RESUMEN
Objetivo: Comparar la satisfacción con la vida y calidad de vida de pacientes en hemodiálisis hospitalaria(HDH) y diálisis peritoneal continua ambulatoria (DPCA), y analizar su asociación con las estrategias de afrontamiento. Método: Se estudiaron, mediante un estudio de corte transversal, 61 pacientes de HDH y 32 de DPCA, con edad 70 años. Se aplicaron los cuestionarios de índice de Charlson, Stai-R, estrés percibido-PSS, percepción de control, soporte social MOS, formas de de afrontamiento, calidad de vida (SF-36) y satisfacción con la vida. Los análisis estadísticos se ajustaron por edad y sexo. Resultados: La proporción de mujeres fue del 35,5%, la edad media de 54 años. El grupo DPCA era más joven con una proporción de mujeres superior. El índice Charlson (comorbilidad) fue similar en HDH y DPCA. El grupo de HDH utilizó psicofármacos en un porcentaje superior a DPCA (el 38 frente al 13%; p 0,01). El grupo DPCA puntuó significativamente más alto en las estrategias de búsqueda de apoyo, regulación emocional, resolución de problemas y distracción, sin diferencias en el soporte social. No se encontraron diferencias en los componentes físico y mental, ni en las 7 dimensiones del SF-36. La satisfacción con la vida fue superioren DPCA (7,12 frente a 6,21; p ¼ 0,07). Conclusiones: Entre las 2 modalidades no hay diferencias en la percepción de calidad de vida. Los pacientes de DPCA tienden a una mayor satisfacción con la vida y un afrontamiento más adaptativo (de regulación emocional y búsqueda de sentido), esto sugiere que podrían tener una mayor asimilación y control del proceso de enfermedad(AU)
Objective To compare satisfaction with life and quality of life in patients receiving continuous ambulatory peritoneal dialysis (CAPD) and hospital hemodialysis (HHD) and to analyze their relationship with coping strategies. Methods. We performed a cross-sectional study in 61 patients aged<70 years old under HHD and 32 patients receiving CAPD. We applied the Charlson Index, the State-Trait Anxiety Inventory (Stai-R), the Perceived Stress Scale (PSS), the MOS Social Support Survey, and the Short-Form 36 questionnaire for quality of life. Coping strategies, perceived control and satisfaction with life were also analyzed. Statistical analyses were adjusted by differences in age and sex. Results. Women accounted for 35.5% of the patients. The mean age was 54 years. The CAPD group was younger and had a higher proportion of women. Charlson Comorbidity Index scores were similar in patients receiving HHD and in those receiving CAPD. The use of psychoactive drugs was higher in the CAPD group than in the HHD group (38% vs. 13%; p<0.01). The CAPD group scored significantly higher in strategies of seeking help, emotional regulation skills, problem resolving and distraction. No differences were found in social support between the two groups. No significant differences were found in the physical or mental components or in the seven dimensions of the SF-36. Satisfaction with life was higher in the CAPD group (7.12 versus 6.21; p=0.07). Conclusions. No differences in the perception of quality of life were found between patients receiving the two modalities. The CAPD group tended to show greater satisfaction with life and more adaptive coping strategies (emotional regulation and search for meaning), suggesting that these patients may have greater acceptance and control over the disease process(AU)
Asunto(s)
Humanos , Diálisis Renal/psicología , Diálisis Peritoneal/psicología , Insuficiencia Renal Crónica/terapia , Atención Ambulatoria/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Calidad de Vida , Atención de Enfermería/métodos , Insuficiencia Renal Crónica/enfermería , Apoyo Social , Estrés Psicológico/epidemiologíaRESUMEN
OBJECTIVE: To compare satisfaction with life and quality of life in patients receiving continuous ambulatory peritoneal dialysis (CAPD) and hospital hemodialysis (HHD) and to analyze their relationship with coping strategies. METHODS: We performed a cross-sectional study in 61 patients aged<70 years old under HHD and 32 patients receiving CAPD. We applied the Charlson Index, the State-Trait Anxiety Inventory (Stai-R), the Perceived Stress Scale (PSS), the MOS Social Support Survey, and the Short-Form 36 questionnaire for quality of life. Coping strategies, perceived control and satisfaction with life were also analyzed. Statistical analyses were adjusted by differences in age and sex. RESULTS: Women accounted for 35.5% of the patients. The mean age was 54 years. The CAPD group was younger and had a higher proportion of women. Charlson Comorbidity Index scores were similar in patients receiving HHD and in those receiving CAPD. The use of psychoactive drugs was higher in the CAPD group than in the HHD group (38% vs. 13%; p<0.01). The CAPD group scored significantly higher in strategies of seeking help, emotional regulation skills, problem resolving and distraction. No differences were found in social support between the two groups. No significant differences were found in the physical or mental components or in the seven dimensions of the SF-36. Satisfaction with life was higher in the CAPD group (7.12 versus 6.21; p=0.07). CONCLUSIONS: No differences in the perception of quality of life were found between patients receiving the two modalities. The CAPD group tended to show greater satisfaction with life and more adaptive coping strategies (emotional regulation and search for meaning), suggesting that these patients may have greater acceptance and control over the disease process.
