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Background and Objective: To estimate the prevalence of known diabetes mellitus (KD), unknown diabetes (UD), and carbohydrate metabolism disturbances in a population of Castilla-La Mancha (CLM) older than 30 years old; To study the cardiovascular risk factors related with diabetes., Patients and Methods: A transversal study was performed in order to determine these prevalence data. Reference date: 2007/06/01. 3,092 subjects were selected, and 1,181 of them (38.1%) participated in the study. A questionnaire, physical exploration and glucose tolerance test were performed. The diagnostic criteria of diabetes were those established by the American Association of Diabetes (ADA) and were compared with the World Health Organization criteria (WHO)., Results: Prevalence of diabetes in individuals younger than 30 years: 17.9% (DM 10.7%, DO 7.2%). Ratio UD/KD: 0.7. Prevalence of impaired glucose tolerance (IGT) 5.6% and impaired fasting glucose (IFG) 22.3% based on ADA criteria and 7.2% if WHO criteria applied. KD, IFT and IFG increased with age. Global prevalence was higher in males (20.9%) than females (14.5%), but the prevalence was higher in females older than 74 years. A positive relationship was found with obesity, male sex, age and familiar history of diabetes., Conclusions: Prevalence of diabetes in the adult population of CLM is very high, higher in males and increase with age. A great percentage of diabetic people or with carbohydrate metabolism alterations do not know that condition. This situation makes necessary to create early detection strategies., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Background and Objective: Rendu-Osler's disease (RO) is a rare systemic vascular disorder due to a fibrovascular dysplasia in the endothelium of vessels. Recurrent epistaxis is the main clinical manifestation, but arteriovenous malformations (AVMs) can involve many organs, including the liver. Hepatic involvement can develop refractory heart failure due to large shunts between the hepatic veins and the hepatic artery. Embolization and hepatic artery ligation have also demonstrated to reduce cardiac output in RO, but these therapeutic options have significant morbidity and complications such as necrosis or liver failure., Case Report: We report the case of a 48 years old woman diagnosed in 1987 with RO and significant hepatic involvement, with multiple fistulas between veins and hepatic artery. In the following years she developed progressive heart failure that limited her quality of life., Results: She was admitted on more times with heart failure and her dyspnea worsened progressively up to NYHA IV. At this time, an echocardiograph control showed an output cardiac about 10.6l/min. On December 2004, although the medical treatment, the worsening of the patient went on, so we finally decided to conduct a liver transplant that resolved the symptoms and the hyperdynamic circulation. Despite the fact that liver transplant has become without doubt into the best treatment for these patients in the last years., Conclusions: This is the first one done in Spain. There are different therapies available for these patients, but the indications for transplantation are greater each day, mainly due to the risks of the other options. Currently the stated guidelines are heart failure and portal hypertension refractory to medical treatment. So in these situations, liver transplantation should be proposed in the early stages of the disease and may be the only viable option., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

Background: The aim of our study was to evaluate the prevalence of Cys282Tyr mutation in patients with genetic haemochromatosis (GH) in Cantabria., Patients and Methods: The HFE Cys282Tyr mutation was determined in a cohort of 60 patients with GH and 213 controls., Results: The frequency of the Cys282Tyr mutation in control individuals was 4.4%. Sixty-seven percent of patients with GH were homozygous for the Cys282Tyr mutation. Twenty-seven percent of patients were normal at Cys282Tyr loci., Conclusions: The prevalence of the Cys282Tyr mutation in patients with GH in Cantabria, Spain, seems to be lower than in North America and in North Europe patients.

Background: Liver disease due to hepatitis C virus (HCV) is an increasingly frequent indication for liver transplantation. We performed a clinical and virological study of 20 HCV-infected liver transplant recipients to correlate virological markers with histological recurrence of disease., Patients and Methods: In ninety-four patients who were given transplants for end-stage cirrhosis, IgG and IgM antibodies to HCV and IgM to HCV tested by ELISA; all samples were further examined in a four-antigen recombinant immunoblot assay (2-RIBA). HCV viremia was measured by the conventional nested PCR, HCV genotype was determined by PCR amplification using type-specific primers. We have analyzed de novo infection by HCV, HCV recurrence and the influence of genotype in these recurrence., Results: Nineteen of 20 antibody-positive patients (95%) had HCV RNA before transplantation. All 19 patients who were viremic before transplantation had persistent infection after LT. HCV genotype 1b was the predominant type before and after LT (75%). Ten of the 20 (50%) patients developed histological findings of chronic hepatitis (CH) in liver allografts. HCV recurrent liver disease after LT was not related with HCV genotype. Of 4 deaths after transplant in hepatitis C group, only one was related to recurrent disease. We have not found de novo hepatitis C., Conclusions: Our results indicate the general persistence of hepatitis C virus infection and the excellent short-term prognosis after liver transplantation. Chronic hepatitis by HCV in liver transplant was not related with HCV genotype.

