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Resumen Objetivo Analizar la influencia del clima y el impacto de cada parametro meteorologico sobre la incidencia del infarto agudo de miocardio (IAM) en Galicia. Metodos Estudio retrospectivo analizando el numero de IAM diagnosticados y trasladados a hospitales por la Fundacion Publica de Urgencias Sanitarias de Galicia-061 entre 2002 y 2009. Incluimos pacientes con criterios clinicos y electrocardiograficos de IAM, y analizamos su correlacion con variables meteorologicas diezminutales (temperatura, humedad, presion, precipitaciones acumuladas y velocidad del viento) registradas por MeteoGalicia. Resultados Se incluyeron 4.717 infartos diagnosticados (72,8% varones y 27,2% mujeres), sin detectar variacion estacional. La temperatura media diaria (p = 0,683) y la velocidad media del viento (p = 0,895) no mostraron relacion significativa con la incidencia de IAM. La presion atmosferica presenta una asociacion estadisticamente significativa con la incidencia de IAM (p Conclusiones Nuestro estudio muestra una asociacion estadisticamente significativa entre la presion atmosferica y la humedad relativa media diaria con la incidencia de IAM en Galicia. Dado que las condiciones locales en las diferentes estaciones son muy variables, los futuros trabajos deberian dirigirse a establecer la relacion entre patrones climaticos (definidos por combinaciones de parametros meteorologicos individuales), en lugar de variaciones estacionales, y la incidencia de IAM.

Fundamento y objetivo La torasemida es un diuretico de asa utilizado con frecuencia en el tratamiento de la insuficiencia cardiaca, la insuficiencia renal y la hipertension, en funcion de resultados basados, sobre todo, en la medida clinica de la presion arterial, sin que se haya valorado la eficacia y la duracion del farmaco durante las 24 h. Por ello, hemos investigado la eficacia antihipertensiva y los efectos de la torasemida en el perfil circadiano de la presion arterial, administrada a distintas horas en funcion del ciclo de actividad y descanso. Pacientes y metodo Estudiamos a 58 pacientes hipertensos (25 varones y 33 mujeres) con una media (DE) de edad de 48,7 (11,9) anos, asignados aleatoriamente a 2 grupos de tratamiento en funcion del momento de tomar una dosis de 5 mg/dia de torasemida: a la hora de levantarse o a la hora de acostarse. La presion arterial se determino ambulatoriamente durante 48 h consecutivas antes y despues de 6 semanas de intervencion terapeutica. Resultados La eficacia de la torasemida fue mayor con la dosis nocturna (11,2 y 8,0 mmHg en la media de 24 h de la presion arterial sistolica y diastolica, respectivamente) que con la matutina (6,2 y 3,7 mmHg de presion sistolica y diastolica). El porcentaje de pacientes con presion arterial ambulatoria controlada fue el doble cuando se administro la torasemida a la hora de acostarse (54%) que cuando se la administro a la hora de levantarse (27%). La duracion de la eficacia terapeutica se mantuvo a lo largo de las 24 h solo cuando se administro la torasemida a la hora de acostarse. Con respecto al perfil de seguridad, 2 pacientes presentaron efectos secundarios (dolor abdominal, diarrea) con la toma matutina y 4 con la nocturna (nicturia). Conclusiones Una dosis de 5 mg/dia de torasemida en monoterapia reduce de forma eficaz la presion arterial cuando se administra el farmaco a la hora de acostarse. Se debe tener en cuenta las diferencias en la eficacia antihipertensiva, la duracion del efecto terapeutico y el grado de control en funcion de la hora de tomar la torasemida cuando se prescriba este diuretico de asa en el tratamiento de pacientes con hipertension arterial esencial.

