[Spontaneous infectious spondylodiscitis in an internal medicine department: epidemiological and clinical study in 41 cases]. / Espondilodiscitis infecciosa espontánea en un servicio de medicina interna: estudio epidemiológico y clínico de 41 casos.

INTRODUCTION: The clinical-epidemiological characteristics of patients who were diagnosed of spontaneous infectious spondylodiscitis (SIS) in our Internal Medicine Department are analyzed and the related factors associated with the increase of the incidence are evaluated. PATIENTS AND METHODS: A cross-sectional, retrospective study of patients diagnosed of SIS from 1996 to 2005 was conducted. The study was divided in two periods: A (1996-2000) and B (2001-2005) and two main etiologic groups (pyogenic SIS and mycobacterial SIS) were compared. RESULTS: A total of 41 patients were diagnosed of SIS: 13 (31.7%) in period A and 28 (68.3%) in period B. Mean age was 58.5 +/- 17.6 years (range: 29-89). There were 73.2% men and all women presented in period B (0 vs 11, p = 0.008). Backgrounds were: 28 (68.3%) predisposing factors for SIS, 22 (53.6%), previous infections and 23 (56.1%) spinal diseases. There were not changes in the backgrounds during the study. The etiology of SIS was: 26 (63.4%) pyogenic, 12 (29.3%) mycobacterial and 3 (7.3%) brucellar. Patients with pyogenic SIS were older (63.6 +/- 3.2 vs 51.2 +/- 5.1 years, p = 0.035) and had less from onset of symptoms to diagnosis (62 +/- 12 vs 291 +/- 66 days, p = 0.0001) than patients with mycobacterial SIS. Total incidence of SIS and incidence of pyogenic SIS increased significantly during the study: (1.7/1000 admissions/year, p = 0.0057) and (1/1000 admissions/year, p = 0.0476). In the multivariate analysis, time from onset of symptoms to diagnosis was the only variable independently associated with the pyogenic etiological group (OR: 0.985, 95% CI: 0.975, 0.996, p = 0.005). CONCLUSIONS: In our study, the increasing incidence of SIS was related to an increase in pyogenic SIS incidence. Although older age and some backgrounds could be orientative of SIS etiology, these factors did not increase during the study.

[HIV infection in old age: an epidemiological and clinical study in 42 patients in the Community of Madrid]. / Infección por el VIH en la edad geriátrica: estudio epidemiológico y clínico en 42 pacientes de la Comunidad de Madrid.

A cross-sectional study was conducted at diagnosis of HIV infection in 42 patients aged > or = 60 years attended in two hospitals in the Madrid Community. Clinical and epidemiologic characteristics were retrospectively analyzed. Mean age was 64 years, 38 patients (90.4%) were males, and 24 (57.1%) met the AIDS criteria at diagnosis. Risk behaviour: 14 (33.3%) heterosexuals, 13 (30.9%) homosexuals, 3 (7.1%) bisexuals, 3 (7.1%) had received blood derivatives, 2 (4.7%) transfused patients, 1 (2.3%) parenteral drug abuser, 1 (2.3%) others and 5 (11.9%), unknown. In 18 (42.8%) patients there was a delay of diagnosis of 7.5 +/- 1.2 months (range: 1.5-24 months). These patients had lymphocyte counts lower than those diagnosed without delay (102 +/- 20 vs 262 +/- 67.10(9)/l, p < 0.01). Patients without AIDS criteria had a likelihood of 15.4% of progression towards AIDS at one year. The survival rate of patients with AIDS at one year was 50.1%. Patients with AIDS and diagnostic delay had a survival rate at one year lower than that in patients without diagnostic delay (30.7% vs 77.8%, p = 0.03). In summary, a predominant sexual transmission was found in our series. Delay of diagnosis entails a greater clinical and immunologic deterioration and a lower survival at one year. Early diagnosis and therapy with anti-retroviral agents might induce a longer survival in these patients.

