactin levels, performed on conscious male rats. SNP (1, 5 and 10 microg) inhibited the TH activity of the ME, 15 min following injection in a dose-dependent way, although the effect was only significant with the highest dose, and also increased in a dose-dependent manner the serum prolactin levels. Both actions were transient but vanished at different times following injection of 10 microg of SNP. These results suggest that NO, released from SNP, inhibits the tuberoinfundibular dopaminergic neurons of the basal hypothalamus to stimulate prolactin secretion.

[Gammagraphy with HMPAO-99mTc leukocytes in intestinal inflammatory disease]. / Gammagrafía con leucocitos HMPAO-99mTc en la enfermedad inflamatoria intestinal.

The value of 99mTc-hexamethylpropyleneamine oxime (HMPAO) leukocyte images has been confirmed in patients with Inflammatory Bowel Disease. We performed 121 scintigraphic examination. The results were evaluated by radiologic and/or endoscopic examinations. The patients were divided into three subgroups: A) patients with active disease and less than 15 days of corticotherapy (n = 42). B) patients with active disease and more than 15 days of corticotherapy (n = 31). C) asymptomatic patients (n = 48). Over all sensitivity and specificity were 86% and 92.2% respectively. The sensitivity in subgroup A was 97.5% and 70% in the subgroup B. In the subgroup A the isotopic study showed the entire area of active inflammation in 95% (38/40) and colonoscopy in 32.5% (13/40). The leucocyte scanning showed clear pathologic activity in the ileum with a sensitivity of 86%. We conclude that 99mTc-leukocyte scintigraphy is the best method to assess the location of active inflammation in patients with less than 15 days of treatment. Scintigraphy was best in the assessment of active disease especially in Crohn's disease of the small bowel.

Effects of nitric oxide donors sodium nitroprusside and 3-morpholino-sydnonimine on prolactin secretion in conscious rats.

In the present study, we have examined the possible involvement of the central nitric oxide (NO) pathway in the control of prolactin secretion in vivo. The effects of intracerebroventricular (i.c.v.) injections of L-arginine (L-Arg), a precursor of NO, N omega-nitro-L-arginine methyl ester (L-NAME), an inhibitor of NO synthase (NOS), and of sodium nitroprusside (SNP) and 3-morpholino-sydnonimine (SIN-1), NO donors, on basal prolactin levels were studied in conscious male rats. Microinjections of L-Arg (100 and 500 mu g) or L-NAME (100 and 500 mu g) did not modify plasma prolactin levels, however i.c.v. injections of both SNP (1, 5, 10 and 20 mu g) and SIN-1 (1, 10 and 100 mu g) induced dose-dependent increases in these levels although SNP was much more potent than SIN-1. These results suggest a role of NO in the control of prolactin secretion.

Interleukin-1 beta stimulates tyrosine hydroxylase activity in the median eminence.

The effects of intracerebroventricularly (i.c.v.) injected interleukin-1 beta (IL-1 beta) on tyrosine hydroxylase (TH) activity in the median eminence and on serum adrenocorticotropin hormone (ACTH) and prolactin (PRL) levels were studied in freely moving male rats chronically implanted with i.c.v. cannulas. IL-1 beta stimulated TH activity of the median eminence in a dose-dependent manner. Intracerebroventricular injections of 100 ng and 200 ng IL-1 beta significantly increased TH activity in the median eminence by 40.6% and 74.7% respectively over the saline-injected control group. The stimulation of ACTH secretion was statistically significant for all doses used, however i.c.v. injections of IL-1 beta failed to elicit significant changes in the serum PRL concentrations. These results suggest that IL-1 beta increases dopaminergic activity of the medial basal hypothalamus to produce its neuroendocrine effects.