Debut de linfoma Hodgkin con clínica de compresión medular / Spinal involvement as first presentation of Hodgkin´s disease

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[Tumoral markers and acute-phase reactants in the diagnosis of pancreatic cancer]. / Marcadores tumorales y reactantes de fase aguda en el diagnóstico del cáncer de páncreas.

OBJECTIVE: To analyze the diagnostic accuracy of the following parameters in the diagnosis of pancreatic cancer: carcinoembryonic antigen (CEA), tissue plasminogen activator (TPA), carbohydrate antigen 19-9 (CA 19-9), carbohydrate antigen 50 (CA 50), alpha-1-antitrypsin (AAT), alpha-2 macroglobulin (AMG), and ceruloplasmin (CP). PATIENTS AND MENTOD: We prospectively studied 58 patients with pancreatic cancer, 40 with alcoholic pancreatitis and 40 healthy controls, in whom the above-mentioned parameters were analyzed. Receiver operating characteristic curves (ROC curves) were analyzed. RESULTS: The specificity of TPA, CA 19-9 and CA 50 in the differential diagnosis between pancreatic cancer and chronic pancreatitis was 87.5%, 90% and 95% respectively, with a sensitivity of nearly 90%. Although levels of AAT, AMG and CP were higher in patients with cancer than in those with pancreatitis, their specificity was lower, approximately 65%. CEA and TPA showed a positive association with the presence of metastases. CONCLUSION: TPA, CA 19-9 and CA 50 were useful in the differential diagnosis between pancreatic cancer and chronic pancreatitis.

[Osteonecrosis and HIV]. / Osteonecrosis y VIH.

An increase of the incidence of osteonecrosis in subjects infected with the HIV has been reported. It is unknown if osteonecrosis is an HIV infection consequence, or just the consequence of so many risk factors present among HIV infected subjects. We report five osteonecrosis cases found in our series of 534 HIV patients, and we review the related bibliography. All cases have some conventional risk factor different to the HIV or the antiviral treatment. We can't conclude antiviral treatments are not involved in osteonecrosis, but they have been the only risk factor in none of our patients.

Osteonecrosis y VIH / Osteonecrosis and hiv

En la literatura aparece un incremento de la incidencia de osteonecrosis de cabeza femoral entre sujetos infectados por el VIH, si bien se desconoce si ésto es consecuencia directa o indirecta de la enfermedad infecciosa o más bien se debe al acúmulo de factores que en estos pacientes se da por su pluripatología. En este trabajo describimos cinco casos de osteonecrosis ocurridos entre los 534 pacientes VIH vistos en nuestro hospital y repasamos la bibliografía relacionada. Todos los casos presentan alguno de los factores de riesgo convencional ya relacionados con el desarrollo de osteonecrosis. Si bien no puede descartarse el papel del tratamiento o del VIH en el desarrollo de osteonecrosis, no hemos detectado ningún caso entre nuestros pacientes en que éste haya sido el único factor (AU)

An increase of the incidence of osteonecrosis in subjects infected with the HIV has been reported. It is unknown if osteonecrosis is an HIV infection consequence, or just the consequence of so many risk factors present among HIV infected subjects. We report five osteonecrosis cases found in our series of 534 HIV patients, and we review the related bibliography. All cases have some conventional risk factor different to the HIV or the antiviral treatment. We can’t conclude antiviral treatments are not involved in osteonecrosis, but they have been the only risk factor in none of our patients (AU)

[Diet survey and evaluation of ingested nutrients in a group of HIV patients]. / Encuesta dietética y valoración de los nutrientes ingeridos en un grupo de pacientes VIH.

OBJECTIVE: To study the relationship between nutritional status, immunological condition, clinical progress and food consumption in a group of patients infected with HIV. METHOD: Longitudinal descriptive study of 30 HIV/AIDS patients. Anthropometric assessment (weight, height, skin folds, upper arm circumference). The intake of nutrients was calculated using a one-week dietary record. RESULTS: The mean amount of energy intake is 2,791 kcal with a 13.48% of protein, 40.12% of carbohydrates and 45.89% of lipids. The group of patients with weight loss presented a significantly greater proportion of proteins than group with normal weight. Patients with Kwashiorkor-like malnutrition presented an intake of proteins which was significantly lower than the group of well-nourished patients. The group of those whose nutritional status improved presented a significantly higher mean percentage of proteins in the diet than the other groups. CONCLUSIONS: The amount of the energy intake by patients is higher than that recommended. The diets show an excessive consumption of fats and a shortage of carbohydrates and proteins. Deficits are observed in vitamin B6 and vitamin E, magnesium and zinc. The increase in intake, by itself, does not improve the health status of the patients, indicating the need to provide them with the necessary dietary supplements from the early stages of their condition.

[Nutritional status of the HIV patient. Description and clinical course of a group of patients over a year]. / Estado nutricional del paciente VIH. Descripción y evolución durante un año de un grupo de pacientes.

