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Introduction: the high prevalence of cardiovascular diseases in the modern society brings a high prescription of platelet antiaggregation and anticoagulant medications. These treatments have been related to an increased incidence of upper gastrointestinal bleedings (UGB). Our aim was to estimate the fraction of UGB's presented to our hospital that was related to this kind of treatments and describe their clinical features in our environment. Material and methods: a retrospective search was performed in the archives of our hospital of all the patients with diagnosis of UGB admitted during the period 2004-2007 both years inclusive. Patients on antiplatelet and/or anticoagulant treatment were included. We analyzed the information regarding the use of medication, the bleeding lesion, the severity of the bleeding, recurrences, mortality and their clinical features. Results: we found 523 episodes of UGB. Of these 137 (26.1%) were patients receiving platelet antiaggregation or anticoagulant drugs. The patients were male 60.2%, and had a mean age of 75.6 (± 10.8) years. The 65.5% (74) had HBP, 43.4% (49) diabetes mellitus and 37.2% (42) dislypemia and 13.3% (22) dementia. The drug most frequently implicated was ASA in 36.3% (41), followed by acenocumarol in 27.4% (31), clopidogrel 18.6% (21), double therapy (ASA + clopidogrel) in 6.2% (7), triple therapy (ASA + clopidogrel + acenocumarol) in 0.9% (1), triflusal 4.4% (5), low molecular weight heparin 5.3% (5), and ticlopidine in one patient (0.9%). Only 36.3% (41) were on treatment with proton pump inhibitors. There were 24 recurrences and 4 deaths. Conclusions: the 26.1% of the UGB attended in our environment were of iatrogenic origin. We also found a low use of proton pump inhibitors.

The objective of the present study was to quantify both diagnostic and therapeutic inertia in hypertension and to identify patient-associated variables.Cross-sectional, multicenter study of 35 424 subjects carried out in 428 health centers and/or primary care clinics in the Valencian Community, Spain, in a preventive activity conducted during 2003 and 2004. Diagnostic inertia was identified when a patient without known hypertension had high blood pressure (BP) but was labeled "normal" by the medical staff, and therapeutic inertia when treatment was not modified for a hypertensive patient on the presence of high BP values. Bivariate and multivariate statistical analyses were performed to identify patient's characteristics associated with inertia.Diagnostic inertia was present in 32.5% (95% CI 31.4-33.6) and therapeutic inertia in 37.0% (95% CI 35.6-38.5) of the cases. Both were more frequent in cases of isolated systolic or diastolic high BP. In the multivariate models, the factors associated with diagnostic inertia were type-2 diabetes (p=0.041), non-smoking (p=0.004), previous coronary heart disease (p=0.001), BP values (p0.001) and body mass index (p=0.031), whereas for therapeutic inertia they were type-2 diabetes (p=0.003), previous coronary heart disease (p=0.016) or stroke (p0.001) and BP values (p0.001).Clinical inertia, either diagnostic or therapeutic, was present in one of every three cases of high BP. The most frequent factors associated with clinical inertia were the presence of associated conditions, which requires lower BP goals and the BP values.

Resumen Introduccion y objetivos En el estudio Mediterranea se cuantifica la situacion de riesgo cardiovascular alto (RCVA), la fiabilidad entre REGICOR (R) y SCORE bajo riesgo (SB), las cifras alteradas de presion arterial (APA) en hipercolesterolemia (HCL) sin antecedentes de hipertension arterial (HTA), o valores altos de colesterol total (ACT) en HTA sin antecedentes de HCL, y en los hipertensos la afectacion renal y cardiaca. Pacientes y metodo Diseno transversal multicentrico de ambito nacional. Participaron 751 medicos que individualizadamente valoraron 7.973 pacientes con HTA y 5.319 con HCL. Se definio RCVA a partir del 10% con R y del 5% con SB. Se calculo el coeficiente de correlacion intraclase (CCI) y Pearson (r). Se cuantificaron los porcentajes de APA y ACT. En HTA se analizaron las cifras de creatinina (Cr), la tasa de filtrado glomerular por Cockroft-Gault (CG) y el conocimiento de hipertrofia ventricular izquierda (HVI). Resultados En HTA: el 17,3% de RCVA con R y el 26,1% con SB; CCI = 0,222 (p Conclusiones La escala SCORE identifica mas pacientes con RCVA que la de REGICOR en HTA y parecido en HCL. Entre ambas escalas la fiabilidad es baja. Se cuantifica una importante APA/ACT. En HTA la no valoracion de HVI y el porcentaje de IR son considerables.

