[Chronic thromboembolic pulmonary hypertension associated with endomyocardial fibrosis of the right ventricle]. / Hipertensión pulmonar tromboembólica crónica asociada a fribrosis endomiocárdica del ventrículo derecho.

Chronic thromboembolic pulmonary hypertension is a rare sequela to an acute untreated or recurrent pulmonary embolism. The mechanisms that underlie the failure to resolve the thrombus are still uncertain. As most patients are not diagnosed until a relatively late stage, little is known about the course of their illness. We report the case of a 51-year-old woman who had previously been diagnosed with and operated on for endomyocardial fibrosis of the right ventricle and who developed chronic thromboembolic pulmonary hypertension several years later.

[Referrals from primary care to pneumology: influence of attendance patterns and specialisation]. / Derivaciones desde atención primaria a neumología: influencia del modelo asistencial y especialización.

OBJECTIVE: To study the number and quality of the referrals from primary care to pneumology. To analyse their relationship to specialist medical training and the attendance pattern. DESIGN: A descriptive, retrospective study. SETTING: A Pneumology Clinic at the Peripheral Specialities Centre at Cartuja (Granada). PATIENTS AND OTHER PARTICIPANTS: 597 referrals were gathered. These were for all the patients referred from primary care to this clinic from may to december 1992. MEASUREMENTS AND MAIN RESULTS: The overall population referral rate per 100,000 inhabitants and month of study was 39.73. The out-clinic doctors referred twice as many patients as health centre (HC) doctors, with OR = 2.01 (1.70 < OR < 2.36). Taken together, general physicians referred three times more than family doctors, with OR = 3.04 (2.54 < OR < 3.78). Regarding the quality of the referral documents, HC doctors accompanied a referral with sufficient information eleven times more often than out-clinic doctors, with OR = 11.38 (6.13 < OR < 21.47). Family doctors contributed this "correct" information thirteen times more often than general physicians without specialist training: OR = 13.50 (8.06 < OR < 22.67). CONCLUSIONS: The number and quality of referrals appear to be closely related to the attendance pattern and in particular to the specialist training of health professionals.

[Varicella pneumonia in a healthy adult. Review of risk factors and treatment]. / Neumonia varicelosa en un adulto sano. Revisión de factores de riesgo y tratamiento.

We present the case of a healthy adult patient without underlying risk factors, who developed bilateral pneumonia and respiratory failure during an outbreak in his family of infection by the Varicella-Zoster virus. IV. acyclovir treatment was begun with good clinical and radiological response and improvement in blood-oxygen levels. We review below risk factors and patients susceptible to treatment with acyclovir.