[Diagnosis of metabolic syndrome. Adaptation of diagnostic criteria in our setting. Recommendations of the HDL forum].
Explore the source record for details and available documents.
Anthropometry↗
Biomedical subjects
I Plaza
Publications and source records attributed to I Plaza.
Rapid westernization of children's blood cholesterol in 3 countries: evidence for nutrient-gene interactions?
The aim of this study was to examine potential factors that modify blood cholesterol among children in countries in which dietary and lifestyle habits are becoming westernized. Population data on serum total and lipoprotein cholesterol, anthropometric indexes, and dietary intake were reviewed and compared for children aged 1-18 y from Japan, Spain, and the United States. The data show that total serum cholesterol in Japanese and Spanish children recently exceeded the 75th percentile for US children, primarily reflecting LDL cholesterol, although both LDL and HDL cholesterol contributed. Adiposity indexes do not explain the trends observed. Total and saturated fat intakes increased substantially in both Japan and Spain but in Japan are still lower than intakes in the United States. The Hegsted equation was used to relate differences in serum cholesterol to dietary fat intake. Changes in total serum cholesterol followed established dietary correlations among children in Spain, but not in Japan. Serum cholesterol in Japanese children was predicted to be 0.20-0.32 mmol/L lower than in US children; actual concentrations were considerably higher. These results suggest that a rapid westernization of children's blood cholesterol concentrations has occurred in Japan and Spain. Changes in fat intake predict changes in blood cholesterol in Spain, but not in Japan. Differences in genetic response to diet in certain populations, such as the Japanese, may explain higher blood cholesterol concentrations with lower fat intakes compared with the United States.
Adolescent↗
[Guidelines of the Spanish Society of Cardiology for cardiovascular disease prevention and cardiac rehabilitation].
The priorities for the prevention of cardiovascular diseases should be focused on patients with established disease and high risk subjects, with individual global risk always being taken into account. The current evidence on the influence of the main risk factors are unanimous (dyslipemia, tobacco, hypertension and diabetes mellitus), being somewhat less so in cases of sedentarism, obesity and the metabolic syndrome. The evidence concerning other risk factors still remains controversial. Guidelines for the control of the different risk factors should be based on the evidence derived from both epidemiological or clinical trials. The recommendations published by several scientific societies should also be followed. There are, at present, important evidence on the efficacy of smoking cessation, the treatment of arterial hypertension and particularly on the successful control of lipid levels with lipid-lowering drugs, especially with statins. There is also evidence on the need for rigorous control of diabetic patients not only in relation to the glucose levels but also to dyslipemia. The most efficient measures for a reduction in morbidity and mortality are cessation of smoking, appropriate hypertensive therapy, a comprehensive program of cardiac rehabilitation and overall the successful control of lipid levels with statins.
Cardiac Rehabilitation↗
[Normal values for transcranial doppler studies in our medium].
OBJECTIVE: Transcranial Doppler is a technique which is being used ever more frequently in the study of intracranial arteries and is very useful in the study of cerebrovascular disease. The typical values of a healthy population in our country are unknown. The aim of this study was determine mean velocity and pulsatility index reference values in a healthy population. PATIENTS AND METHOD: Transcranial Doppler basal examination was carried out on 118 healthy volunteers without prior haematological or cerebrovascular conditions. Those found to have extracranial arterial stenoses were excluded as were those in whom bilateral temporal bone hyperostosis did not permit insonation in either middle cerebral arteries. The nine intracranial arteries were sounded systematically at fixed depths. The mean and standard deviations of each variable were calculated for side, age group and sex. RESULTS: 49% were males and average age was of 56 years (range, 21-87 years). A sufficient signal to determine the parameters of the study was obtained in 89% of middle cerebral arteries. Statistically significant differences in mean velocity and pulsatility index were found between age groups and sexes. CONCLUSIONS: Sex and age must be taken into account in establishing typical patterns in transcranial Doppler examination. Our results enable parameters of typical values to be established for the adult population in Spain.
Adult↗
Distinct cholesterol and phospholipid incorporation at the platelet plasma membrane of hyperlipidemic subjects: structural order and function.
