[Effect of a global intervention in the integral control of multiple risk factors in patients at high or very high cardiovascular risk. CIFARC 2 project]. / Efecto de una intervención global sobre el control integral de múltiples factores de riesgo en pacientes con alto o muy alto riesgo cardiovascular. Estudio CIFARC 2.

OBJECTIVES: To analyze the effect of a global approach on patients with high cardiovascular risk for the integral control of cardiovascular risk factors. PATIENTS AND METHODS: Multicentric prospective study of patients with high vascular risk, followed-up for one year in internal medicine consultations. We measured the grade of control over major cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, tobacco, obesity) before and after the one-year follow-up period. RESULTS: We studied 456 patients (56% males; age: 66.1, standard deviation: 11.5 years); 54.4% were diabetics, 58.0% had target organ damage and 46.2% had cardiovascular disease. Blood pressure control varied from 50.5 to 60.6; LDL-cholesterol control from 44.7 to 58.1%; diabetes control from 56.5 to 56.6%; tobacco control from 63.0 to 87.5% and obesity control from 60.0 to 55.4%. Integral control of all cardiovascular risk factors varied from 10.7 to 23.2% of patients. Factors independently associated to lack of integral control were: diabetes (Odds Ratio [OR]: 4.42; 95% confidence interval [95%CI]: 2.75-7.14), basal systolic blood pressure (OR: 1.03; 95%CI 1.02-1.05) and basal body mass index (OR: 1.08; 95%CI: 1.02-1.14). Lack of integral control was independently associated to the incidence of cardiovascular events (OR: 2.00; 95%CI: 1.09-5.35). CONCLUSIONS: A global approach on the patient with high cardiovascular risk duplicated the integral control of the five main risk factors. Diabetes and obesity were factors which made integral control difficult. Lack of integral control increased two times the risk of cardiovascular events.

Efecto de una intervención global sobre el control integral de múltiples factores de riesgo en pacientes con alto o muy alto riesgo cardiovascular. Estudio CIFARC 2 / Effect of a global intervention in the integral control of multiple risk factors in patients at high or very high cardiovascular risk. CIFARC 2 project

Fundamento y objetivos. Analizar el impacto que tiene un abordaje global en consultas de Medicina Interna para controlar de forma integral todos los factores mayores de riesgo vascular. Pacientes y métodos. Estudio multicéntrico de cohorte, prospectivo, sobre pacientes con alto riesgo vascular seguidos durante un año en consultas de Medicina Interna. Se evaluó el grado de control de los factores mayores de riesgo vascular (hipertensión arterial, diabetes, colesterol ligado a lipoproteínas de baja densidad [c-LDL], tabaquismo y obesidad) al principio y al final del seguimiento y el número de recursos sanitarios consumidos para su control. Resultados. Se estudiaron 456 pacientes (56,9% varones; edad: 65,1 años; desviación estándar: 10,6 años). El 54,4% eran diabéticos, el 58% presentaban lesión de órgano diana y el 46,2% enfermedad cardiovascular. El porcentaje de pacientes con control inicial y final, respectivamente, de los distintos factores de riesgo fue: presión arterial el 50,55% y el 60,6% (p 0,05); tabaquismo el 63,0% y el 87,5% (p < 0,001), y obesidad el 60,0% y el 55,4% (p < 0,05). El control integral de todos los factores de riesgo basal y final fue el 10,7% y el 23,2% (p < 0,001). Se asociaron a la falta de control integral la diabetes (odds ratio [OR] 4,42; intervalo de confianza del 95% [IC 95%] 2,75-7,14), la presión arterial basal (OR 1,03; IC 95% 1,02-1,05) y el índice de masa corporal (OR 1,08; IC 95% 1,2-1,4). La falta de control integral se asoció con la incidencia de eventos vasculares (OR 2,00; IC 95% 1,09-5,35). Conclusiones. El abordaje global sobre el paciente con alto riesgo vascular consiguió duplicar al año el grado de control integral de los 5 principales factores de riesgo. La diabetes y la obesidad dificultaron el control. La falta de control integral incrementó en 2 veces el riesgo de eventos vasculares (AU)