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Adaptación Psicológica , Unidades de Hemodiálisis en Hospital , Diálisis Peritoneal Ambulatoria Continua/psicología , Calidad de Vida , Diálisis Renal/psicología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
Objetivo. El estudio ZAFRA se diseñó para evaluar la seguridad de un nuevo bloqueantede los canales del calcio, lercanidipino, en la insuficiencia renal crónica, ysu posible sobre la función renal en los pacientes tratados con fármacos que bloqueanel eje renina-angiotensina. Los pacientes que no controlaron su PA con estos fármacosfueron tratados con doxazosina.Diseño y métodos. El estudio reclutó 203 pacientes con insuficiencia renal (creatinina> 1,4 mg/dl en varones o > 1,2 mg/dl en mujeres, o aclaramiento de creatinina< 80 ml/min). Todos los pacientes estaban siendo tratados con IECA o antagonistasde receptores y la medicación se mantuvo a lo largo del estudio, sin quepudieran recibir diuréticos a lo largo del seguimiento. Los pacientes eran evaluadosclínica y analíticamente 1, 3 y 6 meses después de iniciar tratamiento con lercanidipino.Aquellos pacientes que en la segunda visita no estaban controlados añadierondoxazosina GITS (4 mg en dosis única) al tratamiento.Resultados: 57 pacientes que iniciaron el estudio fueron tratados con doxazosina(edad media 64,8 ± 12,7 años, 47,4 varones y 52,6 mujeres). La PA se redujo significativamentedesde 164 ± 17/92 ± 9 hasta 135 ± 13/78 ± 8 mmHg (p < 0,001). Seprodujeron reducciones significativas de la PA en el 67,6% de los enfermos y el32,4% de los pacientes redujeron su PA hasta los límites recomendados (<130/85mmHg). Únicamente 2 (3,6) pacientes han presentado reacciones adversas. No sedetectó aumento de la incidencia de edema. La creatinina plasmática (1,9 ± 0,6mg/dl) no se había modificado al final del estudio (2,0 ± 0,8 mg/dl) ni el aclaramientode creatinina (38,7 ± 15,7 vs 38,5 ± 14,5). También se detectó un descensosignificativo del urato plasmático (7,0 ± 1,9 vs 6,7 ± 1,6 mg/dl, p < 0,05).Conclusiones: La doxazosina ha presentado un excelente perfil de seguridad enlos pacientes renales, destacando la ausencia de edemas a pesar de la insuficienciarenal de los pacientes
Objective. To evaluate the safety and effectiveness of the alfa-blocker doxazosinGITS in CRF patients.Design and methods. The study recruited 203 CRF patients (creatinine > 1,4mg/dl for males, creatinine > 1,2 mg/dl for females, or creatinine clearance < 80ml/min). All patients were receiving ACE inhibitores (63.4%) or angiotensin II antagonist(36.6%) therapy but they had higher blood pressure than recommended forCRF (130/85 mmHg). Patients were clinically evaluated 1, 3 and 6 moths after startingtreatment with lercanidipine (10 mg once daily). Patients with high blood pressurein spite of combined therapy with two drugs added doxazosin GITS 4-8 mgonce daily to treatment.Result: 57 patients rendered evaluable for the study (age 64.8 ± 12.7 years,47.4% males and 52.6 females). BP significantly decrease from 164 ± 17/92 ± 9mmHg to 135 ± 13/78 ± 8 mmHg. 67.6% patients showed a significant BP reductionand 32.4% gets optimal BP control (< 130/85 mmHg). Two patients (3.6%)showed untoward effects. No biochemical changes were detected.Conclusions: Doxazosin showed a good antihypertensive effect in CRF patientswhen used as third drug in resistant severe hypertension. It has a good tolerabilityprofile and showed a neutral profile on biochemical parameters
Asunto(s)
Humanos , Bloqueadores de los Canales de Calcio/uso terapéutico , Doxazosina/uso terapéutico , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/tratamiento farmacológico , Antihipertensivos/uso terapéuticoRESUMEN
