OBJECTIVE: To discuss a case of pituitary abscess presenting with amenorrhea and diabetes insipidus, and to enumerate the differential diagnosis for this condition
SIGNIFICANCE: By presenting this case, the author aims to increase awareness regarding the possibility of infectious causes of pituitary masses, thereby prompting early recognition and treatment of similar cases
CASE REPORT: This is the case of a 42-year old woman admitted due to severe generalized headache, amenorrhea and polyuria of three months duration, preceded by a one-month history of remittent fever. Physical examination was normal except for bitemporal hemianopsia
LABORATORY TEST RESULTS: On admission, she had mild anemia, hypernatremia with elevated serum osmolality, and failure to concentrate urine. Hormonal examinations showed normal thyroxine and growth hormone levels, low basal serum cortisol, and elevated prolactin levels. Cranial CT scan showed widening of the sella turcica with a homogenous, isodense, slightly enhancing focus in the sellar and suprasellar area.
COURSE: Initial considerations were chiasmatic glioma versus a pituitary adenoma. Transphenoidal surgery was done and intraoperatively, purulent fluid was noted. Aspirate gram stain showed 1-2 white blood cells per high power field but with no growth on culture. Subsequently, vision was fully restored but prolactin levels continued to be slightly elevated. Basal cortisol and urine specific gravity were persistently low. Repeat CT scan showed disappearance of the pituitary mass. Six months after the operation, the patient was able to go back to work but continues to take steroids and carbamazepine for the diabetes insipidus.
REVIEW OF LITERATURE: There are about 100 cases of pituitary abscess in literature mimicking pituitary adenoma and presenting with headaches, amenorrhea, visual field cuts, hypopituitarism, fever and meningitis. As in this case, the abscess is frequently sterile. Pituitary abscess should be considered in patients with a primary diagnosis of pituitary adenoma with accompanying signs and symptoms suggestive of an infection. (Author)

Human ; Female ; Adult ; Pituitary Neoplasms ; Sella Turcica ; Hemianopsia ; Hydrocortisone ; Carbamazepine ; Hypernatremia ; Diabetes Insipidus

BACKGROUND: Studies have shown a high prevalence of OSA among the middle-aged group, the male gender and among the obese population. The last two years has likewise shown that OSA is a risk factor for hypertension
OBJECTIVE:To determine the association of age, gender, obesity and hypertension with OSA among Filipino OSA patients
MATERIALS AND METHODS:Cross-sectional study from previous records of polysomnography at St. Lukes Medical Center. Chi-square test of association analysis was performed with the level of significance set at 0.05.
RESULTS: A significant association between age, male gender, obesity and OSA is observed (p value: 0.001). This study showed that hypertension is prevalent among OSA patients (41.3 percent) than those without OSA (33.3 percent), however no statistical significance is noted (p value: 0.132).
CONCLUSION: The male gender, middle-age group and obesity are strongly associated with OSA in Filipino patients.

Human ; Male ; Aged ; Middle Aged ; Adult ; Adolescent ; Polysomnography ; Prevalence ; Hypertension ; Obesity

BACKGROUND: Coronary Artery Disease (CAD) is closely associated with several major risk factors including many that can be modified or eliminated. Hypertension, diabetes mellitus, dyslipidemia, smoking and obesity are among these. Early identification of these risk factors gives the physician opportunities for primary and secondary prevention of CAD.
OBJECTIVE: To assess the practice of physicians with regards identification and management of risk factors of patients with CAD at the Makati Medical Center.
METHODOLOGY: Two hundred and one (201) patients admitted at the Makati Medical Center from July 2001 up to December 2001 with symptomatic or objective evidence of myocardial ischemia during treadmill exercise and angiographic findings of CAD were assessed. Identification and management of the different risk factors by the physicians were reviewed.
RESULTS: Of the 201 patients 167 (83 percent) were male, 65 (32 percent) were over 65 years old and 7 (3 percent) had strong family history of CAD. One hundred twenty seven (63 percent) had hypertension, 77 (38 percent) had diabetes mellitus, 96 (47 percent) had dyslipidemia, 113 (63 percent) were obese and 103 (51 percent) were smokers. Active management was done for the hypertension, diabetes and dyslipidemia. Only 39 percent of the smokers were off the habit for more than a year and only 19 percent of the obese received counseling for weight loss and exercise.
CONCLUSION: All patients identified with hypertension, dyslipidemia and diabetes mellitus were placed on appropriate diet and medications, patients with smoking problems and obesity were less consistently managed with smoking cessation approaches and weight losing manipulation through diet and exercise.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Coronary Artery Disease ; Weight Loss ; Risk Factors ; Smoking Cessation ; Smokers ; Obesity ; Diabetes Mellitus ; Dyslipidemias ; Hypertension ; Smoking ; Diet