Resumen Introduccion y objetivos Es escasa la informacion de estudios cardiovasculares longitudinales. En hipertensos (HTA) y/o hipercolesterolemicos (HCL) espanoles, con mal control inicial de la presion arterial (PA) y/o del colesterol total (CT) se cuantifica la tasa de incidencia (TI), la incidencia acumulada (IA), los riesgos relativos (RR), las curvas de supervivencia (CS), el cumplimiento terapeutico (CU) y se ajusta la escala de Framingham-Anderson (FA) a nuestro entorno. Pacientes y metodos Se analizaron 6.893 HTA y/o HCL en prevencion primaria que aportaron un promedio de 1,22 anos de seguimiento. Participaron 480 medicos. Se calcularon: la TI, IA y los RR; el metodo de Kaplan-Meier para la CS; Haynes-Sackett adaptado para el CU; el ajuste de FA por la recta de los minimos cuadrados, coeficiente de correlacion de Pearson (r) e intraclase (cci). Resultados La IA fue 1,59% (1,31-1,90); la TI de 1.321, 6 eventos cardiovasculares por 100.000 pacientes/ano (1.026,6-1.598,8). Los RR significativos fueron: edad (p = 0,03), PA final (p = 0,02), antecedentes coronarios (p = 0,00), hipertrofia ventricular izquierda (HVI) (p = 0,00), microalbuminuria (p = 0,02), CT = 250 mg/dl al inicio (p = 0,01), glucemia basal (Gb) ≥ 126 mg/dl al inicio (p = 0,00), creatinina ≥ 1,2 mg/dl al inicio (p = 0,00) y final (p =0,00), y no CU en HCL (p = 0,00). Las CS realizadas por antecedentes de HTA y/o HCL, existencia o no de Gb ≥ 126 mg/dl, existencia o no de lesion de organos diana, y tener o no riesgo cardiovascular (RCV) alto con FA, fueron significativas (p Conclusiones Se ajusto la ecuacion FA en nuestros pacientes, con datos propios. Se cuantificaron los factores pronosticos y CS. Se cuantifico un beneficio entre CU y disminucion de RCV en HCL.

Introduction. The aims of this study were to evaluate the consistency between the SCORE (Systematic Coronary Risk Evaluation) and REGICOR (Registre Gironi del Cor) scales in identifying high cardiovascular risk and to describe the characteristics of those individuals for whom scale results were discrepant. Methods. This cross-sectional study involved 8942 subjects aged 40-65 years who had an indication for a complete lipid profile. The agreement between SCORE (for low-risk countries) and Framingham-REGICOR (with a high risk threshold of 10%) scales in classifying patients as high risk was evaluated using the kappa statistic. Subjects for whom there was a discrepancy between classifications were identified and variables associated with this discrepancy were determined by multivariate analysis involving binary logistic regression. Results. The REGICOR scale classified 6.7% of subjects (95% confidence interval [CI], 6.2-7.3) as highrisk, while SCORE classified 12.5% (95% CI 11.8-13.2) as high-risk. Discrepant findings were observed in 10.2% of the total population (8% had a high risk on SCORE but not REGICOR, and 2.2% had a high risk on REGICOR but not SCORE; κ=0.420; P

