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Results in Journal Anales de Medicina Interna: 5,348

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A. Borda Martín, J. M. Martínez-Peñuela Virseda, M. Muñoz Navas, C. Prieto Martínez, M. Betés Ibáñez, F. Borda Celaya
Anales de Medicina Interna, Volume 25, pp 321-324; https://doi.org/10.4321/s0212-71992008000700002

Abstract:
To analyze the relationship between synchronous lesions in patients with colorectal cancer and their prognostic value. We have retrospectively reviewed 369 patients with resected colorectal cancer. We compared the rate of apparently curative surgery, progression and tumoral relapse, development of extracolonic cancer and mortality between patients with and without synchronous cancer. Afterwards, we analyzed the same parameters in colorectal cancer with and without synchronous adenomas. Finally, we repeated the analysis after stratification of cancers in 2 groups according to pTNM staging: 0-I-II stage vs III-IV. We found synchronous adenomas in 54.7% of our patients and synchronous cancers in 7.6%. Follow-up period of groups with and without synchronous lesions were: 70.8 +/- 22.9 and 67.2 +/- 24.5 months (p = 0.55) respectively. Synchronous cancers showed higher mortality: 35.7 vs. 14.4%: p = 0.006; OR = 3.31 (1.33-8.13), higher tumoral progression : 39.3 vs. 19.1%: p = 0.011; OR = 2.75 (1.14-6.56) and higher relapse rate: 10.7 vs. 3.5%: p = 0.096. Stratifying according to stage, patients with stage 0-I-II and synchronous cancer showed worse prognosis: mortality = 27.7 vs. 8.1%, p = 0.019; OR = 4.45 (1.2-15.1), tumoral progression = 27.8 vs. 8.5%, p = 0.02; OR = 4.12 (1.14-14.19), and extracolonic cancer = 16.7 vs. 6.4% p = 0.095. There were no statistical differences between cases with and without synchronous adenomas. Synchronous cancers showed worse prognosis after resection, with higher rate of tumoral progression and mortality. This difference is focused on the cases diagnosed in stage 0-I-II, not being found in III-IV. The presence of synchronous adenomas doesn't influence prognosis.
, A. Muñoz Morente, I. Pérez De Pedro, A. Navarro Piñero, J. M. Reguera Iglesias, R. Gómez Huelgas
Anales de Medicina Interna, Volume 25, pp 359-361; https://doi.org/10.4321/s0212-71992008000700010

Abstract:
Autoimmune pancreatitis is an entity that has recently been included in the differential diagnosis of chronic pancreatitis-pancreatic mass. The presence of diffuse, irregular Wirsung's duct stenosis, together with high levels of IgG4, the existence of certain autoantibodies and lymphoplasmacytic infiltration of the pancreas are key factors in the diagnosis. An early diagnostic suspicion and multidisciplinary collaboration are vital in these cases to avoid unnecessary surgery as the differential diagnosis is established with such entities as pancreas cancer, chronic pancreatitis, primary biliary cirrhosis or primary sclerosing cholangitis. Autoimmune pancreatitis has an excellent response to steroid therapy, with complete resolution of clinical, analytical and radiological parameters, as occurred in our patient. The very few cases reported so far suggest the need for the elaboration of long-term follow-up studies to determine the prognosis and frequency of its association with other diseases.
E. M. Fonseca Aizpuru, E. E. Rodríguez Ávila, I. Arias Miranda, C. Álvarez-Cuesta, A. Martínez Merino
Anales de Medicina Interna, Volume 25, pp 376-377; https://doi.org/10.4321/s0212-71992008000700018

J. Gómez, , M. Martínez Pérez, J. Martínez Lage, J. González Tortosa, M. A. Pérez Espejo, J. Ruiz, J. A. Herrero, M. Canteras, M. Valdés
Anales de Medicina Interna, Volume 25, pp 331-334; https://doi.org/10.4321/s0212-71992008000700004