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Humanos , Hiponatremia/fisiopatología , Desequilibrio Hidroelectrolítico/fisiopatología , Síndrome de Secreción Inadecuada de ADH/fisiopatología , Diuréticos/uso terapéutico , Síndrome Nefrótico/fisiopatologíaRESUMEN
OBJECTIVE: The objective was primary to evaluate the safe use of a new calcium channel blocker, lercanidipine, in patients with chronic renal failure (CRF). The secondary objective was to study the protective effect of calcium channel blocker on renal function in CRF patients previously treated with ACE inhibitors or angiotensin receptor blockers. DESIGN AND METHODS: The study recruited 203 CRF patients (creatinine >1.4 mg/dL for males, creatinine > 1.2 mg/dL for females, or creatinine clearance <70 mL/min). All patients were receiving ACE inhibitors (63.4%) or angiotensin II antagonist (36.6%) therapy, but they had higher blood pressure than recommended for CRF (130/85 mmHg). No patients were under diuretic treatment. Patients were clinically evaluated 1, 3, and 6 months after starting treatment with lercanidipine. Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to the treatment, excluding diuretics. Creatinine clearance was measured using 24 h urine collection. RESULTS: 175 patients rendered valuable for the study (age 63.9+/-11.9 years, 52.9% males and 47.1% females). Blood pressure (BP) significantly decreased from 162+/-17/93+/-8.3 mmHg to 132+/-12/78+/-6 mmHg. 89.2% of patients showed a significant BP reduction, and 58.1% achieved optimal BP control (<130/85 mmHg). Seven patients (3.4%) showed untoward effects. Not one case of edema was detected, and the prevalence of adverse effects related to vasodilatation was extremely low (three patients, 1.48%). Plasmatic creatinine did not change (1.9+/-0.5 baseline versus 1.9+/-0.6 mg/dL), but creatinine clearance increased at the end visit (41.8+/-16.0 baseline versus 45.8+/-18.0 mL/min, p=0.019). Plasmatic cholesterol also decreased from 221+/-46 to 211+/-35 mg/dL (p=0.001). CONCLUSIONS: Lercanidipine showed a high antihypertensive effect in CRF patients. It has a good tolerability profile and showed an interesting effect on plasmatic lipids. An improvement in renal function, measured through creatine clearance, was detected.
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Bloqueadores de los Canales de Calcio/uso terapéutico , Dihidropiridinas/uso terapéutico , Fallo Renal Crónico/tratamiento farmacológico , Anciano , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Riñón/efectos de los fármacos , Fallo Renal Crónico/complicaciones , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the safety and effectiveness of the alfa-blocker doxazosin GITS in CRF patients. DESIGN AND METHODS: The study recruited 203 CRF patients (creatinine > 1,4 mg/dl for males, creatinine > 1,2 mg/dl for females, or creatinine clearance < 80 ml/min). All patients were receiving ACE inhibitores (63.4%) or angiotensin II antagonist (36.6%) therapy but they had higher blood pressure than recommended for CRF (130/85 mmHg). Patients were clinically evaluated 1, 3 and 6 moths after starting treatment with lercanidipine (10 mg once daily). Patients with high blood pressure in spite of combined therapy with two drugs added doxazosin GITS 4-8 mg once daily to treatment. RESULT: 57 patients rendered evaluable for the study (age 64.8 +/- 12.7 years, 47.4% males and 52.6 females). BP significantly decrease from 164 +/- 17/92 +/- 9 mmHg to 135 +/- 13/78 +/- 8 mmHg. 67.6% patients showed a significant BP reduction and 32.4% gets optimal BP control (< 130/85 mmHg). Two patients (3.6%) showed untoward effects. No biochemical changes were detected. CONCLUSIONS: Doxazosin showed a good antihypertensive effect in CRF patients when used as third drug in resistant severe hypertension. It has a good tolerability profile and showed a neutral profile on biochemical parameters.
