Carcinoma neuroendocrino de timo (carcinoide tímico): descripción de un nuevo caso y revisión de la literatura / Neuroendocrine carcinoma of the thymus (thymic carcinoid): report of a new case and review of the literature

Presentamos las características clínicas, procedimientos diagnósticos y estudios histológicos y de inmunohistoquímica empleados en la valoración y tratamiento de un inusual caso de carcinoma neuroendocrino de timo (carcinoide tímico). Se trataba de una gran masa mediastínica anterosuperior, descubierta accidentalmente durante la realización de una técnica de imagen a una mujer de 54 años. Pese a su aparente benignidad, por la ausencia de clínica o endocrinopatía asociada, por su aspecto macroscópico y encapsulamiento, sugerimos que, tras el preciso diagnóstico obtenido mediante punción aspiración con aguja fina (PAAF) bajo control de tomografía computerizada (TC) y su posterior exéresis completa, se realice un estrecho y continuado seguimiento en el tiempo, dada la singular agresividad que le caracteriza. (AU)

Low values of creatine kinase in systemic lupus erythematosus. Clinical significance in 300 patients.

OBJECTIVE: To study creatine kinase (CK) activity in a large series of patients with systemic lupus erythematosus (SLE) and identify the clinical and immunological features related to reduced levels. METHODS: In a cross-sectional study, serum CK activity was measured in 300 consecutive patients with SLE (271 females and 29 males, with a mean age of 36 years). All patients fulfilled the 1982 revised criteria of the American College of Rheumatology. RESULTS: Low serum CK levels (< 33 IU/L) were detected in 118 (39%) of SLE patients. When compared to SLE patients with normal serum CK levels, those with SLE and low serum CK levels had a higher frequency of fever (53% vs. 34%, p = 0.017), renal involvement (43% vs. 27%, p = 0.004), and hemolytic anemia (13% vs. 6%, p = 0.037). In addition, SLE patients with low CK values also presented lower values of hemoglobin, total proteins, albumin, cholesterol and triglycerides, higher values of ESR and low C3 (44% vs. 27%, p = 0.004), C4 (57% vs. 37%, p = 0.001) and CH50 levels (60% vs. 41%, p = 0.02). We analysed in 69 patients the correlation between CK and 24-hour proteinuria values, and found that those with a 24-hour proteinuria > 1500 mg/day showed lower CK values than those with proteinuria < 1500 (31.95 vs 63.84 IU/L, p = 0.046). CONCLUSION: We observed that serum CK levels were reduced in 39% of SLE patients. Reduced serum CK activity was significantly related to some clinical (fever, nephropathy), hematological (high ESR, hemolytic anemia) and immunological (hypocomplementemia) features, which relate to disease activity. This suggest that reduced CK activity might be inversely correlated to inflammatory activity in SLE.

[Population study of users of long term-treatment cards in an urban health center. A system for the evaluation and improvement of the quality of prescription]. / Estudio de la población usuaria de cartillas de largos tratamientos en un Centro de Salud urbano. Un sistema para evaluación y mejora de la calidad de prescripción.

The results of the analysis of the Prolonged Treatment Cards (PTC) for 1988 are presented. The total PTC cases for which care was provided numbered 15,643, which means a 24.3% reduction in the volume of demands for medical attention, with an average decrease of 10.5 patients/day in each one of the family practices. The breakdown of the PTC into age groups revealed that it is the patients over 60 years of age who are in possession of the greatest number of these cards (58.8%). Essential hypertension (40.5%) is the most frequent diagnosis, followed by diabetes (13.8%) and osteoarthritis (13.3%). By subgroups according to treatment, the most frequently used medications are antihypertensives, with diuretics being the ones ranked in the top position (40.72%). The existing discrepancy between the high degree to which benzodiazepines are prescribed and the low percentage of cases diagnosed which can be treated using said medications is also stressed. The conclusion is drawn that the PTC's are of great use to patients and to the Primary Care Teams.

[Control of overweight children in primary care]. / Control del sobrepeso infantil en atención primaria.

The results obtained in the program "Control of overweight in children" in the programmed nurse clinic were evaluated in 25 children distributed for age and degree of overweight. The activities carried out were: control of the number of calories based on carbohydrate and fat reduction, health education using the audiovisual techniques of the program EDALNU of the Ministry of Health, and theoretical program based on it. The group with a greater overweight (higher than 20%) followed, in addition, a 1,500 calories diet. It was concluded that a balanced diet and physical exercise proved to be highly effective for the reduction of overweight in children without additional drug intervention. Obesity in children is a health problem that can be addressed in a primary care context; the role of the nursing staff is crucial through health education activities.