Control sintomático y cuidados paliativos en pacientes que fallecen en un Servicio de Medicina Interna / No disponible

Objetivo: el objetivo de este estudio es describir las características clínicas de los pacientes fallecidos en el Servicio de Medicina Interna del Hospital Cruz Roja de Madrid durante el año 2007, analizando aquellos que fallecieron tras una fase de agonía (describiendo síntomas, control sintomático, fármacos usados y cuidados paliativos no farmacológicos). Material y métodos: se diseñó un estudio observacional retrospectivo donde se examinaron las historias clínicas, excluyendo aquellas que correspondían a pacientes que fallecieron a menos de 24 horas de su ingreso hospitalario o tras maniobras de reanimación avanzada. Resultado: de 861 pacientes ingresados fallecieron 42; el 87,5% fueron catalogados como agónicos y el síntoma principal que presentaron fue la disnea (85,7%), teniendo esta, al igual que los otros síntomas recogidos un control deficitario (sólo el 7,1% falleció con la totalidad de sus síntomas controlados). No se recogió, en las historias clínicas, ningún otro tipo de abordaje paliativo no farmacológico (psicosocial, espiritual o atención tras el duelo). Conclusiones: existe un porcentaje elevado de pacientes que fallecen en agonía en una planta de hospitalización convencional. Los síntomas recogidos en estos pacientes no difieren de los recogidos en las Unidades de Cuidados Paliativos, aunque predomina la disnea y es menos frecuente el dolor no controlado. El control sintomático es dificultoso, pero mejora al emplear fármacos habituales en cuidados paliativos (morfina, midazolam y butilescopolamina). No se recoge de manera habitual o sistemática el uso de cuidados paliativos no farmacológicos en las historias clínicas (AU)

Objective: the aim of this study was to describe the clinical characteristics of patients who died in an Internal Medicine department during 2007, including those who passed over after a phase of agony (including symptoms, symptom control, drugs used, and non-pharmacological palliative care). Materials and methods: this was an observational prospective study that analyzed medical records, excluding those who died less than 24 hours after hospital admission or after advanced cardiopulmonary resuscitation. Result: of 861 admissions 42 subjects died; 87.5% were catalogued as agonizing, and their main symptom was dyspnea (85.7%); control was in adequate for dyspnea as well as for other silent symptoms (only 7.1% died with all symptoms controlled). There were no references in their medical records to any other type of palliative non-pharmacological approach (psychosocial, spiritual, or grief care). Conclusions: there is a high percentage of patients who die in agony in conventional hospitalization wards. Symptoms collected from these patients do not differ from those seen in palliative care units, although dyspnea is most usual and uncontrolled pain is less frequent. Symptom control is difficult but improves with standard palliative drugs (morphine, midazolam and butylscopolamine). There were no systematic references to non-pharmacological palliative care in medical records (AU)

[The prevalence of hepatitis C virus markers in a series of 14 patients with essential mixed cryoglobulinemia]. / Prevalencia de marcadores del virus de la hepatitis C en una serie de catorce pacientes con crioglobulinemia mixta esencial.

This paper studies the prevalence of antibodies against hepatitis B and C virus in 14 patients with essential mixed cryoglobulinemia (EMC), comparing the results with those of 14 systemic erythematosus lupus (SEL) patients and 14 health people. Our results show a very low positivity rate of virus B markers in patients with EMC. In other hand, 10 of 14 patients with EMC have antibodies against hepatitis C virus, both with ELISA and Innolia confirmatory method--and none SEL patient or health people. We conclude, according with other published series, that a very high prevalence of antibodies against hepatitis C is found in patients with EMC.

[Endobronchial inflammatory pseudotumor. A case report and review of the literature]. / Seudotumor inflamatorio endobronquial. Presentación de un caso y revisión de la literatura.

The endobronchial inflammatory pseudotumor is a little described variant of inflammatory lung pseudotumor, the growth of which is directed towards bronchial lumen. A case is presented and seventeen other well documented cases from the medical literature are reviewed. This variant has been frequently observed with clinical manifestations of obstructive respiration and atelectasis as a radiologic pattern allowing detection at an early age. Endoscopy does not usually confirm diagnosis; surgery and study of the specimen removed is therefore necessary.