[The Sister Joseph's nodule-like manifestation of carcinoma of unknown origin: presentation of one case]. / Nódulo de la hermana María José como manifestación de cáncer de origen desconocido: presentación de un caso.

The Sister Joseph's nodule represents an umbilical cutaneous metastasis. It is related to one intraabdominal neoplasia habitually. We presents a 71-year-old male, with the Sister Joseph's nodule, detected in the context of unknown origin carcinoma. The fine needle aspiration cytology (FNAC) of the Sister Joseph's nodule showed carcinoma. We comments the usefulness diagnosis of this clinical sign and the poor prognosis that it represents.

Nocardiosis in a tertiary care hospital on the island of Gran Canaria.

Background: Nocardiosis is an uncommon but serious infection increasingly found in immunosuppressed persons. We describe 14 cases of nocardial infection seen at a tertiary hospital. Methods: All positive Nocardia cultures isolated from 1991 to 2002 were included. We analyzed predisposing factors, epidemiological and clinical features, laboratory and radiological findings, site(s) of infection, antimicrobial susceptibility pattern, treatment, and outcome. Factors related to mortality were analyzed. Results: Nineteen patients with a Nocardia isolate were identified and 14 were finally included. The most common predisposing factors included pulmonary diseases (71.4%), diabetes mellitus (35.7%), systemic diseases (28.6%) and immunosuppressive therapy (28.6%). The site of infection was pulmonary in 12 cases (85.71%), cutaneous or subcutaneous in one case (7.1%), and disseminated in another case (7.1%). The predominant clinical symptom was purulent expectoration (71.4%) while the predominant radiological pattern was a reticulonodular infiltrate (6/12, 50%). Relapse was observed in one case (7.7%) and death in three cases (23.1%). Diabetes mellitus was associated with the mortality rate (p=0.035). Treatment was highly individualized, but trimethoprim (TMP)-sulfamethoxazole (SMX) was the combination most often used. Conclusions: Nocardiosis should be part of the differential diagnosis for patients presenting with pulmonary symptoms, soft tissue infection, or brain abscess.

[Diagnostic usefulness of Alcohol Use Disorders Identification Test (AUDIT) for detecting hazardous alcohol consumption in primary care settings]. / Utilidad diagnóstica del cuestionario Alcohol Use Disorders Identification Test (AUDIT) para detectar el consumo de alcohol de riesgo en atención primaria.

BACKGROUND: To evaluate the diagnostic usefulness of AUDIT (Alcohol Use Disorders Identification Test) for detecting hazardous alcohol consumption in primary care settings, to assess the potential differences according to age or sex and to compare its diagnostic value with that of other conventionally used measures (CAGE questionnaire and biological markers). PATIENTS AND METHOD: This is a descriptive cross-sectional study for evaluation of diagnostic tests with 500 participating patients randomly selected among those attending a family health care center. Data about alcohol intake were collected using a semistructured interview, considering as hazardous alcohol consumption a weekly intake of 35 SDUs (standard drink unit) or above for men and 21 for women. AUDIT and CAGE questionnaires were administered and blood levels of GGT, MCV, AST, ALT, alkaline phosphatase, platelets, tryglicerides and uric acid were determined. For each one of those sensitivity, specificity, global value, predictive values, positive and negative probability ratio were calculated as well as ROC analysis for the questionnaires. RESULTS: Sensitivity of AUDIT in detecting current hazardous drinkers was 89%, specificity was 93% and area under ROC was 0.98 (95% CI, 0.96-0.99). Its sensitivity was found to be lower in the female group (60 vs. 78%) as well as for age group under 60 years (86 vs. 100%). CAGE questionnaire showed a sensitivity of 48% and a specificity of 97%. Biological markers offered sensitivities lower than 40% and specificities over 90%. CONCLUSIONS: AUDIT is a useful tool for detecting hazardous alcohol consumption in ambulatory care. Its sensitivity being lower for women and its diagnostic usefulness significantly exceeding that of other screening measures commonly used.

[Genetic polymorphism of vitamin D receptor and osteoporosis]. / Polimorfismo genético del receptor de la vitamina D y osteoporosis.