Plasma lipid composition, platelet aggregation, cholesterol (Ch)/glycoprotein IIb-IIIa (GP) and phospholipid (Ph)/GP molar ratios, fatty acid composition and structural order (1, 6-diphenyl-1, 3, 5-hexatriene (DPH) fluorescence anisotropy at 35 degrees C (r(DPH,35)) of human platelet plasma membranes (HPPM) were measured in four DPH,35 groups of hyperlipidemic patients (II: plasma Ch < 250 mg/dl and TG (triglycerides) <220 mg/dl, n = 21; III: Ch > 250 mg/dl and TG < 220 mg/dl, n = 23; IV: Ch < 250 mg/dl and TG > 220 mg/dl, n = 18; and V: Ch > 250 mg/dl and TG > 220 mg/dl, n = 12) and compared with those of the control group (I). Our results were: (i) in groups III, IV and V the HPPM (Ch + Ph)/GP molar ratio increased 7.0+/-7.7% (mean SD); (ii) the Ph/GP molar ratio increased significantly in groups III, IV and V, but most in IV and V, while the Ch/GP molar ratio increased only in groups III and V; (iii) the mean relative increase of Ch with respect to Ph in the HPPM of groups III, IV and V was 140% 21% and 54%, respectively; (iv) the Ch/GP molar ratio was correlated with LDL-Ch (0.41+/-0.16, P < 0.002, n = 55, for all the subjects and 0.60+/-0.11, P < 2.10(-4), n = 33, for subjects with TG < 220 mg/dl), however, it was totally uncorrelated with HDL-Ch; (v) the HPPM Ch/Ph molar ratio was positively correlated with plasma Ch (r = 0.51+/-0.08, P < 1.10(-6), n = 83) and with (LDL + HDL) Ch (r = 0.64+/-0.07, P < 1.10(-6), n = 73), the former correlation increased significantly ( r = 0.67+/-0.07, P < 1.10(-6), n = 53) when done only for subjects with TG < 220 mg/dl; (vi) the Ch/Ph molar ratio was only increased in group III (0.70+/-0.03, P < 3.10(-5), n = 23) and decreased in group IV (0.62+/-0.02, P < 0.001, n = 18); (vii) the fatty acid/GP molar ratio was significantly increased in groups IV and V, however, a significant absolute and relative increase of C16:0 and C18:1 was observed only in severe hypertriglyceridemia (> 500 mg/dl), together with a relative decrease of C18:0 and C20:4 ( n - 6); (viii) the HPPM structural order, as probed by r(DPH,35), was negatively correlated with DPH,35 plasma TG (r =- 0.61+/-0.10, P < 4.10(-5), n = 39), the Ph/GP molar ratio (r =-0.58+/-0.10, P < 2.10(-4), n = 39) and the the (C18:1 + C18:2))/GP molar ratio (r =- 0.80+/-0.05, P < 1.10(-6), n = 39), however, it was independent of plasma and HPPM Ch; (ix) the higher HPPM Ch/Ph molar ratio in group III was associated (r = 0.58+/-0.12, P < 0.005, n = 22) with a moderately higher platelet reactivity to collagen. We conclude that Ch and Ph were distinctly incorporated to HPPM in the different groups of hyperlipidemia and, therefore, that the absolute increase of Ch and Ph was more informative to understand the structural and functional modifications of the HPPM in hyperlipidemias, than the Ch/Ph molar ratio. On the other hand, the r was sensitive to the DPH,35 increase in the content of HPPM Ph and C18:1 + C18:2 and it was insensitive to the increase in the Ch content.
Journal Article↗
[Spontaneous dissection of the vertebral artery].