Objectives. To analyze the effect of a global approach on patients with high cardiovascular risk for the integral control of cardiovascular risk factors. Patients and methods. Multicentric prospective study of patients with high vascular risk, followed-up for one year in internal medicine consultations. We measured the grade of control over major cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, tobacco, obesity) before and after the one-year follow-up period. Results. We studied 456 patients (56% males; age: 66.1, standard deviation: 11.5 years); 54.4% were diabetics, 58.0% had target organ damage and 46.2% had cardiovascular disease. Blood pressure control varied from 50.5 to 60.6; LDL-cholesterol control from 44.7 to 58.1%; diabetes control from 56.5 to 56.6%; tobacco control from 63.0 to 87.5% and obesity control from 60.0 to 55.4%. Integral control of all cardiovascular risk factors varied from 10.7 to 23.2% of patients. Factors independently associated to lack of integral control were: diabetes (Odds Ratio [OR]: 4.42; 95% confidence interval [95%CI]: 2.75-7.14), basal systolic blood pressure (OR: 1.03; 95%CI 1.02-1.05) and basal body mass index (OR: 1.08; 95%CI: 1.02-1.14). Lack of integral control was independently associated to the incidence of cardiovascular events (OR: 2.00; 95%CI: 1.09-5.35). Conclusions. A global approach on the patient with high cardiovascular risk duplicated the integral control of the five main risk factors. Diabetes and obesity were factors which made integral control difficult. Lack of integral control increased two times the risk of cardiovascular events (AU)

[Multiple malignant neoplasms in patients with prostate tumours in the health district of Leon]. / Neoplasias malignas múltiples en pacientes con cáncer de próstata en el área sanitaria de León.

OBJECTIVE: We analyze the characteristics of the patients with prostate tumours who developed a multiple malignant primary neoplasms (MMPN) in the health district of León, the impact on survival and the prognostic variables. MATERIAL AND METHODS: We have used the data from the Tumour Registry of the Hospital of León and we have selected all those patients who were diagnosed of a prostate tumor between 1993 and 2002. Later we made two groups: the first with 67 patients with MMPN and a second group with 145 patients with single prostate tumours diagnosed during 1996 and 1997. RESULTS: Prevalence of MMPM was of 5.57 percent. Patients with MMPN were 3 years younger than those with single tumours, with a high frequency (41 percent) of familial oncologic antecedents on first degree parents. The more frequent association was the synchronous urologic neoplasm. During the next two years from diagnosed of prostate tumour, 86 percent of patients with MMPN were diagnosed of their second neoplasm. Survival of metachronous MMPN patients was lower than synchronous MMPN patients, being the variables with prognosis significance the age, metachronous MMPN, stage of second neoplasms and if the second neoplasms was or not urologic. CONCLUSIONS: MMPN in patients with prostatic tumours are frequent in our medium. A genetic base may be associated in these patients. Prognosis of metachronous MMPN patients is worse. No differences were observed about prognosis with single tumour patients.

Neoplasias malignas múltiples en pacientes con cáncer de próstata en el área sanitaria de León / Multiple malignant neoplasms in patients with prostate tumors in the health district of Leon