Abstract:
The aim of this study was to evaluate prognostic factors in brain abscess (AB) and influence of management with antibiotic prescribing protocols (APP). observational study of a cohort of non-paediatric patients with BA admitted at a 944-bed hospital (1976-2005). Data collection from clinical records has been done according to a standard protocol. We analysed epidemiological, clinical, radiological, microbiological and laboratory data associated with mortality. From 1976 to 1983 (Period I), antibiotic treatment was not done according to any internal APP; from 1983 (Period II), antibiotic management was done according to a APP designed by infectious diseases specialists and neurosurgeons. Predictors of mortality were identified by univariate analysis. The influence of the use of APP in outcome was assessed. 104 patients with BA were included (mean age 45 years; range 12-86); presumed primary pathogenic mechanism of BA was identified in 89%; microbiologic diagnosis was made in 76%. Overall mortality was 16.3%. Factors statistically associated with higher mortality were: age > 40 years, ultimately fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequate empirical treatment; 33 patients were treated in Period I and 71 in Period II; no statistically significant differences were found between epidemiological, clinical, radiological or microbiological characteristics of the groups except for mean age (> 40 years in 36% and 62% respectively in Period I and II). Rates of resolution of BA were 60 vs. 77.4% (p < 0.05); relapses 21 vs. 7% (p < 0.05) and mortality 18 vs. 15.4% (p > 0.05), in Period I and II respectively. main prognostic factors associated with mortality in patients with BA are age, rapidly fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequate empirical treatment. Empiric treatment according to APP was associated with greater resolution and lower relapse rates.
G. Eroles Vega, A. B. Mecina Gutiérrez, C. Fernández García, A.B. Mancebo Plaza, I. De La Riva Jiménez
Anales de Medicina Interna, Volume 25, pp 335-341; https://doi.org/10.4321/s0212-71992008000700005

Abstract:
To assess clinical and laboratory features of patients with liver abscesses (LA), and determine prognostic features. We performed a retrospective analysis of medical records of patients receiving a diagnosis of LA in the Hospital Severo Ochoa, between 1989-2005. We were able to find 68 patients: 39 males and 29 females; the incidence amounts 26 cases/100,000 hospital admissions; mean age 63 years. A biliary source accounted for 37%, 16% were of portal origin, 7% were ascribed to hematogenous dissemination, 4% direct inoculation during a procedure and no cause could be found in 35%. Liver ultrasonography allowed diagnosis in 43% of cases, and CT scan un 57%. Sixty-two percent of LA were larger than 3 cm in diameter; 28% of cases had multiple abscesses. Cultures of abscess fluid were positive in 71%, and blood cultures in 52%. Globally, we were able to isolate the causal microorganism in 73.5% of cases. Hundred percent of patients received antimicrobials, 56% had percutaneous drainage performed and 25% were surgically managed. There were complications in 13%, 9% suffered recurrences and we found a 19% mortality rate. LA has an ill-defined clinical picture. A history of neurological disease or abdominal tumor, and multiple LA are associated with an increased complication rate. Following factors correlated with increased mortality: Age-adjusted Charlson's morbidity index > or =5; Quick index < 60% and development of complications. Drainage indication has to be individualized.
, C. Sánchez-Maestre, M. Brosa Riestra, O. Arroyo, V. Sanz De Burgoa, K. Wilson
Anales de Medicina Interna, Volume 25, pp 342-348; https://doi.org/10.4321/s0212-71992008000700006