Background: The prevalence of HBV and HCV infections in patients with hepatocellular carcinoma may be related to variations in the geographic area of study. For this reason, we have analized the relative prevalence of HBV and HCV infections in 94 patients with hepatocellular carcinoma from Cantabria (North of Spain)., Patients and Methods: We have studied 94 patients with hepatocellular carcinoma from January 1988 to December 1993. Commercially available radioimmunoassay or ELISA were used for detection of HBsAg, anti-HBs and anti-HBc. The HBV DNA was analized by PCR. The HCV infection was assayed by ELISA-2 and RT-PCR., Results: The HBV infection was detected in 27 patients: 19 patients were HBsAg positive and 8 patients HBsAg negative, anti-HBc positive, DNA HBV positive by PCR. The HCV infection was found in 57 patients. Forty patients were infected with both viruses. Of the remain twenty-four, forty were alcoholics. We found in 61 patients more than one etiological factor. Hepatoma was the first manifestation of liver disease in 24 cases and these were more frequently in HCV than in those with HBV infection. Moreover, the first group were older and have lower alcohol intake., Conclusions: 1) In Cantabria, Spain, the majority of cases of hepatocellular carcinoma are related to HBV, HCV and alcohol. 2) Analysis of DNA HBV and RNA HCV by PCR allows the diagnosis of cryptic infections by both viruses, especially in the cases of HBV and HCV coinfection. 3) Hepatoma is the first manifestation of liver disease in a high percentage of cases.

Background: To assess the prevalence of left ventricular hypertrophy in hypertensive patients referred to an outpatient cardiology unit, and to assess its evolution under antihypertensive treatment., Methods: One hundred and seven mild to moderate hypertensive patients were randomized to receive either xipamide, verapamil or atenolol. Cross-sectional echocardiography was performed in order to assess left ventricular mass and function., Results: Mean age was 56 years, with a 4:1 female/male ratio. Mean follow-up was 120 days. Left ventricular hypertrophy was very common (65%) and decreased to 54% under antihypertensive treatment. Left ventricular mass decreased from 134.3 g/m2 to 118.1 g/m2 (p < 0.001). Concentric hypertrophy was the most common geometric pattern (42%), decreasing to 30% with treatment. Xipamide decreased ventricular mass by decreasing left ventricular diameters, while verapamil and atenolol decreased left ventricular thickness, mainly in septal wall. Systolic function was not modified during the treatment period. Diastolic function was not modified by xipamide and verapamil, and improved with atenolol., Conclusions: Left ventricular hypertrophy is very frequent when determined by echocardiography and all three drugs produced regression of left ventricular hypertrophy in a different way with respect to left ventricle geometry, an effect which could have potential therapeutic implications.

Background: Viral replication is one of the determining factors of the natural history of infection by the hepatitis B virus (HBV). The clinical significance of the viremia and the DNA-HBV findings in mononuclear cells was therefore analyzed., Methods: The epidemiologic history, liver function tests and the Knodell index were analyzed in 117 patients with chronic hepatitis B (CHB) and 33 healthy HBV carriers. The DNA-HBV was studied in serum and mononuclear cells by dot-blot and polymerase chain reaction (PCR)., Results: The DNA-HBV was detected by dot-blot in 62/117 subjects with and in CHB 3/33 healthy carriers. Viremis was determined by PCR in 107/117 patients with CHB and in 22/23 healthy carriers. Both aspartate aminotransferase (AST) as well as alanine aminotransferase (ALT) and the Knodell index were greater in the patients with positive DNA-HBV dot-blot. No significant differences were observed in the liver function tests and Knodell index with regard to the viremia detectable exclusively by PCR. In the mononuclear cells of peripheral blood, DNA-HBV was observed in 62% by dot-blot and in 95% by PCR. The presence of DNA-HBV by dot-blot in these cells was associated to greater disease activity., Conclusions: The activity of chronic hepatitis B was correlated with the presence of high viremic levels with no direct relation being observed between low grade viremia and disease aggressivity. The finding of DNA-HBV by dot-blot in mononuclear cells was associated with a greater activity of chronic hepatitis B, with these results being in agreement with the serologic data reported.

