[Reason for a medical visit in the diagnosis of lung cancer. A review of 481 cases]. / Motivo de consulta en el diagnóstico de cáncer de pulmón. Revisión de 481 casos.

INTRODUCTION: Lung cancer is the most frequent cancer death related cause in the world. Its clinical presentation usually corresponds to advanced stages. The indication of screening programs for the diagnosis in early phases has been debated for years. AIMS: To know the clinical characteristics in the presentation of the lung cancer in our health care area. MATERIAL AND METHODS: All of the incident lung cancer cases for 3 years (January 1, 1997 to December 31, 1999) among those patients with usual residence in the Santiago de Compostela health care area were retrospectively collected from the available information in the Codification Service. The histological type was graded according to the World Health Organization classification. Date of death was obtained from the patient's clinical history, mortality record, or telephonic calls to the patient's home. The rest of the information was obtained from the clinical records of the patient and Pathology Service. RESULTS: Four-hundred and eighty-one lung cancer cases were diagnosed (incident gross rate of 41.79 per 100,000 inhabitants and year). Median age was 66.9 years (interquartile range 60.5-74.4), 92.77% being males and 94.1% corresponding to smokers or former smokers. The most prevalent symptoms motivating the visit were general syndrome (20%), thoracic pain (19%) and hemoptisis (17%). A group of patients (56), fundamentally males, had an incidental diagnosis. CONCLUSIONS: The incidence of lung cancer seems to be high in our health care area. The standard patient with lung cancer in this health care area is a 67-year-old, male, who smokes, diagnosed in advanced stages, who consults due to a general syndrome and/or chest pain. Some of the symptoms appear with significant gender differences. Likewise, there are differences between histologies, the high frequency of chest pain in adenocarcinoma being outstanding, although it is also the first cause for consultation in small cell lung cancer. On the contrary, hemoptisis, the most frequent consultation cause in squamous cell carcinoma and the general syndrome in the big cells type or with clinical-radiological diagnosis.

[Erectile dysfunction: an insufficiently valued problem in Internal Medicine. Study of patients and related medication]. / Disfunción eréctil: un problema poco valorado en Medicina Interna. Estudio de pacientes y medicación relacionada.

INTRODUCTION: Erectile dysfunction (ED) is a common disease and may be due to psychological or organic causes. It might point to a silent disease and its value could not only be in life quality but also directly resolving the health problem laying beneath. The evaluation of ED begins with sexual records and physical examination which have been reported to have a 95 percent sensitivity, and a 50 percent specificity. Additional diagnostic tests are needed to maximize specificity. Sexual impairment in general Internal Medicine patients has not been sufficiently studied yet. PATIENTS AND METHODS: Unselected ambulatory and hospital admitted patients were interviewed during 2003 using the International Index of Erectile Function (IIEF) ad the Sexual Health Interview for Men (SHIM). The cut-off point was 21. RESULTS: A total of 51 male patients were interviewed, middle age was 65 years old (30-88). Of these, 27 denied sexual activity (group I). Middle age in this group was 64 years old. In the 24 patients with sexual activity (group II) middle age was 61 years old. The IIEF score was less than 45 in 11 patients (groups I and II of erectile dysfunction) The SHIM middle score was 26 points. The score was < 21 in 10 patients (41.6%). Concordance between both test was 90.9%. Risk factors included: tobacco (12 patients), alcohol (9), hypertension (8), and diabetes (7) among others. CONCLUSION: Our investigation seems to show that a great number of patients attended by Internists have sexual impairment (41.6%). None of these were under specific therapy nor consulted for this disease. Middle age is lower among patients with sexual activity as compared with the group without sexual activity. This assessment should be included in the medical interview with the aim of prescribing specific therapy to improve patient's quality of life.

[Medicine in the adolescent]. / Medicina del adolescente.

UNLABELLED: The biologic, cognitive and sociocultural changes that occur during adolescence include a wide range such as to be best treated by internists, but focus in old ages is increasing and younger are being treated by others specialists. We review the data of those adolescents attended in our Hospital and discuss Internal Medicine interest in adolescents. MATERIAL AND METHODS: Epidemiological data, and clinical status of those patients between 15 and 21 years old admitted in our hospital during the period 1996-2002 were analysed. RESULTS: 5894 admissions of adolescent s patients were made in this period. 1326 (23%) where attended in the Internal Medicine Department. 755 (57%) were male. Main causes of admission were infectious diseases, (mostly urinary tract and respiratory infections). Tobacco and alcohol abuse were present in 160 (6%) patients. DISCUSSION: Adolescence marks the transition from childhood to adulthood. Health problems and deaths among adolescents and young adults result from accidents (mostly from motor vehicle), but there are conditions usually matter of our speciality. A significant number of patients are been attended by Paediatrics Department and such a speciality as Adolescence Medicine is mostly integrated by paediatric specialists. We consider as this paper show, these ages ranges are clearly matter of our specialty and best treated by internists, but probably need a better consideration in our training. The opportunity to incorporate more adolescents into practice if realized, could prove challenging for internists.