Fundamento y objetivo Analizar la relacion entre la presencia de las calcificaciones arteriales detectadas por mamografia y el grado de control y gravedad de la diabetes. Pacientes y metodo Se incluyo a todas las mujeres menopausicas de 45 a 68 anos con diabetes, de 2 distritos de salud, que participaban en el Programa de Cribado de Cancer de Mama del area (n = 230). Se revisaron sus mamografias valorando la presencia de calcificaciones arteriales y relacionandola con los factores que determinan el control y la gravedad de la diabetes (glucemia, hemoglobina glucosilada, complicaciones cronicas micro y macrovasculares de la diabetes), obtenidos de las historias clinicas de las pacientes. Resultados La prevalencia de calcificacion arterial mamaria fue del 40%. Las pacientes con calcificacion arterial mamaria presentaron mayor tiempo de evolucion de la enfermedad y mayores complicaciones cronicas microvasculares. Conclusiones La presencia de calcificaciones arteriales detectadas por mamografia en mujeres menopausicas con diabetes mayores de 45 anos se relaciona con la aparicion de mayores complicaciones cronicas microvasculares.

Introduction: Renal function is one of the most important prognostic factors in multiple myeloma (MM). Patients with renal failure are generally excluded from high dose therapy even though they display a poor prognosis with conventional chemotherapy schemes. The aim of this study was to analyze the outcome of MM patients with renal insuAciency undergoing autologous stem cell transplantation (ASCT), including the evaluation of the quality of PB stem cell collections, kinetics of engraftment, transplant-related mortality, response to high dose chemotherapy and survival. Materials and methods: From a total of 566 valuable patients included in the MM Spanish ASCT registry, three groups of patients were defined: group BA, patients with abnormal renal function at diagnosis but normal at transplant (73 cases); group BB, patients with abnormal function both at diagnosis and at transplant (14 cases); and group AA (control group, 479 cases), patients who constantly had normal renal function. Results and conclusion: Patients from groups BA and BB presented with a significantly higher number of adverse prognostic factors, reflecting that we were dealing with high tumor MM cases, as compared with patients from group AA. The number of mononuclear cells, CD34+ cells and CFU-GM cells collected in patients with non-reversible renal insuAciency was similar to those harvested in MM patients with normal renal function. Moreover, neutrophil and platelet engraftments were identical in patients with and without renal failure (days +11 and +12, respectively). By contrast, transplant-related mortality (TRM) was significantly higher in group BB patients (29%) than in groups BA (4.1%) and AA (3.3%). In multivariate analysis only three variables showed independent influence on TRM: poor performance status (ECOG 3), hemoglobin 59.5 g/dl and serum creatinine 55 mg/dl. The response to high dose therapy was independent of renal function. Interestingly, 43% of patients from group BB showed an improvement in renal function (creatinine 52 mg/dl) after transplant. The three-year overall survival from transplantation was 56, 49 and 61% for the BB, BA and AA groups, respectively, with a statistically significant diAerence favoring group AA (P50.01). PFS did not diAer significantly between the three groups of patients. In multivariate analysis the only unfavorable independent prognostic factors for overall survival were poor performance status either at diagnosis or at transplant, high b2-microglobulin levels, and no response to transplant. According to these results, ASCT is an attractive alternative for MM patients with renal insuAciency, and it should not constitute a criterion for exclusion from transplant unless patients display poor performance status and very high creatinine levels (45 mg/dl). The Hematology Journal (2000) 1, 28‐36

