Co-designing a Canadian adaptation of a lifestyle-oriented intervention aimed to improve daily functioning of individuals living with chronic pain: a multi-method study protocol of REVEAL(OT) Canada.

Background: Living with chronic pain (CP) often implies major lifestyle changes, including modifications of daily routines and work. Surprisingly, few validated and effective interventions specifically target functional outcomes in this population. Redesign your Everyday Activities and Lifestyle with Occupational Therapy [REVEAL(OT)] is a lifestyle-oriented intervention led by occupational therapists that directly targets the daily functional challenges of living with CP. The intervention was initially developed and studied as an add-on to standard treatment delivered by Danish multidisciplinary specialized pain clinics. Adapting, implementing, and evaluating REVEAL(OT) within the Canadian healthcare system will contribute to broadening the scope of treatments offered in specialized pain clinics that do not yet include occupational therapy. Objective: The proposed study aims to define and refine REVEAL(OT)/CA with partners (authors of original intervention, people with lived experience, clinicians, managers). Methods: This participatory action research will use a multi-method design and follow the ORBIT model for developing behavioral treatments for chronic diseases. A process of co-construction with partners and an advisory committee will take place in two Montreal specialized pain clinics. It consists of two related work packages (WPs). In WP1, a first series of focus groups with partners (n = 86) and workshops with the advisory committee will be conducted to co-develop the hypothetical pathway describing intervention components and their potential mechanisms of action on targeted outcomes, as well as the first version of the adapted intervention manual. WP2 will co-refine REVEAL(OT)/CA by exploring its acceptability, feasibility and mechanisms of action through intervention deliveries (at least twice in each of two specialized pain clinics; n ≥ 60 patients) and focus groups and/or individual interviews with participating patients and partners. At the end of this study, the intervention manual will be generated both in French and English. Discussion: This study will set the stage for subsequent implementation and effectiveness assessment projects and be an important step towards the deployment of interventions aiming to improve engagement in meaningful daily activities among adults living with CP. Registration: OSF Registries, osf.io/8gksa. Registered 3 August 2023, https://osf.io/8gksa.

Aspectos prácticos de la elección del producto y la titulación con cannabis medicinal para el dolor crónico / Practical aspects of product selection and titration with medical cannabis for chronic pain management

Años de experiencia y multitud de estudios observacionales proponen la eficacia del cannabis medicinal (CM) para aliviar el dolor. La experiencia clínica no se ha podido correlacionar con la evidencia científica. De los países donde el CM se ha legalizado provienen guías basadas en consensos que proporcionan al clínico interesado un conocimiento mínimo esencial para responder a las necesidades de sus pacientes. Esta revisión proporciona aspectos básicos de la selección de pacientes y productos del CM para el especialista en dolor.(AU)

Years of experience and multiple cohort studies suggest the efficacy of medical cannabis (MC) to relieve chronic pain. The clinical experience has not been linked with scientific evidence. In countries where CM has been legalized, guidelines based on consensus have been developed that provide the clinician with the minimum essential knowledge to respond to the needs of his or her patients. This review provides basic aspects of patient and product selection of MC for the pain specialist.(AU)

Rheological properties of ethyl cellulose-monoglyceride-candelilla wax oleogel vis-a-vis edible shortenings.

The gelation process, elasticity, and mechanical recovery after shear were studied in mixed oleogels of ethylcellulose (EC), monoglycerides (MG), and candelilla wax (CW). EC oleogels produced without MG showed grainy texture due to incomplete dissolution of crystalline fractions of raw EC in the vegetable oil (150 °C). These fractions were eliminated by dissolving the raw EC/MG mixture in ethanol, evaporating the solvent, dispersing, and dissolving the solid residue in the vegetable oil (150 °C) prior gelation. The EC polymeric network, and MG, and CW crystals had a positive interaction on the elasticity of mixed oleogels. Mixed oleogels produced under static conditions showed a 100 % of elasticity recovery after shearing, a phenomenon associated with an EC interchain hydrogen bonding mediated by hydroxyl groups of MGs. This tentatively resulted from the formation of junction zones of the type EC-[MG]n-EC. The rheological behavior of these olegels was remarkably close to that of commercial shortenings.