Fundamento y objetivo Los pacientes con hipertension arterial resistente son un problema en la practica clinica habitual por su mal control terapeutico, la elevada incidencia de lesion organica y el consiguiente incremento del riesgo cardiovascular. Las estrategias de tratamiento en este tipo de pacientes incluyen un cambio secuencial de farmacos o la combinacion sinergica de nuevos antihipertensivos. La mayoria de los pacientes, sin embargo, reciben toda su medicacion antihipertensiva en dosis unica matutina. En este estudio hemos evaluado, en pacientes con hipertension resistente, el impacto en el perfil circadiano de la presion arterial (PA) del cambio de la hora de administracion del tratamiento,sin modificar la dosis ni el numero de farmacos. Pacientes y metodo Participaron 123 pacientes con hipertension resistente (73 varones y 50 mujeres) con una media (desviacion estandar) de edad de 59,9 (11,9) anos, que recibian 3 farmacos todos ellos antihipertensivos administrados en dosis unica matutina. Se asigno a los pacientes de un modo aleatorio a 2 grupos, de acuerdo con la modificacion de su esquema terapeutico: a) cambiar un farmaco por otro, manteniendo los 3 medicamentos en regimen de administracion matutina, y b) el mismo cambio de un farmaco por otro, pero administrando 2 a la hora de levantarse y 1 farmaco a la hora de acostarse. Se realizo la monitorizacion ambulatoria de la PA cada 20 min entre las 07.00 y las 23.00 h y cada 30 min por la noche durante 48 h consecutivas antes y despues de 3 meses de tratamiento con el nuevo esquema terapeutico. Resultados Cuando se administro los 3 farmacos en dosis matutina, se produjo una leve y no significativa reduccion de la PA (p > 0,374). En el seguimiento basal, solo un 22% de los pacientes en este grupo era dipper, y este porcentaje se redujo todavia mas (15%) despues de 3 meses de tratamiento con 3 farmacos en la manana. La reduccion de la PA fue mucho mayor y estadisticamente significativa (8,6 y 5,9 mmHg en la media de 24 h de la PA sistolica y la PA diastolica; p Conclusiones Los resultados de este estudio indican que, en pacientes con hipertension arterial resistente,la hora de administracion del tratamiento antihipertensivo puede ser mas importante en el control del paciente y en el modelado adecuado del perfil circadiano de la PA que el cambio de farmacos en el esquema terapeutico combinado.

Fundamento y objetivo Estudios recientes han tratado de superar los pobres resultados obtenidos a partir de medidas clinicas de presion arterial en la deteccion de preeclampsia a traves de la utilizacion de monitorizacion ambulatoria. La baja sensibilidad de la media diaria de la presion arterial ha llevado a concluir que la monitorizacion ambulatoria no tiene utilidad en obstetricia. Por ello, hemos valorado prospectivamente la sensibilidad y especificidad en el diagnostico de hipertension gestacional del test de tolerancia hiperbarica, prueba basada en la construccion de un intervalo de tolerancia para la variacion circadiana de la presion arterial en funcion de la edad gestacional, asi como en el calculo del indice hiperbarico, area de exceso de presion arterial por encima del limite superior de tolerancia Pacientes y metodo Se estudio a 328 gestantes que proporcionaron 2.014 series de presion arterial monitorizadas automaticamente durante 48 h cada 4 semanas desde la primera visita obstetrica hasta el parto. El indice hiperbarico de cada serie de presion arterial se calculo con respecto a unos limites de tolerancia establecidos previamente a partir de 497 series de monitorizacion ambulatoria en una muestra independiente de 189 gestantes normotensas Resultados La sensibilidad en la identificacion de hipertension gestacional y preeclampsia del indice hiperbarico fue del 91% en el primer trimestre, para aumentar hasta el 99% en el tercer trimestre de gestacion. La especificidad fue superior al 99% en todos los trimestres. Los valores predictivos positivo y negativo fueron superiores al 96% en todos los trimestres. Por otra parte, el calculo del indice hiperbarico proporciono, en promedio, una identificacion temprana de complicaciones hipertensivas en el embarazo 23 semanas antes de la confirmacion clinica de la enfermedad Conclusiones El test de tolerancia hiperbarica representa una prueba reproducible, no invasiva y de alta sensibilidad para la identificacion precoz de las gestantes que desarrollaran complicaciones hipertensivas a lo largo de su embarazo, y tambien puede utilizarse para indicar la necesidad de establecer medidas preventivas o terapeuticas