OBJECTIVES: Among relatively healthy Filipinos undergoing executive check-ups (periodic health examinations), the study aims 1.) To determine the correlation of hypertension and serum uric acid, 2.) To determine the association between serum uric acid and age, sex, obesity or relative weight, cigarette smoking, alcohol intake, diabetes mellitus, anti-hypertensive drug intake, cholesterol, and serum triglyceride, and 3.) To determine prevalence of hyperuricemia.

METHODS: Retrospective chart review of 2188 adult Filipinos undergoing executive medical check-ups in 6 major hospitals Results: Hyperuricemia was present in 37.9 percent (adjusted prevalence, 95 percentCI 36.0-39.9) (n=845). The mean uric acid was 0.38 mmol/L (95 percent CI 0.37-0.39). It was significantly associated with hypertension at adjusted Odds Ratio 1.27 (95 percent CI 1.05-1.53, p=0.013). The risk factors for hyperuricemia were age, male, weight, smoking, alcohol intake, hypertension, normoglycemia, triglycerides, and cholesterol. After adjustment in a step-wise logistic regression, the independent predictors identified were hypertension, hypercholesterolemia, age, males and non-diabetics.

CONCLUSIONS: Hypertension was significantly associated with hyperuricemia among adult Filipinos undergoing periodic health check-ups. The major predictors of elevated serum uric acid were hypertension, male sex, hypercholesterolemia, age and absence of diabetes mellitus. The prevalence of hyperuricemia at 37.9 percent was much higher compared to a previous local study (21 percent) and prevalence studies from other countries (8.4-27.6 percent).

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Adolescent ; Uric Acid ; Hyperuricemia ; Antihypertensive Agents ; Triglycerides ; Hypercholesterolemia ; Cigarette Smoking ; Obesity ; Body Weight ; Hypertension ; Cholesterol ; Diabetes Mellitus ; Smoking

OBJECTIVES: To determine the effect of the timing of nephrology referral, whether early (ER) or late (LR), on morbidity and mortality of dialysis patients Study Design: Cohort, retrospective

MATERIALS AND METHODS: We retrospectively reviewed all patients with CRF who were dialyzed for the first time in the Center for Kidney Diseases of the University of Santo Tomas Hospital from January 1 to December 31, 2000. Included cases were classified as either early referral or late referral patients. Excluded in this study were patients with severe acute renal failure (ARF), those who had undergone acute peritoneal dialysis for whatever cause, those with malignancies, those who transferred to another dialysis unit and those who were lost to follow-up.

RESULTS: Among 104 patients, 45 (43.3 percent) were included in the study. Sixteen cases (35.6 percent) were timed as ER and 29 (64.4 percent) as LR. There was no difference in the age, sex, comorbid illness and type of renal diseases in both groups. The mean values of BUN, serum creatinine were higher in the LR group. Majority (50 percent) of the ER group had creation of AV fistula at the onset of the first dialysis. The initial morbity was longer in the LR group (mean, 20.48 +/- 11.55 days). The need for emergent dialysis was similar in both groups. There was no difference in the mortality rate in both groups (ER 75 percent, LR 62 percent). Likewise, survival analysis showed no difference in the two groups at twelve months.

CONCLUSION: To our knowledge, this is the first study in the Philippines that focused on CRF patients early or late referral status, and its effects on morbidity and mortality. Further studies are needed to determine whether these results are linked with dialysis modalities, psychosocial conditions and socioeconomic factors. Widespread dissemination of clear guidelines for general practitioners and non-nephrologists, interventions to promote early diagnosis and adequate pre-dialysis follow-up and development of educational programs for the patients need to be evaluated since they appear to be important in improving the survival of CRF patients.

