Masquerade syndrome: An eye problem as a manifestation of a more sinister disease. / Síndrome de mascarada: un problema ocular como manifestación de un mal mayor.

A middle-aged man with cardiovascular risk factors, who suffered from a slight loss of unilateral vision for 6 months. After obtaining a diagnosis of diffuse choroiditis+papillitis within a probable masquerade syndrome, the patient was referred to outpatient Internal Medicine where this diagnosis was confirmed as an extended neoplastic disease.

Influence of admission blood pressure on mortality in patients with acute decompensated heart failure.

OBJECTIVES: To determine the relationship between admission blood pressure (BP) and prognosis in patients hospitalized for acute decompensated heart failure (HF). BACKGROUND: The relationship between BP admission blood pressure and outcomes in decompensated HF is controversial. It has been suggested that this presentation may be a specific disorder, but their mechanisms and clinical relationships are poorly defined. METHODS: We evaluated the association between initial BP (systolic, diastolic and mean BP) with readmission and mortality, as well as potential interactions with age, clinical characteristics, renal function, left ventricular dysfunction, comorbidities and treatment. By using Cox regression models the association between each outcome and BP was tested. RESULTS: A total of 581 patients (77.5-years-old, range 51-100) were included. At admission, mean BP in quartiles was 77.09 mm Hg (53.3-85.0) (Q1); 91.46 mm Hg (85.0-96.7) (Q2); 103.41 mm Hg (96.7-109.9) (Q3) and 124.79 mm Hg (109.9-209.0) (Q4). Median duration of follow-up was 8 months [95% confidence interval (CI) 5.2-11.1]. Mortality was 15.5% (Q1), 9.2% (Q2), 12.6% (Q3) and 7.3% (Q4). Interquartile hazard ratio (95% CIs) for mortality was 0.40 (0.19-0.85) P=0.017. Body mass index (BMI) was higher in Q4 29.59 k/m2 than in Q1 28.25 k/m2 (P=0.018). There were no differences in age, clinical antecedents, renal function, comorbidities or severity of HF between groups. CONCLUSION: Higher mean BP at admission is associated with significantly lower mortality during follow-up, in patients hospitalized for HF. With the exception of BMI, positively correlated with blood pressure, this relationship is independent of other clinical factors and medications.

Bloqueo aurículo-ventricular completo como signo de afección cardíaca en paciente con esclerodermia / Complete atrioventricular block as sign of cardiac involvement in patient with scleroderma

No disponible

No disponible

Favismo: una entidad a tener en cuenta en la zona mediterránea / Favism: a disease to keep in mind in the Mediterranean area

Se denomina favismo a la hemólisis aguda que se desarrolla tras la ingestión de habas o el polen de estas1. Los síntomas se desarrollan horas después de la ingestión, siendo comunes las náuseas, vómitos, malestar y vértigo. A estos síntomas le sigue una hemólisis. El favismo en el área mediterránea se debe a una variante de la glucosa-6-fosfato deshidrogenasa (G6PDH)1. Para su diagnóstico es fundamental una completa anamnesis, exploración física y la determinación de la actividad enzimática para la G6PDH. Los pacientes deben ser educados con unos consejos dietéticos y deben conocer la posibilidad de crisis hemolíticas agudas ante determinadas infecciones y exposición a determinados fármacos o tóxicos

Favism is called acute hemolysis that has developed after intake of fava beans or their pollen1. The symptoms develop hours after intake. The common symptoms are nausea, vomits, malaise and vertigo. Hemolysis follows these symptoms. Favism in the Mediterranean area is due to a variant of glucose-6-phosphate-dehydrogenase (G6PDH)1. A complete anamnesis, physical examination and measurement of enzyme activity for G6PDH are essential for its diagnosis. The patients should be educated with dietary advise and should know the possibility of acute hemolytic episodes when there are certain infections and exposure to certain drugs or toxics

Dolicoectasia basilar e ictus de repetición: dos nuevos casos / Basilar dolichoectasia and repeated strokes: two new cases

Introducción. La dolicoectasia vertebrobasilar (DEB) se define como la elongación, dilatación y tortuosidad de las arterias de la circulación cerebral posterior. La prevalencia es baja, al igual que la incidencia de ictus secundarios. El tratamiento es controvertido. Las manifestaciones clínicas dependen del territorio vascular afectado, tamaño del aneurisma y compresión de las estructuras adyacentes. Se manifiesta habitualmente por cuadros isquémicos focales del territorio posterior. Los avances en las técnicas de neuroimagen y su extensión a hospitales de nivel básico han incrementado el diagnóstico de DEB. Caso clínico. Presentamos dos casos de DEB manifestada como ictus de repetición. Se optó por el tratamiento antiagregante como opción terapéutica por motivos clínicos y sociales. Conclusión. La DEB es una rara entidad que se manifiesta más frecuentemente como cuadros isquémicos en personas de edad avanzada. La antiagregación plaquetaria puede ser una opción válida en estos pacientes

Introducction. Dolichoectasia vertebrobasilar (DEB) is defined as dilatation and winding of posterior brain circulation. The prevalence is low, as the same as incidence of secondary strokes. The treatment is controversial. The clinical manifestation depend on the vascular territory involved, aneurysm size and compression of adjacent structures. Often it is presented as strokes of vertebrobasilar territory. Advance in neuroimaging technique and the access to primary hospital have increased the diagnostic of DEB. Clinical cases. We report two cases of DEB its present as repeated strokes. Platelet antiagregation was select in basis to social and clinical reason. Conclusion. DEB is a rare entity. Frequently it present as strokes in elderly patients. Platelet antiagregation can be a reasonable therapeutic option

Disección de aorta: a propósito de dos casos / Aortic disection: two cases review

No disponible

Alopecia aguda asociada a empiema por actinomices / Acute alopecia associated to empyema caused by actinomyces

No disponible

Aplasia pulmonar: un hallazgo infrecuente en adultos / Pulmonary hypoplasia: an infrecuent disease in adults

No disponible

Hipertensión arterial con alta variabilidad / Arterial hypertension with high variation

La hipertensión arterial esencial es la entidad que el clínico trata con más frecuencia en la práctica diaria.Los pacientes con gran variabilidad de la presión arterial (PA) representan un problema terapéutico y, con mayor frecuencia aún, un enigma diagnóstico. Se presenta un caso de enferma con crisis hipertensivas severas seguidas de baches hipotensivos en la cual, tras comprobarse la elevada variabilidad de su PA mediante medición ambulatoria de la presión arterial, se descubrió en el estudio posterior la existencia de una trombosis del seno transverso (AU)

Epidemiología de los tumores broncopulmonares en un área sanitaria de Extremadura (suroeste de Extremadura) / Epidemiology of bronchopulmonary tumors in a sanitary of Extremadura (southwest of Extremadura)

No disponible

Tétanos: importancia del diagnóstico clínico en un servicio de urgencias / Tetanus: importance of clinical diagnosis in an emergency service

No disponible