[Pulmonary Langerhans'-cell histiocytosis]. / Histiocitosis pulmonar de células de Langerhans.

Pulmonary Langerhans'-cell histiocytosis belongs to a spectrum of diseases characterized by monoclonal proliferation and infiltration of organs by Langerhans' cells. It is an uncommon interstitial lung disease of unknown etiology occurring almost exclusively in cigarette smokers. It s course in adults is variable and unpredictable, ranging from benign self-limiting types with spontaneous regression to slowly progressive malignant disease that leads to respiratory failure and death. We report one patient diagnoses of pulmonary Langerhans' cell histiocytosis who experimented an objective radiographic improvement and disappearance of symptoms after smoking cessation.

Histiocitosis pulmonar de células de Langerhans / Pulmonary Langerhans´-cell histiocytosis

La histiocitosis pulmonar de células de Langerhans forma parte de un espectro de enfermedades caracterizadas por la proliferación monoclonal y la infiltración de distintos órganos por células de Langerhans. Es una enfermedad pulmonar intersticial de etiología desconocida que ocurre casi exclusivamente en pacientes fumadores. El curso de esta enfermedad en adultos es impredecible, oscilando desde formas benignas autolimitadas, hasta formas malignas con evolución progresiva hacia el fallo respiratorio y la muerte. Presentamos el caso de un paciente diagnosticado de histiocitosis pulmonar de células de Langerhans que presentó una mejoría clínica y radiográfica tras abandonar el hábito tabáquico

Pulmonary Langerhans´- cell histiocytosis belongs to a spectrum of diseases characterized by monoclonal proliferation and infiltration of organs by Langerhans´cells. It is an uncommon interstitial lung disease of unknown etiology occurring almost exclusively in cigarette smokers. It´s course in adults is variable and unpredictable, ranging from benign self-limiting types with spontaneous regression to slowly progressive malignant disease that leads to respiratory failure and death. We report one patient diagnoses of pulmonary Langerhans´cell histiocytosis who experimented an objetive radiographic improvement and disappearance of symptoms after smoking cessation

[Whipple's disease. Two new cases of an underdiagnosed disease]. / Enfermedad de Whipple. Dos nuevos casos de una enfermedad infradiagnosticada.

Whipple's disease is a rare systemic infectious disease caused by the bacterium Tropheryma whippelii. Early diagnosis is essential. Whipple's disease is potentially fatal but responds dramatically to antibiotic treatment. The diagnosis is confirmed by means of polymerase chain reaction (PCR) technology. This analysis may be useful for monitoring the efficacy of therapy. The recommended treatment al present is administration of cotrimoxazole twice daily for one year. When CNS involvement occurs, it is recommended initial treatment with daily parenteral administration of streptomycin 1 g and 1.2 million units of benzyl penicillin (Penicillin G) over a period of 14 days.

Enfermedad de Whipple. Dos nuevos casos de una enfermedad infradiagnosticada / Whipple´s disease. Two new cases of an underdiagnosed disease

La enfermedad de Whipple, también conocida como lipodistrofia intestinal, es un proceso infeccioso, multisistémico y poco frecuente, causado por la bacteria Tropheryma whippelii. El diagnóstico precoz es fundamental porque esta enfermedad es potencialmente letal, pero responde espectacularmente al tratamiento antibiótico. El diagnóstico se confirma con la reacción en cadena de la polimerasa (PCR) que también es útil para monitorizar la respuesta al tratamiento. Actualmente el tratamiento recomendado consiste en la administración de cotrimoxazol oral dos veces al día durante un año. Cuando hay afectación del SNC se aconseja iniciar el tratamiento con la administración intramuscular de 1 gramo de estreptomicina asociado a 1,2 MU de bencil penicilina (penicilina G) de forma diaria durante 14 días

Whipple’s disease is a rare systemic infectious disease caused by the bacterium Tropheryma whippelii. Early diagnosis is essential. Whipple’s disease is potentially fatal but responds dramatically to antibiotic treatment. The diagnosis is confirmed by means of polymerase chain reaction (PCR) technology. This analysis may be useful for monitoring the efficacy of therapy. The recommended treatment al present is administration of cotrimoxazole twice daily for one year. When CNS involvement occurs, it is recommended initial treatment with daily parenteral administration of streptomycin 1 g and 1,2 million units of benzyl penicillin (Penicillin G) over a period of 14 days

Eje hipófiso-suprarrenal en el alcoholismo crónico / Hypophyso-adrenal axis in patients with chronic alcoholism

