Anales de Medicina Interna

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ISSN / EISSN : 0212-7199 / 0212-7199
Total articles ≅ 3,633
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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;

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;

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;

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;

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;

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;

, J. J. López Manzano, J. Rodríguez Cid, C. Garcés Segura, M. T. Llorens Rufach
Anales de Medicina Interna, Volume 25, pp 325-330;

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;

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;

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.
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