[Lipoid pneumonia: presentation of a case]. / Neumonía lipoidea: a propósito de un caso.

We report a case of lipoid pneumonia treated in our Health Centre. It is a disease that occurs rarely, but is important in Primary Care. This condition has been known since 1925, when it was first described by Laughlen, who described a case of lipoid pneumonia secondary to an injection of oil in the nasopharyngeal area. Today it is a rarity, and it is most frequently associated with the use of oil-based nasal drops (which are now decreasing in use). Its aetiology may be endogenous or exogenous. Although the pathological diagnosis is generally the most important, sometimes a lesion in the chest X-ray can lead us to suspect it due to the patient's history. This was a case of acute lipoid pneumonia in a young patient, who periodically performed as a "fire eater".

[Suspected Hirayama disease. Presentation of a case and a clinical review]. / Sospecha de enfermedad de Hirayama. A propósito de un caso en Atención Primaria. Revisión clínica.

Hirayama's disease, or juvenile muscular atrophy of distal upper extremity, is a cervical myelopathy. It affects adolescent males, and is characterized by progressive muscle weakness and atrophy of the distal upper extremities, followed by slow paralysis. Although the cause remains unclear, radiological findings suggest neuropathic forward displacement of the posterior cervical dural sac during neck flexion, causing compression of the cervical cord, resulting in atrophic changes and ischemic disease of the medullar anterior horn. Since the bending of the neck was recognized as a cause of the disease, cervical orthosis, spinal fusion, and duraplasty combined with fusion, have been proposed as treatment. A solid understanding of Hirayama disease is critical as early recognition and effective treatment can stop the deterioration.

[Venous thromboembolic disease: presentation of a case]. / Enfermedad tromboembólica venosa: a propósito de un caso.

Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis. It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation. We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion.

[Screening program for the early diagnosis of colorectal cancer in the Canary Islands: presentation of a case]. / Programa de diagnóstico precoz de cáncer colorrectal en Canarias. A propósito de un caso.

Colorectal cancer is the second leading cause of cancer death in Spain. The main objective of screening programs is the early detection, or even prevention of the development, of colon cancer, as well as the mortality that results from it. If caught early, it is easy to treat and the chances of cure are high. In 2009 only six regions in Spain, among which included the Autonomous Community of the Canary Islands, started this screening program. We report the case of a patient, who after screening for colorectal cancer, was diagnosed with adenocarcinoma of the rectosigmoid.

[Subphrenic abscess in the context of low back pain and reading analytics in the primary care consultations]. / Absceso subfrénico en el contexto de lumbalgia y lectura analítica en la consulta de atención primaria.

The subphrenic space is defined as the area below the diaphragm and above the transverse colon. Most abscesses are due to direct subphrenic contamination associated with, surgery, local disease, or trauma, but the cause still remain undefined or unknown. It is a disease rarely diagnosed in primary care. About 55% of subphrenic abscesses are located on the right side, with 25% on the left, and 20% are multiple. These can be extended to the thoracic cavity, which sometimes produce empyema, lung abscess, or pneumonia. The mortality of subphrenic abscess is between 11%-31%, and may be due to uncontrolled infection, malnutrition, and complications of prolonged hospitalization, such as nosocomial infections. Ultrasound or computed tomography-guided percutaneous drainage is now the preferred treatment, combined with antibiotics.

[Diagnosis of multiple myeloma in primary care. Suspicion with an appropriate clinical history]. / Diagnóstico de mieloma múltiple en atención primaria. Sospecha ante una historia clínica adecuada.

Monoclonal gammopathies are a group of disorders characterized by stable or progressive clonal proliferation of plasma cells producing similar immunoglobulins. Multiple myeloma is characteristic of the presence of bone marrow infiltration by plasma cells, osteolytic lesions, and M component in serum or urine. As cancer cells multiply, they can cause pain and destruction of bone, and if affecting the spine, they can press on nerves causing pain and paresthesias. In patients of advanced age (average 69 years) with bone pain not associated with trauma, and which does not improve with treatment, a differential diagnosis should be performed with multiple myeloma. This should include, at least, a full blood count, biochemistry, total protein, protein electrophoresis, immunofixation, and radiographs of painful areas.

[Primary presentation of non-hodgkin lymphoma. Report of a case]. / Manifestación primaria de linfoma no hodgkiniano. A propósito de un caso.

Lymphomas are the most common non-epithelial tumors of the head and neck and its incidence has increased in recent decades. Around 10% are extranodal lymphomas, and in more than half of the cases are located in Waldeyer's lymphatic ring. The most common presenting symptoms are odynophagia and dysphagia (68%), and symptoms suggestive of oropharyngeal cancer such as cough, hoarseness, earache, feeling of occupation in the back of the mouth, throat or neck. In non-Hodgkin lymphomas in this location, B symptoms (weight loss, fever and sweating) are rare (5%). The histological subtype of each individual lymphoma affects the evaluation, therapy and prognosis.

[Palliative care in Primary Care: presentation of a case]. / Cuidados paliativos en atención primaria. A propósito de un caso.