Spontaneous dissection of the vertebral artery (VA) is an infrequent cause of vertebral-basilar ischaemia in children and young adults, being responsible for 4% of cases of ischaemic infarct in this age group. The distinction between spontaneous dissection and traumatic dissection helps to clarify its vascular tendency, not brought on by laceration of the vessel wall secondary to traumatism. It appears clinically with neck pain and/or headache, followed by a clinical picture of ischaemia in the vertebral-basilar area. Diagnosis is based on clinical suspicion and identification of the angiographic signs of dissection prognosis is favourable with good recuperation in 88% of cases and low recurrence risk. We present a series of seven patients with ischaemic stroke of the brainstem brought about by spontaneous VA dissection. We studied the patients using computerized tomography (CT) scan, magnetic resonance (MR) and brain angiography. The group comprised six men and one woman aged from 9 to 44 years. In one case localization was intracranial, in five there was earlier arterial pathology (hypoplasia or dysplasia) and in the remaining case dissection was bilateral. After a long-term follow-up of between one and seven years, not one of our patients showed any recurrence of ischaemic signs. We would suggest that spontaneous VA dissection should be considered in differential diagnosis in clinical pictures of vertebral-basilar ischaemia in children and young adults since most probably its frequency is greater than that currently supposed. The discussed data would support underlying arterial pathology as a tendency factor.
Adult↗
[The return to work after coronary revascularization].
INTRODUCTION: Work resumption after a therapeutical intervention has been considered as a sensitive indicator of its success. There are some reports analyzing working status after coronary artery revascularization in western countries. However, to our knowledge, similar studies have not been published in Spain. PATIENTS AND METHODS: We studied 210 patients after coronary artery revascularization surgery or percutaneous transluminal coronary angioplasty. Exclusion criteria were age of 65 or more years and female sex gender (n = 64). RESULTS: Working patient rate before and after coronary revascularization was respectively 63.2% and 28.9% for surgery, and 57.1% and 41.4% for percutaneous angioplasty (p = 0.11). None of the former inactive patients, with the exception of one in the surgery group, went back to work after the revascularization procedure. Asymptomatic patients after percutaneous angioplasty had a higher postprocedure working rate than symptomatic ones (58.1% vs 11.1%, p < 0.0001). Patients in the surgery group did not show this relation (30% vs 25%, p = 0.69). CONCLUSIONS: Surprisingly, coronary artery revascularization interventions, mainly coronary surgery, seems to behave in our environment as important determinants of working cessation.
Angioplasty, Balloon, Coronary↗
Dorsal nucleus of the lateral lemniscus in the rat: concentric organization and tonotopic projection to the inferior colliculus.
A basic principle of organization in auditory centers is the topographic-tonotopic order. Whether this applies to the dorsal nucleus of the lateral lemniscus (DNLL), however, is still debated. To clarify this problem, we have utilized the neuroanatomical tracers horseradish peroxidase (HRP) and biotinylated dextran (BD) injected into different regions of the central nucleus of the inferior colliculus (CNIC) in the rat. After large injections of HRP that included most of the CNIC, retrogradely labelled neurons were found all across the ipsi- and contralateral DNLL, showing that all parts of this nucleus innervate the CNIC bilaterally. More neurons were seen consistently on the side contralateral to the injection site. Labelled fibers, however, were abundant ipsilaterally, but scarce in the contralateral DNLL. Single, small injections of HRP or BD into the CNIC resulted in labelling in restricted areas of the ipsi- and contralateral DNLL. In coronal sections, the neurons and fibers labelled in the ipsilateral DNLL formed a well-defined, ring-shaped structure made of dendrites and axons oriented parallel to each other, which we termed "annular band." The observation of serial sections revealed that the annular band seen in any individual section represents a slice through a more or less complete three-dimensional, hollow, ovoid structure oriented rostrocaudally. The position and diameter of the annular band changed as the injection site was shifted along the tonotopic axis of the CNIC. Single injections placed in the ventromedial, high-frequency region of the CNIC produced a large annular band along the periphery of the DNLL. After injections placed in progressively more dorsolateral, lower-frequency regions of the CNIC, the annular band became smaller in diameter and occupied a successively more central position in the DNLL. Double injections along the tonotopic axis of the CNIC resulted in two roughly concentric annular bands. The labelled neurons and fibers in the contralateral DNLL systematically occupied a position symmetric to the annular band seen ipsilaterally. These findings indicate that the rat DNLL is primarily composed of neurons with flattened dendritic arbors and flattened fields of terminal fibers. These two elements intermingle, forming concentric layers around the geometric center of the nucleus. The axons of neurons within corresponding layers on the two sides converge onto the CNIC of both sides in a strict topographic fashion: the peripheral layers project to the ventromedial, high-frequency region of the CNIC, and the central layers project to the dorsolateral, low-frequency region. These results suggest that the concentric arrangement of the DNLL is the substrate of its tonotopic organization.