Abstract:
To analyse the efficiency of varenicline compared with bupropion, NRT (nicotine replacement therapy) and no pharmacological treatment in Spain. A Markov model was developed to analyse the health and economic consequences of smoking cessation therapies. The transition probabilities were taken from published studies. The model allows cost effectiveness analyses for different time frames (10 years, 20 years and life time). Outcomes are measured in terms of incremental life years gained (LYG) and QALYs. Pharmacological costs and costs of medical visits with varenicline and bupropion were considered. Treatment costs of smoking associated morbidity were taken from Spanish studies. The analyses were done under the perspective of the National Health System, discounting costs and health benefits at 3%. The life time cost-effectiveness analysis shows that varenicline dominates all other smoking cessation interventions (more effective at a lower cost). This is due to the higher efficacy of varenicline associated with a reduction in smoking related morbimortality, which, in the long term, accounts for health care cost savings that overcome the extra cost of varenicline. Even when shorter timeframes are considered (20 years), vareniclin is cost-effective in comparison with any other alternative. Varenicline is a dominant option (more effective at a lower cost) compared with all other smoking cessation treatments when the timeframe is the life span of the patient. Varenicline is cost-effective even when shorter timeframes are considered (20 years or more), with an estimated incremental cost per QALY far bellow any threshold commonly accepted in our environment.
, F. Rodero Álvarez, C. M. Ros Tristán, M. J. Calpe Gil, A. Martínez Oviedo
Anales de Medicina Interna, Volume 25, pp 353-355; https://doi.org/10.4321/s0212-71992008000700008

Abstract:
Subarachnoid hemorrhage implies the presence of blood within the subarachnoid space from some pathologic process. The initial study of choice is an urgent Cranial Computed Tomography scan, but its sensitivity declines with time. So that it is recommended that patients with severe sudden headache but normal Cranial Computed Tomography scan, should have a lumbar puncture performed, more than 12 hours after the onset of symptoms, to rule out subarachnoid hemorrhage. The methods for distinguishing among traumatic lumbar puncture and true Subarachnoid hemorrhage include the erythrocyte level, the "three tube test", D-dimer assay and ferritin in cerebrospinal fluid. But the best technique is the xanthochromia o yellow-to-orange cerebrospinal fluid supernatant, measured spectrographically. We report a case of a young woman with a subarachnoid hemorrhage diagnosed by xanthochromia after 18 days after the onset of bleeding.
, V. López Cupido, O. Torrado Sierra, M. Valencia Terrón
Anales de Medicina Interna, Volume 25, pp 356-358; https://doi.org/10.4321/s0212-71992008000700009

Abstract:
Superior vena cava syndrome is obstruction of blood flow through the superior vena cava (SVC). It is most commonly caused by neoplasm, especially lung cancer. An obstructed SVC initiates collateral venous return to the heart from the upper half of the body and the classic symptoms and signs become obvious. Superior vena cava síndrome is a rare cause of ocular manifestations. We report a case of periorbital swelling, conjunctival edema an orbital proptosis in a male patient presenting malignant superior vena cava obstruction.
, C. A. Homs Gimeno, G. Pacheco Arancibia, B. Zalba Etayo, M. Sánchez Marteles
Anales de Medicina Interna, Volume 25, pp 372-373; https://doi.org/10.4321/s0212-71992008000700014

J. Campos Franco, R. López Rodríguez, P. Ordóñez Barrosa, M. L. Pérez Del Molino, A. González Quintela
Anales de Medicina Interna, Volume 25, pp 374-374; https://doi.org/10.4321/s0212-71992008000700016

, J. J. López Manzano, J. Rodríguez Cid, C. Garcés Segura, M. T. Llorens Rufach
Anales de Medicina Interna, Volume 25, pp 325-330; https://doi.org/10.4321/s0212-71992008000700003

Abstract:
The high increase of the metabolic syndrome (MS) on the occidental World, is increasing the cardiovascular disease. Since, as the presence of metabolic syndrome suggests the application of preventive measure necessary, We studied, the prevalence of metabolic syndrome and the cardiovascular risk factors (RF) in our laboral population. The sample included 345 workers, 191 females and 154 males. All the people passed a laboral check-up at the year 2006. Obesity was presented in 12.5% of the sample, 16.9% in males, 8.9% in females. The prevalence of MS was 7.8%, being higher in males than in females. 57.7% of obese males presented MS and 29.4% of obese females presented MS. The older worker presented higher prevalence of MS. The high blood pressure was the factor more prevalent, in worker with MS. All the factors of MS were more prevalent in males, to exception of waist circumference. 1. Almost 8% of workers presented MS, being higher the prevalence in males. The obesity increased of important manner the MS. The older worker had higher prevalence of MS. 2. The waist circumference associated with all the FR related with MS.
, B. C. Finn, M. L. Fox, N. Emery, J. E. Bruetman
Anales de Medicina Interna, Volume 25, pp 349-352; https://doi.org/10.4321/s0212-71992008000700007

