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Introducción: El tratamiento de la hipertensión arterial constituye en la actualidad un pilar fundamental en las estrategias de prevención secundaria del ictus. No obstante, hoy en día no hay unanimidad en las cifras de presión arterial (PA) objetivo en prevención secundaria, y existe controversia sobre si el tratamiento antihipertensivo comprometería la perfusión cerebral de estos pacientes. El objetivo de este estudio es describir y analizar la presencia de hipotensión nocturna (HPN) en pacientes con ictus reciente a través del análisis de la monitorización ambulatoria de la PA (MAPA).Material y método: Cuarenta y ocho pacientes consecutivos que acudieron a revisión al cabo de 6 meses tras un ictus fueron incluidos en el estudio. La MAPA de 24 h se llevó a cabo mediante el monitor Spacelab 90207. Se consideraron episodios de HPN aquellos valores en los que la PAsistólica era menor de 100 mmHg. Posteriormente se compararon los pacientes con HPN frente a los que no la presentaron mediante el programa estadístico SSPS18,0. Resultados: Se estudiaron 30 varones y 18 mujeres, de edad media 68±11 años. En 26 pacientes, el 54,2%, se evidenciaron episodios de HPN. No existieron diferencias significativas entre las características demográficas, tipo de ictus y factores de riesgo entre ambos grupos (..) (AU)

Introduction: Treatment of arterial hypertension is currently a fundamental mainstay in secondary stroke prevention strategies. However, at present there is no unanimity regarding target blood pressure (BP) levels in secondary prevention. Furthermore, controversy exists on whether blood pressure lowering treatment would affect the cerebral perfusion of these patients. This study has aimed to describe and analyze the presence of nocturnal hypertension (NHT)in patients with recent stroke through the analysis of ambulatory blood pressure monitoring(ABPM).Material and method: Forty-eight consecutive patients who came for checkup 6 months after a stroke were enrolled in the study. The 24-hour ABPM was conducted using the Spacelab 90207monitor. Episodes of NHT were considered to be those in which the systolic BP was less than100 mm Hg. After, the patients with NHT were compared with those who did not have it using the SSPS 18.0 statistical program. Results: A total of 30 men and 18 women, mean age 68±11 years, were studied. Of the 26patients, evidence of NHT episodes was observed. There were no statistical differences between the demographic characteristics, type of stroke and risk factors between both groups. In relationship to the BP levels, patients with NHT had significantly lower mean 24 hour BP, mean PB with (..) (AU)

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BACKGROUND: A pathologically reduced or abolished circadian blood pressure variation has been described in acute stroke. However, studies on alterations of circadian blood pressure patterns after stroke and stroke subtypes are scarce. The objective of this study was to evaluate the changes in circadian blood pressure patterns in patients with acute ischaemic stroke and their relation to the stroke subtype. AIMS: We studied 98 consecutive patients who were admitted within 24 h after ischaemic stroke onset. All patients had a detailed clinical examination, laboratory studies and a CT scan study of the brain on admission. To study the circadian rhythm of blood pressure, a continuous blood pressure monitor (Spacelab 90217) was used. Patients were classified according to the percentage fall in the mean systolic blood pressure or diastolic blood pressure at night compared with during the day as: dippers (fall> or =10-20%); extreme dippers (> or =20%); nondipper (<10%); and reverse dippers (<0%, that is, an increase in the mean nocturnal blood pressure compared with the mean daytime blood pressure). Data were separated and analysed in two groups: lacunar and nonlacunar infarctions. Statistical testing was conducted using the SSPS 12.0. Methods We studied 60 males and 38 females, mean age: 70.5+/-11 years. The patient population consisted of 62 (63.2%) lacunar strokes and 36 (36.8%) nonlacunar strokes. Hypertension was the most common risk factor (67 patients, 68.3%). Other risk factors included hypercholesterolaemia (44 patients, 44.8%), diabetes mellitus (38 patients, 38.7%), smoking (24 patients, 24.8%) and atrial fibrillation (19 patients, 19.3%). The patients with lacunar strokes were predominantly men (P=0.037) and had a lower frequency of atrial fibrillation (P=0.016) as compared with nonlacunar stroke patients. In the acute phase, the mean systolic blood pressure was 136+/-20 mmHg and diastolic blood pressure was 78.7+/-11.8. Comparing stroke subtypes, there were no differences in 24-h systolic blood pressure and 24-h diastolic blood pressure between patients with lacunar and nonlacunar infarction. However, patients with lacunar infarction showed a mean decline in day-night systolic blood pressure and diastolic blood pressure of approximately 4 mmHg [systolic blood pressure: 3.9 (SD 10) mmHg, P=0.003; diastolic blood pressure 3.7 (SD 7) mmHg, P=0.0001] compared with nonlacunar strokes. Nonlacunar strokes showed a lack of 24-h nocturnal systolic blood pressure and diastolic blood pressure fall. The normal diurnal variation in systolic blood pressure was abolished in 87 (88.9%) patients, and the variation in diastolic blood pressure was abolished in 76 (77.5%) patients. On comparing lacunar and nonlacunar strokes, we found that the normal diurnal variation in systolic blood pressure was abolished in 53 (85.4%) lacunar strokes and in 34 (94.4%) nonlacunar strokes (P=nonsignificant). In terms of diurnal variation in diastolic blood pressure, it was abolished in 43 (69.3%) lacunar strokes and in 33 (91.6%) nonlacunar strokes (P=0.026). CONCLUSIONS: Our results show clear differences in the blood pressure circadian rhythm of acute ischaemic stroke between lacunar and nonlacunar infarctions by means of 24-h blood pressure monitoring. The magnitude of nocturnal systolic and diastolic blood pressure dip was significantly higher in lacunar strokes. Besides, patients with lacunar strokes presented a higher percentage of dipping patterns in the diastolic blood pressure circadian rhythm. Therefore, one should consider the ischaemic stroke subtype when deciding on the management of blood pressure in acute stroke.