Acoustic Stimulation↗
[Clinical and investigative approaches in mitochondrial diseases. A review of 15 cases].
The results of laboratory investigations in concerning 15 patients suspected of mitochondrial disease (MD) are presented. Our purpose is to provide an outline of the investigative modalities that support the clinical suspicion and have been found to be useful in the diagnosis. Five clinical groups were studied including 5 exercise intolerances (2 with inflammatory myopathy), 3 with myopathies (1 with dilated cardiomyopathy), 2 with progressive external oftalmoplegia (1 associated with cerebellar ataxia+epilepsy+hypertrophic cardiomyopathy+pes cavus), 4 with encephalopathies (3 with myoclonic encephalopathies with ataxia and dementia and 1 with epilepsy and tremor), and 1 with metabolic acidosis and cardiomyopathy. We used the following categories of investigative procedures: clinical phenotype analysis including pedigree study, neurophysiological tests, bicycle ergometric evaluation, neuroimaging, microscopic study of skeletal muscle biopsy, post-mortem examination, biochemical assays and molecular genetic studies. EMG showed myopathic changes in 5 cases, features of neuropathy in 2, mixed myopathic and neuropathic pattern in 1 and nonspecific changes in 3. EMG was normal in 3 patients. The most common skeletal muscle abnormalities were variation in fiber size (60%), lipid inclusions (33.3%), oxidative subsarcolemmal aggregates (26.7%) and ragged-red fibers (26.7%). Electron microscopy revealed mitochondrial abnormalities in 8 out of 14 patients' muscle biopsies, and in myocardiac and hepatic tissues of another. Site of biochemical defect was located in 12 patients. Complex I defect in 6, complexes I+IV deficiencies in 3, complex II defect in 1, complex IV deficiency in 1, complexes II+IV deficiencies in 1, and complex III defect in 1. In 2 patients the biochemical defect was not located. Mitochondrial DNA alterations were not found in 7 investigated patients. The clinical spectrum of MD has become increasingly wider. After the clinica suspicion, the diagnosis depends up on the appropriate use of skeletal muscle biopsy, biochemical investigations and molecular genetic techniques. Conventional EMG and automatic measurement of the electromyogram are particularly helpful in confirming the clinical suspicion in patients with predominantly central nervous system disease or in cases in which clinical signs are few.
Adolescent↗
[Fuenlabrada study: lipid and lipoprotein levels in children and adolescents associated with ischemic cardiopathy prevalence among their relatives].
The prevalence of coronary heart disease (CHD) was studied in parents and grandparents of 2,419 children surveyed for lipid levels. Children and their families were divided into 3 groups depending on the level of each lipid and lipoprotein studied in children: high greater than or equal to 95 percentile (p), medium 5-95 p, and low less than 5 p. Total cholesterol (Chol) and triglycerides (TG) were determined by enzymatic techniques in autoanalyzer. C-HDL was determined by precipitation method. C-LDL and C-VLDL were obtained by Friedewald-Fredrickson's equation. The prevalence of CHD in parents and grandparents was ascertained from clinical history. Fathers of children in the high groups of Chol, TG, C-LDL/C-HDL, and low group of C-HDL had increased prevalence of CHD compared with those of the low groups of Chol, TG, C-LDL, C-LDL/C-HDL and high group of C-HDL. The strongest association was with C-HDL. Maternal and paternal grandfathers of children in the high groups of Chol had also increased prevalence of CHD compared with those of low group of Chol. There was no association with any other variable. The association was not significant neither in mothers nor in maternal and paternal grandmothers. Childhood lipid and lipoprotein levels could identify families at elevated risk for CHD.
Adolescent↗
[The Fuenlabrada study: relationship between anthropometric variables and cardiovascular risk factors].
