RESUMO

In arterial hypertension besides reducing blood pressure, we should think about the circadian pressure profile that the patient presents, since the patients non depressors (not descent of arterial pressure during the night with regard to the day) (non-dipper) they associate to a worse cardiovascular prognosis. The purpose of the present study was to determine the circadian pressure profile in patient treated arterial hypertension and never previously treated with antihypertensive medication; and its relationship with the organic damage. They were included in the study to 702 patients with clinical indication for 24 hour ambulatory blood pressure monitoring. The 39% was dipper, 2% extreme dipper, 49.6% non-dipper and 9.4% riser. The patient non dipper had bigger levels of 24 hours systolic blood pressure, night blood pressure and bigger organic damage. The main factors associated to this pattern were the clinic systolic blood pressure, obesity and overalls a filtrate smaller glomerular to 60 ml/min.

Assuntos

RESUMO

BASIS: A significant proportion of our patients has described to have problems from tolerance to Dolquine, a new presentation of hydroxychloroquine recently marketed in Spain, compared to Plaquenil. The objective was to know the tolerability and the adverse effects of this new presentation. PATIENTS AND METHOD: A cross-sectional multicenter study on 133 patients treated with Dolquine was conducted. RESULTS: Of the 133 patients (87% women; average age [AA]: 32.9 [15.4] years) who received Dolquine during an average period of 6.7 (1.4) months, 32 patients (24%) described to have more problems with this drug in comparison with other antimalarial. The adverse effects experienced were: bitter taste (62.4%), difficulty in swallowing the tablet (13.5%), dyspepsia (9.8%), nausea (7.5%), vomiting (1.5%), pruritus (1.5%), diarrhea (0.7%), and instability feeling (0.7%). The presence of gastrointestinal adverse effects was not related to the consumption of gastroerosive drugs, gastric protectors, or a high number of drugs. The attrition rate was 9.8%. Conclusions. Dolquine induces lower tolerance and more gastrointestinal adverse effects than Plaquenil, pointing out its bitter taste and the difficulty in swallowing it. Despite this higher intolerance there was not an increase in the attition rate from the antimalarial treatment in comparison to other series.

Assuntos

Assuntos

RESUMO

BACKGROUND: The clonidine test has been proposed as diagnostic biochemical test for patients with clinical suspicion of pheochromocytoma. METHODS: The clonidine test was used in 80 patients with suspicion of pheochromocytoma (on account of suggestive clinical findings, increased levels of metanephrines, increased plasma or urinary levels of catecholamines, or suggestive images by ultrasonography or CT). RESULTS: Surgery confirmed the diagnosis of pheochromocytoma in 16 patients. The highest sensitivity (62%) and specificity (46%) of the clonidine test corresponded to a brake degree of 5%, with a predictive negative value of 83%. The test was most useful in patients with increased basal plasma values of catecholamines (sensitivity, 62%; specificity, 66%). CONCLUSIONS: The clonidine test can be useful for the diagnosis of pheochromocytoma in patients with increased basal plasma levels of catecholamines and a brake degree lower than 5% at 180 minutes.

Assuntos

Assuntos

RESUMO

The ultrasonic diagnosis of salivary gland tumors can give a more accurate information than clinical data alone. For example, it will help differentiate intraglandular from extraglandular tumors and benign from malignant processes. We conducted a prospective study in 39 patients with parotidal or submaxillary tumors. Patients were evaluated with a physical exam and a with ultrasound. Results indicate that only 53.86% of the physical examinations were correct in their diagnosis compared to 87.18% of the those done by ultrasound. Specificity and sensibility for malignancy was 96.43% and 81.81% respectively. These results were similar to those reported by other authors. We conclude that the use of ultrasound techniques in the study of salivary gland pathology is well justified, due to its capacity to provide high resolution, improving clinical diagnosis.