El hilo de Ariadna: gestión en CMA. Innovaciones accesibles / Ariadna’s thread: management in outpatient surgery. Accessible innovations

Profesionales, sistemas de información y gestores han de compartir codo con codo la primera línea. El conocimiento de la situación no puede quedarse restringido a una distancia y una mazmorra donde tomar las decisiones sin el concurso personal de los implicados en la toma de decisiones. Las herramientas y el desarrollo de TIC, el compartir las ideas in situ, la bidireccionalidad y, por supuesto, la empatía logran agilizar los procesos. Esta es nuestra experiencia y las mejoras que hemos ido introduciendo en base a las sugerencias, observaciones y, cómo no, a la gestión sincronizada con las demandas. El escollo es duro pero no insalva- ble, y permite una respuesta proactiva al corto y medio plazo que seguirá facilitando y retroalimentando para continuar en este trabajo común y apasionante. (AU)

Professionals, information systems and managers have to share the front lineside by side. Knowledge of the situation cannot be restricted to a distance and a dungeon where decisions can be made without the personal assistance of those involved in decision-making. TICS tools and development, sharing ideas on site, bidirectionality and, of course, empathy manage to streamline processes. This is our experience and the improvements that we have been introducing based on suggestions, observations and, of course, on synchronized management with demands. The obstacle is hard but not insurmountable and allows a proactive response in the short and medium term that will continue to facilitate and provide feedback to continue in this common and exciting work. (AU)

Structuration, elastic properties scaling, and mechanical reversibility of candelilla wax oleogels with and without emulsifiers.

The crystal network development, elastic properties scaling behavior, and mechanical reversibility of candelilla wax (CW) oleogels with and without emulsifiers were studied. Saturated monoglycerides (MG) and polyglycerol polyricinoleate (PGPR) were added at 1 or 2 times the critical micelle concentration. Although the micelles of both emulsifiers act as nucleation sites for the mixture of aliphatic acids and alcohols of CW, they did not affect the oleogel's thermodynamic stability. It was established that the crystal network of CW consists of at least two types of crystals, one rich in n-hentriacontane and other rich in aliphatic acids. Both crystals species contributed significantly to the oleogel elasticity. The elastic properties scaling behavior of CW oleogels fitted the fractal model within the weak-link regime. The setting temperature and added emulsifier modified the crystal network fractal dimension. During shearing, oleogels had massive breaking of junction zones, causing the loss of fractality in the crystal network, which in turn decreased the system's elasticity.

Water-in-oil organogel based emulsions as a tool for increasing bioaccessibility and cell permeability of poorly water-soluble nutraceuticals.

The use of organogels in food and pharmaceutical sciences has several technical problems related with restricted diffusion of the drugs and lack of a proper gelator molecule. These features are important into the new product design. An alternative to improve technological properties in organogels is the use of emulsions. However, there is a lack of knowledge about the behavior on bioaccessibility and permeability of bioactives loaded into organogel-based emulsions. The objective of the present experimental work was to study the physical properties of organogel-based emulsions made with vegetable oil loaded with three different bioactives (betulin, curcumin and quercetin) and the influence on their bioaccessibility. Organogels were made of canola or coconut oils and myverol as gelator (10% w/w). Water-in-oil emulsions (at 5, 10 and 12.5 wt% of water content) were prepared by mixing the melted proper organogel and water (80 °C) under high shear conditions (20,000 rpm). Micrographs, rheological tests (amplitude, frequency, temperature sweeps and creep-compliance measurements), DSC and particle size analysis were performed to samples. In vitro digestion (oral, gastric and intestinal phase), lipolysis assays, bioaccessibility and permeability tests by cell culture of Caco-2 were made. Organogels of coconut oil have shown poor emulsification properties.