Fundamento y objetivos Los estudios previos sobre el posible efecto del acido acetilsalicilico(AAS) sobre la presion arterial no han tenido en cuenta los cambios en la farmacocinetica de lamedicacion antiinflamatoria no esteroidea en funcion de la hora de administracion del farmaco.El objetivo de este estudio piloto ha sido investigar los efectos del AAS sobre la presion arterialen pacientes con hipertension arterial esencial ligera, sin tratamiento antihipertensivo y que recibieronAAS a distintas horas del dia, en funcion de su ciclo de actividad y descanso. Pacientes y metodo Estudiamos a 64 pacientes con hipertension arterial esencial (24 varones),con una edad media (DE) de 43,5 (12,0) anos, que fueron aleatorizados a tres grupos de tratamiento:grupo 1, con recomendaciones higienicodieteticas sin intervencion farmacologica; grupo2, con recomendaciones higienicodieteticas y AAS (100 mg/dia) a la hora de levantarse, ygrupo 3, con recomendaciones higienicodieteticas y AAS (100 mg/dia) en el momento de acostarse.La presion arterial se monitorizo en cada paciente durante 48 h consecutivas antes ydespues de tres meses de intervencion. El patron circadiano de variacion de la presion arterialpara cada grupo de pacientes se establecio mediante analisis poblacional de componentesmultiples. Los parametros circadianos calculados para cada grupo antes y despues de la intervencionse compararon con una prueba no parametrica pareada. Resultados Despues de los tres meses de tratamiento, en el grupo 1 se produjo una leve y nosignificativa reduccion de la presion arterial ( Conclusiones Los resultados indican que la administracion de AAS en pacientes con hipertensionesencial tiene un significativo efecto hipotensor, que es claramente dependiente de lahora de administracion del farmaco. Este efecto del AAS sobre la presion arterial implica la necesidadde tenerlo en cuenta cuando se utilice AAS en los pacientes hipertensos que, ademas,reciben medicacion antihipertensiva.

Fundamento y objetivo El incremento de las concentraciones plasmaticas de fibrinogeno se consideraun factor de riesgo de enfermedad arteriosclerotica, fundamentalmente cardiopatia coronaria y accidentecerebrovascular. En estudios previos se ha descrito una variacion estacional en el fibrinogeno,con valores mas altos en los meses mas frios. Por otra parte, la ausencia de descenso nocturno en lapresion arterial se ha asociado tambien a un aumento de acontecimientos cardiovasculares. En consecuencia,hemos cuantificado la variacion estacional del fibrinogeno en pacientes hipertensos esenciales,clasificados en funcion del descenso nocturno de la presion arterial. Pacientes y metodo Estudiamos a 577 pacientes con hipertension arterial esencial ligera-moderada(254 varones), con una edad media (DE) de 53,8 (13,8) anos, reclutados a lo largo de dos anos. Lapresion arterial se monitorizo cada 20 min de dia y cada 30 min por la noche, durante 48 h consecutivas.La actividad fisica se monitorizo simultaneamente cada minuto con un actigrafo de muneca. Elfibrinogeno se determino a partir de un analisis de sangre realizado el mismo dia de inicio de la monitorizacion.La variacion estacional del fibrinogeno plasmatico se determino para todos los sujetos asicomo para los subgrupos de dippers (n = 287) y no dippers (n = 290; pacientes con un descenso nocturnoinferior al 10% con respecto a la media diurna de la presion sistolica) mediante analisis decomponentes multiples longitudinal. Resultados Para el total de pacientes hipertensos estudiados, el fibrinogeno presenta una variacion estacionalaltamente significativa (p Conclusiones La elevacion de la concentracion de fibrinogeno en pacientes no dipper podria apoyarlos resultados que asocian la ausencia de descenso nocturno en la presion arterial a un aumento deacontecimientos cardiovasculares, de acuerdo con la correlacion existente entre la variacion circanualdel fibrinogeno y la variacion estacional comunicada para acontecimientos coronarios.

