[Cerebrovascular accident in young adults. A study of 52 cases]. / Accidente cerebrovascular en adultos jóvenes. Estudio de 52 casos.

OBJECTIVE: A retrospective study of ischaemic and haemorrhagic cerebral vascular accidents in patients under 45 years of age, admitted to hospital Severo Ochoa (Area sanitaria 9 de la Comunidad de Madrid) during a 6 year period. METHOD: 23 CVAs in women and 29 in men were studied. The aetiology of each episode was determined following preestablished criteria. RESULTS: Aetiology: cardiac 13 (25%), atherosclerosis: 8 (15%), haematological: 6 (11%), non-atherosclerotic: 8 (15%), migraine: 1 (2%), hypertensive: 2 (3%), unknown: 15 (29%). There was a predominance of men in the patients with atherosclerosis. These also had more cardiovascular risk factors and were older than the other patients. All patients with CVA due to antiphospholipid antibodies had multiple CVAs. Examinations used to establish the aetiology were: echocardiogram, angiography, carotid doppler, hypercoagulability studies and the clinical history. CONCLUSIONS: In spite of extensive study, 30% of the CVAs in young people still have no aetiological diagnosis. In general in ischaemic CVAs, there is good recovery of the neurological defects and a low mortality. The detection and oral anticoagulation of patients with a source of cardiac emboli, and the elimination of cardiovascular risk factors would probably considerably reduce the incidence of ischaemic stroke in young adults.

[Carcinomatous lymphangitis. Clinical study of 10 cases]. / Linfangitis carcinomatosa. Estudio clínico de 10 casos.

We analyze the clinical characteristics, the diagnostic criteria and the radiological aspects of 10 cases of Carcinomatous Lymphangitis. The quickly progressing exercise dyspnea and the constitutional syndrome were the most frequent symptoms. In nine patients, the tumor was previously unknown. The image methods (adbominal CAT and Echography) and the fibrobronchoscopic exam allowed a correct diagnosis. The most frequent neoplasia had a pulmonary origin and the most frequent histology was adenocarcinoma. The histological tests (bronchial and transbronchial biopsies) were more effective for the diagnosis than the cytological test (bronchoalveolar lavage, bronchoaspiration and bronchial brushing), although these were complemented. The radiology showed a reticulo-linear pattern in all the cases. The finding of macroscopic disorders in the fibrobronchoscopy, the presence of a local infiltration or a node/mass image in the thoracic radiography were highly suggestive of primary pulmonary neoplasia.

[Impact of HIV infection in hospital environment]. / Impacto de la infección por VIH en el medio hospitalario.

OBJECTIVE: Retrospective study to review the admissions at the Hospital Marina Alta due to infection for HIV or its complications and look for risk factors. METHODS: Clinical charts of patients admitted at the hospital from 1989 to 1996 were analyzed. RESULTS: From 11,932 admissions, 199 (1.7%) were due to patients with infection from HIV, resulting in the 2.4% of the total stay. The medium stays were higher (8.6 +/- 7.4 vs 6 +/- 4.5) more re-admissions (42.7% vs 25.5%) and higher mortality (11% vs 7.8%). The parasitic infestations of the nervous central system and cardiovascular were the most numerous number of admissions and also the longer stays. Throughout the years we saw a increase in the patients at the outpatient clinic with HIV infection and a paradogic decrease in the inpatient admissions, and also a decrease in the media stay and total stays. CONCLUSIONS: There is a decrease in the admissions at the inpatient level in contrast with a increment of the prevalence in the outpatients with HIV infection. The improved treatments, the experience of the physicians, the use of the Day Hospital and the use of the service of Home Care Hospitalization allows to keep more patients with less admissions and more outpatient visits.

[Survival of patients with AIDS treated with protease inhibitors]. / Supervivencia de pacientes con SIDA tratados con inhibidores de la proteasa.

OBJECTIVE: Make a volarization of the effect on survival of the protease inhibitors used on patients with established-AIDS. METHODS: Retrospective study on patients diagnosed of AIDS between January 1989 and March 1998. The main objective is the time between diagnosis and dead. It is compared the survival curve of the patients on treatment with protease inhibitors (PI) with the ones without them. We use the methods of Kaplan-Meier and log-rank. RESULTS: We analyzed 99 patients diagnosed of AIDS. Fifteen were treated with PI in combination and eighty-four with regimens without them. The number of CD4 and the age at the beginning of the study, the type of transmission and the gender were similar at the two groups. The median survival of the treated with PI was 47 (4 months (CI 95%: 39-55), and the one of the no treated as 26(3 months (CI 95%: 20-32) (p = 0.0027) CONCLUSIONS: The treatment with Protease inhibitors plus other antiviral medications is associated with a survival prolongation in patients with AIDS.

[Salmonellosis and ulcerative colitis. A case report and review of the literature]. / Salmonelosis y colitis ulcerosa. Presentación de un caso y revisión de la literatura.

A propos of a case of intestinal infection due to Salmonella non typhi in a patient with ulcerative colitis, we have reviewed the disease and, therefore ran a search through the scientific literature in which we have found 16 cases of ulcerative colitis diagnosed in a clinical setting which began as an enterocolitis due to Salmonella. Bacteriological studies, clinical evolution and response to treatment, normally allow to differentiate between the two clinical entities. Colitis due to Salmonella and ulcerative colitis can coexist in the same patient. Duration of the clinical manifestations oven four weeks, previous history of diarrhea with blood, the sudden worsening of a mild prolonged diarrhea, non-response to specific antibiotic treatment and fast response to therapy with corticoids of a diarrhea positive isolation of Salmonella in stools, should make us immediately think in the coexistence of a subjacent ulcerative colitis. Treatment with steroids always must be associated with systemic antibiotics if Salmonella has been isolated just before or during their administration.

Supervivencia de pacientes con SIDA tratados con inhibidores de la proteasa / Survival of patients with aids on treatment with protease inhibitors

Objetivo: Determinar el efecto del tratamiento con inhibidores de la proteasa (IP) en combinación con otros antirretrovirales sobre la supervivencia de los pacientes con SIDA establecido. Métodos: Estudio retrospectivo de pacientes diagnosticados de SIDA entre Enero de 1989 y Marzo de 1998. Se analiza el tiempo transcurrido desde el diagnóstico de SIDA hasta el fallecimiento. Se compara la curva de supervivencia de los pacientes que han recibido IP en su régimen terapéutico con las de los que no incluían IP en su tratamiento. Se utilizan los métodos de Kaplan-Meier y log-rank. Resultados: Se analizan 99 pacientes diagnosticados de SIDA. Quince fueron tratados con IP en combinación y 84 con regímenes que no incluían IP. El número de CD4 y la edad al inicio del estudio, la categoría de transmisión y el sexo fue similar en los dos grupos. La supervivencia media de los tratados con IP fue de 47 (4 meses (CI 95%: 39-55), y la de los no tratados de 26(3 meses (CI 95%: 20-32) (p=0.0027). Conclusiones: El tratamiento con inhibidores de la Proteasa en combinación con otros antirretrovirales se asocia a una prolongación de la supervivencia de los pacientes con SIDA (AU)