Linfoma esofágico primario en un paciente con síndrome de inmunodeficiencia adquirida: a propósito de un caso / Primary esophageal lymphoma in a adquired immunodeficiency syndrome: a case report

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Morbilidad hospitalaria en pacientes con infección por VIH / Hospital morbidity in HIV infected patients

Fundamento y objetivo: Con el aumento de la esperanza de vida en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) tras el tratamiento antirretroviral de gran actividad (TARGA), las causas de hospitalización han cambiado. Predominan ahora comorbilidades como la hepatopatía crónica, la patología cardiovascular o los efectos secundarios de los tratamientos. Nuestro objetivo es determinar las características clinicoepidemiológicas actuales de estos pacientes. Material y métodos: Estudio descriptivo y retrospectivo. Revisamos las historias clínicas de los ingresos de pacientes con infección por el VIH hospitalizados en los servicios médicos de nuestro hospital en el transcurso de un año. Resultados: Hubo 125 ingresos de 82 pacientes, un 77% varones y un 71% con infección por el virus de la hepatitis C (VHC). La edad media fue de 42 años. En el 64% la vía de transmisión fue la drogadicción parenteral. Un 36% recibían TARGA y un 51% reunían criterios sida. Los motivos de ingreso más frecuentes fueron la patologia respiratoria (32%) y las enfermedades definitorias de sida (EDS) con un 22%, de las que la tuberculosis (TBC) fue la más frecuente. Un 10% fueron ingresados en la Unidad de Cuidados Intensivos (UCI). La mortalidad fue del 11% pacientes/año. Conclusiones: La mayoría de los pacientes fueron varones, con coinfección por el VHC y usuarios de drogas vía parenteral, siendo las causas de ingreso más frecuentes las patologías respiratorias y las enfermedades oportunistas. La TBC permanece siendo la EDS más frecuente

Background and objetive: With the increasing life expectancy in human immunodeficiency virus (HIV) infected patients since the highly active antiretroviral therapy (HAART), other underlying comorbilities such as chronic liver patology, cardiovascular diseases or side effects of treatment may lead to hospitalization. The purpose of this study is to determine the clinical and epidemiological characteristics of these patients. Material and methods: A descriptive-retrospective study. We reviewed the clinical records of patients with HIV infection admitted in our medical departments through a year. Results: There were 125 hospitalizations of 82 patients. 77% were males and 71% had hepatitis C virus (HCV) infection. The median age was 42 years. 64% HIV infection had been acquired by sharing material for intravenous drug use. A 36% were receiving HAART and 51% had AIDS. The respiratory tract patology (32%) and AIDS-defining illnesses (22%) were the most frequent causes of hospitalization, and the main opportunistic disease was tuberculosis (TBC). Ten per cent were admitted in the Intensive Care Unit. Mortality rate was 11% patients/year. Conclusions: Most of the patients were male, drug users and HCV positive, and the admissions to hospital were mostly due to respiratory patology and opportunistic diseases. TBC remains like the most frequent AIDS-defining illness

Síndrome de hipersensibilidad a fenitoína / Hipersensitivity syndrome to phenitoin

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[Hospital morbidity in HIV infected patients]. / Morbilidad hospitalaria en pacientes con infección por VIH.

BACKGROUND AND OBJECTIVE: With the increasing life expectancy in human immunodeficiency virus (HIV) infected patients since the highly active antiretroviral therapy (HAART), other underlying comorbilities such as chronic liver pathology, cardiovascular diseases or side effects of treatment may lead to hospitalization. The purpose of this study is to determine the clinical and epidemiological characteristics of these patients. MATERIAL AND METHODS: A descriptive-retrospective study. We reviewed the clinical records of patients with HIV infection admitted in our medical departments through a year. RESULTS: There were 125 hospitalizations of 82 patients. 77% were males and 71% had hepatitis C virus (HCV) infection. The median age was 42 years. 64% HIV infection had been acquired by sharing material for intravenous drug use. A 36% were receiving HAART and 51% had AIDS. The respiratory tract pathology (32%) and AIDS-defining illnesses (22%) were the most frequent causes of hospitalization, and the main opportunistic disease was tuberculosis (TBC). Ten per cent were admitted in the Intensive Care Unit. Mortality rate was 11% patients/year. CONCLUSIONS: Most of the patients were male, drug users and HCV positive, and the admissions to hospital were mostly due to respiratory patology and opportunistic diseases. TBC remains like the most frequent AIDS-defining illness.