Fundamento y objetivo Los cambios en el patron de variacion circadiana de la presion arterial pueden utilizarsepara predecir la preeclampsia o para valorar su gravedad. Con el objetivo de identificar posiblesdiferencias en la presion arterial en estadios tempranos del embarazo, hemos evaluado y comparado elpatron de variacion circadiana de la presion arterial en gestantes sanas y con complicaciones de la hipertensionarterial al embarazo que fueron monitorizadas sistematicamente a lo largo de la gestacion. Sujetos y metodo Se analizaron 2.014 series de presion arterial monitorizadas automaticamente durante48 h cada 4 semanas desde la primera visita obstetrica hasta el parto en 205 gestantes normotensas,92 que desarrollaron hipertension gestacional y 31 con preeclampsia. El patron circadiano devariacion de la presion arterial para cada grupo de gestantes en cada trimestre de gestacion se determinomediante un analisis de componentes multiples poblacional. Resultados En comparacion con los embarazos sin complicaciones, las gestantes que desarrollaronhipertension gestacional o preeclampsia se caracterizan por una elevacion estadisticamente significativaen la media diaria de la presion arterial en todos los trimestres (p Conclusiones Las diferencias de presion arterial entre grupos de gestantes aparecen con valores mediosque estan dentro de los margenes aceptados de normotension, incluso para la mayoria de las mujeresque desarrollaron hipertension gestacional o preeclampsia. Estas diferencias, significativas ya desde elprimer trimestre, ofrecen nuevos parametros para la identificacion temprana de complicaciones hipertensivasen el embarazo y el establecimiento de medidas profilacticas.

Objective To assess the interactions between weather and the impact of each individual meteorological parameters in the incidence of acute myocardial infarctions (AMI) in Galicia. Methods Retrospective study analyzing the number of AMI diagnosed and transferred to the hospital by the Emergencies Sanitary System of Galicia between 2002 and 2009. We included patients with clinical and ECG findings of AMI. The correlation between 10-minute meteorological variables (temperature, humidity, pressure, accumulated rainfall and wind speed) recorded by MeteoGalicia and the incidence of AMI was assessed. Results A total of 4717 AMI were registered (72.8% men, 27.2% women). No seasonal variations were found. No significant correlations were detected with regard to average daily temperature ( P = .683) or wind speed ( P = .895). Correlation between atmospheric pressure and incidence of AMI was significant ( P P = .005). Conclusions Our study showed a statistical significant association with atmospheric pressure and with the daily relative humidity average. Since the local conditions of weather are widely variable, future studies should establish the relationship between weather patterns (including combinations of meteorological parameters), rather than seasonal variations, and the incidence of AMI.

Torasemide is a high ceiling loop diuretic frequently used for treatment of heart failure, renal failure and hypertension, according to results mainly based on clinic blood pressure measurements, without proper evaluation of the 24-hour efficacy of the drug. Accordingly, we investigated the time-dependent antihypertensive efficacy of torasemide in hypertensive patients.We studied 58 patients with grade 1-2 essential hypertension (25 men and 33 women), 48.7 (11.9) years of age, randomly assigned to receive torasemide (5 mg/day) either upon awakening or at bedtime. Blood pressure was measured by ambulatory monitoring for 48 consecutive hours before and after 6 weeks of therapy.Efficacy of torasemide was significantly higher with bedtime dosing (11.2 and 8.0 mmHg reduction in the 24-hour mean of systolic and diastolic blood pressure, respectively) as compared to the administration of the drug on awakening (6.2 and 3.7 mmHg reduction in systolic and diastolic blood pressure). The percentage of patients with controlled ambulatory blood pressure after treatment was also higher after bedtime treatment (54% versus 27%). The time-response curves indicate a full 24-hour therapeutic duration only when torasemide was administered before bedtime. With regard to the safety profile, 2 patients presented secondary effects (abdominal pain, diarrhea) in morning dose, and 4 patients taking the drug at bedtime reported nicturia.A dose of 5 mg/day torasemide is effective for blood pressure reduction after bedtime administration. The differences in efficacy and therapeutic duration as a function of the circadian time of treatment with torasemide here documented should be taken into account when prescribing this loop diuretic for treatment of patients with essential hypertension.