Anthropometric variables were studied in 2,153 healthy children, 1,115 males and 1,038 females, aged 0 to 18 years, of the Fuenlabrada population, Madrid. Height was measured by an anthropometer and weight by a weighting scale. Tricipital and subscapular skinfold thickness were measured by Holtain caliper. Body mass index (kg/m2) and ponderal index (kg/m3) were calculated from weight and height. In the total population skinfold thickness had the highest correlation with total body fat. But, when only obese children (greater than 95 p) were analyzed, other variables like body mass index and ponderal index had also high correlation. Different fatness trends were observed between sexes, although females always were the fattest. In our population the correlation of skinfold thickness, body mass index and ponderal index with lipids, blood pressure, glycemia and uric acid were significant. Obese children and adolescents had nearly a twofold increase in relative risk of arterial hypertension, hypertriglyceridemia, hyperuricemia and low C-HDL.
Adolescent↗
[The Fuenlabrada study: a familial aggregation of ischemic cardiopathy and cardiovascular risk factors].
UNLABELLED: Familial aggregation of coronary heart disease (CHD) and coronary risk factors (CRF) were evaluated by clinical history in adult relatives of children surveyed for CRF. Population was divided into two groups: Group I included 2,153 children without parental history of CHD. Group II included 266 children of 112 families with parental history of early CHD (before 56 years). In 105 cases the patients were the fathers and in 7 cases the mothers. All the patients were admitted to a coronary care unit. Familial aggregation of CHD was 9.7 times more frequent in paternal families of group II (p less than or equal to 0.0001) than in group I; there was no differences in maternal families. Higher prevalence of hyperlipidaemia, blood pressure hypertension, smoking habits, diabetes and obesity in fathers of group II was observed. Children in group II showed increased levels of C-LDL and decreased levels of C-HDL compared with those of group I. The prevalence of CRF was also significantly higher in children of group II, although in the 33% of the children of group II no CRF was detected. CONCLUSION: a substantial proportion, but not all cases, of familial aggregation of CHD could be explained by known CRF.
Adolescent↗
[The Fuenlabrada study: arterial pressure in children and adolescents].
Blood pressure was studied in 2,153 healthy children of both sexes, from 0 to 18 years of age; 1,115 were males and 1,038 females. Systolic and diastolic blood pressures were measured in the sitting position by the auscultatory method on the right arm with a mercury sphygmomanometer using an appropriate cuff size. Systolic blood pressure was measured on the first sound and diastolic blood pressure in the fourth phase of Korotkoff. In children younger than 3 years blood pressure was measured in the decubitus supine position using the Doppler technique. There were no significant differences in mean systolic and diastolic blood pressure in both sexes. But the percentage of systolic blood pressure greater than or equal to 130 mmHg was higher in males than females (p less than or equal to 0.01). 8.4% of the total population had systolic blood pressure greater than or equal to 130 mmHg, and 1.3% had diastolic blood pressure greater than or equal to 90 mmHg. The annual increase rates of systolic and diastolic blood pressure were 2.31/0.94 mmHg in males and 2/0.97 mmHg in females. Children with blood pressure greater than or equal to the 95th percentile had a higher prevalence of hypertriglyceridemia and obesity. 54% of the variation in systolic blood pressure was explained by the association of weight, subscapular skinfold, body mass index and C-HDL. 30% of the variation in diastolic blood pressure was explained by the association of weight, obesity index, subscapular skinfold and C-HDL.
Adolescent↗
[Cardiovascular risk factors in children and adolescents in Fuenlabrada: objectives, features of the population, design, participation, equipment, laboratory technics, and quality control].
Fuenlabrada is at the present time the most industrialized town placed at the south are of Madrid. This population has some peculiar attractive characteristics from the epidemiologic point of view. Perhaps the most important is that the majority of its inhabitants are immigrant from other depressed rural areas of the country, with a low socio-economic and cultural level. The new conditions of life could have changed the life expectation and the causes of morbidity and mortality of this population. Between 1981 and 1984 we have studied the prevalence of cardiovascular risk factors in children and adolescents of its population, the relationships with cardiovascular risk factors and cardiovascular disease of the family and type of lactancy of the newborn. The variables studied were: height, weight, skin fold, blood pressure, lipids, lipoproteins, glycemia, uric acid and tobacco habit. The laboratory technics were standardized with serums of reference. The index of participation in the study of the required population was approximately of 80%.
Adolescent↗
[Combination of quinidine and verapamil in auricular fibrillation].