BACKGROUND: Genetic factors condition an important part of bone mass. The role of vitamin D receptor polymorphism (VDR) as genetic marker of osteoporosis is a matter of discussion. We have studied the possible influence of VDR on bone remodelling, calciotropic hormones, on the presence of osteoporosis and osteoporotic bone fractures. PATIENTS, CONTROL POPULATION AND METHODS: A case-control study. We have studied a total of 127 postmenopausal Canarian women from Canary Islands, Spain; 66 healthy controls and 61 with the diagnosis of osteoporosis, which was made by clinical, radiological and densitometric criteria. 17 osteoporotic women have had a fracture: Colles, hip or vertebral (spinal deformity index) fracture. VDR were determined by PCR directed to demonstrate the presence (b) or absence (B) of a restriction target for Bsml in intron 7. We analyzed some biochemical markers of bone remodelling: serum levels of alkaline phosphatase, tartrate resistant acid phosphatase and urine ratios of calcium/creatinine and hydroxyproline/creatinine. We also determined calciotropic hormones: parathyroid hormone and calcitonin. Bone mass was measured by DEXA and TC. RESULTS: There were no significant differences in either biochemical bone remodelling markers or in bone mass between the three genotypes: bb, Bb and BB, either in controls or in osteoporotic women with the exception of alkaline phosphatase which had a significative increase compared to control in women with unfavorable alleles distribution (bB and BB). Distribution of genotypes was similar between controls and osteoporotic women, with or without fractures. CONCLUSIONS: In Canarian women, VDR genotype is not associated with changes in biochemical markers of bone remodelling or in bone mass or with the presence of osteoporosis or osteoporotic fractures.

Reduction of serum cholesterol and low-density lipoprotein cholesterol levels in a juvenile population after isocaloric substitution of whole milk with a milk preparation (skimmed milk enriched with oleic acid).

OBJECTIVE: To study the effects of serum lipid levels by isocaloric substitution of whole milk intake in a group of children with a milk preparation (fat-free milk enriched with oleic acid containing a small amount of cholesterol) that is frequently consumed in our community. DESIGN: A crossover clinical trial was carried out with random selection. There were 88 children of both sexes, ranging in age from 3 to 9 years, selected at a Primary Care Center. The children were divided into two homogeneous groups. The first group consumed whole milk for the first 7-month study period, whereas the second group drank the milk substitute. At the end of the first test period, serum lipid levels were measured. Then the type of diet was reversed: Group 1 children consumed the milk substitute whereas Group 2 children drank whole milk. The rest of their intake did not vary throughout the study. At the end of the second 7-month period we measured serum lipid levels again. The levels of serum lipid evaluated were total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, Apoprotein A1, Apoprotein B, and lipoprotein (a). For the statistical analysis the nonpaired and paired t tests were used. RESULTS: The mean level of cholesterol after taking whole milk was 4.53 mmol/L (175.26 mg/dl), and the mean level after taking the milk preparation was 4.2 mmol/L (162.65 mg/dl), which indicates a 7.2% decrease. The mean level of low-density lipoprotein cholesterol after whole milk intake was 2.73 mmol/L (106.1 mg/dl), whereas after consuming the milk preparation it was 2.47 mmol/L (96.1 mg/dl), which indicates a decrease of 9.5%. Triglycerides were reduced from 0.83 mmol/L (73.53 mg/dl) after whole milk to 0.72 mmol/L (63.79 mg/dl) after the milk substitute, which suggests a 13.25% decrease. High-density lipoprotein cholesterol, apoprotein A1, apoprotein B, and lipoprotein (a) did not undergo any significant change. CONCLUSIONS: To reduce serum levels of total cholesterol and low-density lipoprotein cholesterol, without reducing caloric intake, it may be beneficial to substitute the whole milk customarily consumed by children with a milk preparation of fat-free milk enriched with oleic acid.

[Distribution of habits related to health in a female Canarian population]. / Distribución de hábitos relacionados con la salud en una población femenina canaria.

BACKGROUND: To compare several anthropometric variables, obesity and some life-style (tobacco, coffee and alcohol consumption and physical activity during leisure time) in women 45 years old and older. METHODS: From the 1991 electoral roll, we obtained a population of 1221 women aged more than 45 years living in the island of Gran Canaria. A questionnaire and a physical examination including weight and height with light clothes was performed in every woman. Obesity was defined according to the Quetelet index, and weight (in kg) divided by height (in m) at square. RESULTS: Rural women aged more than 45 years old are heavier, have a larger corporal surface, have a higher Quetelet index, smoke less and do greater activity during leisure time than urban women the same age. We found no differences either in alcohol or coffee consumption. CONCLUSIONS: There are statistically significant differences between women that live in rural and urban habitats. Anthropometric variables (weight, corporal surface, Quetelet index) show higher values in rural women than in urban ones. On the other hand, tobacco consumption and sadentarism have a higher prevalence in the urban women compared to rural ones.