Fundamento y objetivo La aparicion de anemia hemolitica por incompatibilidad menor ABO o Rh en los receptores de trasplantes de organo solido es debida al paso con el organo trasplantado de linfocitos con informacion inmunologica. El desarrollo de anticuerpos y hemolisis depende de la cantidad de linfocitos que acompanan al organo trasplantado. Se presentan 5 casos de pacientes que desarrollaron anemia hemolitica, dos por el sistema ABO y tres por el sistema Rh. Pacientes y metodo Desde enero de 1991 a junio de 2001 se realizaron en nuestro centro 22 trasplantes hepaticos ABO no identicos, 236 trasplante renales Rh no identicos y 240 trasplantes hepaticos Rh no identicos. En los donantes y receptores se realizo un estudio detallado de determinacion de grupo sanguineo y escrutinio de anticuerpos irregulares (EAI) por medio de la prueba de antiglobulina indirecta (PAI). Cuando la PAI fue positiva se identifico el anticuerpo por diferentes paneles comerciales de hematies. En caso de sospecha de hemolisis se realizo la prueba de antiglobulina directa (PAD) y posteriormente se determino la especificidad del anticuerpo. Resultados Desarrollaron anemia hemolitica dos trasplantados hepaticos ABO no identicos y tres trasplantados Rh no identicos (uno renal y dos hepaticos). La hemolisis fue grave en todos y se presento entre los dias 8 y 40 postrasplante. El EAI fue negativo en todos los receptores pretrasplante. En los donantes se determino la presencia de anti-D en dos casos. En el postrasplante la PAD y PAI fueron positivas en todos los pacientes, determinandose la presencia de anti-A en dos, anti-D en dos y anti-E en uno. Los pacientes fueron tratados con glucocorticoides intravenosos. Cuatro requirieron transfusion de concentrados de hematies. ConclusiOn La aparicion de un cuadro anemico en el contexto de un trasplante de organo solido con incompatibilidad menor ABO o Rh debe hacer pensar en la posibilidad de hemolisis secundaria al paso de linfocitos del donante.

The aims of this study were to evaluate the consistency between the SCORE (Systematic Coronary Risk Evaluation) and REGICOR (Registre Gironí del cor) scales in identifying high cardiovascular risk and to describe the characteristics of those individuals for whom scale results were discrepant.This cross-sectional study involved 8942 subjects aged 40-65 years who had an indication for a complete lipid profile. The agreement between SCORE (for low-risk countries) and Framingham-REGICOR (with a high risk threshold of 10%) scales in classifying patients as high risk was evaluated using the kappa statistic. Subjects for whom there was a discrepancy between classifications were identified and variables associated with this discrepancy were determined by multivariate analysis involving binary logistic regression.The REGICOR scale classified 6.7% of subjects (95% confidence interval [CI], 6.2%-7.3%) as high-risk, while SCORE classified 12.5% (95% CI 11.8%-13.2%) as high-risk. Discrepant findings were observed in 10.2% of the total population (8% had a high risk on SCORE but not REGICOR, and 2.2% had a high risk on REGICOR but not SCORE; kappa=0.420; P.001). The best agreement was observed between SCORE and REGICOR with a high-risk threshold of 8% (kappa=0.463). Multivariate analysis showed that a high risk on SCORE but not REGICOR was associated with lower age, female sex, a high fasting glucose level, and raised diastolic blood pressure, and a high risk on REGICOR but not SCORE, with male sex, smoking, and a low high-density lipoprotein (HDL) cholesterol level. These variables accounted for the extent of the discrepancy in 93.2% of cases.The SCORE and REGICOR (threshold 10%) scales identified different populations as being at a high risk, though the agreement between them was reasonably good. The concurrence of a number of factors (e.g., male sex, low HDL-cholesterol, and smoking) in a subject with a low risk on the SCORE scale should be regarded as increasing the cardiovascular risk.

Our goal was to analyze the association between the presence of arterial calcifications detected on mammography and the degree of control and severity of diabetes.We included all menopausal women with diabetes aged between 45 and 68 years from two health districts who participated in the breast cancer screening campaign of the region (n = 230). We reviewed their mammographies to evaluate the presence of arterial calcifications and thus associate these findings with factors determining the control and severity of diabetes (glycemia, glycosylated hemoglobin, micro- and macrovascular chronic complications) as obtained from the patients' medical records.The prevalence of breast arterial calcification was 40%. Patients with breast arterial calcifications had had diabetes for longer time and had more microvascular chronic complications.The presence of arterial calcifications detected on mammography in menopausal women with diabetes over 45 years of age is associated with microvascular chronic complications.