Human ; Male ; Female ; Nephrology ; Renal Dialysis ; Creatinine ; Blood Urea Nitrogen ; Peritoneal Dialysis ; Morbidity ; Survival Analysis ; Acute Kidney Injury ; Socioeconomic Factors ; Neoplasms ; Fistula

OBJECTIVES: 1. To report cases of "normal", asymptomatic, young, pre-employment males without significant cardiovascular risk factors but with electrocar diographic (ECG) T-wave inversion in multiple leads; and 2. To emphasize the importance of overall clinical correlation in interpretation of the ECG and in overall diagnostic and management decisions.
SETTING: Outpatient urban pre-employment clinic
CASE SUMMARY: Seven young (44 years of age), pre-employment, asymptomatic, male cases with resting ECG findings of T-wave inversion in multiple leads but with normal physical, radiographic, and cardiosonographic cardiac anatomy are herein reported. All cases did not have significant cardiovascular risk factors and were able to uneventfully hurdle at least 9 METs of monitored treadmill exercise. All cases were eventually cleared for employment and presumably enjoying a productive life; nobody among them was repatriated.
CONCLUSION: Clinical presentation is the more important arbiter of cardiovascular/physical fitness than any isolated ECG finding.

Human ; Male ; Adult ; Cardiovascular Diseases ; Risk Factors ; Physical Fitness ; Exercise Test ; Exercise ; Heart ; Electrocardiography ; Employment

OBJECTIVE: The objective of this study was to determine the safety, tolerability, and efficacy of valsartan (Diovan?) 80 mg tablet in the treatment of mild to moderate, uncomplicated essential hypertension in Filipino patients.
METHODS: Patients who were 18-80 years of age, male or female diagnosed with essential hypertension with mean sitting diastolic blood pressure (SDBP)> 90mmHg to 115mmHg were given valsartan? 80mg tablet daily for a minimum of 2 weeks to a maximum of 8 weeks of treatment.
RESULTS: A total of 3224 evaluable patients were included in the study. Almost forty percent (39.6%) of patients are newly-diagnosed hypertensives, 25.8% have been hypertensives for 1 to 2 years,17% for 3-5 years, and 17.6% for more than 5 years. The mean systolic blood pressure (SBP) at baseline was 156.9 mmHg ± 15.4 mmHg while the mean diastolic blood pressure (DBP) at baseline was 98.7 mmHg ± 6.4 mmHg. The SBP decreased at visit 2 to a mean of 135.3 mmHg ± 12.6 mmHg which reduction was very highly significant (paired t-test= 9.13, p<0.0001). On the other hand, the mean DBP decreased to 85.3 mmHg ± 7.2 mmHg at visit 2 which reduction from baseline to visit 2 was also very highly significant (paired t-test= 94.2, p<0.0001). Adverse events in patients had been mild. Over-all the drug had demonstrated its relative safety in this population of subjects.



Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Adolescent ; Valsartan ; Blood Pressure ; Essential Hypertension ; Hypertension ; Systole ; Blood Pressure Determination ; Diastole ; Tablets

BACKGROUND:?There is a critical relationship of time to treatment and myocardial salvage in the patient with acute myocardial infarction (AMI). As the proven beneficial management options for AMI have been extensively studied, the challenge lies in developing a process that minimizes pre-hospital delays, delays in assessment and initiation of reperfusion therapy. A greater emphasis on pre-hospital care has more potential in reducing mortality from acute MI than further development of hospital based treatments.

OBJECTIVE:?This study identifies the socio-demographic risk factors in patients with acute coronary syndrome and correlate them with pre-hospital delay. This response time to treatment is then correlated with the clinical outcome.

STUDY DESIGN:?Clinical Descriptive Study

METHODS:?Adult patients with diagnosis of acute coronary syndrome at the ICU setting of the USTH were sampled. Charts were reviewed and socio-demographic profiles identified. Pre-hospital delay from the onset of chest pain were correlated with these socio-demographic factors using multiple regression logistic regression. Chi square test was used to determine association between pre-hospital delay and clinical outcome.

RESULTS:?The study sample consisted of 220 patients with acute coronary disease. The sample population included 63% Non ST Elevation Myocardial Infarction (NSTEMI), 4% ST Elevation Myocardial Infarction (STEMI) and 33 percent with unstable angina. Male population accounted for 54% of the population. Thirty eight?percent(38%) of the population belonged to the 61.70 age group with mean age of 65 years old. The prevalence of hypertension (70%) and DM (41%) was high and about 30% of the population had prior history of coronary artery disease (CAD). About 35% reported family history of CAD and 41% had family history of DM. More than half of the population are smokers (55%). Majority of the patient population live within 10 kilometers from USTH (70%) while 28 patients (13%) came from the province. Thirty-eight percent (38%) sought consultation after two pain events, while only 4% came after more than 4 chest pain events. A significant number of population in the present series presented to the hospital delayed by more than four hours. Majority of the patients (40%), came in more than 6 hours. Twenty one percent (21%) came 2-4 hours while 30 percent came 4-6 hours from the onset of chest pain. The most common reason for the delay in seeking medical attention is financial limitation (36%), 31% had relief of chest pain by nitrates. Of the 220 included in the group, 50% had morbidity (such as development of acute renal failure, congestive heart failure), 41% had unremarkable outcome while there was 10% mortality noted. However in this study, we were not able to associate any socio-demographlc factors and the delay in time to treatment with the clinical outcome using available data and statistical.