Phase behavior, structure and rheology of candelilla wax/fully hydrogenated soybean oil mixtures with and without vegetable oil.

Vegetable oil organogelation is one of the most promising strategies to eliminate trans fatty acids in plastic fats. Organogels prepared with edible wax are stable at refrigerator and room temperature. Some functional properties (i.e., texture) of wax organogels can be improved by adding saturated triacylglycerols. Mixtures of fully hydrogenated soybean oil (FH) and candelilla wax (CW) were studied with and without the addition of high oleic safflower oil (HOSFO). Crystallization and melting behavior, X-ray diffraction, and crystalline microstructure of the mixtures were analyzed. The elastic modulus (G'), and the structural recovery after shear of the organogels were also assessed. Mixtures without HOSFO formed solid dispersions of CW and FH crystals, where up to ~10% CW crystals were incorporated into the FH crystal lattice. The vegetable oil solutions of FH/CW mixtures crystallized from the melt, developed mixed crystal networks composed of FH crystals in the ß polymorph and CW in an orthorhombic subcell packing. As the systems crystallized in the most stable polymorph, only minor microstructural changes were shown along 28days of storage at 25°C. CW and FH crystals showed a synergistic effect on the elasticity of organogels. This was attributed to the large number FH crystals nucleated on the surface of CW crystals. The structural recovery after shear was superior for mixed organogels composed of CW platelets and grainy FH crystals compared to that of CW organogels. A recovery of up to 65.7% the G' of gels formed under static conditions was observed upon shearing.

Diferencias en el uso de las estrategias de afrontamiento, el catastrofismo y el estado de ánimo en función del tiempo de evolución del dolor crónico / No disponible

Introducción: este estudio describe el dolor crónico como un estresor complejo al que la persona debe adaptarse continuamente usando diferentes estrategias. Método: el objetivo de esta investigación es observar las diferencias que existen en las variables psicológicas y el uso de las estrategias de afrontamiento del dolor en función del tiempo de evolución. Los instrumentos de evaluación son: "Cuestionario del Dolor McGill" (MPQ), "Estrategias de Afrontamiento del Dolor Crónico" (CADR), "Escala Hospitalaria de Ansiedad y Depresión" (HAD), "Escala de Catastrofismo del CSQ" (CSQ-C). Los 60 participantes del estudio son pacientes de una unidad de tratamiento especializada en el ámbito hospitalario. De estos se crearon dos grupos, uno de menor tiempo de evolución (de 1 a 5 años) y el otro de mayor tiempo de evolución (de más de 13 años). Resultados: los resultados muestran que tanto el tiempo de evolución como la edad del paciente se asocian con el uso de una estrategia pasiva, la "catarsis" y la evaluación del dolor tiene una relación positiva con el catastrofismo, las estrategias pasivas, la ansiedad y la depresión. Mediante el análisis de la comparación de medias de los dos grupos se confirma que el grupo de menor tiempo de evolución hace mayor uso de la estrategia de afrontamiento "catarsis" y además presenta puntuaciones más altas en "catastrofismo" en comparación con los componentes del otro grupo. Conclusión: se observa la relación entre del dolor y las variables psicológicas del estudio como también los cambios que pueden aparecer en diferentes etapas de la evolución del dolor