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BACKGROUND AND AIM: With respect to the general population, hypertensive patients show an increase in plasma total cholesterol and triglycerides, a decrease in HDL-cholesterol (HDLc) and a higher degree of insulin resistance. Apolipoprotein C-III (apo C-III) plays a regulatory role in the catabolism of triacylglycerol-rich lipoproteins. The S2 allele has been associated with elevated plasma triglycerides concentration, blood pressure and increased risk of myocardial infarction, all of which are characteristic of an insulin resistant state. The aim of this study was to investigate the SstI polymorphism of the apo C-III gene locus on the lipoprotein metabolism, apolipoproteins and basal glucose and insulin levels in essential hypertensive patients. We also examined the influence of the S1S2 allele on blood pressure and the interaction of the mutation at the apo C-III gene and the gender. METHODS AND RESULTS: We studied 104 essential hypertensive patients (59 males and 45 females) determining the carriers of the S2 allele of the genetic polymorphism in the apo C-III gene by polymerase chain reaction, lipoprotein metabolism by standard laboratory methods and ultracentrifugation, apolipoproteins A-I and B by immunoturbidimetry and basal glucose and insulin levels by enzymatic method and radioimmunoassay, respectively. The frequency for the carriers of the SstI minor allele S2 (S1S2 genotype) was 0.17. Patients with the rare S2 allele compared with those with S1S1 allele showed higher plasma triglycerides, total cholesterol and apo B (255.9 +/- 114.6 vs 135.8 +/- 89.1; 250.6 +/- 56.6 vs 214.8 +/- 47.9 and 128.7 +/- 34.8 vs 103.1 +/- 28.6 respectively). Furthermore, basal glucose, insulin levels in S2 allele, and the rate Tg-VLDL/HDLc were increased in the same group. Subgroup analysis revealed that the association between these polymorphism and lipoprotein metabolism, apolipoprotein and basal glucose and insulin levels occurred predominantly in females. A study on the effect of the interaction between this mutation with gender revealed an additive effect on changes in total triglycerides levels. However age, blood pressure and body mass index were similar in both groups of patients (S1S1 and S1S2 genotypes). CONCLUSIONS: These results provide evidence of interaction between gender and the Sst1 polymorphism of the apo C-III on lipoprotein metabolism and insulin resistance in essential hypertensive patients. However, the studied mutation does not contribute to blood pressure levels in essential hypertensive patients (crossover study).