CONCLUSION:?The results of this study demonstrate that patients with acute coronary event continue to exhibit prolonged delay in seeking medical care. This paper, Likewise, demonstrated that certain demographic and socioeconomic characteristics are associated with pre-hospital delay such as age, sex, history of CAD, hypertension and DM, proximity to the hospital, pain events prior to consultation and educational attainment. However, no correlation can be made between delay in time to treatment and clinical outcome.

Human ; Male ; Female ; St Elevation Myocardial Infarction ; Acute Coronary Syndrome ; Coronary Artery Disease ; Myocardial Infarction ; Hypertension ; Heart Failure

OBJECTIVE: Measurement of kidney size by ultrasonography is an important parameter in the renal evaluation of patients. This study aims to establish the average size of kidneys of healthy adult Filipinos and examine the factors that influence it.
DESIGN: Cross-sectional, observational study
SETTING: Section of Nephrology, Department of Medicine and Department of Radiology, UP-PGH Medical Center, a tertiary government hospital
PARTICIPANTS: 264 healthy Filipino adults underwent kidney ultrasound after preliminary screening by history, physical examination, urinalysis, and serum creatinine
RESULTS: Renal sizes and volume were measured by ultrasound in 105 males and 159 females, with ages ranging from 18 to 75 years old. The left kidney was significantly larger than the right for mean length but not for width or thickness. Except for cortical thickness, renal length (L=98 mm, R=96mm vs. L=95mm, R=93mm), width (L=48mm, R=49mmvs. L=46mm,R=46mm), and thickness (L=43mm, R=42 mm vs. L=39 mm, R=39 mm) were significantly larger in males compared to females. While the gender differences persisted when corrected for age and body mass index, this disappeared when corrected for total body area. With advancing age, there was minimal shortening but significant increases in width and thickness (renal shape index)
CONCLUSION: Our study provides estimates of the average kidney size for normal adult Filipinos. The average kidney size of Filipinos is smaller than that of Caucasians for length (L=96mm vs. 112 mm, R=94mm vs. 109mm) and for width (L=47mm vs. 58mm, R=48mm vs. 57mm). Males have larger kidneys than females but the gender difference disappeared when corrected for total body area. Height but not weight has a significant influence on kidney size. With advancing age, kidneys tend to increase in width and thickness with no significant decrease in length or volume.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Kidney ; Radiology ; Adult ; Ultrasonography ; Patients

To establish reference values for lung function test in Filipinos, 283 (130 males and 153 females) normal non-smoking (< 0.5 pack years), adults were studied using a body plethysmograph (Jaeger, West Germany). Spirometric indices were integrated from a pneumotachograph (linear at flows between 0-20 1/sec with ± 2% error). Spirometric performance and measurements followed the ATS Snowbird Workshop recommendations. Lung volumes and airway resistance (Raw) were taken from the average of three plethysmographic determinations.

Multiple linear regressions with backward elimination was done. The data obtained was regressed against independent variables of age height, weight, and body surface area for each sex.

Analysis of variance (ANOVA) of the regression equations for most parameters were significant at = 0.01. In a few parameters were significance was = 0.05. Only in Raw was the regression model not significant. The coefficient of determination (R) of our regression equations were low (<0.50). However, such low R have been observed in other predictions equations which have gained widespread acceptance, attesting to their clinical usefulness. Ninety five percent confidence interval was used to determine the lower limit of normal for FEV1 and FVC. Since the other parameters showed greater individual variability, cumulative percentiles of % of predicted were determine instead (Knudson 1977). For performance test, the 5th percentiles of % of predicted was computed. For lung volumes, the 5th and 95th percentiles were determined. For Raw, the 95th percentiles of the actual values was used. Since there were fewer subjects above the age of 60 years, the use of these equations is subject to this limitation.

Human ; Male ; Female ; Smoking ; Lung ; Analysis Of Variance ; Population