Introduction: preliminary study on the psychological variables and coping strategies in chronic pain related to duration. This study describes chronic pain as a stressor complex that the person using a coping strategies to adapt continuously. Method: the primary objective of this research observes differences in psychological variables and the use of pain coping strategies depending on the time of evolution. The assessment instruments are McGill Pain Questionnaire (MPQ), "Strategies for Coping with Chronic Pain" (CADR), Hospital Anxiety and Depression Scale (HAD), Catastro-phism Scale CSQ (CSQ-C). Participants of this study are patients with chronic pain and are treated in to specialized unit. The results show that duration and patient's age are associated with the use of a passive strategy, the "catharsis". The perception of pain has a positive relationship with catastrophizing, passive strategies, anxiety and depression. Results: results obtained by comparing the average of the two groups, one with 1 to 5 years of evolution, and another 13 to 33 years, show that the group of shorter duration makes greater use of the coping strategy of catharsis and it has scored higher on catastrophizing compared to another group. Conclusion: we observe the relationship between pain and psychological variables of this study and changes that may occur in different stages of duration of pain (AU)

[Short cold ischaemia time optimises transplant results for kidneys from expanded criteria donors]. / El tiempo de isquemia fría corto optimiza los resultados de los trasplantes renales efectuados con donantes con criterios expandidos.

INTRODUCTION: Outcome of renal transplant from expanded criteria donors (ECD) is usually inferior than those from standard criteria donors (SCD) and may be improved decreasing cold ischemia time (CIT) and minimizing preservation injury. We compare the results obtained with CIT <15 hours in kidney transplants from ECD vs SCD. SUBJECTS AND METHODS: Prospective, single center study of kidney transplants performed since June 2003 to December 2007. Minimum follow-up period was 12 months. Data of donors, receptors and transplant outcome from ECD and SCD are compared. RESULTS: CIT (mean +/- SD) was 9.3+/-2.5 hours in transplants from ECD (n=24) and 8.3+/-3.3 hours in those from SCD (N=50), p=0.18. We did not find significant differences among recipients of grafts from ECD and those from SCD regarding: primary non-function (4.2% vs 2%, respectively), delayed graft function (16.7% vs 10%), surgical complications (25% vs 16%) or acute rejection episodes (8.3% vs 2%). Glomerular filtration rate at one year follow-up was 65.8+/-14.9 ml/min in ECD recipients and 49.4+/-12.5 ml/min (p<0.0001). One year graft survival was 95.8% in ECD recipients and 94% in SCD recipients (p=0.75). CONCLUSIONS: Short CIT in kidney transplant from ECD leads to similar outcome than that obtained from SCD, although renal function is inferior in ECD grafts.

El tiempo de isquemia fría corto optimiza los resultados de los trasplantes renales efectuados con donantes con criterios expandidos / No disponible

Introducción: Los resultados de los trasplantes efectuados condonantes con criterios expandidos (DCE) son inferiores a los obtenidos con donantes con criterios estándar (DCS). Para optimizar su evolución, se podría reducir su tiempo de isquemiafría (TIF) reduciendo su daño de preservación. Comparamoslos resultados obtenidos al aplicar TIF <15 horas tanto a DCE como a DCS. Material y métodos: Realizamos un estudio unicéntrico, de cohortes, prospectivo, de casos incidentes de trasplante renal de cadáver entre junio de 2003 y diciembre de2007. El tiempo mínimo de seguimiento fue de 12 meses. Comparamos los datos de los donantes, de los receptores y de la evolución de los trasplantes efectuados con DCE frente a los de los DCS. Resultados: El TIF para los DCE (N = 24) y para los DCS (N = 50) fue, respectivamente, de 9,3 ± 2,5 y 8,3± 3,3 horas (p = 0,18). No encontramos diferencias significativas entre los receptores de DCE y DCS en cuanto a: no función primaria del injerto 4,2 vs. 4%, retardo en la función del injerto 16,7 vs. 10%, complicaciones quirúrgicas 25 vs. 16% y rechazos agudos 8,3 vs. 2%. El filtrado glomerular estimado al año para los DCS fue de 65,8 ± 14,9 ml/min y para los DCE de 49,4 ± 12,5 ml/min (p <0,0001). La supervivencia renal al año fue del 95,8% para los receptores de DCE y del 94% para los DCS (p = 0,75). Conclusiones: La aplicación de TIF cortos a los DCE permite conseguir una evolución similar a la de los DCS, aunque su función renal sea en todo momento inferior (AU)