Background: The discovery of the hepatitis C virus (HCV) and the possibility of determining anti-HCV serum antibodies has permitted greater etiological, clinical and epidemiological knowledge of non A non B hepatitis (NANB)., Methods: The clinical and epidemiological characteristics of 47 patients with acute hepatitis C were studied. Diagnosis was based on compatible clinical and analytical picture as well as positivity of the anti-HCV antibodies., Results: Thirty-eight percent of the patients were intravenous drug abusers (IVDA). Thirty-four percent had transfusion antecedents and the remaining were sporadic forms of which 3 cases corresponded to health care workers. The study of other viral markers demonstrated that only in the IVDA collective did infections by hepatitis B and delta (HBV and HDV) and by the human immunodeficiency virus (HIV) coexist. Anti-HCV antibodies were detected between 15 days and 8 months (mean 38 +/- 74 days) of clinic initiation; with no differences being found regarding the form of contagion. The incubation period of transfused patients was 50 +/- 15 days. In 2 cases the disease followed a biphasic course, in 4 patients a cholestatic profile was observed, and in 12 the hepatitis was anicteric. In 28% of the cases controlled over 6 months the disease autolimited itself and 72% developed active chronic hepatitis., Conclusions: Most cases of acute hepatitis C are of intravenous origin with a prolonged period of anti-HCV positivization. No differences exist in the clinical picture of the disease regarding the form of contagion and the great tendency to chronicity of hepatitis C is confirmed, regardless of the mechanisms of acquiring the disease.

Many findings suggest that the alterations in immune response observed in intestinal inflammatory diseases may play a part in their pathogenesis. This observation led us to study 22 patients with chronic ulcerative colitis, of whom seven were in the acute stage and the other 15 were asymptomatic. The T and B lymphocyte populations were determined as well as the serum levels of immunoglobulins and acid alpha-1-glycoprotein as acute phase reactants. The results were compared with those obtained from a control group of 10 normal individuals. No statistically significant differences were observed in the percentages and absolute values of T and B lymphocytes as compared with the controls. nor in relation to the activity of the lesions. Neither were there any observable variations in the serum concentrations of immunoglobulins. On the other hand, analysis of the acid alpha-1-glycoprotein showed highly significant values as related to the degree of activity of the inflammatory lesion (p less than 0.005). Our results confirmed the value of determining serum acid alpha-1-glycoprotein levels as an index of inflammatory activity. The immunitary parameters under study did not vary in the different stages of the disease.

We have reviewed the nuclear resonance NR images in three patients with intracranial venous thrombosis. Tomodensitometric findings are not reliable in intracranial venous thrombosis and cerebral angiography is required for the diagnosis. The usefulness of NR for the investigation of venous disease has been recently demonstrated. Ten patients in whom a diagnosis of intracranial venous thrombosis was made with NR have been reported. Initially, the vacuum signal in the T1 enhanced sequences disappears and the thrombus becomes hypointense in the T2 enhanced sequences. In the following phase, proton relaxation is impaired by methemoglobin production and thrombosis appears as hyperintense in both the T1 and T2 enhanced sequences. During the resolution phase, the vacuum signal in the vascular lumen reappears and the hyperintensity of the thrombus signal becomes attenuated. In our study we have shown the different stages of intracranial venous thrombosis with NR. In addition, we have demonstrated the close relation between these images and the clinical evolution. NR is a useful noninvasive investigation in patients with suspected intracranial venous thrombosis.

The clinical, biochemical and pathological studies of the first case of Tangier's disease that, to our knowledge, has been detected in Spain are reported. The patient had all the characteristic features of the disease: hypercholesterolemia with very pronounced reduction of plasmatic high density lipoproteins, splenomegaly, orange yellow tonsils and peripheral neuropathy. In addition, he had pneumonia and pancytopenia. Neurological examination and computed tomography suggested cerebral involvement, not previously reported in this condition. Biopsies demonstrated lipid accumulation in the reticuloendothelial cells of diverse localizations and in Schwann's cells.