Objetivos: Valorar la situación del eje hipófiso-suprarrenal en pacientes con alcoholismo crónico. Método: Se estudiaron 24 pacientes alcohólicos crónicos ingresados en nuestro centro en situación de delirio agudo. Se determinaron cortisolemia a.m. y p.m. y niveles de ACTH a.m.junto a serie roja con sus índices de Wintrobe, número de plaquetas, trigliceridemia, colesterolemia total y HDL y actividad de transaminasas, fosfatasa alcalina y gammaglutamiltranspeptidasa en el suero. Resultados: Las cifras medias de ACTH a.m. fueron de 41.2 pcg/ml para valores normales de 10-80 pcg/ml, las de cortisolemia a.m. de 22 mcg/ml (rango normal 5-25 mcg/ml) y las de cortisolemia p.m. de 12.3 mcg/ml (tango normal 5-15 mcg/ml). Conclusiones: Las cantidades de alcohol ingeridas por los pacientes alcohólicos no parecen equiparables a las utilizadas y a las que condicionan una hiperfunción suprarrenal en la experimentación animal. Los niveles de ACTH en sangre y de cortisolemia no son útiles como parámetros indirectos de alcoholismo. Al respecto, destacan como más efectivos los índices de Wintrobe y la actividad de gammaglutamiltranspeptidasa en el suero. (AU)

[Rhabdomyolysis syndrome and hyperthermia secondary to cocaine and/or ecstasy consumption. Report of 2 new cases and review of the problem]. / Síndrome de rabdomiolisis e hipertermia secundario al consumo de cocaína y/o éxtasis. Comunicación de dos nuevos casos y revisión del problema.

We describe two cases of hyperthermia and rhabdomyolysis related to cocaine and/or ecstasy consumption. The clinical and laboratory findings are characteristic of hyperthermia syndrome in both cases. The first patient consumed cocaine, ecstasy and alcohol and afterwards suffers from hyperthermia and rhabdomyolysis associated with decreased conscious level, labile blood pressure, severe renal insufficiency (needing hemodialysis) and important liver failure. The second patient consumed ecstasy and alcohol with intense physical activity and shows the same but moderate clinical picture rapidly responding to intravenous fluid therapy. The incidence of this drug-induced hyperthermia is low compared to the important use of these illicit drugs. Nevertheless its increasing consumption will lead physicians to attend more patients with this syndrome and other related complications. For this reason we have reviewed and up-dated this problematic subject.

Síndrome de rabdomiolisis e hipertermia secundario al consumo de cocaína y/o éxtasis. Comunicación de dos nuevos casos y revisión del problema / Rhabdomyolisis syndrome and hyperthermia secondary to cocaine and/or ecstasy intake. Communication of two new cases and review of the problem

Se describen dos casos de síndrome de hipertermia y rabdomiolisis en pacientes que habían consumido cocaína y/o éxtasis. Ambos muestran una clínica y unas alteraciones analíticas características de este síndrome.El primer paciente a consecuencia de la toma de cocaína, éxtasis y alcohol sufre un cuadro grave de hipertermia y rabdomiolisis asociado a estupor, confusión, tensión arterial lábil, grave insuficiencia renal, que precisó de hemodiálisis, e intenso daño hepático. El segundo consume éxtasis asociado a alcohol e importante ejercicio físico y sufre de un cuadro similar aunque moderado que revirtió con medidas de reposición hidrolectrolítica. Si bien la incidencia de esta patología es muy limitada en relación al amplísimo consumo de estas drogas, su continuo uso llevará consigo la atención de nuevos pacientes afectos de esta y otras complicaciones agudas. Con este motivo se realiza una revisión y actualización del problema (AU)

[Hypophysio-adrenal axis in patients with chronic alcoholism]. / Eje hipófiso-suprarrenal en el alcoholismo crónico.

OBJECTIVES: To study the situation of the hypophyso-adrenal axis in patients with chronic alcoholism. METHOD: 24 patients with chronic alcoholism admitted in our Institution with acute delirium were studied. Cortisol am and pm und (ACTH levels, along with hemogram with Wintrobe indexes, patelets number, triglicerides, total and HDL cholesterol, transaminases, alkaline phosphatase and gammaglutamyltranspeptidase were measured in serum. RESULTS: The mean values of ACTH am were 41.2 pcg/ml (normal values 10-80 pcg/ml), of plasma cortisol am 22 mcg/ml (normal values 10-24 mcg/ml) and plasmo cortisol pm 12.3 mcg/ml (normal values 5-12 mcg/ml). CONCLUSIONS: The amount of alcohol consumed by alcoholic patients ist not comparable to that used in animal models, which induced adrenal hyperfunction. Blood ACTH and cortisol levels are not useful as indirect markers of alcoholism. The Wintrobe indexes and serum gammaglutamyltranspeptidase levels are more useful for that purpose.

[Epidemic parotitis and Reiter's syndrome]. / Parotiditis epidémica y síndrome de Reiter.

A case of epidemic parotiditis in an adult male affected by Reiter's syndrome, is presented. The symptoms of Reiter's syndrome lasting 3 months after the recovery from epidemic parotiditis. Although descriptions of Reiter's syndrome of viral origin (adenovirus or hepatitis virus) exist, we have not found references of a relation to epidemic parotiditis. The diagnosis criteria of this syndrome is discussed, as well as the study of the epidemic parotiditis. We review the existing theories in order to justify the multiple etiology of this interesting syndrome.