Abstract:
Vocal cord dysfunction (VCD), is characterized by a paradoxical adduction of the vocal cords during inspiration, and occurs predominantly in young women. Common symptoms are cough, wheezing, episodic dyspnea, and inspiratory stridor. The true incidence and course of the disease are unknown, and it is usually self limited. It can coexist with, or mimic refractory asthma. Psychological disorders were thought to be the principal cause, subsequently multiple organic diseases have also been reported, like gastroesophageal reflux disease (GERD). Diagnosis is made by clinical suspicion and direct observation. The Gold standard for diagnosis is laryngoscopy with visualization of the paradoxical motion of the vocal cords when the patient is symptomatic. Speech therapy and psychotherapy have been used extensively without any prospective study. We report two cases of VCD associated with GERD, both with excellent respond to treatment.
, M. Cervantes Llano, G. Pentón Rol
Anales de Medicina Interna, Volume 25, pp 362-365; https://doi.org/10.4321/s0212-71992008000700011

Abstract:
The Optic Neuromyelitis is an inflammatory and autoimmune illness of the central nervous system. Presently work is carried out a revision of the different mechanisms involved in the pathogenesis of the Optic Neuromyelitis, the paper of the eosinophils is analyzed, of the antibodies against own antigens and of the regulatory T cells in the illness. In the Optic Neuromyelitis is very important the humoral response, the illness exists it is characterized by the immunocomplex deposit, activation of the complement, production of antibodies against proteins of the myelin and eosinophils recruitment in the lesions. It also exists an increase of the expression of chemokines receptors like the CCR3, specific of TH2 cells; the illness is associate predominantly to a TH2 response.
, A. Del Castillo Rueda, G. Pérez Manga
Anales de Medicina Interna, Volume 25, pp 366-369; https://doi.org/10.4321/s0212-71992008000700012

Abstract:
Neoplastic angiogenesis is an essential process in the progressive growth of neoplasms and the production of metastasis. Angiogenesis consists of a series of linked and sequential steps that ultimately leads to the development of a neovascular blood supply to the tumor mass. VEGF has got an essential role in neoplastic angiogenesis, therefore it is an important target in the treatment of neoplasms. Bevacizumab, a humanized monoclonal antibody, inhibits VEGF, and may also improve the delivery of chemotherapy to the tumor mass. Multi-kinase ihibitors (sorafenib and sunitinib) are orally administered small-molecules, that inhibit different receptors (essentials in the neoplastic angiogenesis), such as the VEGFR or PDGFR. These agents are useful in the treatment of advanced renal-cell carcinoma, and are under investigation in several tumors.
M. A. Sancho Zamora, L. M. González López, M. A. Martínez García, A. M. Puig Rullán
Anales de Medicina Interna, Volume 25, pp 379-380; https://doi.org/10.4321/s0212-71992008000700020

, I. Sánchez Romero, P. A. Saura Lorente, A. Parajón Díaz, Antonio Ramos
Anales de Medicina Interna, Volume 25, pp 284-286; https://doi.org/10.4321/s0212-71992008000600007