Patients with resistant hypertension represent an important clinical problem due to their poor control, high prevalence of target organ damage, and the associated increase in cardiovascular risk. Therapeutic strategies in resistant hypertension currently include a sequential change of drugs or the synergic combination of new drugs. Most patients, however, receive all their drugs in a single morning dose. We have evaluated the impact on the circadian pattern of blood pressure (BP) of modifying the time of treatment without increasing the number of prescribed drugs.We studied 123 patients with resistant hypertension (73 men and 50 women), 59.9 (11.9) years of age, who were receiving 3 antihypertensive drugs in a single morning dose. Patients were randomly assigned to one of two groups according to the modification in their treatment strategy: a) Changing one of the drugs, but keeping all 3 in the morning. b) The same approach but prescribing one of the drugs to be taken at bedtime. Blood pressure was measured at 20-minute intervals from 07:00 to 23:00 hours and at 30-minute intervals at night for 48 consecutive hours at baseline and after 3 months of treatment with the new therapeutic scheme.There was a small and non-significant BP reduction when all drugs were still taken on awakening (p0.374). On baseline, only 22% of the patients in this group were dippers, and this percentage was further reduced to 15% after 3 months of therapy with all drugs on awakening. The blood pressure reduction was statistically significant (8.6 and 5.9 mmHg for systolic and diastolic blood pressure; p0.001) with one drug at bedtime. This effect was markedly larger in the nocturnal mean of blood pressure. Thus, while only 13% of the patients in this group were dippers at baseline, 53% were already dippers after 3 months of therapy.Results from this prospective trial indicate that, in patients with resistant hypertension, time of treatment may be more important for patient control and for the proper modeling of the circadian blood pressure pattern than just changing the drug combination.

Recent studies have tried to overcome poor results from isolated blood pressure values in detecting hypertension in pregnancy by relying on ambulatory monitoring. Low sensitivity of the 24-hour mean has led many authors to conclude that ambulatory monitoring is not a valid approach in pregnancy. Against this background, we have evaluated prospectively the sensitivity and specificity in the diagnosis of gestational hypertension of the tolerance-hyperbaric test. This is a combined approach consisting of establishing tolerance intervals for the circadian variability of blood pressure as a function of gestational age, and then computing the hyperbaric index (area of blood pressure excess above the upper limit of the interval) by comparison of any patient's blood pressure profile with those limits.We studied 328 women who provided a 2014 blood pressure series. They were sampled for 48 hours once every 4 weeks from the first obstetric visit (mostly within the first trimester of gestation) until delivery. The hyperbaric index of each blood pressure series was calculated by taking into account the reference circadian tolerance limits established from a 497 series previously sampled from an independent reference group of 189 normotensive pregnant women.Sensitivity of the tolerance-hyperbaric test was 91% for women sampled during the first trimester of gestation, and increased up to 99% in the third trimester. Specificity was above 99% in all trimesters. Positive and negative predictive values were above 96% in all trimesters. Moreover, the hyperbaric index provided an early identification of subsequent gestational hypertension and preeclampsia, on the average of 23 weeks prior to the clinical confirmation of the disease.The tolerance-hyperbaric test represents a reproducible, stable, noninvasive, and high sensitivity test for the very early identification of subsequent gestational hypertension and preeclampsia, which can also be used as a guide for establishing prophylactic or therapeutic interventions.