The efficacy of the association of verapamil plus quinidine in 70 patients with atrial fibrillation, 64 of them after having cardiac surgery, was assessed. Oral dosage ranged from 825 mg to 1,100 mg for quinidine polygalacturonate and 240 mg to 320 mg for verapamil. All patients but two reached a good control of heart rate (mean heart rate less than 110 beats/min) while arrhythmia persisted. Sixty patients (85.7%) reverted to normal sinus rhythm in a period of 2.4 +/- 1.5 days (mean +/- SD). According to the atrial fibrillation duration three subsets of patients with different conversion rates to sinus rhythm were established (p less than 0.01): group A (lasting from 1 day to 3 months) 31/39 (96%); group B (lasting 3 to 6 months) 18/21 (85.7%) and group C (lasting 6 to 12 months) 5/10 (50%) (p less than 0.01). Plasma quinidine levels were maintained at either near to or therapeutic range (2.6 +/- 0.94 micrograms/ml). Adverse effects comprised one ventricular arrhythmia-induced syncope (quinidine syncope) and two cases of systemic hypotension. Quinidine-verapamil association is a good alternative in the treatment of atrial fibrillation, particularly in those of recent onset, according to the high rates of conversion to normal sinus rhythm, affording control of heart rate while atrial fibrillation persists. Adverse reactions did not differ in severity from those observed with quinidine monotherapy.
Administration, Oral↗
[Free thrombus in the left atrium associated with mitral stenosis. Diagnostic and therapeutic aspects. Apropos of a case].
A patient with a history of transient cerebral ischemic episodes had two-dimensional echocardiographic findings consistent with mitral stenosis associated with a spherical free-floating left atrial thrombus. The patient was operated on in the next few days, performing a mitral commissurotomy, and the left atrial thrombus was removed, without intra- or postoperative complications. The patient was discharged from the hospital on an antiplatelet drug regimen. Free-floating left atrial thrombi are a very rare finding with an easy echocardiographic diagnosis. Prompt surgical treatment is mandatory because the risk of systemic embolization and sudden death are inherent in this entity.
Echocardiography↗
Cardiac size and function in Paget's disease of bone.
We performed non-invasive assessment of cardiac size and function by clinical criteria, standard electrocardiography, chest X-ray, systolic time intervals and echo-cardiography in 27 patients with Paget's disease of bone and in 20 control subjects. The patients were divided into two groups on the basis of the degree of skeletal involvement (less than 15% in Group I and greater than 15% in Group II). No differences in heart size parameters of left ventricular performance were noted between Group I and controls. Cardiomegaly, increased left ventricular diastolic dimension and increased left ventricular mass indicative of ventricular hypertrophy were found in Group II compared to control subjects. In addition, patients with more extensive skeletal involvement had signs of depressed myocardial contractility, increased left ventricular volumes in diastole and systole and enlarged stroke volume, with no differences in echographic cardiac output compared to Group I and controls. The findings show an above normal incidence of cardiac enlargement and disturbed left ventricular performance in patients with Paget's disease and osseous lesions in greater than 15% of skeleton. The clinical implications of the altered cardiac function in patients with Paget's disease are briefly discussed.
Aged↗
Atrioventricular nodal dysfunction in patients with atrial septal defect. Abnormalities of conduction and reciprocal rhythms.
Electrophysiologic studies were performed in 17 unselected patients (mean age, 20 years) with atrial septal defect (ASD) of the ostium secundum type. In nine (52.9 percent) signs were found of atrioventricular (A-V) nodal dysfunction, in seven (41.1 percent) prolonged A-H interval, and in three (17.6 percent) prolonged effective refractory period of A-V node and in five (29.4 percent) A-V nodal tachycardia and reentry. Three of the four cases showed anterograde conduction (Ae-H interval) faster than retrograde conduction (H-A3 interval) during the tachycardia. In one patient with reentry a similar phenomenon was observed. In the remaining patient the conduction time was reversed (Ae-H longer than H-Ae). In two patients infrahisian and intrahisian block (first and second degree) with persistence of the tachycardia was observed. Patent or latent abnormalities in A-V node function are a frequent finding in patients with ASD. In the sinus node, any kind of significant abnormality can be found.
Adolescent↗