[Idiopathic cholestasis associated with bloody diarrhea as the first manifestation of Hodgkin's lymphoma]. / Colestasis idiopática asociada a diarrea sanguinolenta como primera manifestación de linfoma de Hodgkin.

Jaundice in Hodgkin's disease occurs in 3-13% of the cases reported in the medical literature and can be due to several causes. Cholestatic jaundice associated with ductopenia may be a consequence of an associated paraneoplastic process and can occur several months before the development of Hodgkin's disease. When there is a finding of jaundice of unknown etiology associated with ductopenia, the possible existence of Hodgkin's disease should be investigated. We describe a case of cholestatic jaundice associated with Hodgkin's disease. The first clinical and laboratory manifestations were symptoms of bloody diarrhea months before the development of Hodgkin's disease. We discuss the differential diagnoses considered, given the complexity of the case.

[Results of pulmonary embolism treatment in a tertiary hospital short stay unit. Is this the right place?]. / Resultados del tratamiento médico de la embolia de pulmón en una unidad de corta estancia de un hospital de tercer nivel: ¿es el lugar adecuado?

OBJECTIVES: To determine the mean stay (MS) of patients with pulmonary embolism (PE) in a thrombosis unit (TU) with a short stay unit (SSU) in a tertiary hospital. To compare the data collected with those of other hospitals in the same region, of other regions (Autonomous Communities [AACC]), and within the same hospital in the year before the SSU opened. MATERIAL AND METHODS: A descriptive retrospective observational study that included patients with a diagnosis of PE in the University Hospital Virgen de la Arrixaca (HCUVA) in 2012. These data were classified by hospital department, and used for calculating the mean stay. This was then compared with that of other hospitals in our region, with the rest of the regions, and with the data in 2007 (the last year without a TU). RESULTS: A total of 113patients with PE were included, 60 (53%) in the TU with an MS of 4.39, in Oncology, 7.45, and Internal Medicine (IM), 15.38days. There were no deaths in the TU and only 3 (5%) readmissions. Published data showed that the MS in all hospitals in our region was 8.25, 5.18 in our hospital, and higher in the rest of hospitals. The best AACC was the Basque Country with an MS of 6.85days. In 2007, there were 70patients with PE in the HCUVA, 34 (49%) in IM, with an MS of 8.50, Oncology 11 (31%) with an MS 9.64, and Chest Diseases 3 (4.3%) with an MS 19days, and with an overall mortality of 11% and a rate of readmissions in IM of 6%. CONCLUSION: The mean stay for a PE in the SSU of a TU was lower than in the rest of the hospital departments, lower than the rest hospitals of our region, lower than the rest of the regions, and lower than any department of our hospital before the SSU existed, without increasing the readmission or mortality rate.

Rhabdomyolysis after initial session of indoor cycling: analysis of 11 patients.

AIM: The aim of this paper was to highlight the special frequency of cases of rhabdomyolysis related to the practice of indoor cycling and to define the characteristics, course, and outcome of this disease. METHODS: Retrospective review of clinical histories of patients diagnosed with rhabdomyolysis after indoor cycling in our unit from January 2012 to April 2013. RESULTS: Eleven patients were analyzed. All patients, regardless of the degree of previous physical training, were diagnosed after a first session of indoor cycling. Mean age was 27.63 years (SD=5.74). Fifty-four percent were women. Creatine kinase (CK) levels gradually decreased in response to rest and intensive intravenous hydration. Only in two cases was renal failure observed, and in none were electrolyte disorders, disseminated intravascular coagulation (DIC) or compartmental syndrome detected. CONCLUSION: A first session of indoor cycling has become a common cause of rhabdomyolysis secondary to the physical exercise in recent years, which should alert those responsible for teaching this sport of the need for a gradual start under adequate hydration and environmental conditions, because although the condition has a benign course with adequate treatment and the complication rate is low, there are patients with increased susceptibility to very high CK blood levels requiring hospitalization for treatment and follow-up of possible complications.