Abstract:
Suppurative thrombophlebitisis a very infrequent complication of the central venous catheterization. The majority of the cases are produced by species of staphylococci. A 22-year-old colombian-woman, student, without toxic habits was admitted because of temporary left astrocytoma (grade II). Nine days after implementing a catheter in the right subclavian vein she presented high fever (39.5 degrees C), shivers, progressive right side neck swelling and odinofagia. She had leukocytosis (26,300 cells/microl) and normal cerebrospinal fluid. After withdrawing the catheter, Staphylococcus aureus was isolated in the tip of the catheter and in four bottles of blood cultures. A neck CT demonstrated expansion and absence of contrast in the right internal jugular vein. The patient evolved satisfactorily with cloxacillin, gentamycin and low molecular weight heparin.
T. Martín Santos, L. Morabito, J. M. Raya Sánchez, M. M. Alonso Socas, B. González González, M. T. Hernández García, L. Hernández Nieto
Anales de Medicina Interna, Volume 25, pp 287-290; https://doi.org/10.4321/s0212-71992008000600008

Abstract:
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.
I. F. Aomar Millán, I. Aguilar Cruz, L. Pérez Fernández, L. López Pérez, J. Pozo
Anales de Medicina Interna, Volume 25, pp 306-307; https://doi.org/10.4321/s0212-71992008000600013

, M. Pazo Núñez, R. De La Fuente Cid, F. L. Lado Lado, L. Hernández Fernández, I. Rodríguez López
Anales de Medicina Interna, Volume 25, pp 256-261; https://doi.org/10.4321/s0212-71992008000600002

Abstract:
The present study aimed to evaluate the profile of patients with decompensated heart failure hospitalized in a tertiary hospital. It was designed an observational and retrospective study where data from clinical records of patients suffering from heart failure along 2005 were registered randomly. 209 patients were collected (average age: 78.6 +/- 9.1; male: 52.4%) with a comorbidity rate of 87.55%. Almost one third of them have not stimation of systolic function and among the others 72.4% have it preserved. Most of decompensated were due to respiratory infections. Ischemic-hipertensive cardiopathy was the most frequent aetiology of systolic disfunction. Average stay was 12.9 days with a mortality rate of 9.56%. Its main risk factors were advanced stages in NYHA od Red Cross scales, as so as dementia or ictus. The present study shows a patient hospitalized for decompensated heart failure roughly different from that one reported at clinical trials. It makes difficult to apply therapeutical interventions, previously well documented to be useful.
, S. Dorado Pombo, A. Díaz Brasero, M. E. García Gil, L. Yubero Salgado, N. Torres Pacho, C. Ibero Esparza, J. Cantero Bengoechea
Anales de Medicina Interna, Volume 25, pp 262-268; https://doi.org/10.4321/s0212-71992008000600003

Abstract:
VEIA study is an evolutional registry of acute poisonings (AP) attended in the Emergency Room of the Doce de Octubre Hospital in Madrid (Spain) in a whole year (1979, 1985, 1990, 1994,1997 and 2000). We present the 2004 study and compare the results with the previous years. Methodology has been identical across VEIA STUDY. Of 1508 AP, 610 are suicide attempts (IAVIS), 319 ethylic, (IAVE), and 218 by illicit drugs (IAVD). Of the 2,259 toxics involved, 48% are medications (50% benzodiacepines) alcohol 25% and illicit drugs 13%. There is an important increase (34%) of cases and the incidence surpasses all published in our country. There are no gender differences nor in the whole neither the Health Area Census, but there are differences in IAVIS, IAVE and IAVD. IAVIS increase in 35%. Benzodiacepines poisoning increases two-fold as well as antidepressive drugs do in women. In men also increase, but in a minor extent. Acetaminophen remains the same in 23%. NSAID's, adjuvants and myorelaxants increase in women as do also alcohol and other poisons that almost equal men's. There are 13 cases of IAVIS in patients with alimentary disorders. Among men, a quarter are illicit drug abusers. In IAVE, the group without alcoholism grows and the total decreases. Illicit drugs duplicate the number of the former year. Cocaine supposes already 2/3 of the cases, MDMA ascends to 22 cases and they appear new substances as glue, without doubt as an effect of immigration and ketamine. Finally 205 household accidents and 57 industrial injuries complete the series.
, J. L. Menéndez Gómez, A. M. Pérez Cogolludo, S. Domínguez Martín, E. Fernández Rodríguez
Anales de Medicina Interna, Volume 25, pp 279-283; https://doi.org/10.4321/s0212-71992008000600006