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OBJECTIVE: The patients with hypertension who do not present a night decrease of the arterial pressure are a bigger degree of target organ damage due to the supported hypertension. In our work we analyzed after ambulatory blood pressure monitoring (ABPM) the prevalence of the condition dipper of the patients with hypertension of degree 1 and/or 2 after the suppression controlled of the antihypertensive medication; as well as the magnitude of the effect of white coat (object of another study). DESIGN: Almost experimental study and descriptive. SETTING: Primary care. Urban health centre. Participants measurements and results. Studies of ABPM were realized in 70 essential hypertense patients with good control of the arterial pressure after pharmacological treatment before suspending the antihypertensive medication (1 phase) and to the 4 weeks of leaving the treatment (2 phase), two periods being programmed: diurnal and night. RESULTS: Of all 70 hypertense patients, 18 (26%) did not manage to carry out 2 ABPM since after the retreat of the medication there presented blood pressure unacceptable values that forced to re-introduce the medicaments. The 79% of the hypertense patients were dipper after the 1 monitoring and that after the suppression of the antihypertensive medication, 83% was continuing being dipper. Depending on the gender there were no statistically significant differences as for the night decrease of the arterial pressure in both periods. Finally, 75% and 11.5% of the patients were dippers or not dippers, respectively, in both phases and only 13.5% of the patients it changed its condition. CONCLUSIONS: The retreat of the medication in hypertense of degree 1 and/or 2 well controlled does not modify the patients' percentage with night decreases of the blood pressure.

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Objetivo. Los pacientes con hipertensión arterial (HTA) que no presentan un descenso nocturno de la presión arterial (PA) suelen tener un mayor grado de afección de órganos diana debido a la hipertensión mantenida. En nuestro trabajo analizamos, mediante monitorización ambulatoria de la presión arterial (MAPA), la prevalencia de la condición dipper de los pacientes con HTA de grados 1 y 2 tras la supresión controlada de la medicación antihipertensiva, así como la magnitud del efecto de bata blanca (objeto de otro estudio).Diseño. Estudio cuasi-experimental y descriptivo. Emplazamiento. Atención primaria. Centro de salud urbano. Participantes mediciones y resultados. Se realizaron estudios de MAPA a 70 hipertensos esenciales con buen control de la PA después de tratamiento farmacológico antes de suspender la medicación antihipertensiva (1.ª fase) y a las 4 semanas de abandonar el tratamiento (2.ª fase), programándose dos períodos, diurno y nocturno. Resultados. De los 70 pacientes hipertensos, 18 (26 por ciento) no llegaron a realizarse la segunda MAPA, ya que tras la retirada de la medicación presentaron valores inaceptables de PA que obligaron a reintroducir los fármacos antihipertensivos. El 79 por ciento de los pacientes hipertensos eran dipper tras la primera monitorización, y tras la supresión de la medicación antihipertensiva el 83 por ciento continuaba siendo dipper. En función del sexo, no hubo diferencias estadísticamente significativas en cuanto al descenso nocturno de la PA en ambos períodos. Finalmente, el 75 por ciento y el 11,5 por ciento de los pacientes fueron dipper y non-dipper, respectivamente, en las 2 fases sólo un 13,5 por ciento de los pacientes cambió su condición. Conclusiones. La retirada de la medicación antihipertensiva en pacientes con hipertensión de grados 1 y 2 bien controlados no modifica de manera significativa la prevalencia de pacientes con descensos nocturnos de la PA (AU)

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Subacute thyroiditis is an inflammatory disorder of the thyroid caused probably by viruses. It is clinically characterized by the presence of anterior cervical pain and/or painful goiter, and rarely as fever of unknown origin or as prolonged fever syndrome. We report a case of a 49-year-old female admitted to the hospital because of fever during last month, leukocytosis and accelerated erythrocyte sedimentation rate. Following observation, slight tenderness over the thyroid gland and signs of hyperthyroidism occurred. After the laboratory studies, low thyroidal radioactive iodine uptake and fine-needle aspiration cytology (FNAC) of thyroid, she was diagnosed of subacute thyroiditis with hyperthyroidism. We believe that the etiologic agent was the Epstein-Barr virus because heterophile and Epstein-Barr virus-specific antibodies were positive. The patient was treated with acetaminophen (1.500 mg/day) with prompt and complete resolution of the clinical and laboratory abnormalities. There has been no recurrence of the disease during a 1 year follow-up.