Asunto(s)
Bloqueadores de los Canales de Calcio/uso terapéutico , Doxazosina/uso terapéutico , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/tratamiento farmacológico , Antihipertensivos/uso terapéutico , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: To evaluate the safe use of a new calcium channel blocker, lercanidipine, in diabetic chronic renal failure (CRF) patients. DESIGN AND METHODS: The study recruited 42 diabetic CRF patients (creatinine > 1.4 mg/dl for males, creatinine > 1.2 mg/dl for females, or creatinine clearance < 70 ml/min). Mean age was 68.2 +/- 9.1 years. 53.8% were males and 46.2% females. Three patients were type 1 diabetics and 39 ones were type II. All patients were receiving ACE inhibitors (67.4%) or angiotensin II antagonist (32.6%) therapy but they had higher blood pressure than recommended for CRF patients (130/85 mmHg). No patients were under diuretic treatment. Patients were clinically evaluated 1, 3 and 6 months after starting treatment with lercanidipine. Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to treatment, excluding diuretics. Creatinine clearance was measured using 24 h urine collection. RESULTS: BP significantly decrease from 163 +/- 18/90 +/- 8 mmHg to 134 +/- 12/77 +/- 9 mmHg. One half of patients showed significant reduction of blood pressure, 26.7% reached the target blood pressure (< 130/85 mmHg) and 20.0% gets optimal BP control (< 130/85 mmHg). No one patient showed untoward effects. No edema was detected nor adverse effects related to vasodilatation were found. Plasmatic creatinine did not change (1.9 +/- 0.5 baseline vs 1.8 +/- 0.5 mg/dl) and creatinine clearance increased at the end visit (40.1 +/- 14.5 baseline vs 45.4 +/- 18.2 ml/min) but the difference was not significant. Proteinuria was unchanged. CONCLUSIONS: Lercanidipine showed a good antihypertensive effect in diabetics CRF patients. It has a good tolerability profile and showed neutral effect on plasmatic lipids. Neither impairment of renal function nor increment in proteinuria were detected.
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Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Nefropatías Diabéticas/complicaciones , Dihidropiridinas/uso terapéutico , Fallo Renal Crónico/etiología , Anciano , Antihipertensivos/efectos adversos , Antihipertensivos/farmacología , Bloqueadores de los Canales de Calcio/efectos adversos , Creatinina/metabolismo , Diabetes Mellitus Tipo 2/complicaciones , Dihidropiridinas/efectos adversos , Edema/inducido químicamente , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteinuria/tratamiento farmacológico , Resultado del TratamientoRESUMEN
The acute renal failure is a grave pathology, of rapid establishment and relatively frequent in the hospital environment. We can describe three etiological groupS, which are responsible for it, amongst which are emphasized the pre-renal reasons. The obstructive pathology, of minor incidence, increases with the age. It is described the case of a 67-yr-old patient who was admitted in the Nephrology Service because of abrupt decline of the renal function. Among the initial symptoms, he presented arterial hypertension (190/90) and preserved diuresis. Blood analysis: urea 199 mg/dl, creatinine 7.7 mg/dl, without proteinuria. Sonography reported a bilateral ureteral hydronephrosis with simple cyst of possible ischemic origin. In view of the absence of previous biochemical data of renal failure, we considered possible reasons which start with an acute pattern. In initial evaluation, pre-renal etiology was not seen (high blood pressure, right cardiac systole function). The absence of prostatic syndrome and sonography discovery did not justify a diagnosis of urinary tract obstruction. Finally, abdominal-pelvic scan showed a periaortic retroperitoneal mass which included both ureters and appeared to trigger the obstruction. Combined efforts were pursued with the Urology Service, which implanted a bilateral "double J" catheter and later operated surgically on the patient, carrying out an alternating ureterolysis of both ureters. The biopsy manifested a retroperitoneal fibrosis, and the renogram showed a residual renal function of 20% in the right kidney and 80% in the left kidney. Due to the failure of the previous measures and as a last therapeutic recourse when one year had passed from the diagnosis, a continuous regimen with tamoxifen (anti-estrogen drug) in dose of 20 mg/dl each 12 hours was started, which began a progressive remission in the size of the observed mass by scan (CT) and magnetic resonance (MR). The treatment was completed during 12 months and in this time, the levels of blood urea nitrogen and creatinine were reduced gradually too. Finally, at the end of the treatment, the magnetic resonance demonstrate the complete disappearance of the fibrosis.
