[Chimerism: origin and medical implications]. / Quimerismo: origen e implicaciones médicas.

The organism whose cells come from different individuals is called chimera. It is frequently observed in nature: pregnancy, organ transplantation or transfusion are considered chimeric cell sources. It has been involved in autoimmune diseases development such as scleroderma, because of similarities between it and graft versus host disease, long term persistence of fetal cells in women and the finding of greater number of chimeric cells in affected women than healthy ones. It is not strictly a disease but might be considered helpful in non-invasive prenatal diagnosis and damaged organs regeneration.

[Arterial hypertension and lipid metabolism]. / Hipertensión arterial y metabolismo lipídico.

The frequent connection between essential hypertension and lipid metabolism alterations has led doctors to look for possible pathogenic links between them. Common genetic factors as well as exogenous factors, like diet, have been described. The pathogenic mechanisms through which genetic or exogenic causes work, would be changes in cellular functions. This would be especially so in the case of membrane transporters and insulin resistance which may be a consequence, or a cause, of high blood pressure, but which give rise to lipid metabolism alterations. It is advisable to follow dietetic hygiene measures to combat hypertension and dyslipemic disorders, such as: weight loss, reduction of saturated fats fibre intake reduction of salt and alcoholic drinks, abstaining from tobacco and doing regular aerobic exercise. We will choose the drugs whose structure and doses will not alter lipid levels and will increase insulin sensitivity.

[Stays occasioned by patients hospitalized in internal medicine services]. / Estancias ocasionadas por los pacientes hospitalizados en los Servicios de Medicina Interna.

BACKGROUND: Study of average stay in Department of Internal Medicine. METHODS: Prospective descriptive study in which different clinical-epidemiological variables and their relation with average stay are analysed. RESULTS: Length of stay: 13.23 +/- 11.04 days. Increase in the average stay related to age, specially between 65 and 74 years, and among 45 and 55 (p = 0.02). Longer stays among those admitted from Other Departments and Urgencies (p = 0.04), and those destined to Hospitals for Chronic Patients (p = 0.0001). CONCLUSIONS: Alternative formulas to the conventional hospitalization, coordination among different sanitary levels and others clinical measures would contribute to reduce this parameter.

[Hospital-based evaluation of knowledge about their illness in a diabetic population]. / Valoración del nivel de conocimientos sobre su enfermedad en una población diabética hospitalaria.

OBJECTIVE: To evaluate a group of diabetics' understanding of their illness, both generally and in detail in various ways. Their understanding was also assessed in relation to gender, age, educational level, the type and length of evolution of their diabetes mellitus and what sort of diabetes training they had received. DESIGN: The study was observational. A questionnaire completed at a personal interview was used to collect data. SETTING: Hospital out-patient endocrinology clinics. PATIENTS AND OTHER PARTICIPANTS: 520 diabetics who attended out-patient clinics were selected. 35 were excluded because of auditory, linguistic or psychological problems. One patient refused to take part. MEASUREMENTS AND MAIN RESULTS: Sufficient understanding was observed only in the area concerning "glucose in the blood" (79.08% of right answers). With the exception of the length of the illness, a certain relationship between patients' understanding (both in determined areas and in general) and the rest of the variables was revealed. CONCLUSIONS: Except for understanding about the level of "glucose in the blood" important educational deficiencies in the group under study were detected. This showed the need to prioritise improvements in diabetes training, so that patients can better monitor their condition.

[Diuretics in the treatment of arterial hypertension in the aged]. / Los diuréticos en el tratamiento de la hipertensión arterial del anciano.

Diuretics have been used in the treatment of arterial hypertension (AHT) for more than 30 years. However, its use as first-step drugs has been recently questioned, due to their "negative" effects on other cardiovascular risk factors and the lower than expected remission of the coronary artery disease. Based on the last interventionist studies on the AHT among the elderly, it seems that this statement can be put in doubt. The application of some general rules in the treatment of AHT and a rational and careful use of diuretics, allow them to play a relevant role, even nowadays, in the treatment of AHT among the elderly.

[Study of smoking habit among the adult population of Aragón]. / Estudio del hábito tabáquico en población adulta aragonesa.

