Search

Background and Objective: Detection of asymptomatic peripheral arterial disease increases the risk of vascular morbibity and mortality. We aimed to estimate the prevalence of clinical and subclinical peripheral arterial disease using the ankle-arm index (AAI) as diagnostic tool in a working population., Subjects and Method: We included 450 workers, older than 50 years old, attending voluntary regular health check-up at Centro de Prevención de Riesgos Laborales de la Junta de Andalucía in Málaga (Spain). We recorded clinical and anthopometrical data. Blood samples were taken after an overnight fast. Vascular risk was calculated using Framinghan and SCORE scales. Every participant was asked for symptoms of intermittent claudicatio and AAI was measured. AAI was considered normal within 0.9-1.3 values., Results: Most of our workers were at low- or moderate vascular risk. Only 48 (10.6%) of individuals had an abnormal AAI: 9 (2%) showed an AAI<0.9 and 39 (8.6%) showed an AAI>1.3. An AAI<0.9 was found in 19% of those with a SCORE risk > or = 5%, and in 11% of those having a Framinghan risk > or = 20%. Intermittent claudication was present in 4 out of 9 (44%) of those having an AAI<0.9 and in 7 out of 402 (1.7%) with a normal AAI., Conclusions: Systematic screening of peripheral arterial disease using the AAI is not recommended in active working population over 50 years-old of age. Thus, AAI measurement is indicated only for those individuals suffering from intermitent claudicatio and those who are at moderate- or high vascular risk.

Objective: To report the natural history of patients with hepatitis C virus (HCV) infection and hepatocarcinoma (HCC) and to define clinico-biological variables with prognostic and predictive value of this complication., Materials and Methods: A total of 543 patients consecutively diagnosed of chronic infection with HCV were included and followed prospectively and observationally regarding the development of HCC by means of semestral abdominal ultrasonography and measurement of serum alpha-fetoprotein (AFP). To determine variables with predictive value of HCC, the parameters determined at the start were compared, and all subjects diagnosed of hepatoma during the first twelve months after admission were excluded from the analysis. The Kaplan-Meier method was used to evaluate both survival and accumulated probability of HCC., Results: During a mean follow-up period of 28.9 months, an incidence density of HCC of 2.6 per 100 inhabitants-year was obtained (n = 35). 52.6% of those with HCC in the first year were asymptomatic. The only initial variables associated with further development of HCC were age (64.6 vs 58.4 years; p = 0.0039) and alkaline phosphatase (373.5 vs 259 U/l; p = 0.001). Patients with cirrhosis at the start of the study had a higher risk of developing hepatoma than non-cirrhotic patients (RR: 11.5; 95% CI: 4.25-29.9; p < 0.0001). The presence of HCC decreased the survival of patients with cirrhosis (median 20 vs 75 months; log rank < 0.0001), with the exception of patients in stage C of the Child-Pugh classification., Conclusions: a) In the chronic infection with HCV, HCC showed to be an oligosymptomatic complication affecting almost exclusively patients with long-lasting cirrhosis. b) Survival in patients in the stage C of the Child-Pugh classification is independently associated with the coexistence of hepatoma; therefore, the early diagnosis of this complication should be restricted to those with a better liver functional reserve.

In a sample made up of 83 males and 68 females different parameters and external anthropometric indexes were compared (folds, perimeters and indexes of central fat distribution) with direct measurements of abdominal fat obtained by computerized tomography (visceral fat, subcutaneous fat and visceral/subcutaneous index). Anthropometric and tomographic differences between males and females were determined. Likewise, an analysis was made of variations in the fat pattern and subcutaneous and intra-abdominal visceral fat deposits, considering age and overweight. The results obtained in this study reveal different fat patterns for each sex, changes with age in body fat distribution, and different usefulness of external anthropometric measures in males and females to predict fat deposits and their distribution at the abdominal level.

The use of non-specific markers before 1989 (increased serum transaminase values and antibodies to hepatitis B core antigen) as a screening method for blood donors in an attempt to decrease the incidence of post-transfusional non-A non-B hepatitis (currently hepatitis C virus) was a matter of controversy. To determine the impact of the use of these markers on the detection of blood donors infected with hepatitis C virus, a prospective study was undertaken in Málaga (1988-1989) with 5,003 volunteer donors with two objectives: a) to know the prevalence of these non-specific markers (anti-HBc and increased serum transaminase) and antibodies to HCV (anti-C100) in our blood donor population; b) to determine whether the presence of some of these non specific markers in blood donors was associated with a higher rate of virus C infection. The prevalence of antibodies to HCV in blood donors with increased serum transaminase and/or anti-HBc was significantly higher than the prevalence found among the general blood donor population.

Methods: From January 1986 to 31 November 1993, 354 cases of AIDS (CDC criteria 1987) were diagnosed. The possible existence of spontaneous pneumothorax at any time during the evolution and its presumed cause were evaluated., Results: During the period studied, 7 (1.9%) of AIDS patients presented pneumothorax. The existence of a pulmonary infection was proven in 6: 3 pneumonia by Pneumocystis carinii, 2 bacterial pneumonia (Streptococcus pneumoniae and Pseudomonas sp.) and 1 tuberculosis. One patient presented a Pneumocystis carinii pneumonia 3 months prior to the pneumothorax. In the study period 88 (22.8%) of the AIDS patients presented pneumonia by Pneumocystis carinii and 181 (51.1%) presented tuberculosis. The rate of pneumothorax in patients with a history or presence of pneumonia by Pneumocystis carinii was of 4.5% and 0.5% in patients with tuberculosis., Conclusions: The development of pneumothorax is relatively frequent in patients with AIDS in our area. As found in other series, its most frequent cause was Pneumocistis carinii pneumonia, despite the high incidence of tuberculosis.