Abstract:
The risk of suffering opportunistics infections in the immunoincompetent patient is a fact perfectly established. An uncommon situation constitutes the bronchopaties, pathologies with a high prevalence among the general population that they require habitually, among other, steroid treatment. The immunosupression confers to the clinical evolution of the infections, as a consequence of the inadequate response to the physical stress, due to the inhibition of the hypothalamus-hypophysis axis being able to in particularly serious cases, to develop the denominated macrophage activation syndrome, a serious and uncommon syndrome that darkens the clinical prognosis in these patients. In presence of a feverish syndrome of uncertain origin in a patient in immunosuppressor treatment, although it is to low dose, it is necessary to carry out a exhaustive differential diagnosis, should consider, among them, the infection for Leishmania, a parasitosis whose incidence is increasing notably in the last years in the immunosuppressed population. We present the clinical case of a 63 year-old patient, immunoincompetent as a consequence of secondary chronic steroid therapy to asthmatic bronchopaty that experiences an uncommon form of visceral leishmaniasis in our area, consistent in multiorganic failure in the context of the development of a macrophage activation syndrome.
I. M. Arias Miranda, E. M. Fonseca Aizpuru, M. E. González García, A. G. Barrero López
Anales de Medicina Interna, Volume 25, pp 314-314; https://doi.org/10.4321/s0212-71992008000600019

F Blasco Patiño, R Pérez Maestu, J Martínez López De Letona, A I Jiménez, M J García Navarro
Published: 1 June 2008
Anales de Medicina Interna, Volume 25

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C Macaya Miguel, R Bover Freire
Published: 1 June 2008
Anales de Medicina Interna, Volume 25

, R Aller,
Published: 1 June 2008
Anales de Medicina Interna, Volume 25

The publisher has not yet granted permission to display this abstract.
, , R Aller, M González-Sagrado, L Cuellar, M C Terroba, T Martín
Published: 1 June 2008
Anales de Medicina Interna, Volume 25

The publisher has not yet granted permission to display this abstract.
, F. Martelo Villar
Anales de Medicina Interna, Volume 25, pp 291-293; https://doi.org/10.4321/s0212-71992008000600009

Abstract:
Necrotizing fascitiis due to Streptococcus Pyogenes has a high mortality rate. Detection of the infection before it developes to the streptococcal toxic shock syndrome is quite challenging and its one of the main goals of its management because at this final stage the treatment is in most of the cases ineffective. In a secuence of events of the progression of the infection to shock, renal failure occurs before hipotension very often. We report the case of a 38-year-old patient affected by a fulminant necrotizing fascitiis by Streptococcus Pyogenes which presented at admission with lower leg cellulitis and acute renal failure.
I. Lopategui Cabezas, M. Cervantes Llano, G. Pentón Rol
Anales de Medicina Interna, Volume 25, pp 294-296; https://doi.org/10.4321/s0212-71992008000600010

Abstract:
The optic neuromyelitis or syndrome of Devic is an inflammatory and autoimmune illness of the central nervous system. It is characterized by attacks of optic neuritis and myelitis, being able to produce blindness, great neurological disability and even the short term death. Until the moment an effective treatment doesn't exist, the therapy is centred in the treatment of the acute attacks, the medical prevention of the complications and the rehabilitation. This article is a revision of this not very common illness, considering that its prevalence in our country has gone in increase. We compare between the optic neuromyelitis and the multiple sclerosis, being based on the main ones characteristic clinical-epidemic that distinguishes these two pathologies, considered by many clinical variants of oneself illness.
R. Baños Madrid, F. Alemán Lorca, M. Alajarín Cervera, A. Serrano Jiménez, F. Alberca De Las Parras, J. Molina Martínez, F. Carballo Álvarez
Anales de Medicina Interna, Volume 25, pp 309-309; https://doi.org/10.4321/s0212-71992008000600015