GOAL: To know the nutritional and immunological status of a sample of patients infected by HIV and their evolution over a one-year period. Relationship between nutritional status, immunological status and clinical evolution. METHOD: Longitudinal descriptive study of 30 HIV-infected patients. Anthropometric evaluation (weight, height, skin folds, arm circumference) and immunological assessment (CD4 and CD4/CD8). STATISTICAL ANALYSIS: means, absolute and relative frequencies, Student's T test. RESULTS: 30 patients, 73.3% males and 27.7% female. Mean age 34.7 years. Initial nutritional assessment: 30% of patients had normal weight, 36.7% presented mild undernourishment, 16.7% moderate undernourishment, 6.7% were overweight and 10% were obese. The evolution of CD4 and CD4/CD8 levels was not significantly influenced by nutritional status. CONCLUSIONS: The patients in the study presented a deterioration of their nutritional status, as assessed by triceps skin fold. The nutritional status of the HIV-infected patients in our study is not dependent on their immunological status. The diagnosis and treatment of their de-nourishment on diagnosis of HIV infection will contribute to the prevention of complications, thus reducing the human and health-care costs. An increase in food intake, on its own, does not improve the condition of the patients, indicating the need to provide them with the necessary dietary supplements from the early stages of illness.

[Neurophysiological parameters and CD4 lymphocyte count in patients infected by human immunodeficiency virus]. / Parámetros neurofisiológicos y cifra de linfocitos CD4 en pacientes infectados por el virus de la inmunodeficiencia humana.

INTRODUCTION AND OBJECTIVE: The human immunodeficiency virus (HIV) causes serious, irreversible, progressive deterioration of the immune and nervous systems. The main target cells are the 'helper' T lymphocytes and monocyte-macrophage cells with CD4 molecules on the surface acting as virus receptors. In this study we attempt to find whether the immune state and the nervous system are involved in parallel, or whether, on the contrary, HIV neurotropism is such that it leads to early nerve involvement, out of proportion to that of the immune system. PATIENTS AND METHODS: We studied a total of 66 persons, 30 seronegative and 36 seropositive, with different CD4 lymphocyte counts. In all cases motor and sensory conduction studies were done in the arms and legs, namely auditory, visual and somatosensory evoked potentials and also endogenous potentials (mainly P300). CONCLUSIONS: There are neurophysiological parameters which give pathological figures, even when immunity is maintained (figures of CD4 greater than 500/mm3) especially with regard to the figures for sensitivity of the legs, somatosensory evoked potentials and P300. Moreover, these are increased and others added at the same time as the CD4 count falls as the disease advances.

[Value of C-reactive protein for detecting bacteremia in febrile patients]. / Utilité de la protéine C réactive dans la détection de bactériémie chez les patients fébriles.

OBJECTIVES: Mortality among bacteremic adults ranges between 14 and 35%, and there is no biological clue to identify such patients a priori. As C-reactive protein (CRP) blood level rises in children during bacteremia, we investigated its accuracy to identify bacteremic patients among febrile adults who were admitted to our hospital either for study or treatment. METHODS: Patients older than 14 entering the emergency room with objective axilar temperature above 37.5 degrees C and admitted either for study or treatment were elligible for enrollment. After initial examination, samples were obtained for blood cultures and CRP measurement. Follow-up during hospitalization was assessed. All variables were related with one another by bivariant statistical methods performed with Sigma Horus hardware. After bivariant study we used the program BMDP Statistical Software (1991) to perform the multivariate study in its discriminant analysis. RESULTS: One hundred seventy-four patients entered the study with an average age of 58.9 years; 47.7% were over 65 years of age; 88% of febrile syndromes were of infectious origin and among them, bacteremia ranged up to 17.2%. Values of CRP were significantly related with the following variables: "age": patients younger than 45 had average CRP concentrations of 9.5 mg%, age over 45 had 17.4 mg% (Mann Whitney U (MW) p < 0.001); "clinical situation on admission": for poor, intermediate and stabilized situations average CRP levels were 14.7, 18.5 and 12.4 mg% respectively (MW p < 0.05); "time from fever onset"; "clinical outcome": for death average CRP was 23.01 mg% and for cure 14.6 mg% (MW, p < 0.05), in that way probability of death was 21%, 9% and 3% for CRP concentrations higher than 20, between 10 and 20 and under 10 mg% respectively. There was no link between CRP serum levels and sex, severity of chronic illness, cause of fever, localization of infection and existence of bacteremia. The multivariate study in its discriminate mode was of no use to identify bacteremic patients. CONCLUSION: According to our findings CRP determination can not be used alone or associated to identify patients with positive blood cultures among the febrile ones. CRP blood determination should not be considered before 24 hours from disease onset as this time is required for CRP to stabilize. Patients with CRP levels higher than 20 mg% on admission have a higher risk of dying during hospitalization.