Introduction: Outcome of renal transplant from expanded criteria donors (ECD) is usually inferior than those from standard criteria donors (SCD) and may be improved decreasing cold ischemia time (CIT) and minimizing preservation injury. We compare the results obtained with CIT <15 hours in kidney transplants from ECD vs. SCD. Subjects and Methods: Prospective, single center study of kidney transplants performed since June 2003 to December 2007. Minimum follow-up period was 12months. Data of donors, receptors and transplant outcome from ECD and SCD are compared. Results: CIT (mean ± SD)was 9.3 ± 2.5 hours in transplants from ECD (n = 24) and8.3 ± 3.3 hours in those from SCD (N = 50), p = 0.18. We did not find significant differences among recipients of grafts from ECD and those from SCD regarding: primary non-function (4.2% vs. 2%, respectively), delayed graft function (16.7% vs. 10%), surgical complications (25% vs.16%) or acute rejection episodes (8.3% vs. 2%).Glomerular filtration rate at one year follow-up was 65.8± 14.9 ml/min in ECD recipients and 49.4 ± 12.5 ml/min (p<0.0001). One year graft survival was 95.8% in ECD recipients and 94% in SCD recipients (p = 0.75).Conclusions: Short CIT in kidney transplant from ECD leads to similar outcome than that obtained from SCD, although renal function is inferior in ECD grafts (AU)

Conversion to tacrolimus extended-release formulation: short-term clinical results.

OBJECTIVE: To determine the short-term clinical results of conversion of treatment from tacrolimus twice daily (BID TAC) to the extended-release formulation (OD TAC), milligram for milligram, and whether such conversion is safe in stable kidney transplant recipients. PATIENTS AND METHODS: The study included 38 kidney transplant recipients (median [SD] age, 54.3 [14.4] years) with stable renal function (mean [SD] serum creatinine concentration 1.29 [0.38] mg/dL). Posttransplantation follow-up was 3.4 (3.1) years (range, 4-168 months). All patients had been receiving BID TAC (2.45 [1.52] mg/d) when treatment was converted to OD TAC, milligram for milligram. Follow-up including clinical evaluation and laboratory tests was at 7, 21, and 90 days postconversion. RESULTS: No significant differences were observed during follow-up in serum creatinine concentration, blood glucose level, hemoglobin level, or proteinuria. There were no episodes of acute rejection. No de novo posttransplantation diabetes mellitus was diagnosed; patients with diabetes required similar dosage of hypoglycemia treatment. Arterial pressure remained stable without changes in antihypertension treatment. Tacrolimus doses were not modified (2.45 [1.52] mg/d at baseline vs 2.45 [1.67] mg/d at 3 months postconversion; however, tacrolimus concentration decreased significantly (7.6 [1.8] ng/mL at baseline vs 6.42 [1.13] ng/mL at 3 months postconversion. Reduction in tacrolimus concentration was more remarkable in patients receiving a dose of less than 0.025 mg/kg/d. CONCLUSIONS: Conversion from BID TAC to OD TAC, milligram for milligram, is clinically safe; however, monitoring of tacrolimus concentration in patients receiving low dosage is mandatory to prevent subtherapeutic levels.

Secondary amyloidosis associated with histiocytosis X.

We report a 34-year-old man diagnosed with Langerhans cell histiocytosis (LCH) or histiocytosis X in 1980. He had multiple focal osseous lesions, difficult control of the disease activity and was treated many times with chemo- and radiotherapy for symptomatic control. His kidney disease started 20 years after the diagnosis with progressive renal failure and increasing non-nephrotic proteinuria, coinciding with two flares of LCH. A percutaneous renal biopsy demonstrated amyloidosis. There is only one case described in the amyloidosis literature associated with LCH.