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Presentamos el caso clínico de una paciente de 49 años de edad que ingresó en el hospital con el diagnóstico de SFP de 1 mes de evolución, leucocitosis y aumento de la velocidad de sedimentación globular. Varios días después desarrolla molestias en región anterior del cuello y signos de hipertiroidismo. Tras los resultados de las pruebas complementarias (bioquímicos, hormonales, gammagrafía tiroidea y punción aspiración con aguja fina -PAAF- de tiroides) fue diagnosticada de Tiroiditis subaguda con hipertiroidismo. Nosotros pensamos que el agente etiológico fue el virus de Epstein-Barr ya que los anticuerpos heterófilos y específicos fueron positivos. La paciente fue tratada con paracetamol a la dosis de 1.500 mg/día con recuperación completa sin recidiva posterior tras 1 año de seguimiento (AU)

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OBJECTIVE: To report a case of granulomatous cystitis in a patient receiving bacillus Calmette-Guerin intravesical therapy for urothelial carcinoma in situ. METHODS: A 58-year-old man undergoing BCG intravesical therapy for urothelial carcinoma in situ presented symptoms of intense cystitis. Cystoscopy was performed and several bladder cold biopsies were obtained. RESULTS: Histopathological analysis demonstrated epithelioid granulomas. CONCLUSION: Cystitis arising from BCG therapy is defined as drug-induced or BCG-induced cystitis. Intense cystitis and malaise are a serious complication since it is not possible to distinguish patients with a simple uncomplicated local reaction from those who will develop progressive systemic infection. Cystoscopy and biopsy can be helpful in determining the nature of the condition and are recommended.

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We present a 79-yr-old white woman admitted to the hospital with diffuse myalgias and muscle weakness associated with eosinophilia. Examination of a muscle biopsy section revealed eosinophilic myositis with vasculitis. This association is infrequent and we describe the first case report with symmetrical polyneuropathy. The treatment with prednisone (60 mg/day) led to a complete clinical-pathological recovery of the disease. We review the differential diagnosis and the aetiopathogenic mechanism.

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The effects of cyclosporin and prednisone on plasma lipid and lipoprotein levels were studied in 20 allogeneic bone-marrow transplantation patients receiving cyclosporin plus prednisone therapy, and in 14 allogeneic patients treated only with cyclosporin during 100 days. Eighteen autologous bone-marrow patients not requiring cyclosporin were used as a control group. Patients were studied 5 days prior to transplantation, and on days 30, 60, and 100 after transplantation. To determine the reversibility of the changes, lipid parameters were analyzed 30 days after completion of the treatment. Nutritional supplementation, conditioning regimens, and concomitant medications were not significantly different between groups. Furthermore, no significant differences in age, weight, lipid, or lipoprotein levels were found at baseline. Our results indicate that cyclosporin therapy induces a reversible increase of plasma cholesterol, LDL-cholesterol, triglycerides, VLDL-triglycerides, and apolipoprotein B and a decrease of HDL-cholesterol, HDL2-cholesterol, and apolipoprotein A-I. The addition of prednisone to cyclosporin therapy induces a higher increase in plasma cholesterol mainly due to an increase in HDL-cholesterol. Total cholesterol/HDL-cholesterol ratio increased significantly in patients treated only with cyclosporin. No differences were found in this ratio in patients treated with prednisone compared to those submitted to autologous bone-marrow transplantation. Lipid changes observed in this study were reversible 30 days after cessation of cyclosporin treatment.

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The effects of cyclosporin on plasma lipoproteins and lipoprotein lipase (LPL) activity were studied in rats treated with different doses of the drug for periods ranging between 7 and 30 days. The treatment with cyclosporin resulted in an increase in plasma triglycerides and non-HDL-cholesterol, and a dose and time-dependent decrease of LPL activity and HDL-cholesterol, mainly because of a fall in the HDL2-cholesterol subfraction. The decrease of LPL activity was positively correlated (p < 0.01) with plasma HDL-cholesterol and HDL2-cholesterol and negatively with plasma triglycerides and non-HDL-cholesterol (p < 0.01). Our results indicate that the decrease in plasma LPL activity may be responsible for the increase in plasma triglycerides and the decrease in plasma HDL-cholesterol found in rats under cyclosporin treatment.

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