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Lesión Renal Aguda/etiología , Fibrosis Retroperitoneal/complicaciones , Lesión Renal Aguda/sangre , Anciano , Humanos , Hidronefrosis/complicaciones , Hidronefrosis/cirugía , Enfermedades Renales Quísticas/complicaciones , Imagen por Resonancia Magnética , Masculino , Fibrosis Retroperitoneal/diagnóstico , Fibrosis Retroperitoneal/diagnóstico por imagen , Fibrosis Retroperitoneal/tratamiento farmacológico , Stents , Tamoxifeno/uso terapéutico , Tomografía Computarizada por Rayos X , Uréter/cirugía , Disfunción Ventricular Izquierda/complicacionesRESUMEN
El fracaso renal agudo es un proceso grave, de instauración rápida y relativamente frecuente en el medio hospitalario. Clásicamente se describen tres grupos etiológicos responsables del mismo, entre los cuales destacan las causas prerrenales. La patología obstructiva, de menor incidencia, aumenta con la edad. Se describe el caso de un paciente de 67 años que ingresa en el Servicio de Nefrología por un deterioro brusco de la función renal. Entre los síntomas iniciales, presenta hipertensión arterial (190/90) y diuresis conservada. La analítica pone de manifiesto una urea de 199 mg/dl, con creatinina de 7,7 mg/dl, sin proteinuria. La ecografía informa una hidronefrosis renoureteral bilateral con quistes simples de posible origen isquémico. Dada la ausencia de datos bioquímicos previos de insuficiencia renal, se consideran posibles causas desencadenantes del cuadro agudo. En la valoración inicial, la etiología prerrenal no tienen fundamento clínico (tensión arterial elevada, correcta función sistólica cardíaca por ecocardiografía), ni bioquímico. La ausencia de síndrome prostático y los hallazgos ecográficos tampoco justifican una obstrucción del tracto urinario. Por último, la tomografía abdomino-pélvica evidencia una masa retroperitoneal periaórtica que engloba ambos uréteres y parece desencadenante del cuadro obstructivo. Se inicia un seguimiento conjunto con el Servicio de Urología, que implanta unos catéteres «doble J» bilaterales y más adelante, interviene quirúrgicamente al paciente llevando a efecto una ureterolisis alterna de ambos uréteres. El material de biopsia informa de fibrosis retroperitoneal, y el renograma evalúa una función renal residual del 20% en riñón derecho y del 80% en el izquierdo. Ante el fracaso de las medidas quirúrgicas anteriores y como último recurso terapéutico, se ensaya al año del diagnóstico, una pauta continua con tamoxifeno (antiestrógeno) a dosis de 20 mg/dl cada 12 horas, que inicia una remisión progresiva en el tamaño de la masa, objetivada por tomografía (TAC) y resonancia magnética (RMN). La pauta se completa durante 12 meses y en este tiempo se reducen también de forma paulatina, los niveles de nitrógeno uréico y creatinina en sangre. Finalmente al término del tratamiento, la RMN evidencia la desaparición total de la fibrosis (AU)
The acute renal failure is a grave pathology, of rapid establishment and relatively frecuent in the hospital environment. We can describe three etiological group, which are responsible of himself, amongst which are emphasized the pre-renal reasons. The obstructive pathology, of minor incidence, increase with the age. It in described the case of a patient with 67 years old who is admitted in the Nephrology Service because of abrupt spoiling of the renal function. Between initials symptons, he presents arterial hipertension (190/90) and preserved diuresis. The analytics manifest: urea 199 mg/dl, creatinine 7.7 mg/dl, without proteinuria. Sonography reports a bilateral ureteral hydronephrosis with simple cyst of possible ischemia origin. In view of the absence of previus biochemicals data of renal failure, it is considered possibles reasons which start acute pattern. In initial evaluation, pre-renal etiology has not clinical basis (high blood pressure, right cardiac systole function). The absence of prostatic syndrome and sonography discovery, neither justify an urinary tract obstruction. Finally, abdominal-pelvic scan show a periaortic retroperitoneal mass which include both ureter and appear like outbreak ob obstruent patern. It is begun a combined pursuit with the Urology Service, which implant a bilateral «double J» catheter and later, operate on surgicaly the patient, carrying out an alternating ureterolysis of both ureter. The equipment of byopsy manifested a retroperitoneal fibrosis, and the renogram evaluate a residual renal function of 20% inside right kidney and 80% inside left kidney. Before the failure of the previous measuring and like last therapeutic recourse, it is tried when one year has passed from the diagnostic, a continuous guide with tamoxifen (anti-estrogen drug) in dose of 20 mg/dl each 12 hours, which begins a progressive remission in the size of the objectified mass by scan (CT) and magnetic resonance (MR). The guide is completed during 12 months and in this time, the levels of ureic nitrogen and creatinine in blood, are reduced gradually too. Finally, at the end of the treatment, the magnetic resonance demonstrate the complete disappearance of the fibrosis (AU)