Objetivos: Analizar las características de los pacientes con tumores prostáticos que desarrollaron una neoplasia primaria maligna múltiple (NPMM) en el área sanitaria de León, el impacto sobre la supervivencia y las posibles variables pronósticas. Material y métodos: Utilizando los datos del Registro de Tumores del Hospital de León se han seleccionado aquellos pacientes con tumores prostáticos diagnosticados entre 1993 y 2002, creando dos grupos: el primero constituido por 67 pacientes con NPMM y el segundo formado por 145 pacientes con tumores únicos diagnosticados entre 1996 y 1997. Resultados: La prevalencia de NPMM fue del 5,57%. Los pacientes con NPMM fueron 3 años más jóvenes que los pacientes con tumores únicos, con una elevada proporción (41%) de antecedentes familiares oncológicos en familiares de primer grado. La asociación más frecuente fue el cáncer urológico sincrónico. El 86% de los pacientes fueron diagnosticados del segundo tumor en los primeros dos años. La supervivencia de los pacientes con NPMM metacrónicas fue inferior a la de los pacientes con NPMM sincrónicas, siendo las variables con significación pronóstica la edad, el padecimiento de una NPMM metacrónica, el estadio del segundo tumor y el padecimiento de un segundo tumor urológico. Conclusiones: Las NPMM en pacientes con tumores prostáticos son relativamente frecuentes en nuestro medio. Parece existir una base genética en estos pacientes. El pronóstico de los pacientes con NPMM metacrónicas es peor. No existen diferencias significativas en cuanto al pronóstico con respecto a los pacientes con tumores únicos

Objetive: We analize the characteristics of the patients with prostate tumours who developed a multiple malignant primary neoplasms (MMPN) in the health district of León, the impact on survival and the prognostic variables. Material and methods: We have used the data from the Tumour Registry of the Hospital of León and we have selected all those patients who were diagnosed of a prostate tumor between 1993 and 2002. Later we made two groups: the first with 67 patients with MMPN and a second group with 145 patients with single prostate tumours diagnosed during 1996 and 1997. Results: Prevalence of MMPM was of 5.57 percent. Patients with MMPN were 3 years younger than those with single tumours, with a high frecuency (41 percent) of familial oncologic antecedents on first degree parents. The more frequent association was the synchronous urologic neoplasm. During the next two years from diagnosed of prostate tumour, 86 percent of patients with MMPN were diagnosed of their second neoplasm. Survival of metachronous MMPN patients was lower than synchronous MMPN patients, being the variables with prognosis significance the age, metachronous MMPN, stage of second neoplasms and if the second neoplasms was or not urologic. Conclusions: MMPN in patients with prostatic tumours are frequent in our medium. A genetic base may be associated in these patients. Prognosisof metachronous MMPN patients is worse. No differences were observed about prognosis with single tumour patients

Hiperaldosteronismo e hiperparatiroidismo: ¿causalidad o casualidad? / Hyperaldosteronism and hyperparathyroidism: causality or coincidence?

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Panhipopituitarismo secundario a traumatismo craneoencefálico / Panhypopytuitarism secondary to cranioencephalic trauma

No disponible

[Neurosarcoidosis mimicking cerebral tumor]. / Neurosarcoidosis simulando un tumor cerebral.

We report a case of neurosarcoidosis, which simulated a cerebral tumor located at the floor of the III ventricle, associated to an aseptic meningitis and diabetes insipidus. It was the first and only manifestation of the illness. The response to steroid therapy was very favourable, with complete clinical recuperation and radiological resolution.

Pelvic-peritoneal tuberculosis simulating ovarian carcinoma: report of three cases with elevation of the CA 125.

We report three cases of women with abdominal pathology in which an elevated serum CA 125 tumor marker could have led to an erroneous diagnosis of ovarian carcinoma. However, after peritoneal biopsies were taken, tuberculosis was diagnosed. Furthermore, specific tuberculostatic treatment normalized serum CA 125 levels.

[Dynamic intracavitary echoes from non-slow flow in a patient with a mitral prosthesis]. / Ecos dinámicos intracavitarios por flujo no lento en un paciente con prótesis mitral.

The infrequent finding of visualization of circulating blood by two-dimensional echocardiography in the left ventricle in a patient with a mitral prosthetic valve is reported. In contrast to most of the reports on dynamic intracavitary echoes, no correlation with blood stasis or diminished flow velocity is found, being normal in this pulsed Doppler study.