Increased plasma fibrinogen is recognized as a significant parameter for assessing the potential risk of myocardial infarction and stroke. A seasonal variation has been reported for plasma fibrinogen, with highest values occurring in the coldest months of the year. On the other hand, the lack of nocturnal decline in blood pressure has been associated with an increase in cardiovascular events. Accordingly, we have quantified the yearly variation in plasma fibrinogen in hypertensive patients classified according to their nocturnal decline in blood pressure.We studied 577 mild-to-moderate hypertensive patients (254 men), 53.8 13.8 years of age. Blood pressure was measured every 20 min during the day and every 30 min at night for 48 consecutive hours. Physical activity was simultaneously evaluated at 1-min intervals with a wrist actigraph. A complete blood test was performed on the same day before starting blood pressure monitoring. The circannual variation of plasma fibrinogen was established for all patients as well as for subgroups of dippers (n = 287) and non-dippers (n = 290; patients with a nocturnal blood pressure decline10% of the diurnal mean) by multiple-component analysis.For the whole group of hypertensive patients, plasma fibrinogen was characterized by a highly significant seasonal variation (p0.001), with a mean value of 324 mg/dl, double circannual amplitude (i.e, extent of predictable change along the year) of 75 mg/dl, and time of peak value on the first week of March. This circannual variation can be best represented by a model that includes components with periods of 12 and 6 months. The same model also characterized dippers as well as non-dippers, analyzed separately. Non-dippers showed higher plasma fibrinogen throughout the whole year as compared to dippers (p = 0.002).The elevation of plasma fibrinogen in non-dipper patients as compared to dippers could support the association between the lack of nocturnal decline in blood pressure with an increase in cardiovascular events, since the circannual variation in fibrinogen is timely correlated with the reported yearly variation in coronary events.

Previous studies on the potential influence of aspirin (AAS) on blood pressure have not taken in consideration the chronopharmacologic effects of non-steroidal antiinflammatory drugs. This pilot study investigated the effects of AAS on blood pressure in hypertensive patients under no antihypertensive treatment who received AAS at different day times according to their rest-activity cycle.We studied 64 untreated patients with mild hypertension (24 men), 43.5 (12.0) (mean [SD]) years of age, randomly divided in 3 groups: group 1, non-pharmacological hygienic-dietetic recommendations; group 2, the same recommendations plus AAS (100 mg/day) on awakening, and group 3, the same recommendations plus AAS (100 mg/day) before bedtime. Blood pressure was measured every 20 min during the day and every 30 min at night for 48 consecutive hours before and after 3 months of intervention. The circadian pattern of blood pressure in each group was established by population multiple-component analysis. Circadian parameters obtained for each group of patients before and after the intervention were compared with a nonparametric paired test.After 3 months of non-pharmacological intervention, there was a small and non-significant reduction of blood pressure (1.5 mmHg; p = 0.28). There was no change in blood pressure when AAS was given on awakening (p = 0.21). A highly significant blood pressure reduction was, however, observed in patients who received AAS before bedtime (decrease of 7 and 5 mmHg in systolic and diastolic blood pressure, respectively; p = 0.006).Our results indicate a statistically significant time-dependent administration effect of low-dose AAS on blood pressure in untreated patients with mild hypertension. This effect reinforces the need to quantify and control AAS effects in patients using this agent in combination with antihypertensive agents.

Changes in circadian variation of blood pressure could be used either to predict preeclampsia or to assess its severity. With the objective of identifying potential differences in blood pressure at the early stages of pregnancy, we examined and compared the characteristics of circadian variability in blood pressure in healthy and complicated pregnant women who were systematically monitored throughout gestation.We analyzed 2,014 blood pressure series sampled through ambulatory monitoring for 48 hours once every 4 weeks from the first obstetric visit until delivery. The study included 205 women with uncomplicated pregnancy, 92 with gestational hypertension and 31 with preeclampsia. The circadian pattern of blood pressure variation for each group and trimester of gestation was established by means of a population multiple-components analysis.Differences in the 24-hour mean between healthy and complicated pregnancies were highly significant in all trimesters (p0.001), with values of 15.1 and 9.1 mmHg for systolic and diastolic blood presure, respectively, in the third trimester of pregnancy. The 24-hour mean of systolic/diastolic blood pressure for complicated pregnancies was always below 120/72 mmHg. Results further indicated similar circadian characteristics between gestational hypertension and preeclampsia in the first trimester of pregnancy. The difference between these two groups in the 24-hour mean was significant in the second trimester for systolic (3 mmHg; p = 0.002) but not diastolic blood pressure (0.9 mmHg; p = 0.230). In the third trimester, the difference between gestational hypertension and preeclampsia was significant for both variables (5.4 and 3.7 mmHg for systolic and diastolic blood pressure, respectively; p0.001).The differences in blood pressure between healthy and complicated pregnancies, which are observed as early as the first trimester of pregnancy, are detected when both systolic and diastolic blood pressure measurements in women with a late diagnosis of gestational hypertension or preeclampsia fall within accepted ranges of normotension. These differences offer new end points that may lead to an early identification of hypertensive complications in pregnancy as well as to the establishment of prophylactic interventions.