Realidad de la prescripción y grado de cumplimiento de los suplementos de calcio + vitamina D en el tratamiento de la osteoporosis en la Atención Primaria de Andalucía. Estudio SOL-D8 / Reality of the prescription and degree of compliance regarding calcium + vitamin D supplements in the treatment of osteoporosis in Primary Care of Andalusia. SOL-D8 Study

INTRODUCCIÓN. La osteoporosis es una enfermedad crónica que afecta en España a más de dos millones de mujeres. En su abordaje terapéutico, además de un tratamiento antirresortivo, se debe garantizar un adecuado aporte de calcio y vitamina D, y cuando la paciente no alcanza un mínimo diario de estos elementos se debe proceder a su administración de forma exógena mediante la recomendación de suplementos. En nuestro entorno no se conoce cuál es la realidad de la prescripción y grado de cumplimiento desde la práctica clínica en Atención Primaria de los suplementos de calcio y vitamina D para el tratamiento concomitante de la osteoporosis, por lo que nos hemos planteado realizar un estudio de índole pragmática que permita aclarar estos interrogantes. MATERIAL Y MÉTODOS. Estudio transversal utilizando un cuestionario ad hoc a partir del objetivo del estudio, que fue administrado durante los meses de marzo y abril de 2006, por 49 médicos de Atención Primaria de los 32 distritos sanitarios de Andalucía, elegidos mediante muestreo no probabilístico a criterio, siendo el criterio de selección la condición de experto en osteoporosis. Cada uno de estos investigadores se responsabilizó de contactar con al menos 10 médicos que debían ejercer su actividad profesional en el ámbito de la asistencia primaria, de cara a poder administrarles el cuestionario. RESULTADOS. Respondieron el cuestionario un total de 749 médicos de Atención Primaria correspondientes a todos los distritos sanitarios de Andalucía. Se ha recogido información de 3.745 pacientes ya que cada médico debía revisar 5 historias de pacientes en tratamiento para la osteoporosis. El 31% de los encuestados reconocía que no asocia calcio y vitamina D junto al tratamiento antirresortivo, o lo hacía en menos del 50% de las veces. El 52% de los encuestados reconoció que la tolerancia a los suplementos de calcio y vitamina D era regular, mala o muy mala, y hasta un 62% de los médicos encuestados afirmaron que la mitad de sus pacientes abandonaba los suplementos a los tres meses por intolerancia o efectos secundarios. La mitad de los médicos reconocía no estar preocupado por el aporte de vitamina D en estos pacientes, dado que consideraban que en España, por su clima soleado, el déficit de vitamina D era una situación infrecuente. CONCLUSIONES. La mayoría de los médicos de Atención Primaria de Andalucía opinan que el cumplimiento de los suplementos de calcio y vitamina D para el tratamiento concomitante de la osteoporosis es bastante deficiente, por lo que el abordaje terapéutico integral de la osteoporosis es inadecuado, debiéndose insistir en la importancia de garantizar una adecuada ingesta de calcio y vitamina D. Existe un alto porcentaje de abandono de los suplementos por efectos secundarios e intolerancia. Hay una falsa asociación entre clima soleado y niveles adecuados de vitamina D

