Anales De Medicina Interna最新文献

We report the case of a 68-year-old male with a diagnosis of unclassifiable myelodysplatic/myeloproliferative disease (WHO classification), under prolonged steroid treatment and unsuccesful chemotherapy response, who developed progressive asthenia, thoracic pain, minimal efforts dyspnea, and abdominal distension, that initially was suspicious of splenic rupture. Exploratory laparotomy showed multiple peritoneal implants, and a diagnosis of peritoneal tuberculosis was obtained from local biopsy. Definitive diagnosis included a positive result to culture and PCR urine test, together with a possible pleural and splenic tuberculous affectation. Response to tuberculostatic treatment was successful. To the best of our knowledge, this is the first reported case with such characteristics.

Germ-cell tumours of male ussually arise from the testis. However, in 2-5% of the cases, they also occur outside of the testis as a primary site without evidence of testicular primary tumour. This infrequent entity often appears in the body midline, predominantly in mediastinum and retroperitoneum. Mediastinal germ-cell tumours (MGCT) shall be included in the differential diagnosis of any mediastinic tumour of unknown origin. An accurate diagnosis is essential, due to the fact that these tumours are curable with chemotherapy. The histopathologic and clinical features, and its differences with germ-cell tumours from testicular origin are revised in this article.

Introduction: Lithium salts have been mainly used in the treatment of bipolar disorder. Because of its narrow therapeutic range, and several well characterised adverse effects, serum lithium levels must be monitored regularly in patients given lithium treatment in order to prevent intoxication.

Objective: To describe the clinic and toxic characteristics in inpatients at our Clinic Toxicologic Unit.

Material and methods: Descriptive and retrospective study of lithium intoxications in 150 inpatients between 2003 and 2006. Patients were classified based on their neuropsychiathric symptom profile and serum lithium levels.

Results: Sixteen of 150 inpatients had lithium intoxication: 58.3% women and 43.8% men; 49.19% +/- 18.49% years old. Lithium was used as treatment of bipolar disorder in 87.5% of cases. The most frequent cause of intoxication was attempted suicide. Using neuropsychiatric parametres, intoxication was moderate in 50% of cases, and mild in 25% and severe or very severe in 25%. Using serum lithium levels, intoxication was very severe in 31.35%, severe in 25%, and slight-moderate in 43.7%. Conservative measures were used as the most frequent treatment (50%), and haemodialfiltration was needed in 37.5%. Mean stay was 4,8 days in acute intoxication, and 11.2 days in chronic. Sequelaes were found in two patients (ataxia). Death was not present.

Conclusions: Lithium intoxications can involve severe complications, even death. Narrow control is encouraged in polymedicated and elderly patients, and in concommitant treatment with antidepressant and neuroleptics.

We describe an oligosymptomatic patient with Good syndrome (thymoma and hypogammaglobulinemia) in who a follow-up chest computed tomography showed circumferential tracheobronchial wall thickening. Bronchoscopy demonstrated tracheobronchitis with necrotic, vesicular and blister areas. The histopathological and immunohistochemical findings were compatible with herpes simplex virus infection. The therapeutical response to oral acyclovir was satisfactory.

Objectives: To determine the general referral and neurological rate per center and the adjusted efficiency indexes, through the retrospective implementation of the Adjusted Clinical Groups (ACG) in a primary care setting.

Patients and methods: To design multicenter retrospective study. Attended patients by five primary care teams (PCT) during the year 2006 were included. The main measurements were general parameters, age, gender, dependent (visits and episodes) and morbidity of each patient relative to each ACG. The referral rate was defined as the quotient between the number of referrals and the visits made. Efficiency Index (EI) was established dividing the observed by the expected referrals obtained by indirect standardization. Statistical significance, p < 0.05.

Results: Studied patients 80775 (use: 72.4%), 4.8 +/- 3.5 episodes and 7.9 +/- 8.2 visits/patient/year. Percentage of visits with a referral was 9.0% (confiance interval [CI]: 8.8-9.2); age: 44.8 +/- 22.8 years (women: 54.6%), p = 0.000. The average of referrals was of 70.5 per 100 attended-patients/year (p = 0.000) 2.5% referrals of the total were made to the neurological, being patient of greater age, with predominance of women and displaying the head pain/migraine as main consultation reason. Visits and episodes explain 43.2%-73.9% respectively (p = 0.000), the explanatory power of the classification's variability was of 46.3% (p = 0.0001) and the referral 20.1%. EI per center were: 0.97 (CI: 0.77-1.18), 0.79 (CI: 0.57-1.01), 0.88 (CI: 0.62-1.14), 1.29 (CI: 0.94-1.65) and 0.91 (CI: 0.58-1.25), p = 0.023 (family practice) and 0.90 (CI: 0.47-1.33), 0.78 (CI: 0.35-1.21), 0.93 (CI: 0.43-1.44), 1.21 (CI: 0.60-1.82) and 0.97 (CI: 0.39-1.56), p = 0.031 (pediatrics); respectively.

Conclusions: Adjusted morbidity by ACG explains an important part of the referrals variability. A low percentage was derived to neurology. The study results must be interpreted cautiously even after adjustment by age, gender and morbidity. Should the results be confirmed it would allow an improvement in the measurement of referrals for clinical management in the PCT.