Automedidas de presión arterial domiciliarias con aparatos electrónicos automáticos. ventajas e inconvenientes en su utilización como técnica de medición de la presión arterial

La automedición de la presión arterial domiciliaria con aparatos semiautomáticos validados es una técnica cada vez más utilizada en la práctica clínica habitual. En el presente artículo se revisan las ventajas que su uso tiene sobre otras técnicas de medición, tanto para el establecimiento del diagnóstico de hipertensión arterial como para la evaluación de la potencial repercusión orgánica y el seguimiento terapéutico de los pacientes, así como los inconvenientes que su uso generalizado puede tener (criterios de normalidad no establecidos, relación con morbimortalidad, técnica de medición más indicada), y que creemos que en la actualidad más que desventajas son preguntas no respondidas en su totalidad. Continúa por tanto existiendo la necesidad de seguir desarrollando estudios bien diseñados en este tema que traten de responder a estas cuestiones (AU)

[Glucocorticoid treatment improves glucose tolerance in patients with temporal arteritis or polymyalgia rheumatica]. / El tratamiento con glucocorticoides mejora la tolerancia a la glucosa en pacientes con arteritis de la temporal o polimialgia reumática.

BACKGROUND: Corticosteroid therapy has been shown to improve glucose tolerance in some connective tissue diseases. This fact has been inadequately investigated in vasculitis. OBJECTIVE: To evaluate the effect of glucocorticoid therapy on glucose tolerance in patients with temporal arteritis (TA) or polymyalgia rheumatica (PR). MATERIALS AND METHODS: An oral test with glucose overload (OGO) was performed before and after one month of initiating therapy with corticosteroids in 14 patients with TA or PR (TA/PR group) and in nine patients with other chronic inflammatory diseases (control group). RESULTS: After treatment, patients with TA/PR experienced a decrease in the area under the glucose curve and in serum glucose values at minutes 0, 90, and 120 of the OGTT. Also, a decrease was observed for the area under the insulin curve and for plasma insulin levels at minutes 90 and 120 after OGO. CONCLUSIONS: Therapy with corticosteroids improves glucose tolerance in TA/PR with no increase in insulin secretion.

An open comparison of the diabetogenic effect of deflazacort and prednisone at a dosage ratio of 1.5 mg:1 mg.

OBJECTIVE: To compare the diabetogenic effects of deflazacort (D) versus prednisone (PN) using a dosage ratio of 1.5 mg deflazacort:1 mg prednisone. METHODS: Thirty-three patients suffering from various active connective tissue or chronic inflammatory diseases were randomized to be treated with D or PN, assuming a therapeutic equipotency ratio of 1.5 mg D:1 mg PN. Neither dosage nor glucocorticoid employed were modified during the study. Patients had not received steroid treatment during the month prior to their inclusion date. Fasting glucose, glycosylated haemoglobin and fructosamine were determined before and after 1 month of treatment. Non-diabetic patients were also submitted to an oral glucose tolerance test (OGTT) at entry and after 1 month. Results were compared by univariate, and multivariate tests to correct the effects of age, body mass index and diagnosis. RESULTS: After 1 month of treatment there were no differences between D and PN in fasting glucose, glycosylated haemoglobin, or fructosamine. OGTT performed after treatment showed similar glucose values for both treatment groups. Patients treated with D had insulin levels at min 60 of the post-treatment OGTT which were higher than those treated with PN [114.1 (62.8) mcUI x ml(-1) versus 73.5 (32.7) mcUI x ml(-1), P = 0.049], but the difference lost its statistical significance in the multivariate analysis. CONCLUSION: D and PN have similar effects on glucose tolerance when an equipotency ratio of 1.5 mg D:1 mg PN is employed. Previous studies employing a ratio of 1.2:1 mg may have underestimated the adverse effects of D on glucose metabolism.

[Xanthogranulomatous pyelonephritis: experience at the General Hospital of Albacete. Report of 16 cases]. / Pielonefritis Xantogranulomatosa: experiencia en el Hospital General de Albacete. Presentación de 16 casos.

A retrospective study of 16 Xanthogranulomatous Pyelonephritis (XGP) cases seen during a 12-years period (1983-1994) at the Hospital General de Albacete was performed. An analysis is made of the clinical features, laboratory data and imaging diagnostic techniques, comparing our findings with those of several series published in the literature. The outcome of this study is that clinical and biological picture of XGP is characteristic: Middle-aged woman admitted to a Internal Medicine Service because a constitutional syndrome, with important weight loss, general poor health, acceleration of erythrocyte sedimentation rate (ESR), anemia, hepatic disfunction and renal destruction imagings, frequently with renal stone and urinary tract infection history. This characteristics can be useful to suspect a XGP.

[Internal medicine at a health center. Experience evaluation]. / Medicina interna en un centro de salud. Evaluación de una experiencia.

UNLABELLED: GROUND: The current situation of internal medicine is evolving to alternative asistential plans related to traditional hospital attention. We present in this article the resulte obtained in an experience conducted to share the assistential task with a primary care center which is located in our Health Area. METHODS: During the period of time between 11-15-93 and 06-30-94 it was prospectively analyzed all the outpatients studied by an internist of the Department of Internal Medicine of the Albacete General Hospital in the Primary Care Center of Almansa. After a definitive diagnosis the following parameters were evaluated: age, sex, type of consult, first and second diagnosis and follow-up. Data of the evaluation according to the request new consults and waiting list patients was taken. RESULTS: The total consults analyzed were 1,651 (578 first visits and 1,073 second visits). Definitive diagnosis were obtained in 752 patients during this time (342 males and 406 females). The average age was 55.56 +/- 0.72 years and the number of diagnosis 1.7 +/- 0.32. The weekly request of new consults decreased from 25.7 to 12.25. Number of patients in waiting list decreased from 94 to 37. CONCLUSIONS: Approach between Internal Medicine and Primary Care is a feasible plan useful for both and for the assistential quality in the Primary Care Centers.

[Obliterating bronchiolitis with organized pneumonia. Experience in a general hospital]. / Bronquiolitis obliterante con neumonía organizada. Experiencia en un hospital general.

Bronchiolitis obliterans with organizing pneumonia (BOOP) is a histopathologic entity that has been described in association with numerous clinical conditions. In the 1980s an idiopathic form was described as a definite clinicopathologic entity differentiated from other infiltrative pulmonary processes. We present 7 patients diagnosed of BOOP over the past 6 years and discuss their clinical and radiologic signs as well as their response to steroid treatment. Our patients' evolution was subacute, cough and fever being the main symptoms. Lung function tests revealed a pattern that was predominantly restrictive. Radiology showed 1 or several alveolar infiltrates in all patients; these were migratory in 3. Bilateral pleural effusion with marked eosinophilia in pleural fluid was observed in 1 patient. In another cavitated nodules were present in chest-X-ray, with no evidence of vasculitis in tissue examination. All patients were treated with steroids (mean 10 months) and a low maintenance dose was required in only 1. The remaining patients experienced full recovery.