Assuntos

RESUMO

BACKGROUND: The association of uveitis and systemic disease is well known. Patients suffering from uveitis often undergo a extensive battery of tests in order to detect underlying disease, but the efficiency of such screening is uncertain. The aim of this study was to investigate useful clinical data for recognizing secondary uveitis. PATIENTS AND METHODS: We conducted a prospective analysis of 115 patients with uveitis of unknown etiology. All of them were included in an extensive protocol study. Four groups were considered: specific ocular disease (SOD), idiopathic uveitis, HLA-B27 associated uveitis without arthritis (HLA-B27-AU) and secondary uveitis. Groups were compared by analysis of variance for continuous variables, and chi 2 test or Student's t-test for discrete variables. A stepwise multiple discriminant analysis was performed for ranking the variables in order of their usefulness for distinguishing idiopathic and secondary uveitis. RESULTS: We diagnosed 11 SOD (9.6%), 54 idiopathic uveitis (47%), 6 HLA-B27-AU (5.2%) and 41 secondary uveitis (35.7%). The discriminant analysis showed that age, an elevated erythrocyte sedimentation rate, presence of cutaneous lesion, joint pain and genital ulcers are the strongest predictors of secondary uveitis. This model classification functions detected 92.5% of idiopathic uveitis and 72% of secondary uveitis. The global percentage of patients with a correct diagnosis was 84.6%. CONCLUSIONS: Anamnesis, physical examination and basic laboratory tests are sufficient tools for the diagnostic approach of the majority of patients with uveitis. Subsequent diagnostic procedures must be planned in each patient to confirm a specific disease.

Assuntos

RESUMO

Varicella is a highly infectious disease mainly affecting young children under 14 years of age, and being generally mild. In adults immunodeficient children and neonates exposed in utero, the illness tends to be more severe with higher incidence of complications. The type of complication is linked to the age: in children, bacterial infection of skin lesions and acute cerebellar ataxia are more frequent while lower respiratory tract infection, Reye syndrome and encephalitis are less common. Varicella pneumonia is found typically in adult patients and diffuse encephalitis which course is worse than children could be less frequently. Acute pericarditis is an exceptional complication with a benign course, but only if myocarditis or pericardial effusion are not concurrent. It usually appears in teenagers and young adults; only a few times, it has been linked to other complications as pneumonia or arthritis. We report a varicella case in an adult patient who suffered from pneumonia and pericarditis, both of them were benign.

Assuntos

RESUMO

BACKGROUND: Large granular T lymphocytes (LGL) make up a small portion of cellular population in peripheral blood. An abnormal proliferation of LGL is detected together with cytopenic and other autoimmune disorders and is often associated with rheumatoid arthritis. The association with other autoimmune diseases, such as systemic lupus erythematosus, is poorly known. The clinical and immunological profile in five patients with SLE and LGL proliferation is here reported. MATERIALS AND METHODS: A clinical follow-up and prospective phenotypic study of mononuclear cells was conducted in patients with SLE for a period of 24 months. LGL were identified on the basis of their shape and analyzed by flow cytometry as cells coexpressing thymic differentiation antigens (CD3 and CD4, or CD8) and NK cells CD16, CD56 or CD57). RESULTS: Five out of 43 patients with SLE showed recurrent proliferations of LGL (from 2 to 4 per patient) chronologically associated with lupus exacerbations. LGL represented 52 to 78% (mean +/- SD = 56 +/- 8%) from the total of lymphocytes. The phenotype in proliferations was heterogeneous but it was consistent in later relapses in each patient (patient #1 and #2: CD3+CD8-CD4+CD16+CD56+CD57-HLA/D+ patients #3 and #4: CD3+CD8+CD4-CD16+CD56+CD57-HLA/DR+ patient #5: CD3+CD8+CD4- CD16+CD56+CD57-HLA/DR+patient 5:CD3+CD8+CD4-CD16 +/- CD56-CD57+HLA/DR+). These five patients had long term SLE with a greater number of exacerbations and a tendency to develop hemocytopenias, requiring high doses of corticosteroids and even immunosuppressors to control their condition. CONCLUSIONS: Some patients with SLE develop LGL proliferations. The activity, clinical severity and hematological involvement seem to be associated with this immunological disorder, but the pathogenic significance and prognosis of these proliferations are still to be elucidated.

Assuntos

RESUMO

We present the case of a 52-years-old patient which was diagnosed of septic primary meningococcal arthritis, being acute arthritis the only form of presentation without any other manifestations of the meningococcal disease. We want to stress that despite the low frequency of this disease, especially in the adult, it must be taken into account for the assessment of acute mono-oligoarthritis.

Assuntos