We determined the prevalence of tobacco consumption among the general population and established its distribution considering socioeconomical variables. We performed a cross-sectional study with 2781 subjects from 93 rural and urban areas, selected by randomized, census-based, multi-staged and stratified sampling. 40.9% of the population from Aragon are regular smokers (58.6 of men and 23% of women). Heavy smokers comprise 17.2% of the total (30.1% of men and 3.8% of women). The higher proportion of smokers in observed among single men over 40 and single women under 40. The percentage of smokers is lower among 20 to 29-years-old young people from high socio-economical than from low levels. In general, the mean percentage of smokers among men and, specially, among women from rural areas is higher than in the rural areas. In Aragon, tobacco is a risk factor affecting 41% of the adult population and, specially, young people, men, single persons from both sexes and living in urban areas. It seems that young people with a high socio-economical level are becoming smokers at a lower frequency.

[Rare manifestations of diabetic neuropathy]. / Manifestaciones poco frecuentes de la neuropatía diabética.

Up to 50% of diabetic patients develop neuropathies during their lives. Distal symmetric polyneuropathy is the most frequent variety, but there are other forms that are not exceptional and must be considered for the differential diagnosis of these patients. In this paper, the authors present three clinical cases of rare types of diabetic neuropathy: oculomotor cranial neuropathy (Case 1), diabetic amyotrophia (Case 2) and mixoide type with proximal asymmetrical locomotor neuropathy and distal polyneuropathy (Case 3). Their most relevant clinical characteristics are described, along with their differential diagnosis, evolution and therapeutical alternatives, in order to contribute to a better management of these patients.

[Cerebrovascular accident: study of risk factors and development in 154 cases]. / Accidente cerebrovascular: estudio de los factores de riesgo y evolución en 154 casos.

A retrospective study of 194 patients is carried out. Patients were divided into two groups: 154 patients with acute cerebrovascular accident (ACA) and 40 patients without vascular pathology, hospitalized for other causes. A descriptive analysis of these patients is made with respect to age, sex, type of ACA, previous ACA and potential relationship between the type of this first ACA and the one motivating current hospitalization. In addition, ACA is related to risk factors (hypertension, dyslipemia, diabetes, cardiopathy). In our series, variables that can be considered as risk factors, with significant differences between both groups, are: HTA, tobacco consumption, cardiopathy, dyslipemia (hypercholesterolemia and hypertriglycemia, hyperuricemia and diabetes. Alcoholism, anticoagulation, antiaggregation or polyglobulia were not risk factors. In 33.2% of patients with current ACAs, there were antecedent of clinically documented cerebrovascular pathology; one thing of them were transitory cerebral ischemias and more than half of them, cerebral infarcts. In conclusion, we stressed the role of primary and secondary prevention acting against risk factors, given the recurrence of this pathology and the irreversibility of the injuries once happened.

[Idiopathic retroperitoneal fibrosis. An atypical case of multisystem presentation]. / Fibrosis retroperitoneal idiopática. Un caso atípico de presentación multisistémica.

Idiopathic retroperitoneal fibrosis (IRF) is a disease difficult to diagnose. It is considered by different authors of autoimmune origin given its similarity to other connective tissue diseases. We present the case of a female patient diagnosed by a postmortem study, of IRF with multiorgan involvement (lymph nodes, serose tissue, liver, spleen, adrenal glands, thyroid and kidneys) and atypical presentation, not finding other similar cases in the national literature.

[Double heart prosthesis in a patient with rheumatoid arthritis]. / Doble prótesis cardiaca en un paciente con artritis reumatoide.

The incidence of rheumatoid valvular disease is among 2.5% to 30% of necropsy patients with rheumatoid arthritis. The valves may be affected by a granulomatous form patognomonic, or by unspecific inflammatory changes (the most frequent 90-99%). We present a patient affected by a classical seropositive rheumatoid arthritis accompanied by mixed stenosis and incompetence of both mitral and aortic valves. The patient underwent replacement of both valves, and typical unspecific inflammatory changes were detected histologically in the valvular tissues. Replacement of the valves by a prosthesis is the choice treatment despite severe joint disease. The echocardiography is the ideal method for detection of cases with subclinic lesions and to continue evolution.