The global prognostic after acute myocardial infarction depends of the left ventricular function and the residual ischemia. However, there is controversy about the capacity of some variables reflecting this prognostic factors to predict futures complications. The main objective of this study is to know the influence of the kind of complications in the prognostic value of the variables more frequently used in the clinical practice. We studied 121 consecutive patients with acute myocardial infarction discharged from hospital. The previous and during acute infarction clinical variables were analyzed. The regional and global left ventricular function was studied by 2D echocardiography. An exercise test symptoms-limited was performed at 3rd week after discharge in 94 patients selected. The patients were followed during selected one year. The first year cardiac mortality rate was 8.6%. In the multivariate, the independent predictors of mortality were: age > 60 years (p = 0.02) and the impossibility to perform exercise test (p = 0.0002). In the univariate analysis the echocardiographic motility score > or = 17, eyection fraction < 35% and Killip class > or = II were also death predictors. Non fatal complications (angina, reinfarction o heart failure) were present in 47 patients (42.3%) of 111 survivors. The ischemic complications were predicted in multivariate analysis only by postinfarction angina (p = 0.0007), and heart failure by eyection fraction < 35% (p = 0.006), previous infarct (p = 0.002) and Killip class (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Background: To investigate the influence of dietary changes on plasma lipoproteins and apoproteins in 10 patients with hypertriglyceridemia (plasma triglycerides greater than 1000 mg/dl)., Methods: A sequential study with three periods was designed: 1) Inclusion with uncontrolled free diet; 2) Two weeks of a diet with about 1000 calories/day, controlled with a daily survey; and 3) One week of "free" diet of about 2000 calories. At the end of the three periods the following were measured in each patient: weight, glycemia, plasma IRI and C-peptide, plasma, triglycerides, cholesterol, chylomicron, VLDL, LDL and HDL cholesterol. At the end of the second and third periods the caloric and immediate principles intake were individually considered., Results: A reduction in plasma cholesterol and triglycerides was observed in all cases after the caloric reduction, and also a disappearance of chylomicrons. The reduction of triglycerides took place in all lipoproteins. By contrast, after the low-calorie diet only the VLDL-cholesterol was reduced, while LDL- and HDL-cholesterol increased. The apo C-III/apo C-II ratio was significantly reduced after the low-calorie diet. The plasma glycemia, IRI and C-peptide were negatively correlated with LDL-cholesterol and with the apo C-III/apo C-II ratio. The best model to explain the oscillations of plasma triglycerides depending on the diet was that including the three ingested immediate principles together with the total diet calories., Conclusions: During the caloric restriction there would be an increased catabolism of VLDL to LDL. This reduction would be mediated by C-III and C-II apoproteins, probably through the oscillations of plasma IRI.

We present 1 case of right sided endocarditis caused by Fusobacterium nucleatum in a patient with intravenous drug addiction and human immunodeficiency. The clinical features were fever, anemia, and pulmonary embolism. The echocardiogram showed a giant vegetation originated from the right atrial wall prolapsing in diastole into the right ventricle which disappeared after the patient presented pulmonary embolism. The clinical course was uncontrolled with empiric antimicrobial therapy but it was good with metronidazol. The cases previously described in the literature caused by gram-negative anaerobic bacteria are discussed and compared with the present case.

The distribution of apoprotein E phenotypes in a randomly chosen population sample of Málaga was compared to other published studies performed in other countries, observing minimal differences in Caucasian populations but significant differences with oriental ethnic groups. Cholesterol and triglyceride plasma levels were not significantly different in the different apo E phenotypes. A high proportion of subjects (26%) with hydrocarbon metabolism abnormalities (diabetic and glucose intolerant) was observed in phenotype E4/3 and very low (4.7%) in phenotype E3/2. The study of plasma triglyceride levels which were higher in the diabetic group, revealed a greater increase in phenotype E4/3 than in E3/3. These results support the idea about the complex relationship that exists between apo E phenotypes and some cardiovascular risk factors.

To assess the abnormalities induced by alcohol on plasma lipids and lipoproteins and their possibly involved mechanisms three basis of the daily intake: social drinkers (less than or equal to 20 g/day; n = 10), moderate drinkers (greater than 20 to less than 70 g/day; n = 11), and severe drinkers (greater than or equal to 70 g/day; n = 15). Eleven nondrinkers were evaluated as control group. Very low density lipoproteins (VLDL), low density lipoproteins (LDL), high density lipoproteins (HDL)-2 and HDL-3 were isolated by preparative sequential isopicnic centrifugation, and their apolipoprotein and lipidic composition were measured. In the group of severe drinkers, a marked tendency of HDL-3 cholesterol to be higher than in the remaining groups was found. There was no correlation between this parameter and hepatic enzymes. The HDL-2 cholesterol of severe drinkers was significantly increased (p less than 0.005). The parallel enrichment in apolipoproteins C of the HDL-2 particle in all groups of alcohol users suggests a transfer phenomenon from VLDL. The apoA/C ratio of HDL-2 might be useful as a marker of alcohol intake.