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Unlabelled: In order to establish the prevalence of hypertension (according to both the JNC-V/ADA and the WHO/ISH criteria) in patients with insulin-dependent diabetes mellitus (IDDM), a group of 142 unselected young adults with IDDM from Northern Gran Canaria Island was cross-sectionally studied. The relationship of hypertension to diabetic nephropathy and lipid profile was also studied. Blood pressure, urinary albumin excretion and plasma lipids (total cholesterol with VLDL, LDL and HDL fractions, triglycerides and Lp(a)) were measured. The prevalence of hypertension was 11.9% (95% CI 6.5-17.3) with the WHO criteria (> 160/95 mmHg) versus 58.7% (50.5-66.9) with the JNC-V criteria (> 130/85 mmHg). The respective prevalences were 3.8 (0.0-8.1) versus 49.4% (38.0-60.7) in patients with normoalbuminuria (< or = 20 micrograms/min), 17.9 (2.7-33.0) versus 71.4% (53.6-89.3) in patients with microalbuminuria (21-200 micrograms/min), and 44.4 (9.0-69.9) versus 83.3% (64.3-100) in patients with macroalbuminuria (> 200 micrograms/min). The presence of hypertension and of micro or macroalbuminuria was associated with a worse lipid profile., In Conclusion: the new JNC-V criteria drastically increase the figures of prevalence of hypertension in young insulin-dependent diabetic adults. Early and aggressive antihypertensive treatment benefits at least those patients with incipient nephropathy.

Most researchers have found increases of lipoprotein (a) [Lp(a)] in uremic patients, as well as in those undergoing hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). The mechanisms for this increase remain unclear. We studied 71 patients undergoing CAPD, 48 men and 23 women. According to the time spent on CAPD, the patients were divided into three groups: group 0: 29 patients at the starting off point of dialysis treatment; group I: 22 patients with an average stay of 15.2 months; group II: 20 patients with an average stay of 69.3 months on CAPD. We have only observed significant increases of Lp(a) levels in those patients initiating the dialysis, but no significant differences are found in the other groups undergoing CAPD for longer periods when compared to the control group. We found no significant relation between Lp(a) levels and peritoneal protein loss, and not with absorption of glucose from the dialysate either. We have found a positive and significant correlation between Lp(a) levels and urinary protein loss (r = 0.41; p < 0.001). It is possible that an element associated with proteinuria might have an effect on the metabolism of Lp(a) in CAPD patients.

An asymptomatic 15-year-old woman was studied because of a systolic ejection murmur. The echocardiogram showed a mobile, leaflet-like structure attached to the ventricular surface of the anterior mitral leaflet, chordae tendineae and papillary muscle. This structure moved to the left ventricular outflow tract during systole occupying the subaortic area. Conventional Doppler examination revealed left ventricular outflow obstruction caused by the accessory mitral valve tissue that produced a pressure gradient of 25 mmHg between the aorta and left ventricle. The diagnosis was not obvious clinically and was based on the echocardiographic data.

In this study we evaluate prospectively a new color Doppler method for calculating the mitral valve area based on identifying a blue-red aliasing interfase proximal to the orifice, corresponding to the flow convergence region (FCR). This method can be used to calculate areas using the continuity equation. We studied 61 patients with stenosis. The mitral valve area was calculated using pressure half-time (PHT) Doppler method which were compared with values that obtained by the FCR method, according to the following formula. AVM (cm2) = 2 pi r2 x VN/Vmax; where "r" is the FCR radius measured from the orifice to the first color aliasing (blue-red interface); VN is Nyquist velocity and Vmax is the peak flow velocity by continuous wave Doppler. Twenty three patients had pure mitral stenosis and 38 double mitral lesion. Twenty patients were on sinus rhythm while 41 in atrial fibrillation. Calculated mitral valve area using the FCR method correlated well with mitral valve area determined by PHT method at a correlation coefficient of r = 0.96 (y = 0.097 x + 54.9, SEE = 0.10 cm2, p < 0.001). MVA by FCR ranged from 0.4 to 2.5 cm2 (mean = 1.19 cm2). MVA by PHT ranged from 0.42 to 2.48 cm2 (mean = 1.15 cm2). Color Doppler FCR method provides an accurate estimate of effective mitral valve area and may be useful as an alternative to the pressure half-time method. The calculated mitral valve area by the FCR method is not influenced by the presence of mitral regurgitation nor atrial fibrillation.

In our study we have analyzed the influence of family environment on adjustment of renal patients to the HD as well as on the attitude towards kidney transplantation. The study included 57 patients (34 M, 23 F), mean age 52.3 years, and they had been on dialysis for an average of 34.5 months. We obtained information about adaptation and behavior in the care unit, and attitude and motivation towards renal transplantation. Biochemical variables were used to register disruption of medical compliance or dietetic transgression (K, PRC, BUN, weight gain, etc.). The patient's family climate was assessed through use of the Family Environment Scale (FES, Moos and Moos, 1981). The results showed that patients with aggressiveness and noncompliance during HD sessions tended to have high family conflict in family members. The most positive attitudes towards renal transplantation were found in the patients that came from families with the greatest degree of cohesion and expressiveness. In summary, family social climate is a variable influencing outcome of these patients. Its routine assessment would permit the prediction of adaptation to the therapeutic program as much as better efficacy of HD treatment.

The prevalence of gallstone disease in the world is heterogenous, it exist a wide range between different geographic areas, sex and age groups. Its distribution seems to be influenced by various factors such as age, sex, socieconomic class, genetic and ethnic influences and diseases like diabetes mellitus and obesity. Therefore, in this study, we will analyse the importance of each of those factors in the development of cholesterol gallstone disease.

A patient with renal colicky pain caused by urinary tract obstruction, as a result of psoas abscess, is presented. It was the first manifestation of Crohn's disease. A Gram negative bacteria was isolated from the abscess. The CT images performed to evaluate the abscess suggested this etiology, even though there were no previous symptoms.