High levels of plasma total homocysteine (tHcy) are involved in arterial or venous occlusive diseases. It essentially depends on the nutritional status of folic acid (FA) and vitamins B12 or B6, but also on the methylenetetrahydrofolate reductase (MTHFR) enzymatic activity. We aim to evaluate the response of the hyperhomocysteinemia (HHcy) to a standard schedule of vitamin supplementation, according with the MTHFR genotype.227 patients, diagnosed with venous thromboembolism (VTE) were analysed for tHcy (in fasting conditions), and for the MTHFR-C677T gene polymorphism. When the tHcy exceeded the cut-off point (men = 16, women = 15 mumol/l), the patients were supplemented with a dose equivalent to 1 mg FA, 0.2 mg B12 and 100 mg of B6, daily by 6 weeks. Afterwards they were reanalysed and the reduction was stratified by MTHFR genotype, looking for any difference in the response.The mean fasting tHcy was 12.3 mumol/l (SD = 8). The 51 hyperhomocysteinemic patients (22%) were older (65.1 y) than the normal ones (55.0 y) (p = 0.0001). The treatment was carried out properly in 46 patients (90%). The pre-treatment mean Hcy was 23.2 (SD = 10.5) mumol/l, and it was reduced to 13.0 (SD = 5.9) (p = 0.0001) (mean reduction = 42.1%). By genotype, the C/C reduced from 21.0 to 13.2 mumol/l (37%) (n = 18), the C/T from 25.0 to 12.6 mumol/l (46%) (n = 24), and the abnormal homozygotes T/T from 22.7 to 14.5 mumol/l (39%) (n = 4), although no statistical significant differences were found. In 80% of cases (37/46), tHcy values normalised. A negative correlation (r = -0.471) (p = 0.005) was observed between age and response.The FA/B6/B12 based therapy reduces in a simple, quick and effective way (40% in 6 weeks) the pathologic tHcy levels on a VTE population and this is not influenced by the MTHFR genotype. As HHcy seems related with recurrences of venous thrombosis, we could speculate if it would be useful to analyse routinely the tHcy, attempting reduction in selected cases.

Anisakiasis, or anisakidosis, is a parasitic zoonosis due to the infestation by nematodes of the Anisakidae family, mainly by Anisakis simplex. Notwithstanding its world wide distribution, in our country its appearance is quite recent (1991) with only 19 cases previously reported. We refer 13 cases diagnosed in different hospitals in the province of Córdoba, Spain, from September 1994 to July 1998 which represents the biggest series described in Spain so far. All the patients had a clinical onset as acute abdomen, so that they required early surgery in which a narrowing and inflammatory intestinal segment was observed and subsequently resected. Pathology revealed in such segments an intense eosinophilic infiltrate in the mucosa. Only in one of the cases parasitic fragments were detected in the intestinal mucosa and in the 12 remaining cases the diagnosis was immunological by IgE specific for Anisakis simplex determination and antigens detection of the nematode with monoclonal antibodies. As interesting epidemiologic antecedent we shall mention the fact that all patients referred a usual raw fish consumption (mainly anchovy with vinegar) which is host of third-stage larval of the parasite.

The increase in pulmonary vascular resistences in acute pulmonary thromboembolism (APT) is the consequence of anatomical obstruction and pulmonary artery constriction. The administration of inhaled nitric oxide (NO) may be therapeutically useful in acute pulmonary hypertension by APT given its limited vasodilator effect on pulmonary circulation. A patient with APT in whom this selective vasodilator effect was observed is presented. The authors suggest that the administration of inhaled NO may be a potentially beneficial coadjuvant therapy in acute pulmonary hypertension induced by APT.