Asunto(s)
Anciano , Humanos , Masculino , Lesión Renal Aguda/etiología , Fibrosis Retroperitoneal/complicaciones , Fibrosis Retroperitoneal/diagnóstico , Fibrosis Retroperitoneal/tratamiento farmacológico , Fibrosis Retroperitoneal , Stents , Lesión Renal Aguda/sangre , Hidronefrosis/complicaciones , Hidronefrosis/cirugía , Enfermedades Renales Quísticas/complicaciones , Imagen por Resonancia Magnética , Tamoxifeno/uso terapéutico , Tomografía Computarizada por Rayos X , Uréter/cirugía , Disfunción Ventricular Izquierda/complicacionesRESUMEN
BACKGROUND: Epidemiologic and experimental data suggest that cholesterol may play a role in the pathogenesis of AD. Modulation of cholesterolemia in transgenic animal models of AD strongly alters amyloid pathology. OBJECTIVE: To determine whether a relationship exists between amyloid deposition and total cholesterolemia (TC) in the human brain. METHODS: The authors reviewed autopsy cases of patients older than 40 years and correlated cholesterolemia and presence or absence of amyloid deposition (amyloid positive vs amyloid negative subjects) and cholesterolemia and amyloid load. Amyloid load in human brains was measured by immunohistochemistry and image analysis. To remove the effect of apoE isoforms on cholesterol levels, cases were genotyped and duplicate analyses were performed on apoE3/3 subjects. RESULTS: Cholesterolemia correlates with presence of amyloid deposition in the youngest subjects (40 to 55 years) with early amyloid deposition (diffuse type of senile plaques) (p = 0.000 for all apoE isoforms; p = 0.009 for apoE3/3 subjects). In this group, increases in cholesterolemia from 181 to 200 almost tripled the odds for developing amyloid, independent of apoE isoform. A logistic regression model showed consistent results (McFadden rho2 = 0.445). The difference in mean TC between subjects with and without amyloid disappeared as the age of the sample increased (>55 years: p = 0.491), possibly reflecting the effect of cardiovascular deaths among other possibilities. TC and amyloid load were not linearly correlated, indicating that there are additional factors involved in amyloid accumulation. CONCLUSIONS: Serum hypercholesterolemia may be an early risk factor for the development of AD amyloid pathology.
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Enfermedad de Alzheimer/epidemiología , Péptidos beta-Amiloides/análisis , Angiopatía Amiloide Cerebral/epidemiología , Hipercolesterolemia/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/etiología , Enfermedad de Alzheimer/patología , Apolipoproteínas E/sangre , Apolipoproteínas E/genética , Angiopatía Amiloide Cerebral/etiología , Angiopatía Amiloide Cerebral/patología , Femenino , Hipocampo/química , Hipocampo/patología , Humanos , Hipercolesterolemia/complicaciones , Hipercolesterolemia/tratamiento farmacológico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Placa Amiloide , Isoformas de Proteínas/sangre , Isoformas de Proteínas/genética , Estudios Retrospectivos , Factores de Riesgo , Lóbulo Temporal/química , Lóbulo Temporal/patologíaRESUMEN
INTRODUCTION: In view of the discrepancy between the siting of electrodes and the effects on BAEP, we made a morphological study of 30 healthy volunteers, 15 men and 15 women. DEVELOPMENT: In each person we obtained the BAEP with the active electrode on the ear lobe ipsilateral to the stimulated ear and the reference ear successively at four different sites: vertex (Cz), high frontal (Fz), earlobe contralateral to the stimulated ear and the spinous process of the seventh cervical vertebra (CV7). The I, III and V waves were present in all cases and tests, followed in frequency by II, IV and VII. In Cz and Fz the first five deflections were almost always seen, and these are the most useful for neurodiagnosis. The waves of greatest amplitude were 1 in both sexes in the ear lobe and CV7 for Fz and Cz in men and V for women. Regarding the complex morphological variants, the greatest incidence in the III IV V complex was observed in Fz in both sexes. In CV7 there was a greater range of variants, as found by other workers, but with greater morphological separation of waves IV and V. They were infrequent in waves I II and VI VII and least common in Fz and Cz. CONCLUSION: We consider that the BAEP obtained with reference to Cz and Fz are ideal for interpretation, since there is greater constancy, global amplitude and morphological clarity of the first five deflections and less morphological complexity of the other waves.