INTRODUCTION. Osteoporosis is a chronic disease that affects more than two million women in Spain. In addition to an antiresorptive agent in its therapeutic approach, adequate intake of calcium and vitamin D should be assured. When the patient cannot achieve these minimum daily requirements, these should be administered exogenously through supplements. The real situation in regard to the prescription and degree of compliance with these elements from the clinical practice of Primary Care is unknown, thus we have considered conducting a pragmatic study to address the unanswered questions. METHODS. Cross-sectional study which includes an ad hoc questionnaire, based on the study objective that was administered by 49 Primary Care physicians from the 32 health districts of Andalusia, during March-April 2006, who were chosen by non-probability sampling criteria, the condition of being an expert in osteoporosis being the selection criteria. Each one of the investigators had to contact at least 10 Primary Care physicians in the Primary Care area providing them with the questionnaire. RESULTS. A total of 749 Primary Care physicians from all of the health districts answered the questionnaire. Information was collected from 3,745 patients since each physician had to review 5 clinical records of patients being treated for osteoporosis. A total of 31% of the physicians admitted that they were not concomitantly associating an antiresorptive agent with calcium-vitamin D supplements for at least 50% of the time. Fifty-two percent of those questioned admitted that tolerance to calcium supplements is either regular, poor or very poor, and up to 62% of the physicians addressed claimed that 50% of their patients discontinued supplement treatment within a three month period due to intolerance or adverse effects. Fifty percent of the physicians admitted they were not concerned about vitamin D intake in these patients, since they believed that due to the sunny climate in Spain, insufficient vitamin D was not a frequent issue. CONCLUSIONS. The majority of Primary Care physicians in Andalusia believe that compliance with calcium and vitamin D supplements for concomitant treatment of osteoporosis is quite poor. Therefore, integral therapeutic management of osteoporosis is inadequate. An effort must be made to increase physicians' awareness regarding adequate intake of calcium and vitamin D. There is a high rate of withdrawal of supplements due to side effects or intolerance as well as a false concept of association between sun exposure and adequate vitamin D levels

Glomerulonefritis aguda post-estreptocócica en paciente añoso / Acute post-estreptoccocal glomerulonephritis in the elderly

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[Giant adrenal myelolipoma: hypertension, renal failure and spontaneous rupture]. / Mielolipoma suprarrenal gigante: hipertensión, insuficiencia renal y rotura espontánea.

Adrenal myelolipoma is a rare, benign, slow-growing tumor composed of adipose tissue and hematopoietic elements. It is usually diagnosed incidentally, although there are reports of patients with symptoms and descriptions of retroperitoneal hemorrhage due to rupture of large tumors. The condition has been associated with obesity, high blood pressure and adrenal dysfunction. We present a patient with retroperitoneal hemorrhage due to spontaneous rupture of a myelolipoma, hypertension, and renal failure secondary to nephroangiosclerosis.

Mielolipoma suprarrenal gigante: hipertensión, insuficiencia renal y rotura espontánea / Giant adrenal myelipoma: hypertension, renal failure and spontaneous rupture

El mielolipoma suprarrenal es un tumor raro, benigno, de lento crecimiento,compuesto por tejido graso y elementos hematopoyéticos. Suele diagnosticarse demanera incidental, aunque se han descrito casos de pacientes sintomáticos, e inclusohemorragias retroperitoneales por rotura en los de mayor tamaño. Se ha descritosu asociación con obesidad, HTA y disfunción suprarrenal. Presentamos unpaciente diagnosticado de mielolipoma, con hemorragia retroperitoneal espontáneapor rotura del mismo, e HTA, con insuficiencia renal secundaria a nefroangioesclerosis

Adrenal myelolipoma is a rare, benign, slow-growing tumor composed of adiposetissue and hematopoietic elements. It is usually diagnosed incidentally, althoughthere are reports of patients with symptoms and descriptions of retroperitonealhemorrhage due to rupture of large tumors. The condition has beenassociated with obesity, high blood pressure and adrenal dysfunction. We presenta patient with retroperitoneal hemorrhage due to spontaneous rupture of a myelolipoma,hypertension, and renal failure secondary to nephroangiosclerosis

[Meningoencephalitis by Listeria in the lupus disease]. / Meningoencefalitis por Listeria en el lupus.

We present a patient with lupus nephropathy of 20 years of evolution in treatment with oral steroids who developed a meningoencephalitis associated to bacteraemia by Listeria monocytogenes. The patient was treated successfully with gentamicin and ampicillin for 6 weeks. Infection by Listeria monocytogenes occurs more frequently in individuals with some form of immunodeficiency like lupus disease, with a mortality around 30%.