The aim of this study was to know the prevalence, clinical and immunological characteristics and evolution of thromboangiitis obliterans.Between 1982-1990 41 cases of thromboangiitis obliterans were diagnosed from among 373,899 patients registered (11/100,000) according to the clinical and arteriographic criteria. Of these 41 cases 40 were males with mean age 36 +/- 7 years (mean +/- SD) with only two cases being over 45 years of age. In 40 cases was followed for 44 +/- 29 months (mean +/- SD).All the patients had ischemia of the lower limbs, 34% of the upper limbs, 39% superficial thrombophlebitis, 53% Raynaud's phenomenon, 5% mesenteric ischemia, and 7% myocardial infarction. In 30 symptomatic patients anticardiolipin antibodies were determined and one patient was positive for IgG antibodies. In the 23 patients in whom HLA and anticollagen antibody studies were performed a significant increase was found in HLA-B35, HLA-B40 and type VI denaturalized anticollagen antibodies compared to controls. In general the evolution was progressive when the patients continued smoking and favorable when tobacco was given up except in 2 cases who stopped smoking and in whom the disease progressed and death occurred. The total number of patients who died during follow up was 3 (7%), 2 due to mesenteric ischemia and the third during i.v. infusion of PGE1.The results demonstrate that thromboangiitis obliterans is a rare disease in Spain. The involvement of visceral arteries is not very infrequent with worse prognosis when the mesenteric arteries are involved. There is a significant increase of determined HLA antigens and anticollagen antibodies in the patients with thromboangiitis obliterans.

The use of monoclonal antibodies against tumoral antigens marked with radioactive isotopes is the basis of immunoscintigraphy. The specificity of the technique is high owing to its intrinsic characteristics.40 patients with colorectal cancer who were awaiting surgery were evaluated by immunoscintigraphy. The group consisted of 34 primary diseases and 7 recurrences. Two days before surgery the specific monoclonal antibody BW 431/26 (Behringwerke, FRG) labeled with 99mTc was injected and scintigraphic images were obtained 4 and 24 hours after its administration.The following results were found after a comparison of the data with those from other diagnostic procedures and surgical findings: in primary disease, sensitivity (S) was 59% and accuracy (A) was 56% (these rates increased to 82% and 75%, respectively, when rectal tumors were excluded). For hepatic metastases, S was 44% and A was 85%. In the recurrence group the results were: 4 true positives, 2 false negatives (in the rectum), and one false positive.These results confirm the validity of immunoscintigraphy in patients with colorectal carcinoma. This test may supplement the information of other diagnostic tests, particularly when these have more limitations as it is the case for recurrences.

The prevalence of hepatitis C infection was evaluated (Ortho HCV Antibody ELISA Test) in 64 patients with chronic renal failure treated in a single hemodialysis unit. None of these patients was a carrier of hepatitis B virus nor of antibodies against human immunodeficiency virus. Antibodies against hepatitis C virus were detected in 11 patients (17%). The prevalence was higher in the 13 previously diagnosed of non A, non B hepatitis (77%) than in the 51 without previous hepatitis (2%) (p less than 0.001). A relationship between the infection rate and the number of previous blood transfusions was also observed: 5% in the patients without previous transfusions, 13% in the 30 patients who had received between 1 and 10 blood units and 40% in the 15 who had received more than 10 blood units (p less than 0.05). These data suggest that the hepatitis C virus may be responsible for most episodes previously diagnosed as non A, non B hepatitis, and that blood transfusions are the major risk factor.

A case of pseudomonas endocarditis of biliary origin with impairment of the mitral and tricuspid heart valves is reported. Former history of the patient did not reveal narcotic addiction or previous open-heart surgery. Osteomyelitis is an uncommon complication of pseudomonas endocarditis. Echocardiography was a useful diagnostic method in the present case, showing the vegetation on the tricuspid valve. The poor prognosis of cases with left valvular heart disease which are resistant to medical treatment is emphasized. Differential count of the colonies did not localize the affected heart valve in this case.

We report the first case in the Spanish literature of pulmonary hypertension (PHT) caused by vascular sclerosis in a parenteral drug abuser female. The clinical diagnosis of PHT was confirmed in the necropsy study, which ruled out granulomas and discovered only vascular sclerosis and hypertrophy as causative factors of the clinical picture. The different etiological and pathogenetical mechanisms reported in the literature as causing PHT in this type of patients are reviewed.