[Dabigatran: transforming the management of oral anticoagulation]. / Dabigatrán: transformando el manejo del paciente anticoagulado.

The utility of oral anticoagulation with warfarin in thromboembolic disease has been demonstrated for several decades, although these drugs have significant problems in terms of adequate control, interactions and risk of bleeding. In the last decade, new anticoagulants have emerged. The first was dabigatran with a demonstrated anticoagulant effect approaching the ideal anticoagulant profile. The view that dabigatran transforms oral anticoagulation therapy has arisen from the RE-VOLUTION program, with more than 34000 patients analyzed. This program has confirmed the value of oral anticoagulation with dabigatran compared with other anticoagulants; this drug eliminates all the drawbacks of warfarin, benefitting both patients and the healthcare system. The growth of the aging population has increased the number of risk situations in which anticoagulation is used. There is now a drug that meets the criteria for the ideal anticoagulant, transforming the management of oral anticoagulation. The findings demonstrated with dabigatran in prior studies are progressively being transferred to clinical practice. Following the usual development of new drugs, and according to the latest Laurence Desmond stages, results in agreement with those of previous studies are expected, namely, indisputable improvements in oral anticoagulation for patients and the health system.

[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.

[Invasive infection by Aspergillus terreus treated successfully with liposomal amphotericin B]. / Infección invasiva por Aspergillus terreus tratada con éxito con anfotericina B liposomal.

A woman of 75 years old was admitted at our hospital for evaluation of worsening and weakness in inferior limbs. Several vertebral fractures by crushing, one doubtful discitis, an infiltrate with cavitation in the right superior lobe and one infiltrate in the left superior lobe were detected. In the biopsy of the consolidation a filamentous fungus was watched and in the bronchial washing specimen culture grew Aspergillus terreus. The infiltrates disappeared with liposomal Amphotericin B remaining with oral Itraconazol during three months more. The clinical and analytical data demonstrate the existence of a Overlap syndrome associate to antiphospholipid-antibody syndrome. We comment the peculiarity of the infection by Aspergillus terreus in patients who have not been in critical care and the good response at treatment with liposomal Amphotericin B. It contrasts with the high mortality referred in a recent review. Other aspects to comment are the coexistence with a collagen vascular and an antiphospholipid-antibody syndrome with the higher titles of IgM ACA that we have found in literature.

[Diagnostic usefulness of the questionnaire "Alcohol Use Disorders Identification Test" (AUDIT) to detect conditions associated with alcohol in hospitalized patients]. / Utilidad diagnóstica del cuestionario "Alcohol Use Disorders Identification Test" (AUDIT) para detectar trastornos relacionados con el alcohol en pacientes hospitalizados.

OBJECTIVE: To evaluate the diagnostic usefulness of AUDIT (Alcohol Use Disorders Identification Test) for detection of alcohol-related problems (ARP) among hospitalized patients, to assess the potential differences according to age or sex and to compare its diagnostic value with that of some other conventionally used measures (CAGE questionnaire and biological markers). MATERIAL AND METHODS: This is a cross-sectional study for evaluation of diagnostic tests including 179 hospitalized patients in a Medicine Unit. Data about weekly alcohol intake were collected through a semistructured interview. AUDIT and CAGE questionnaires were administered and blood levels of GGT, MCV, AST, ALT, alkaline phosphatase, platelet count, trylicerides and uric acid were determined. RESULTS: AUDIT sensitivity in detecting ARP was of 98%, specificity was of 94% and area under ROC was 0.99 (95% CI: 0.98-1). Its sensitivity was shown to be lower both in the female group (94% vs. 99%) and in age group under 60 years (97% vs. 100%). CAGE showed a sensitivity of 78% and a specificity of 99%. Among biological markers GGT and MCV should be highlighted with sensitivities of 83% and 74% and specificities of 53% and 74% respectively. CONCLUSIONS: AUDIT is an effective tool for detection of ARP among hospitalized patients. Its diagnostic usefulness being lower for females, similar for both age groups considered and clearly higher than that of other commonly used measures.

[Sweet's syndrome and motor neuron disease associated with esophageal carcinoma]. / Síndrome de Sweet y afectación de motoneurona asociados a carcinoma de esófago.