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Electrofisiología/métodos , Potenciales Evocados Auditivos del Tronco Encefálico/fisiología , Adolescente , Adulto , Vértebras Cervicales , Oído/fisiología , Electrodos , Femenino , Humanos , MasculinoRESUMEN
Ante la discrepancia en la ubicación de electrodos y sus efectos sobre los BAEP, se ha realizado un estudio morfológico en 30 voluntarios sanos, 15 hombres y 15 mujeres. En cada sujeto se obtuvieron los BAEP con electrodo activo en lóbulo de oreja ipsilateral al oído estimulado y la referencia, sucesivamente, en cuatro emplazamientos distintos: vértex (Cz), frontal alto (Fz), lóbulo de oreja contralateral al oído estimulado y apófisis espinosa de la séptima vértebra cervical (Cv7). Las ondas I, III y V estuvieron presentes en todos los casos y montajes, seguidas en constancia por la II, IV y VII. En Cz y Fz casi siempre se obtuvieron las cinco primeras deflexiones, las más útiles con fines neurodiagnósticos. Las ondas de mayor amplitud fueron la I para ambos sexos en lóbulo de oreja y Cv7 y para Fz y Cz la III en hombres y la V en mujeres. Para las variantes morfológicas 'complejas' la mayor incidencia en el complejo III-IV-V se observó en Fz, en ambos sexos. En Cv7 hubo una mayor gama de variantes, como señalan otros autores, pero con mayor separación morfológica de las ondas IV y V.En las ondas I-II y VI-VII, resultan infrecuentes, siendo en Fz y Cz donde menos se presentan. Consideramos que los BAEP obtenidos con referencia en Cz y Fz, son los idóneos a la hora de su interpretación, por una mayor constancia, amplitud global y claridad morfológica de las cinco primeras deflexiones y menor complejidad morfológica de las restantes ondas (AU)
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Adulto , Adolescente , Masculino , Femenino , Humanos , Potenciales Evocados Auditivos del Tronco Encefálico , Vértebras Cervicales , Oído , Electrofisiología , ElectrodosRESUMEN
Introducción. Ante la discrepancia en la localización de los electrodos y sus efectos sobre los potenciales evocados auditivos de tronco encefálico (PEAT), se ha realizado un estudio estadístico de dichos potenciales utilizando cuatro emplazamientos distintos del electrodo de referencia para determinar cuál podría ser el montaje óptimo. Sujetos y métodos. El estudio se realizó en 30 voluntarios sanos de 17 a 22 años de edad, 15 varones y 15 mujeres. En cada sujeto se obtuvieron sucesivamente los PEAT con electrodo de referencia en vértex (Cz), frontal alto (Fz), lóbulo de oreja contralateral al oído estimulado y apófisis espinosa de la 7.ª vértebra cervical (Cv). En todos los casos el electrodo activo se colocó en lóbulo de oreja ipsilateral al oído estimulado. Tras obtener unas tablas de normalidad para las latencias y amplitudes de las ondas I a VII en cada uno de los montajes utilizado, se llevó a cabo un estudio comparativo intersexual y otro interlateral mediante la t de Student para datos apareados. Resultados. No se han encontrado diferencias estadísticamente significativas en las latencias y amplitudes de las ondas I a VII para los PEAT obtenidos con los cuatros montajes empleados. Conclusiones. A la vista de nuestros resultados, podemos concluir que el lugar de ubicación del electrodo de referencia no parece un factor importante a la hora de obtener los PEAT. No obstante, ante los registros obtenidos, preferimos la ubicación de dicho electrodo de referencia en Cz o Fz para la obtención de los PEAT, ya que dichos emplazamientos presentan un trazado más claramente definido (AU)
Asunto(s)
Adolescente , Adulto , Masculino , Femenino , Humanos , Potenciales Evocados Auditivos del Tronco Encefálico , Electrodos , Estimulación Eléctrica , Valores de ReferenciaRESUMEN
The testicular infarction can be a rare complication of the orchiepididymitis. The ultrasonography appearance of the partial infarctions creates confusion with expansive intratesticular processes. We present three cases of focal testicular infarction associated with orchiepididymitis, stressing the usefulness of the Color doppler sonography for detecting the avascular nature o these lesions. The determination of de indeces of resistance (IR) in the doppler spectrum of intratesticular arteries showed a highly increased vascular resistance in respect of the healthy testicle. In patients with grave orchiepididymitis vein drainage can be affected due to compressive edema or to thrombosis, causing the raising of the resistance indeces. Acknowledging the avascular resistance of the focal post-orchiepididymitis infarction we can prevent unnecessary orchiectomy.
