Meningoencefalitis por virus herpes tipo 6 en paciente anciano con Alzheimer / Meningoencephalitis by herpes virus-6 in elder patient with Alzheimer

No disponible

[Treatment with indomethacin for the control of the metabolic disorder caused by a villous adenoma of the rectum]. / Tratamiento con indometacina para el control del trastorno metabólico producido por un adenoma velloso de recto.

A 79 year old patient with a previous history of 10 months of mucous diarrhea is admitted due to pre-renal insufficiency, hyponatremia, hypokalemia and metabolic alkalosis secondary to rectal villous adenoma. The volume of the rectal discharge was 2.500 cc/day. Sodium level of the rectal secretion was 145 mEq/L and potassium 20 mEq/L. E2 prostaglandin: 1500 pg/ml. After hydroelectrolytic treatment, a PG synthetase inhibitor (indomethacin) was added to a dosage of 25 mg q/d PO. Rectal discharge was reduced to 500 cc/day, as well as sodium and prostaglandin levels. It has been proved that the use of PG synthetase inhibitors can facilitate the preparatory metabolic control in patients with villous adenoma.

[Toxic hepatitis from cinchophen: report of 3 cases]. / Hepatitis tóxica por cincofeno: descripción de tres enfermos.

Three cases of hepatic toxicity due to cincophen (a uricosuric drug used for the treatment of gout) are reported. The three patients were females aged 57, 60 and 67 years, respectively, who were treated with cincophen because of renoureteral urate stones. The mean dose was 300 mg/day for a mean duration of 3-4 months before the hepatotoxic features first developed. Cincophen induces hepatic necrosis through a hypersensitivity or metabolic idiosyncrasy mechanism with histologic abnormalities similar to those due to isoniazid, anticonvulsants, halothane and methyldopa. In two patients the disease presented as acute hepatitis. One had severe hepatic failure and died. Cincophen had been widely used in Europe and severe hepatotoxicity reactions have been reported since then (with a mortality rate of about 50%). It is still commercially available in Spain in two preparations as lithium cincophenate and piperacine. The present study has the aim of recalling the severe problems associated with cincophen hepatotoxicity, so that new cases can be prevented.

[Clinical forms and prognostic criteria in alcoholic hepatitis]. / Formas clínicas y criterios pronósticos en la hepatitis alcohólica.

The biological and clinical features and prognostic factors of 65 patients affected by alcoholic hepatitis were studied. All patients had an ethanol intake higher than 80 gr/day during at least 3 years. 22 patients were female and 43 male with a mean age of 45 +/- 11.7 years. 19 had acute hepatitis (29.2%), 2 had acute hepatic insufficiency (3%), one had acute cholestasis (1.5%), 14 had chronic hepatopathy (21.5%). 29 patients had the diagnosis (44.6%) confirmed by histologic analysis. All patients had liver enlargement, 25 had jaundice and 4 had fever. The hepatic biopsies showed steatosis in 53 cases, centrilobular sclerosis in 32 cases and cirrhosis in 19.8 patients developed hepatic encephalopathy, 3 had renal insufficiency, and 4 died. The levels of albumin (P = 0.0043), total bilirubin (P = 0.0003), prothrombin (P = 0.0001) and the development of hepatic encephalopathy or/and renal insufficiency were the parameters to define the group of patients with bad evolution, the IgA also being significant. The low mortality of our studied (6.1%) can be justified by the diagnosis at non-symptomatic stage. We recommend a liver biopsy in all patients with chronic alcoholism and liver enlargement, or biologic markers suggesting alcoholic hepatopathy.

[Recurrent Budd-Chiari syndrome as a complication of nocturnal paroxysmal hemoglobinuria]. / Síndrome de Budd-Chiari recidivante como complicación de una hemoglobinuria paroxística nocturna.

Budd-Chiari syndrome is a frequent complication of nocturnal paroxysmal hemoglobinuria, histologic and angiographic study being fundamental for diagnosis. We emphasize the importance of ultrasonography and abdominal CAT as noninvasive methods of early diagnosis, and the value of ultrasonography in the follow-up of these patients. Radical therapy of the disease from onset is a determinant of the final prognosis of these patients, as well as early treatment of thrombosis with thrombolytics and/or anticoagulants.

[Whipple's disease and splenomegaly with negative intestinal biopsies]. / Enfermedad de Whipple y esplenomegalia con biopsias intestinales negativas.

A case is presented of a patient with a picture of acute gastroenteritis and splenomegaly. Microscopic study of the spleen and a lymph node showed the characteristic findings of Whipple's disease, although no digestive alteration was found, in spite of performing several duodenal and jejunal biopsies. The etiopathogenesis of this entity is commented on and discussed.