Ultrasound screening for abdominal aortic aneurysm in primary care. / Utilidad de la ecografía en el cribado del aneurisma de aorta abdominal en atención primaria.

INTRODUCTION: Abdominal aortic aneurysm (AAA) constitutes a pathology with high mortality. There is currently no screening program implemented in primary care in Spain. OBJECTIVES: To evaluate the usefulness of ultrasound in the detection of AAA in the at-risk population in primary care. Secondarily, to identify subjects whose vascular risk (VR) should be reclassified and to determine whether AAA is associated with the presence of carotid plaque and other risk factors. MATERIAL AND METHODS: Cross-sectional, descriptive, multicenter, national, descriptive study in primary care. SUBJECTS: A consecutive selection of hypertensive males aged between 65 and 75 who are either smokers or former smokers, or individuals over the age of 50 of both sexes with a family history of AAA. MEASUREMENTS: Diameter of abdominal aorta and iliac arteries; detection of abdominal aortic and carotid atherosclerotic plaque. VR was calculated at the beginning and after testing (SCORE). RESULTS: One hundred and fifty patients were analyzed (age: 68.3±5 years; 89.3% male). Baseline RV was high/very high in 55.3%. AAA was detected in 12 patients (8%; 95% CI: 4-12); aortic ectasia in 13 (8.7%); abdominal aortic plaque in 44% and carotid plaque in 62% of the participants. VR was reclassified in 50% of subjects. The detection of AAA or ectasia was associated with the presence of carotid plaque, current smoking and lipoprotein(a), p<0.01. CONCLUSIONS: The prevalence of AAA in patients with VR is high. Ultrasound in primary care allows detection of AAA and subclinical atherosclerosis and consequently reclassification of the VR, demonstrating its utility in screening for AAA in the at-risk population.

Pupila de Adie / Adie's pupil

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Encondroma / Encondroma

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Poliquistosis renal / Polycystic kidney disease

Presentamos el caso de un varón de 45 años con poliquistosis renal dominante, al que desde hace años se le realiza el seguimiento de su patología renal desde Atención Primaria. La poliquistosis renal es una enfermedad hereditaria que puede tener un patrón de transmisión autosómica dominante o recesiva, manifestándose clínicamente este último desde las primeras etapas de la vida. Se trata de una enfermedad poco frecuente y desconocida para muchos médicos, por lo que es esencial conocer su existencia con la finalidad de realizar un diagnóstico precoz y evitar la progresión general de la enfermedad hacia la insuficiencia renal. En Atención Primaria, nuestro objetivo prioritario será el control de la hipertensión arterial y de las infecciones urinarias, para evitar la progresión de la enfermedad, así como la búsqueda activa de familiares afectos. El uso de la ecografía en Atención Primaria nos permite realizar tanto el diagnóstico como el seguimiento, así como el cribado de familiares de pacientes con la enfermedad (AU)

We report the case of a 45-year-old male with dominant polycystic kidney disease who has received follow-up in Primary Care for years. Polycystic kidney disease is an inherited disease that can have an autosomal dominant or recessive pattern of transmission, being the latter clinically manifest from the earliest stages of life. This disease is rare and unknown to many physicians. It is therefore essential to be aware of its existence in order to make an early diagnosis and prevent the overall progression of the disease towards kidney failure. At primary care level, our priority objective will be the control of arterial hypertension and urinary tract infections to prevent the progression of the disease, as well as the active search for affected relatives. The use of ultrasound in primary care allows us to perform both diagnosis and monitoring of our patient, and to perform screening of the patient's relatives with the disease (AU)

Shock anafiláctico con manzana. Síndrome LTP / Anaphylactic shock caused by apple. LTP syndrome

Presentamos el caso de una paciente atendida en urgencias del centro de salud por un cuadro clínico de shock anafiláctico desencadenado tras la ingesta de manzana y realización posterior de ejercicio físico. En alergia a alimentos, hay que tener presente que en algunas personas es necesaria la presencia de determinados cofactores como el ejercicio físico o la ingesta de determinados fármacos como los AINEs para que suceda una reacción alérgica. Se sospecha que el mecanismo responsable consiste en que aceleren la absorción del alimento en el intestino y así lleguen a modular la severidad de los síntomas. Por este motivo cuando las LTP (proteína de transferencia de lípidos) están implicadas, si los cofactores no se detectan y previenen, pueden representar un serio riesgo para el desarrollo de episodios de anafilaxia severos o fatales (AU)

We report the case of a patient treated in an emergency department of a health center for a clinical picture of anaphylactic shock triggered after ingestion of apple and subsequent practice of physical exercise. In food allergy, it must be remembered that in some people the allergic reaction requires the presence of certain cofactors, such as physical exercise or use of certain prescription drugs such as NSAIDs. It is suspected that the mechanism responsible for this consists in accelerating the absorption of food in the intestine and thereby modulating the severity of symptoms. That is why when lipid transfer proteins (LTP) are involved, if the cofactors are not detected and prevented, they can pose a serious risk for developing severe or fatal episodes of anaphylaxis (AU)

Enfermedad de Paget monostótica / Monostotic Paget's Disease

Presentamos el caso de un paciente al que, de modo casual, se detecta deformidad de miembro superior debido a enfermedad de Paget localizada en húmero. La enfermedad de Paget es la segunda enfermedad ósea metabólica en frecuencia después de la osteoporosis, afectando en España a un 3 % de la población mayor de 55 años. Aunque de causa desconocida, tiene implicaciones genéticas y víricas. Puede afectar a uno o varios huesos produciendo dolor, deformidad y fracturas, sobre todo en huesos largos. La radiología es la clave del diagnóstico en caso de sospecha y los marcadores bioquímicos de reabsorción ósea pueden sernos de utilidad. El pilar básico del tratamiento se basa en el uso de bifosfonatos (AU)

The present is the case of a patient who was by chance detected a deformity in his upper arm due to Paget's Disease localized in the humerus. Paget's Disease is the second most common metabolic disease after osteoporosis, affecting 3% of the population over the age of 55 in Spain. While its etiology remains elusive, genetic factors and viral implications are involved. It can affect one or several bones causing pain, deformities and fractures, especially in long bones. Radiologic tests are the key for correct diagnosis in case of disease suspicion and biochemical resorption bone markers could also be useful. The basic pillar of therapy is based on the use of bisphosphonates (AU)