Shock séptico por Pasteurella multocida / No disponible

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Hipercalcemia secundaria a carcinoma paratiroideo / Hypercalcemia secondary to paratyrhoid carcinoma

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Radiografía de tórax

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Aortitis por Listeria monocytogenes

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[Left ventricular diastolic dysfunction in young people with type 1 diabetes mellitus. Associated factors]. / Disfunción diastólica del ventrículo izquierdo en jóvenes con diabetes mellitus tipo 1. Factores asociados.

AIM: The aim of our study was to evaluate left ventricular function of diastolic in young (< 40 years) asymptomatic patients with type 1 diabetes mellitus free of cardiovascular disease symptoms and to analyze the associated factors to the left ventricular diastolic dysfunction (LVDD) in these patients. PATIENTS AND METHODS: Thirty-five type-1 diabetic patients (mean age 27.8+/-7.5 years) old and 54 healthy controls (mean age 26.1+/-4.1 years) were studied. Anamnesis, physical exploration, general analytical studies, microalbuminuric and Doppler-echocardiographic studies were performed. RESULTS: The LVDD was present in 13 (37.1%) of the diabetic patients and none of the control patients. The ratio of peak early to peak late (atrial) filling velocity was significantly decreased in diabetic compared with control subjects (1.1+/-0.3 versus 1.5+/-0.2; p<0.01). The isovolumetric relaxation time was increased in diabetic patients compared with control subjects (104+/-11 versus 79+/-11; p<0.01). Diabetics with LVDD were older aged, predominantly males, had worse glucemic control, more alteration of lipidic metabolism and higher levels of microalbuminuria, than diabetics without LVDD. CONCLUSIONS: The LVDD is frequent in young diabetics free of cardiovascular disease symptoms. These studies suggest that because this patients were of older age, of the masculine sex with, poor glucemic control, altered lipidic metabolism, and microalbuminuria they might be a group that is associated with LVDD which, in the absence of cardiovascular disease, might be an early preclinical alteration, potentially related to subsequent development of diabetic cardiomyopathy.

[Medical rhabdomyolysis in the elderly]. / Rabdomiólisis médica en el anciano.

BACKGROUND: To investigate the characteristics of medical rhabdomyolysis (RM) in the elderly, as well as differences compared with those observed in younger patients. PATIENTS AND METHODS: Prospective study of 56 elderly patients (> or = 65 years) with RM and 73 younger patients (> 7 years and < 65 years) with RM for 43 months. The RM characteristics were analyzed in the elderly group (ERM) and compared with those in the younger group (YRM). RESULTS: Fifty-six elderly patients with RM (38 males and 18 females, with a mean age of 76.3 +/- 7.6 years; range: 65-92 years) and 73 younger patients (57 males and 16 females, with a mean age of 37.9 +/- 15.6 years; range: 13-63 years), made up the 129 patients in the study. The most common cause for RM in the ERM was muscle compression due to immobilization and the multicausative group, both with 9 (16%) cases, followed by respiratory infection with 8 (14.2%) cases. In the YRM, the most common cause was physical exertion with 15 patients (20.5%) and multicausative with 18 patients (24.6%). Myalgia predominated in the YRM group, with 25 vs. 9 (odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.0-7.3; p < 0.05). Acute renal failure (ARF) occurred in 13 patients in the ERM group compared with 4 in the YRM group (OR: 5.2; 95% CI: 1.4-23; p < 0.01). In the logistic regression analysis an association was found between hypoalbuminemia and ARF for the ERM group. In the presence of ARF, both ERM and YRM had decreased serum calcium levels, deeper in YRM and more prolonged in the ERM. Six patients in the ERM died, and four of them had developed ARF. In contrast, none of the two deceased patients in the YRM had the complication of ARF. CONCLUSION: Almost half of cases of RM occur in elderly patients, which is mostly due to muscle compression and infections, particularly in the respiratory tract. Symptoms are usually mild and the development of ARF is more common than in younger patients, and its presence is associated with hypoalbuminemia. Hypocalcemia associated with ARF was less deep in the elderly, but more persistent than in younger patients. Most deceased patients in the elderly group previously developed ARF.

[Nontraumatic rhabdomyolysis: its etiology and the predictive factors of acute kidney failure]. / Rabdomiólisis no traumática: etiología y factores predictivos de insuficiencia renal aguda.

BACKGROUND: The aim of this study was to determine the causes of non traumatic or medical rhabdomyolysis (RM) and analyze the clinical and biologic characteristics, as well as the predictive factors of acute renal failure (ARF). METHODS: Fifty-nine patients with RM admitted to the Internal Medicine Department over an 18-month period were prospectively studied. The patients were classified into etiologic groups. Anamnesis, physical exploration and general analytical studies including creatinkinase, myoglobin, aldolase, magnesium and proteinogram were performed. Urine sodium was determined in patients with ARF> RESULTS: Myalgias in 14 patients (23.7%) and a decrease in strength in 11 patients (18.6%) were the main clinical manifestations observed. As a sole cause, convulsion was the most frequent manifestation in 11 patients (18.6%) followed by muscular compression in 10 patients (16.9%). In the plurietiologic group the most frequent manifestation was muscular compression in 5 patients (16.9%) followed by alcoholism in 4 patients (6.7%). No differences were found in either the clinical manifestation or the biology of the RM among the different etiologies. Eight patients presented ARF (13.5%) with one patient requiring dialysis, and good response being observed with conservative treatment in 5 patients. On multivariant analysis the statistically significant ARF predictive factors were: age over 70 years (p = 0.003), nonketotic hyperosmolar diabetic coma (p = 0.01), previous dehydration (p = 0.001) and initial uric acid levels greater than or equal to 6 mg/dl (p = 0.002). CONCLUSIONS: The clinical expression of rhabdomyolysis was small with the most frequent manifestations being convulsions and muscular compression. The predictive factors for acute renal failure were advanced age, nonketotic hyperosmolar diabetic coma, dehydration, and hyperuricemia.