[Morbidity and mortality of osteoporotic proximal femoral fracture after one year follow-up]. / Morbilidad y mortalidad de la fractura osteoporótica de la extremidad proximal del fémur tras un año de seguimiento.

BACKGROUND: The aim of the present study was to follow for a year all the osteoporotic proximal femoral fractures that happened in the island of Gran Canaria during 1990 and to analyze: a) mortality; b) the degree of functional capacity; c) their destination after being attended from the fracture. METHODS: Personal interviews were performed in almost every patient (68%), either directly to them or the relatives who were at their care (23.5%), after excluding those patients who died during the acute phase (7.6%) a year after the fracture. Two patients were missed (0.9%). We had the collaboration of every public and private center in the island. 209 patients (154 women and 55 men) were interviewed. Age mean of the patients was 77.1 +/- 10.9 years. The degree of functional capacity was determined by Karnofsky scale. RESULTS: Mortality within the acute phase was 7.6%, rising to 20.8% 6 months later and to 30.7% after a year. There was an important disability in 30.7% of the remainder living patients. In the postsurgical period, 18% of the patients were transferred to a center for chronic care and 25% to a rehabilitation center. Although 48.9% of the patients are discharged to their homes from the hospital, surprisingly, when they die, only 15% do so in their homes, while 59% of the patients die in a center for chronic care. CONCLUSIONS: Osteoporotic proximal femoral fracture produces an important mortality within the first year after fracture, and also an important deterioration of functional capacity. Most of the patients are admitted later on and die in a center for chronic care.

[Tuberculosis as risk factor for venous thrombosis]. / La tuberculosis como factor de riesgo de trombosis venosa.

Over a 2-year period, 3 patients with deep venous thrombosis associated to advanced pulmonary tuberculosis have been observed. One of them died suddenly, probably due to thromboembolic complications. In the other two cases, a triggering factor of venous thrombosis, probably related to tuberculosis, was detected and their evolution was satisfactory. The high frequency of antiphospholipid antibodies detected in the tuberculosis and the potential relationship between these and deficit of protein S is mentioned. Advanced pulmonary tuberculosis is described as a risk factor for the development of venous thrombosis in patients with negative serology for human immunodeficiency virus type 1 and 2. We recommend not to use deep venous catheters and we stress the potential value of heparin prophylactic therapy in order to prevent venous thrombosis and its complications.

[Alterations in osmoregulation in the elderly]. / Alteraciones en la osmorregulación en el anciano.

In the present work we study the modifications in hydrosaline metabolism which occurred in two groups of healthy male individuals, one consisting of 15 young men (mean age of 20 years) and the other of 30 elderly subjects (mean age of 75 years) when the thirst test was performed for 48 hours. After performing the thirst test we observed that the elderly were less thirsty than the young group and that the former presented more marked alterations in the hydrosaline metabolisms. Thus, the elderly presented at the end of the test higher serum and urine sodium levels, a greater serum osmolarity and higher plasmatic ADH levels both basal and at the end of the test. However, inspite of all this, the elderly scarcely reduced their diuresis and urinary osmotic values were much lower (almost half) than the young subjects. The mechanism for which these alterations occur is probably multifactorial, in which the decrease in glomerular filtrate, the increase in filtration fraction, the proportional increase in medullar flux together with some tubular resistance to ADH action could intervene.

[Idiopathic myelofibrosis with cutaneous extramedullary hematopoiesis]. / Mielofibrosis idiopática con hematopoyesis extramedular cutánea.

Idiopathic myelofibrosis is a chronic myeloproliferative syndrome characterized by the proliferation of the three hemopoietic series and the marrow connective tissue and the development of extramedullary hemopoiesis in the liver and spleen. Cutaneous extramedullary hemopoiesis is and uncommon finding, and only thirteen cases have been reported up to now. We report the first case in the Spanish literature. The patient was a 78-year-old male in whom skin lesions preceded the diagnosis of myelofibrosis. These lesions, consisting of violet coloured maculae and papulae, contained elements from the three hemopoietic series. Therapy with hydroxyurea was started, but the patient died because of cardiorespiratory complications.