[Spectrum of the renal pathology in HIV infection: description of 85 autopsies and clinico-pathologic correlation]. / El espectro de la patología renal en la infección por el VIH: descripción de 85 autopsias y correlación clínico-patológica.

A descriptive cross-sectional study was conducted on the prevalence and histologic characteristics of renal lesions found in the autopsies of 85 patients with HIV infection: also, a retrospective analysis of clinico-biological characteristics in 56 of these patients in order to establish the factors associated with the histological findings. A total of 85 autopsies were made from 1985 to 1993; 50 autopsies (58.8%) showed renal changes: 23 (27%) infections, 13 (15.2%) acute tubular necrosis (ATN), 6 (7%) tumors, 5 (5.8%) intersticial nephritis (IN), 5 (5.8%) nephrocalcinosis (NC), 10 (11.7%) others. In an additional study: group IIc (n = 37, study group with nephropathy) had a higher incidence in the hepatitis B surface marker (HBsAg) than in group Ic (n = 19, control group, without nephropathy) (0 vs 10, p < 0.05). The presence of disseminated mycobacteriosis in the autopsy was significantly higher in the group with nephropathy than in the group without nephropathy (11 vs 1, p < 0.05). No consistent data were observed between the clinical diagnosis of nephropathy and autopsic findings. In summary, a high incidence of nephropathy was found in the autopsies of HIV infected patients, although it was not previously suspected. Renal lesions in autopsies of HIV infected patients had a tubular-intersticial predominance over glomerular lesions. The use of potentially nephrotoxic drugs, the presence of HBsAG, and some opportunist infections apparently influenced on the development of renal lesions among these patients.

[The polyangiitis overlap-Schönlein-Henoch purpura-PAN syndrome: a case of more than a rare association]. / Síndrome poliangeítico de solapamiento púrpura de Schönlein Henoch-PAN: un caso más de una rara asociación.

A fifty-four-years old male with palpable purpura, polyarthritis and nephritic syndrome is presented. The renal biopsy disclosed mesangial proliferation with IgA deposits. During hospitalization abdominal pain and upper digestive bleeding also presented. Digital angiography showed splenic artery microaneurysms. Then it's a new case of polyangiitis overlap with mixed features of Schönlein-Henoch purpura and polyarteritis nodosa. Differential diagnosis between several vasculitic associations in a patient is discussed.

[Sneddon syndrome: diagnostic value of antiphospholipid antibodies]. / Síndrome de Sneddon: valor diagnóstico de los anticuerpos antifosfolípido.

The association of livedo reticularis and cerebrovascular lesions is known as Sneddon's syndrome. It affects young adults and is more common in females. Repeated strokes lead these patients to residual deficits. Recently, Sneddon's syndrome has been described in a subset of patients with systemic lupus erythematous and primary antiphospholipid syndrome. We report two cases, one of them with antiphospholipid antibodies. Antiphospholipid antibodies do not seem to explain the events of Sneddon's Syndrome. Perhaps, different pathogenic mechanisms play role in the clinical expression of this syndrome.

[Sclerosing cholangitis, papillary stenosis and B-cell lymphoma in a patient with acquired immunodeficiency syndrome]. / Colangitis esclerosante, estenosis de papila y linfoma-B en un paciente con síndrome de inmunodeficiencia adquirida.

The case of a 31 year old man who had been intravenous drug abuser for years is reported. He was studied because of abdominal pain, jaundice, a weight loss of 10 kg, and the presence of a subclavicular mass. Biopsy of the mass demonstrated a high-grade B-cell non-Hodgkin's lymphoma, and the patient was classified in group IV-D of the human immunodeficiency virus infection because he had HIV serum antibodies and a reduced CD4/CD8 lymphocyte ratio. Although lymphoma had a good response to chemotherapy, persistent cholestasis led to liver and biliary evaluation. Sclerosing cholangitis and papillary stenosis were found. He has been followed for two years, without evidence of any secondary infectious disease associated to the acquired immunodeficiency syndrome.