Salmonella Tyfhi como agente excepcional de pericarditis infecciosa: a propósito de un caso / Salmonella Typhi as an excepcional agent in infectious pericarditis

Presentamos , dado la infrecuente del caso, un cuadro de pericarditis infecciosa producida por S. typhi en un paciente pluripatológico, confirmado por la clínica, exploración, pruebas complementarias y estudio microbiológico, que fueron compatibles con dicha entidad. Una lesión pericárdica o la presencia de un pequeño derrame pericardio aséptico previo, podría haber servido de excelente caldo de cultivo para este microorganismo, en este caso favorecido por la comorbilidad asociada. El drenaje pericardio y el tratamiento antibiótico parenteral llevado a cabo, es la mejor medida terapéutica, siendo innecesaria el recurso del tratamiento intrapericárdico (AU)

Given the infrequency of the case, we present a medical profile of infectious pericarditis due to S. typhi in a patient with several pathologies, confirmed by clinical examination, complementary tests and microbiological study compatible with said entity. Pericardial injury, or the presence of a small previous aseptic pericardial effusion, may have been useful as an excellent culture medium for this microorganism, helped in this case by associated comorbididity. Pericardial drainage and parenteral antibiotic treatment carried out are the best therapeutic measures being unnecessary resorting to intrapericardial treatment (AU)

Carcinoma pulmonar con metástasis cerebelosa única / Pulmonary carcinoma with brain metastasis

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Metástasis cerebelosa con captación en anillo / Cerebelous metastasis and ring enhancement

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[Acute liver failure following heat stroke]. / Fracaso hepático agudo tras golpe de calor.

Hepatic involvement during heat stroke appears frequently. In some severe and rare cases liver transplantation is needed. We report a case of a 31 years old man, amateur runner, who suffered heat stroke-related acute liver failure, rhabdomyolysis, renal failure and coagulation im-pairment during a marathon. High environmental temperature, exercise duration and height where race took place could be involved. Patient had a favourable course with conservative treatment being discharged in a few days.

Hematoma subcapsular como complicación de biopsia hepática percutánea / Subcapsular hematoma as complication of percutaneous hepatic biopsy

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Afectación multicéntrica en el sarcoma de Kaposi clásico agresivo / Systemic afectation in the classical kaposi's sarcoma of agresive course

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[Microalbuminuria in arterial hypertension]. / Microalbuminuria en la hipertensión arterial.

Microalbuminuria is a considerable good indicator of atherogenic disease and cardiovascular risk. In the arterial hypertension, the main centre organ is the kidney. Structural and functional changes that happen in the hypertensive nephropathy are going to cause alterations m the albumin urinary excretion. The authors have done a revision of the main factors which can origin the existence of microalbuminuria in patients with arterial hypertension, and they conclude that this is an useful biochemist indicator in order to evaluate the degree of renal disease in these patients.

[Usefulness of hepatic biopsy in an internal medicine service]. / Utilidad de la biopsia hepática en un servicio de Medicina Interna.

OBJECTIVES: Study the percentage of clinical successes which have been confirmed by percutaneous hepatic biopsy guided by echography (PHBE) in those diseases which can affect the liver in an Internal Medicine service. PATIENTS AND METHODS: 78 patients were chosen for this study. All of them were admitted to hospital during the last eight years. Each patient had had a PHBE made regarding clinical, analytical and echographic criteria that were necessary to conclude their diagnostic studies. They were distributed into different groups. RESULTS: Patients could be distributed into five different groups. There was a higher percentage of clinical successes on those who suffered from chronic hepatopathy derived from alcohol-addiction and on those with carcinomatous hepatopathies. When corroborating the diagnosis of clinical suspect, the diagnostic profitability of the biopsy proved to get down in the others groups, depending on it was the group of miscellaneous, dissociate cholestasis and, in the last place, unknownly originated fever. CONCLUSIONS: The diversity of diseases which can affect the liver in an Internal Medicine service gives PHBE a particular diagnostic character. The diagnosis of clinical suspect was confirmed in 78.2% of the total of cases that made up the different groups. Therefore, PHBE plays a main role in a large amount of hepatic repercussive diseases that are treated in Internal Medicine services where, despite the clinical suspect, a diagnostic corroboration is often required for a right treatment.

[An echocardiographic study of the aortic root in ankylosing spondylitis]. / Estudio ecocardiográfico de la raíz aórtica en la espondilitis anquilosante.

The inflammatory condition in ankylosing spondylitis (AS) may affect cardiac structures, being the aortic valve mostly studied. Several studies regard the existence of a subaortic ridging as specific for AS. Our objective was to assess abnormalities in the aortic root in AS using echocardiography and its relation to HLA B-27 and clinical parameters of the disease. Thirty patients with no clinical, radiographic or electrocardiographic evidence of cardiovascular disease were studied by monodimensional, bidimensional and Doppler echocardiography. After an initial ultrasound examination to detect subclinical cardiac abnormalities, aortic root dimensions were measured at the aortic annulus, at the tip of the cusps and 1 cm above the cusps. The existence of subaortic ridging was assessed using bidimensional echocardiography. As clinical parameters were estimated duration of AS, sacroiliac joint X-ray involvement and activity of disease. The results are compared with those in a control group of thirty healthy people with same age, sex and corporal surface. No statistical differences were observed in the mean values of aortic root dimensions between the two groups; in patients with AS were not seen significant differences in the echocardiographic measurements related to clinical parameters or HLA B-27. Only in one patient was observed the characteristic subaortic ridging (4%, NS compared to control group). We conclude, in contrast to other authors, that in patients with AS without cardiovascular disease echocardiographic examination of aortic root does not detect significant abnormalities.

[Amyloid angiopathy as a clinico-pathological entity to consider in the differential diagnosis of any hemorrhagic cerebrovascular accident]. / La angiopatía amiloide como entidad clínico-patológica a valorar en el diagnóstico diferencial de todo accidente cerebro vascular hemorrágico.

Intracerebral hemorrhages represent about 10% of the whole of vascular cerebral accidents. According to different authors, the incidence of cerebral amyloid angiopathy varies between 5-10% and up to 20-30% of all primary non-traumatic intracerebral hemorrhages. This incidence was analyzed in our environment. A retrospective study was carried out on 403 patients, 203 of them were analyzed between 1990-91 and the other 200 between 1992-3. Age, arterial tension, relapses and localization were taken as criteria for a diagnosis. For the statistical analysis, Student's T-test was used for quantitative variables, while square Chi with Yates' correction was used for qualitative variables. Ischemic cerebral accidents (90.5% of the total) are more frequent than hemorrhagic cerebral accidents, which represent 5.7%. 3.7% were not registered. Therefore, it was suspected cerebral amyloid angiopathy in 1.4% of all vascular cerebral accidents. This represents 26.1% of the total of hemorrhagic patients. Different variables from groups of hemorrhagic vascular cerebral accidents were compared to those caused by amyloid cerebral angiopathy and significant statistics were found with respect to localization in the cerebral hemispheres (p < 0.01). Neither age, nor arterial tension or relapses were significant. Amyloid cerebral angiopathy as a cause of hemorrhagic cerebrovascular accident is and entity to be considered in the diagnosis of these patients. By using clinical criteria and others of localization through complementary explorations, a diagnosis for guessing such a process can be determined.