Planimetric and histological study of the aortae in atherosclerotic chickens treated with nifedipine, verapamil and diltiazem.

Calcium appears to be involved in many of the cellular events which are thought to be important in atherogenesis. Calcium channel blockers have been shown to reduce arterial lipid accumulation in animals without altering serum cholesterol. Avian models of atherosclerosis offer economic and technical advantages over mammalian models. In this study, we examine the effects of nifedipine, verapamil and diltiazem at clinical and higher doses, on the extent of atherosclerosis of egg-fed chickens. In order to assess the extent of atherosclerosis quantitatively, the aortic lesions of the thoracic and abdominal aorta, aortic arch and supraaortic regions were measured by planimetry. Atherosclerotic lesions were evaluated histologically. Statistically significant reductions in the lipid deposition of the aorta were found in all the treated groups. The extent and distribution of atherosclerotic lesions were decreased in a significant way by verapamil, nifedipine and diltiazem. The higher the dosage used, the higher the regression of the atherosclerotic lesions. At clinical dosage, nifedipine showed the highest decrease of the lesions. In addition, the chicken atherosclerosis model has proved itself useful and very suitable for in vivo drug intervention studies.

[Multiple angiodysplasia of the small intestine. A diagnostic and therapeutic challenge]. / Angiodisplasia múltiple de intestino delgado. Un reto diagnóstico y terapéutico.

Small bowel bleeding is infrequent and presents a challenge to the clinician. Approximately 30-40% of gastrointestinal bleeding localized in the small bowel is due to angiodysplasia, a vascular malformation. We present the case of a patient with multiple angiodysplasia of the small bowel who required push enteroscopy and capsule endoscopy to establish the diagnosis. Treatment with subcutaneous octreotide was successful. In conclusion, in doubtful cases or in patients with persistent hemorrhage, capsule endoscopy can improve the diagnostic yield of enteroscopy in bleeding gastrointestinal vascular lesions such as angiodysplasia. Endoscopic treatment (laser coagulation) and drug therapy (somatostatin or analogs) are valid alternatives in inoperable or non-resectable cases.

[Thoracic and retroperitoneal dissemination of multiple myeloma. 2 cases]. / Diseminación torácica y retroperitoneal del mieloma múltiple. Dos observaciones.

The dissemination of multiple myeloma out of the bone marrow is very rare, even though the observation of plasmacytosis in the bodies of patients having died of this disease is not rare. We present 2 patients affected by multiple myeloma and with extra-bone marrow plasmacytomas at the diagnosis, localized at posterior mediastinum and retroperitoneum, discovered by tomography.

[McArdle disease: report of four brothers with myophosphorylase deficiency]. / Enfermedad de McArdle: descripción de cuatro hermanos con déficit de miofosforilasa.

Myophosphorylase deficiency, or McArdle disease, is an uncommon entity. The gene for human myophosphorylase has been cloned and is located on chromosome 11, in keeping with the autosomal recessive nature of the disease and there is an excess of male patients. The diagnosis is established by documentation of elevated glycogen content and reduced phosphorylase activity in biopsied muscle tissue. We report four cases with McArdle disease which were 16, 15, 11 and 5 years old. They were brothers, and they came to the hospital because of pain, cramps and myoglobinuria after exercise or infection; in the first case, a male patient, myoglobinuria caused acute renal failure. Three of them showed reduced phosphorylase activity in biopsied muscle tissue. We discuss the different therapeutic possibilities.

Resultados del tratamiento médico de la embolia de pulmón en una unidad de corta estancia de un hospital de tercer nivel: ¿es el lugar adecuado? / Results of pulmonary embolism treatment in a tertiary hospital short stay unit. Is this the right place?