We present a case of a patient diagnosed with glioblastoma multiforme refractory to treatment. Glioblastoma multiforme is the most common primary brain tumour and unfortunately the most aggressive, with an estimated mortality of about 90% in the first year after diagnosis. In our case the patient had reached a stage of life where quality of life was importsnt, with palliative care being the only recourse. The family is the mainstay in the provision of care of terminally ill patients, and without their active participation it would be difficult to achieve the objectives in patient care. We must also consider the family of the terminally ill in our care aim, as its members will experience a series of changes that will affect multiple areas where we should take action.

[Onset of myasthenia gravis in primary care. Presentation of a case]. / Debut de miastenia gravis en atención primaria. A propósito de un caso.

Myasthenia gravis is an autoimmune disorder of neuromuscular transmission involving the production of autoantibodies directed against skeletal muscle receptors, in most cases of acetylcholine. Clinically it is characterized by the appearance of muscle weakness after prolonged activity, which tends to recover after a period of rest, or administration of acetylcholinesterase inhibitors. It is a relatively rare disease, although the prevalence has increased by improved diagnosis and increased longevity of the population. The diagnosis can be based on evidence after it is suspected using pharmacological, immunological or electrophysiology tests. Treatment can be divided into: symptomatic, short term and long term. We report the case of a patient who complained of diplopia, this muscle weakness being the most common initial symptom of the disease.

[Rhabdomyolysis associated with cocaine use]. / Rabdomiólisis asociada al consumo de cocaína.

Cocaine is a drug that has been used by humans for 15 centuries. In our environment, the prevalence of alcohol consumption, and emergencies arising from it, has increased over the last 10 years. Cocaine has been used by 2.6% of the Spanish population between 15 and 64 years old at some time in their life, placing it among the most widely consumed illicit drug after cannabis. Cocaine use is associated with multiple complications: neurological, cardiovascular, psychiatry, nephrology, pulmonary and gastrointestinal. The first cases of rhabdomyolysis and kidney failure were found in the medical literature in 1987. Rhabdomyolysis is a potentially lethal clinical syndrome that results from the necrosis of muscle fibres, with the passage of its components into the circulation, and is underdiagnosed in primary care.

[Zuska disease. Diagnosis and treatment in primary care]. / Enfermedad de zuska. Diagnóstico en atención primaria.

A fistula is an abnormal pathological communication which links two organs together or with the exterior. They are fibrous paths internally coated with granulation tissue, extending from an internal o primary opening to one or more openings located outside or on the skin. The recurrent mastitis that some patients suffer is due to a fistula between a lactiferous duct and the limit of the areola, and this condition is called a recurrent periareolar fistula.To incorporate this clinical condition into the proposed terminology, Zuska disease, is essential to believe in its existence, in order to to treat it from the source. The knowledge of this disease, a proper diagnosis and treatment will prevent the constant recurrence of mastitis as presented by these patients, avoiding their pilgrimage to various specialists. In this article we review this disease, methods of diagnosis and treatment.

[Retroperitoneal schwannoma]. / Schwannoma retroperitoneal.

Schwannomas, also called neurilemmomas, are a rare type of tumour in the body and even more rare in the retroperitoneal cavity. They arise from Schwann cells of the peripheral nerves. Retroperitoneal Schwannomas are rare and they account for 0.7 to 2.7% of all Schwannomas. They are slow growing tumours, and their location in the retroperitoneum is associated with poor clinical symptoms, and is often an incidental radiographic finding. Although it is a histologically benign tumour, we must not under-estimate the damage caused by compression of adjacent structures, as well as the rare but possible malignant transformation. We present this case as a casual finding after a systematic examination of the patient performed for assessment of his hypertension, with an abdominal mass being the principal finding.

[Prevalence of domestic violence in a primary care area of Santa Cruz de Tenerife]. / Prevalencia de violencia de género en atención primaria de Santa Cruz de Tenerife.

OBJECTIVES: To estimate the prevalence of domestic violence (DV) in adult women attending Primary Care medical consultations, to determine the associated factors, and family physician involvement in its detection. MATERIAL AND METHODS: We performed a cross-sectional analytical study in two urban health districts of Santa Cruz de Tenerife, Canary Islands. A consecutive sample of women aged 18 or older, whether or not they had a current partner were selected.. The Bradley questionnaire, which is validated (26 items) and assesses physical, psychological and sexual violence was used anonymously. Demographic characteristics, and those related to the couple, health history, presence of anxiety and depression (Goldberg scale) were recorded. RESULTS: A total of 299 women were interviewed, and 154 women recognised some kind of abuse at least once in their life (51.5%, 95% Cl: 40%-62%). Psychological violence was the most mentioned (n = 153; 99.35%), followed by physical (n = 39; 25.32%) and sexual violence was stated by 12 women (7.79%). Domestic violence was associated with: younger age, less time in a previous relationship, lack of social support (OR=2.18, P=.019), presence of probable anxiety (OR = 1.77, P = .015) and probable depression (OR = 1.58, P = .049). After multivariate analysis the association persisted with the Length of time of the relationship with previous partner (OR = 0.998; P < .0001) and the presence of probable anxiety (OR = 1.79; P = .024). Early detection of domestic violence was recorded in the medical records of 111 women (37.1%; 95% CI: 36.90-37.23). CONCLUSIONS: As in other studies, DV is associated with mental disorders, and there is a need for greater involvement by family physicians to detect this prevalent problem in our clinics.