Respuesta paradójica sistémica a tratamiento tuberculostático, a propósito de un caso / Sistematic paradoxical response to tuberculosis treatment, a case review

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Enfermedad de Crohn: un amplio espectro clínico

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[Hospital detoxification unit: 4-year experience. Treatment and infections]. / Unidad de desintoxicación hospitalaria: cuatro años de experiencia. Tratamiento e infecciones.

BACKGROUND: Analysis of the main infections complications in drug-dependents and their relation between the way of consumption and sexual activity; the detoxification treatments used are taken into consideration. MATERIAL AND METHODS: We studied the patients admitted to the HDU (Hospital Detoxification Unit) between 1991 and 1995 revising their Clinical Histories with a protocol made for the occasion; the statistical calculations were subjected to the SPSS program, applying the Fisher's and Chi-square tests. RESULTS: 458 patients were included (males = 365); drug were taken intravenously in 290 cases (distribution from 1991 to 1995: 61, 92, 72, 88-p = 0.05), smoked in 120 cases (distribution: 18, 57, 60, 67-p = 0.01), inhaled in 29 cases (2, 16, 4, 6-p = 0.01) and taken orally 176 cases (29, 50, 46, 50). The Hepatitis B Virus (HBV) was positive in 186 of 403; the Hepatitis C Virus (HCV) was positive in 259 of 374 (known = 115/discovered = 144) and incidence with respect to the human immunodeficiency virus (HIV) has p < 0.000001; HIV was positive in 85 (known = 69). Sexually Transmitted Diseases (STD) were present in 94 patients, 27 of whom were women (p = 0.03), HBV(+) = 38, HCV(+) = 49 and HIV(+) = 52 (p = 0.02). Candida infections is present in 31 HIV(+). Phlebitis antecedents are found in 79 (424), 48 of whom were HBV(+) (p = 0.00003), 60 were HCV(+) (p = 0.000008) and 29 HIV(+) (p = 0.00003). The patients were mainly treated with Clonidina (450) and tricyclic antidepressants (242). CONCLUSIONS: In our study, we observe the increase of intravenous drug users, being phlebitis the most frequent antecedent in HBV(+), HCV(+) and HIV(+); we have also detected a higher number of STD both in these groups and in women as well.

[The acquired immunodeficiency syndrome in the elderly]. / Síndrome de inmunodeficiencia adquirida en el anciano.

Three cases of AIDS in patients older than 60 years of age are presented and are characterized by the delay in diagnosis even in the face of suggestive clinical manifestations because of the lack of suspicion leading to fatal short term evolution in all the cases. The importance of HIV infection and its characteristics at this age are discussed. Transfusion is the most frequent method of transmission. The clinical manifestations do not differ from those of other ages with neurological and psychiatric manifestations being significant as a form of presentation. Evolution is usually rapidly progressive. The need to suspect HIV infection is emphasized in elderly patients when presenting typical AIDS pathology or atypical dementia or rapid evolution specially if pertaining to a risk group.

[Cholestasis and prostatic carcinoma. Description of a case and review of paraneoplastic cholestasis]. / Colestasis y carcinoma de próstata. Descripción de un caso y revisión de las colestasis paraneoplásicas.

We report a patient with cholestasis associated with prostatic carcinoma. When metastasic hepatic occupation, bile tract obstruction and other causes were ruled out, cholestasis was attributed to carcinoma itself as a paraneoplastic syndrome. This possibility has been previously reported as exceptional in prostatic carcinoma and in other tumors. We review cholestasis associated with tumors and we discuss its possible etiological and pathogenetical mechanisms.