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Epididimitis/complicaciones , Infarto/diagnóstico por imagen , Infarto/etiología , Orquitis/complicaciones , Testículo/irrigación sanguínea , Testículo/diagnóstico por imagen , Ultrasonografía Doppler en Color , Adulto , Epididimitis/fisiopatología , Humanos , Infarto/fisiopatología , Masculino , Orquitis/fisiopatología , Testículo/fisiopatología , Factores de Tiempo , Resistencia VascularRESUMEN
INTRODUCTION: In view of the discrepancy in the placement of electrodes and their effects on the auditory evoked potentials of the brainstem (PEAT), we made a statistical study of these potentials using four different sites for the reference electrode to determine the best position for it. SUBJECTS AND METHODS: The study was done in 30 healthy volunteers aged between 17 and 22 years, 15 men and 15 women. In each person successive measurements were made of the PEAT, with the reference electrode on the vertex (Cz), high frontal (Fz), ear lobe of the opposite side to that of the ear being stimulated and the spinal apophysis of the 7th cervical vertebra (CV). In all cases the active electrode was placed on the ipsilateral ear lobe of the ear being stimulated. After obtaining tables of the normal values for the latency and wave amplitude of waves I to VII in each electrode montage used, we made a study of sex differences and results from the other ear using Student's t test for paired data. RESULTS: No statistically significant differences were found between the latencies and amplitudes of the waves I to VII for the PEAT obtained with the montage used. CONCLUSIONS: From our results, we may conclude that the position of the reference electrode does not seem to be a major factor when obtaining PEAT. However, in view of the recordings made, we prefer the reference electrode to be at Cz or Fz when obtaining PEAT, since a clearer recording is obtained when these positions are used. Influence of the reference electrode on PEAT.
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Estimulación Eléctrica , Electrodos , Potenciales Evocados Auditivos del Tronco Encefálico , Adolescente , Adulto , Femenino , Humanos , Masculino , Valores de ReferenciaAsunto(s)
Nefritis Intersticial/complicaciones , Panuveítis/complicaciones , Enfermedad Aguda , Adolescente , Femenino , Humanos , Nefritis Intersticial/tratamiento farmacológico , Nefritis Intersticial/patología , Panuveítis/tratamiento farmacológico , Panuveítis/patología , Esteroides/uso terapéuticoRESUMEN
INTRODUCTION AND OBJECTIVE: In view of the disparity of data and methodology concerning medium (MAEP) and long latency (LAEP) acoustic evoked potentials, we have obtained tables of normal values using a reliable method and statistical study of these potentials in 30 healthy persons, in order to serve as a basis for clinical reference and for possible further studies. MATERIAL AND METHODS: In the MAEP we used the two types of stimuli most commonly employed, first a click and then a rising-plateau-falling tone (2-6-2). We observed that this did not affect the latency or amplitude of the different waves, although the best defined waves are obtained with tones. In the LAEP we always used a tone with rise-plateau-fall of 10-50-10, as recommended by the American Electroneurophysiological Society. In all cases the intensity was of 70 db, with rarefaction and masking of the contralateral ear with an intensity of 50 db. Self-adhesive electrodes were used for captation; the active one was placed on the ipsilateral ear lobe and the reference electrode in Cz for the LAEP. For the LAEP the lower filter was of 1 Hz and the higher of 70 Hz. In view of the variety of filters recommended, 10 Hz at the lower level and 500, 1000 and 2000 at the higher level were used successively for the MAEP. We observed that these did not affect the latency or amplitude of the waves, so these three values may all be used equally well. RESULTS AND CONCLUSIONS: In the inter-sexual study, no differences were seen between men and women. Nor were there significant differences between the acoustic evoked potentials on the right and left sides of the same person.