[Hypermineralcorticism syndrome secondary to topical application of 9-alpha-fluoroprednisolone (author's transl)]. / Síndrome de hipermineralcorticismo por aplicaciíon tópica de 9-alfa-fluorprednisolona.

A patient is reported who presented with severe arterial hypertension and pronounced hypokalemic metabolic alkalosis along with suppression of 17-hydroxicorticoids, plasma renin activity and urinary aldosterone excretion, in relation to topical application of 9-alpha-fluoroprednisolone, 300 mg weekly. The clinical picture changed after discontinuation of the steroid preparation. Whenever topical steroids are prescribed for extensive chronic skin the development of systemic side-effects must be watched. Depending on the type of steroid employed, Cushing's syndrome or a hypermineralcorticism state may appear. The differential diagnosis of a hypermineralcorticism syndrome without aldosteronism should include the possible topical application of fluorated steroids.

[IgA mesangial glomerulonephritis (author's transl)]. / La glomerulonefritis mesangial IgA.

Glomerulonephritis with mesangial deposition of IgA was diagnosed in 31 patients. In Spain this disease is the second more frequent primary glomerulonephritis, representing 27% of them. One out of every four patients with IgA mesangial glomerulonephritis ends the clinical course in renal failure. Such bad evolution might be predicted by the existence of arterial hypertension, severe proteinuria, degree of glomerular sclerosis, presence of HLA Bw35, and increased polymeric IgA in serum. The present pathogenetic concepts are reviewed.

[Conn's syndrome]. / Síndrome de Conn.

Adrenal hypertension is an uncommon phenomenon. When seen in association with hypokalemia the existence of primary aldosteronism, the most frequent cause of which is an adenoma of the adrenal gland cortex, should be suspected. This paper contributes one case of primary aldosteronism treated by unilateral resection of the adrenal adenoma, with no surgical complications and good medium-term results.

Intestinal permeability to 51Cr-EDTA and orocecal transit time in cystic fibrosis.

Intestinal permeability was investigated in 16 children with cystic fibrosis and 14 age-matched controls, making use of 51Cr-EDTA as probe molecule. Orocecal transit time was also evaluated using the lactulose/hydrogen breath test. There was an increase in permeability to 51Cr-EDTA in patients with cystic fibrosis (mean 13.62%) compared with the control group (mean 1.08%). The orocecal transit time was prolonged in patients with cystic fibrosis compared with controls. Mean fasting breath hydrogen concentration was significantly greater in cystic fibrosis patients (13 ppm) compared with control patients (3 ppm). There was no correlation between the percentage of 51Cr-EDTA excreted and the orocecal transit time in either control or cystic fibrosis patients.

Transfusion-induced anergy: skin test as an index for pretransplant transfusions.

Cell-mediated immunity in vivo was studied by delayed cutaneous hypersensitivity (DCH) to seven antigens in 156 chronic haemodialysis (HD) patients, using a disposable multipuncture device. Anergy was found in 46.8 per cent of patients, and a positive correlation was seen between anergy and female sex, time on HD, glomerulonephritis as primary renal disease, younger age and previous blood transfusions (BT). The effect of BT on DCH was studied prospectively in 29 responsive patients. A significant decrease in DCH response was seen. The transfusion-induced anergy remained for a variable time. The pretransplant BT policy suggested by our data would be to periodically undertake skin tests and to transfuse only responsive patients, thereby avoiding the adverse effects of multiple BT.

Arthropathy and cutaneous calcinosis in hemodialysis oxalosis.

Recently, calcium oxalate crystals have been identified in the synovial fluid of patients with arthritis and end-stage renal failure. We describe 4 patients who, during the course of long-term hemodialysis, developed calcium oxalate crystal deposits in the synovium and skin. Clinical manifestations included podagra, tenosynovitis, olecranon bursitis, and acute and chronic synovitis of the large joints that were associated with chondrocalcinosis or subchondral bone erosions. Diffuse involvement of the hand, with chondrocalcinosis of the finger joints, miliary calcified deposits in the skin, and artery calcifications, was observed in 3 patients. The fourth patient had erosive arthropathy. Oxalosis secondary to end-stage renal failure in patients treated with long-term hemodialysis can present with articular manifestations that resemble those of gout, pseudogout, and apatite deposition disease. Other characteristic features of the synovitis associated with oxalosis secondary to end-stage renal disease were: predominant involvement of the hand, mild inflammatory changes in the synovial fluid and synovium, and poor response to administration of nonsteroidal antiinflammatory agents.