Carcinoma sarcomatoide de pulmón / No disponible

El carcinoma sarcomatoide es una neoplasia maligna, poco frecuente,de localización extremadamente rara en pulmón, más frecuenteen varones y en clara relación con el hábito tabáquico.Describimos el caso de un varón de 72 años que presentaba clínicade tos con expectoración hemoptoica, síndrome febril y cuadroconstitucional, en el que se objetivó en la radiografía de tóraxduplicación del tamaño de una lesión quística, ya conocida previamentey con sospecha clínica de quiste hidatídico en lóbulo superiorderecho. Ante la falta de diagnóstico con las pruebas no invasivas,se realizó una toracotomía diagnóstico-terapéutica,estableciéndose el diagnóstico anatomopatológico de carcinomasarcomatoide de pulmón tras la extirpación de la pieza quirúrgica (AU)

Sarcomatoid carcinoma is an infrequent malignant neoplasia,extremely rare in the lung, more frequent in men and with a clearrelationship with the tobacco habit.We describe the case of a 72 year old man who presented a clinicalpicture of cough with haemoptoic expectoration, febrile syndromeand constitutional syndrome, in which chest X-ray examinationshowed a duplication in the size of a previously known cystic lesion,with the clinical suspicion of a hydatid cyst in the right upper lobe.Faced with the lack of a diagnosis with non-invasive tests, a diagnostic-therapeutic thoracotomy was made, establishing the anatomopathologicdiagnosis of sarcomatoid carcinoma of the lung afterthe surgical resection of the lesion (AU)

Evaluación del derrame pleural de origen infeccioso / No disponible

No disponible

Asignatura de libre elección “Abordaje del tabaquismo” en la Facultad de Medicina de Badajoz (Universidad de Extremadura) / Free choice subject “Approach to smoking” in the Medical School of Badajoz (University of Extremadura)

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Evolution of the management of depression in Spain from the psychiatrist's perspective. A comparative analysis: 1997 vs 1982.

The main problem of depression is not only the high prevalence of the disorder but also its serious consequences on the patient's quality of life and the associated social costs in terms of health care resource utilization and productivity losses. In recent years, there has been a considerable improvement in the knowledge of depression from the pathogenic, clinical and therapeutic perspectives. The present study analyzes whether such advances are reflected in a positive evolution of the treatment of depression in Spain. To this effect we have contrasted the results of two socio-sanitary studies published in this country: the White Book editions of 1982 and 1997 (WB82 and WB97, respectively). From the methodological perspective, the physician selection criteria employed were very uniform (structured questionnaires delivered to 128 (WB82) and 300 (WB97) randomly selected psychiatrists). The origin of patients consulting for specialized care has varied over this 15-year period. In effect, WB82 patients were essentially referred by friends (87.5%) and from the primary care setting (44.5%), whereas in the WB97 study referral from primary care predominated (50.1%), followed by the patient's personal decision (24.8%). In turn, 40.7% and 51.7% of the psychiatrists in WB97 respectively considered the diagnostic and therapeutic means available in primary care to be insufficient. The priorities for improving patient quality of life, as reflected by both editions of the study, were the training of primary care physicians and the adequate provision of means in the mental health care centers. On the other hand, fewer problems for establishing a correct diagnosis were referred in the 1997 edition of the study (28.7%) than in 1982 (48.4%). In this sense, the main problem reported in WB82 was the lack of specialized training, whereas the masking of depression by some other disease process or symptoms was the main problem in WB97 (67.6% vs 21.1% according to WB82). The main symptoms upon which the diagnosis of depression are based do not seem to have evolved much in the past 15 years. The most frequently cited manifestations were a worsening of mood, loss of interest and leisure capacity, sleep alterations and diminished vitality. A comparative analysis of the therapeutic resources used was not possible, for prior to 1982 the only drugs available to physicians were the classical tricyclic agents and some MAO inhibitors; the selective serotonin reuptake inhibitors (SSRIs) - possibly the greatest advance in the treatment of depression in these 15 years - had not yet been introduced. Nevertheless, it should be pointed out that 98% of the psychiatrists consulted in WB97 considered pharmacologic treatment to be the most widely adopted form of management once depression has been diagnosed.

Transvaginal sonographic depiction of aborting pedunculated intracavitary uterine leiomyoma.

We present an unusual case in which, following indeterminate findings on transabdominal sonographic assessment, transvaginal sonography clearly depicted an aborting pedunculated intracavitary leiomyoma within the uterine cervix. The lesion measured 4x4 cm and exhibited central cystic degenerative changes.

[A pharmacovigilance study with bentazepam in a sample of 1046 psychiatric outpatients]. / Estudio de farmacovigilancia con bentazepam en una muestra de 1.046 pacientes psiquiátricos ambulatorios.

A pharmacovigilance study was performed upon 1,046 ambulatory patients that have been treated in external psychiatric consultation with bentazepam. The sample size made possible to detect with 99% of security the incidence higher to 5% secondary effects, as mouth dryness, somnolence, asthenia, gastralgias/dyspepsias, constipation and sickness. It has as well been possible to detect the most usual ways of coprescription, and the most frequent was with antidepressants drugs that undertook approximately 1/3 of the sample and that it was responsible for some of the secondary effects observed. The bentazepam treatment cut down significatively the score mean in Hamilton scale for the anxiety after 10-15 days of treatment. According to an intention analysis a therapeutic profit was got in the 76.7% of the sample depending on medical criteria and the 74.0% on patient criteria after 20-30 days of the treatment. The results obtained are discussed in terms of the sample characteristics.

Role of cardiopulmonary mechanoreceptors in the postural regulation of renin.

To change the stretch on cardiopulmonary mechanoreceptors, large shifts of blood in the capacity space were elicited by tilting and by exerting positive lower body pressure in the tilted position. Twelve volunteers underwent invasive hemodynamic studies and in 10 other subjects cardiac size was determined by radionuclide cardiography. In all 22 subjects tilting caused the expected increase of renin, which was abolished by lower body compression. Decompression caused renin to increase again. Right atrial pressure in invasive studies and end-systolic and end-diastolic counts in noninvasive studies showed a significant and strong negative correlation with renin and norepinephrine levels. Thus, the degree of stretch of the cardiopulmonary mechanoreceptors is a major determinant of reflex regulation of renin release in humans.

[Immunological alterations in a case of desquamative interstitial pneumonia (author's transl)]. / Alteraciones inmunológicas en un caso de neumonía intersticial descamativa.

A 48-years-old patient with a clinical picture of dyspnea, unproductive cough, and nonspecific thoracic pain is reported. The most outstanding finding in the physical examination was the auscultation of fine crepitants after inhalation, located in both pulmonary bases. The chest X-ray desmonstrated the existence of some confluent, bilateral opacities of a net basal predominance, which were suggestive of an interstitial process. The lung biopsy, through a thoracotomy, has allowed for the diagnosis of a desquamative interstitial pneumonia. The alterations found in the humoral immunity, which basically consisted of an important increase of IgG and a less-marked increase of IgA, have shown a regressive tendency, closely correlated to a good response to the steroid therapy. The clinical and roentgenological course of the patient has been similarly favourable.