P. Benito García, A. Fuertes Martín, E. Santos Corraliza, S. Bahamonde Cabria, R. Merchán Rodríguez
Anales de Medicina Interna, Volume 25, pp 311-312; https://doi.org/10.4321/s0212-71992008000600017

, F. Martínez-Sagasti, M. Matesanz, J. Gonzalez Del Castillo, F. Ortuño, F. J. Martin, A. Moneo, I. Candel
Anales de Medicina Interna, Volume 25, pp 205-208; https://doi.org/10.4321/s0212-71992008000500002

Abstract:
Systemic Inflammatory Response Syndrome (SIRS) is a clinical situation frequently observed in Emergency Room (ER). Its early detection and supporting measures improve prognosis of these patients. To know the incidence of SIRS among patients who come to ER, their frequency and distribution factors and the clinical evolution at 3 and 30 days. Observational prospective simple-blind study. During 24 hours, SIRS was detected by observant doctors with an independent registry. Their management was observed. Patients from Obstetrics and Traumatology were not observed. Follow-up was done using telephonic and informatical techniques at 3 and 30 day. A descriptive analysis was done. There were 163 patients attended in ER; 25 of them with SIRS (15.3%), 16 were male (65%) and 9 female (35%). By ages 8 were under 30, 4 were between 30 and 60 and 13 were over. The respiratory rate was not measured in 12 of the 25 patients with SIRS (48%). An infectious etiology (sepsis) was found in 19 of those 25 (76%) patients. The most frequent criterion of sepsis was tachycardia, followed by leukocyte disorders. Support of volume and antimicrobial therapy were only started at once in 21 and 42% respectively on patients with sepsis. 15 of 25 were admitted (2 in ICU). After 3 days, 11 of 25 remained at hospital and after 30 days 2. SIRS is a prevalent situation in ER with a high percentage of admissions. Most of SIRS were of infectious origin (sepsis). Major attention is needed among physicians to establish a promptly diagnose and starting support measures that improve their prognosis.
E. Herrera De Pablo, , D. García Escrivá, J. Pérez Silvestre, P. Herrera Pablo, A. Herrera
Anales de Medicina Interna, Volume 25, pp 209-212; https://doi.org/10.4321/s0212-71992008000500003

Abstract:
Introduction:Lithiumsaltshavebeenmainlyusedinthetreatmentof bipolar disorder. Because of its narrow therapeutic range, and several well characterised adverse effects, serum lithium levels must be moni - tored regularly in patients given lithium treatment in order to prevent intoxication. Objetive: To describe the clinic and toxic characteristics in inpa - tientsatourClinicToxicologicUnit. Material and methods:Descriptiveandretrospectivestudyoflithium intoxications in 150 inpatients between 2003 and 2006. Patients were classified based on their neuropsychiathric symptom profile and serum lithiumlevels . 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,intoxicationwasmoderatein50%ofcases,andmildin25% and severe or very severe in 25%. Using serum lithium levels, intoxica - tion was very severe in 31.35%, severe in 25%, and slight-moderate in 43.7%.Conservativemeasureswereusedasthemostfrequenttreatment (50%),andhaemodialfiltrationwasneededin37.5%.Meanstaywas4,8 days in acute intoxication, and 11.2 days in chronic. Sequelaes were foundintwopatients(ataxia).Deathwasnotpresent. Conclusions: Lithium intoxications can involve severe complica - tions, even death. Narrow control is encouraged in polymedicated and elderlypatients,andinconcommitanttreatmentwithantidepressantand neuroleptics.
V. M. Díaz Muñoz De La Espada, P. Khosravi Shahi, B. Hernández Marín, S. Encinas García, J. A. Arranz Arija, G. Pérez-Manga
Anales de Medicina Interna, Volume 25, pp 241-243; https://doi.org/10.4321/s0212-71992008000500011

Abstract:
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.
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