Objetivo. Describir la estancia media (EM) de la embolia de pulmón (EP) en una unidad de trombosis (UT) dependiente de una unidad de corta estancia (UCE) de un hospital de tercer nivel. Comparar estos datos con el resto de hospitales de nuestra región, con los del resto de comunidades autónomas (CCAA) y con el mismo hospital durante un año previo a nuestra existencia. Material y método. Estudio observacional retrospectivo descriptivo en el que se incluyeron los pacientes con diagnóstico de EP en el Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA) durante el año 2012. Clasificamos estos datos por servicio hospitalario, calculando la EM. Comparamos esta con la del resto de hospitales de nuestra región, con el resto de CCAA y con nuestros datos en el año 2007, cuando no existía aun la UT. Resultados. Se incluyeron 113 pacientes: 60 (53%) ingresaron en la UT, siendo la EM de 4,39 días, en Oncología, de 7,45, y en Medicina Interna (MI), de 15,38. No hubo ningún fallecido en la UT y solo se produjeron 3 reingresos (5%). Los datos publicados mostraron que la EM en todos los hospitales de nuestra región fue de 8,25 días; en nuestro hospital fue de 5,18 días y en el resto de hospitales, mayor. La CCAA con mejor EM fue el País Vasco con 6,85 días. En el año 2007, hubo 70 pacientes con EP en el HCUVA: 34 (49%) en MI con una EM de 8,50 días, 11 (31%) en Oncología con una EM de 9,64 días y 3 (4,3%) en Neumología, con una EM de 19 días; la mortalidad global fue del 11% y la tasa de reingresos en MI, del 6%. Conclusión. La EM de la EP en la UT en una UCE fue menor que en el resto de servicios de nuestro hospital, menor que en el resto de hospitales de nuestra comunidad, menor que en el resto de CCAA y menor que en cualquier servicio de nuestro hospital en una época anterior a nuestra existencia, sin aumentar la tasa de reingreso ni la mortalidad (AU)

Objectives. To determine the mean stay (MS) of patients with pulmonary embolism (PE) in a thrombosis unit (TU) with a short stay unit (SSU) in a tertiary hospital. To compare the data collected with those of other hospitals in the same region, of other regions (Autonomous Communities [AACC]), and within the same hospital in the year before the SSU opened. Material and methods. A descriptive retrospective observational study that included patients with a diagnosis of PE in the University Hospital Virgen de la Arrixaca (HCUVA) in 2012. These data were classified by hospital department, and used for calculating the mean stay. This was then compared with that of other hospitals in our region, with the rest of the regions, and with the data in 2007 (the last year without a TU). Results. A total of 113 patients with PE were included, 60 (53%) in the TU with an MS of 4.39, in Oncology, 7.45, and Internal Medicine (IM), 15.38 days. There were no deaths in the TU and only 3 (5%) readmissions. Published data showed that the MS in all hospitals in our region was 8.25, 5.18 in our hospital, and higher in the rest of hospitals. The best AACC was the Basque Country with an MS of 6.85 days. In 2007, there were 70 patients with PE in the HCUVA, 34 (49%) in IM, with an MS of 8.50, Oncology 11 (31%) with an MS 9.64, and Chest Diseases 3 (4.3%) with an MS 19 days, and with an overall mortality of 11% and a rate of readmissions in IM of 6%. Conclusion. The mean stay for a PE in the SSU of a TU was lower than in the rest of the hospital departments, lower than the rest hospitals of our region, lower than the rest of the regions, and lower than any department of our hospital before the SSU existed, without increasing the readmission or mortality rate (AU)

Effects of atorvastatin on progression-regression of renal injury in hyperlipidemic chickens.

Complex interrelationships exist between hyperlipidemia and the progression of renal injury. The aim of this study was to evaluate the impact of high plasma cholesterol and triglyceride levels on renal structure and the effects of atorvastatin on progression-regression of renal injury. One-hundred chickens were divided into five groups: Group A: Standard diet (SD) for 6 months; Group B: Hyperlipidemic diet (HD) for 6 months; Group C: HD for three months and SD during the next 3 months; Group D: HD for 3 months and SD during the next 3 months, when they received oral atorvastatin (3 mg/kg/d); Group E: HD for the whole 6 months, and atorvastatin (3 mg/kg/d) during the last 3 months. Increased alpha-actine immunostaining was found in glomeruli of groups B and C. An important decrease of immunostaining was observed in glomeruli of atorvastatin treated groups. Group D showed the lowest value for presence of lipids, and significant differences were found with respect to the rest of the groups. The glomeruli of group B presented the highest damage grades and those of group D showed the lowest grades and presented significant differences from the rest of the groups. The combination of atorvastatin therapy and proper diet proved to be effective in promoting renal disease regression. However, the study of several parameters indicates that neither only diet nor atorvastatin in the progression group resulted completely effective in decreasing the progression of the disease.