The paraneoplastic syndromes are an a group of clinical manifestations of uncommon frequency that they are associated with tumors and they often are precursors of these. The Sweet's syndrome is a dermatosis characterized by fever, erythematous plaques and infiltrate consisting of mature neutrophils. It occurs occasionally in association with hematologic malignancies and is very rare with solid tumors. The isolated motor neuron disease is rare like paraneoplastic syndrome. We report the case of a patient with epidermoid carcinoma of esophagus that it was diagnosed after beginning clinically with two paraneoplastic syndromes: Sweet's syndrome and motor neuron disease.

[Cardiopathy and human immunodeficiency virus infection: report of 2 cases]. / Cardiopatía e infección por el virus de la inmunodeficiencia humana: presentación de dos casos.

Two patients with immune deficiency virus infection and cardiac manifestation are presented. The first was admitted by encephalopathy. On the first days of hospital stay were observed episodes of supraventricular tachycardia with echocardiography normal. An initial improvement made us suppose the clinical context in relationship to toxoplasmosis. Subsequently the patient experienced neurological deterioration and pericardial effusion was evidenced. Therapeutic trials with ceftriaxone and tuberculostatics were useless. The postmortem pericardial aspiration showed signs of acute inflammation, but germs were not identified. The second case was admitted for longstanding fever. Because of epigastric pain an electrocardiogram was done, which revealed suggestive alterations of pericarditis. The echocardiography demonstrated the presence of pericardial effusion. The positive serology for toxoplasmosis, the bone marrow biopsy which showed reactivity with hemophagocytosis and the presence of myeloid metaplasia in the liver biopsy were the most relevant data. On the fifth day of hospital stay and second of the tuberculostatic treatment the patient expired unexpectedly.

[Recurrent bilateral paralysis: our 15-year experience]. / Parálisis recurrencial bilateral: nuestra experiencia en quince años.

We report our experience with the treatment of patients with bilateral vocal cord paralysis. The sample was small because the disease is rare. The therapeutic techniques first used were arytenoidopexy using King's technique and Graff-Woodman's arytenoidectomy with cordopexy. Cordectomy was used when other techniques failed. Nine of 11 patients were decannulated successfully. Tracheotomy was maintained in the other 2 for reasons unrelated with the initial picture. Breathing and voice quality were acceptable in all patients. Complications were limited to aspiration pneumonia. Cordectomy was necessary in 3 cases because conservative treatment was insufficient. Although the development of new techniques for treating this problem should continue, classic techniques remain valid. A case of paralysis caused by nitrocuanitin intoxication is reported.

[Liver fibrosis associated with hepatorenal polycystosis in adults]. / Fibrosis hepática asociada a poliquistosis hepatorrenal del adulto.

OBJECTIVE: A case of hepatic fibrosis in adult polycystic liver disease is reported. This association, commonly present in infancy, is exceptional in the adult polycystic liver disease. PATIENT: We report a 69-years-old female with adult polycystic kidney and liver disease with fatal hepatic failure, portal hypertension and renal failure. An autopsy was performed showing hepatic and renal polycystic disease with hepatic fibrosis. CONCLUSION: Hepatic fibrosis is a rarely associated phenomenon with adult polycystic liver disease. This data may suggest a relation of this entity with infancy fibropolycystic liver disease.

[Encephalopathy, convulsions and hypopotassemia in theophylline poisoning: a case analysis]. / Encefalopatía, convulsiones e hipopotasemia en la intoxicación teofilínica: análisis de un caso.

A 73-year-old man was admitted to our hospital after convulsive seizures preceded by encephalopathy lasting one week. He had a history of long-standing chronic obstructive pulmonary disease and analysis showed hypokalemia, respiratory alkalosis and toxic levels of theophylline. We discuss the severity of the convulsions and arrhythmias, the high incidence of hypokalemia in theophylline poisoning, as well as the role of hypokalemia in the pathogenesis of the convulsions and the high level of mortality in this type of intoxication. Other possible mechanisms involved in theophylline encephalopathy are mentioned, along with the controversial use of theophylline for continuous treatment of chronic obstructive pulmonary disease.