[Descriptive study of autopsies of internal medicine department at the hospital of Barbastro and clinico-pathological correlation]. / Estudio descriptivo de las autopsias del Servicio de Medicina Interna del Hospital Comarcal de Barbastro y correlación clínico-patológica.

BACKGROUND: To review the autopsies of Internal Medicine Department at the Hospital of Barbastro and to compare clinical and pathological diagnosis. MATERIAL AND METHODS: Retrospective study of 51 consecutive autopsies performed between April 1989 to December 1996 is carried out. Clinico-pathological correlation is stablished with the underlying cause of death distinguishing among concordance and severe (with adverse impact on survival) or mild discrepancy. RESULTS: The autopsy rate was 6.6% in that period. 70.5% were male. The median of the age was 70. Severe yatrogenia was found in one case. Respiratory diseases (23.5%) followed by cardiovasculars (19.6%) and infections (17.6%) were the most frequents underlying cause of death. Pulmonary thromboembolism was demonstrated in 37.2%, being massive only in 7.8%. Discrepancies were found in 31% of cases, 25% mild and 6% severe. CONCLUSIONS: Our data are similar to other studies but differ essentially in a lesser number of severe discrepancies in our findings and also in the frequency of the groups of diseases (there are more infections and tumours in other series) attributed to the hospital features and to the oldness of the studied population, among others.

Estudio descriptivo de las autopsias del Servicio de Medicina Interna del Hospital Comarcal de Barbastro y correlación clínico-patológica / Descriptive study of autopsies of internal medicine department at the hospital of Barbastro and clinico-pathological correlation

Fundamento: Revisión de las autopsias del servicio de Medicina Interna (MI) del Hospital de Barbastro y comparación de los diagnósticos clínicos y patológicos. Material y métodos: Estudio retrospectivo de 51 autopsias consecutivas realizadas desde abril de 1989 a diciembre de 1996. La correlación clínico patológica se estableció con la causa básica de muerte (CBM) diferenciando entre concordancia y discrepancia grave (el diagnóstico en vida hubiera supuesto un cambio en el pronóstico) o leve. Resultados: La tasa de autopsias de MI en este periodo es de 6,6 porciento. El 70,5 porciento fueron varones. La media de la edad fue de 70 años. Se comprobó yatrogenia grave en 1 caso. La autopsia fue completa (incluyendo cavidad craneal) en el 70,5 porciento. Las enfermedades respiratorias (23,5 porciento) seguidas de las cardiovasculares (19,6 porciento) y de las infecciosas (17,6 porciento) representaron las CBM más frecuentes. Se comprobó tromboembolismo pulmonar en el 37,2 porciento aunque sólo en el 7,8 porciento fue masivo. Hallamos discrepancias en el 31 porciento de los casos, el 25 porciento leves y el 6 porciento graves. Conclusiones: Nuestros datos se aproximan a los de otros estudios pero difieren fundamentalmente, en el menor número de discrepancias graves encontradas por nosotros y en la frecuencia de los grupos de enfermedad (mayor número de enfermedades infecciosas y tumores en otras series) lo que atribuimos, entre otras causas a las características del hospital y al envejecimiento de la población estudiada (AU)

[Wegener's granulomatosis in the elderly. Report of 3 cases]. / Granulomatosis de Wegener del anciano. Descripción de tres casos.

Wegener's Granulomatosis (W.G.) is a systemic vasculitis which the usual age of presentation is the fourth and fifth decades. It seldom appears in the aged patients and it often exists a greater delay in the diagnosis time and in the beginning of therapy in them. We present three cases of W.G. in aged patients (66, 79 and 80 years). One case was diagnosed in the autopsy and the two others had a favourable evolution after therapy. We insist on the need of using all the available tools in order to confirm the W.G. diagnostic, in spite of the aging. The therapy of these patients must be as vigorous as in the young patients in order to avoid the development of renal failure, the most important cause of death in this disease.

[Hospital mortality at the internal medicine service of a local hospital]. / Estudio de mortalidad hospitalaria en el Servicio de Medicina Interna de un hospital comarcal.

We conducted a retrospective study of the hospital mortality in a service of Internal Medicine at the Hospital de Barbastro during the years 1991 and 1992, recording 97 deaths during 1991 and 87 during 1992, with a mortality rate of 6.7% and 6.6% respectively. The mean age was 77.2% +/- 9 years with a 93% > or = 65 years. The average length of stay of the dead patients was 8.9 days. Cardiovascular diseases were the most frequent cause of death (41.85%), followed by respiratory diseases (17.93%) and neoplasias (15.76%). CVA was the single most frequent disease (17.9%). Ten autopsies (5.4%) were performed. In 16 cases (8.6%), we obtained data suggesting iatrogenesis, which in 7 cases (3.8%) clearly contributed to the direct cause of death.

[Gastric ulcers: a rare manifestation of secondary syphilis]. / Ulceras gástricas: una rara manifestación de sífilis secundaria.

Gastric lesions in the progression of syphilis are very rare and they have several forms of presentation resembling lesions of different nature. We describe a case of secondary syphilis in an heterosexual patient, with persistent gastric ulcers and hepatic affection, in which the evolution and the observations with laparotomy suggested neoplasia. In the gastric biopsy, an infiltration of plasmatic and neutrophil cells was observed and in the hepatic biopsy, necrotic nodules and granulomas. The spirochaeta-specific tinction, although not indispensable, confirms the diagnosis of gastric syphilis. The previous presence of a syphilitic chancre and typical cutaneous lesions are of great help in suspecting a luetic process.

[Effect of age, nutritional status and tumor extension on various immunologic parameters in cancer patients]. / Influencia de la edad, el estado nutricional y la extensión tumoral sobre diversos parámetros inmunitarios en pacientes neoplásicos.

We studied cellular immune (total lymphocytes, lymphocytary populations and delay hypersensitivity skin tests) and humoral (immunoglobulins and complement) response, as well as nutritional status (anthropometric and biochemical para meters), antitumoral treatment. The effect of tumoral extension, nutritional status and age on immunity was assessed. We have demonstrated a poor relationship between the cellular immunological response and the extension of neoplasia, a moderate effect of age and a significant impact of nutritional status.