Queilitis comisural como forma de presentación de una leishmaniasis cutánea crónica / Chronic cutaneous leishmaniasis presenting as commissural cheilitis

No disponible

Caracterización del pollo como biomodelo experimental en arteriosclerosis: lesiones en troncos supra-aórticos / Use of the chicken as experimental biomodel in atherosclerosis: supra-aortic lesions

La enfermedad cardiovascular es hoy en día la primera causa de mortalidad en las sociedades desarrolladas. Dada la complejidad del desarrollo de la lesión aterosclerótica en el ser humano resulta interesante investigar en modelos animales en los que dicho proceso sea semejante a la enfermedad humana. El pollo, al igual que otras aves, es capaz de desarrollar arteriosclerosis aórtica y coronaria de forma natural o espontánea, e inducida por una dieta enriquecida en colesterol. Teniendo en cuenta que la mayoría de los trabajos publicados describen las lesiones en segmentos aórticos y la variedad de métodos de inducción de la arteriosclerosis, el objetivo de esta investigación es caracterizar de manera adecuada en el modelo aviar utilizado, las lesiones arterioscleróticas de troncos supra-aórticos en un grupo experimental con respecto a un grupo control. Se emplearon 20 pollos de la raza White Leghorn divididos en dos grupos (control y aterogénico) que recibían una dieta normal o hiperlipémica respectivamente durante un periodo de 6 meses. Se sacrificaron entonces los animales para llevar a cabo el estudio bioquímico del plasma (perfil lipídico), evaluación histológica de los troncos supra-aórticos y valoración semicuantitativa de las lesiones según la clasificación de Stary. Se observaron diferencias estadísticamente significativas entre ambos grupos para los diferentes parámetros bioquímicos estudiados y para la cuantificación del grado de lesión de Stary. En el grupo aterogénico se observó un endotelio conservado, con íntimas muy aumentadas de tamaño (10 veces el tamaño del grupo control) y muy desorganizadas. En conclusión, estos hallazgos confirman el uso del pollo como biomodelo experimental para el estudio de la arteriosclerosis en troncos supra-aórticos, y podrían ser empleados como referencia para futuros estudios intervencionistas(AU)

Cardiovascular diseases are considered first cause of human mortality in developed countries. Animal models allow adequate research of atherosclerosis, given the similarities with the human lesions. Chickens may develop spontaneous and also induced atherosclerosis by use of a cholesterol-enriched diet. Most published findings describe aortic lesions in a variety of induction methods. Therefore, the aim of this research is to characterize the used avian model, describing supra-aortic trunk lesions in atherosclerotic chickens and to compare it with control animals. Twenty White Leghorn chickens were used (10 controls fed with a normal diet and 10 atherogenic animals fed with a hyperlipidemic diet, for 6 months). After sacrifice, lipid biochemical parameters were analysed, as well as histologic evaluation of supra-aortic vessels and quantification of lesions following the Stary classification. Statistically significant differences for each parameter were observed between the control and experimental groups. Increased intima layer width with disorganization was observed in atherogenic animals. These findings confirm the use of the chicken as an adequate experimental animal for atherosclerosis, and could be used as a reference for future interventional studies(AU)

Manifestación atipica de una lesión infrecuente: vídeo y ecoendoscopia de un schwanoma gástrico / Atipic manifestation of an infrequent lesion. Video- and ecoendoscopy in a gastric schwannoma

No disponible