Terapia inmunológica en psoriasis pustulosa grave / No disponible

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[Amyloidosis secondary to xanthogranulomatous pyelonephritis: a case report and review of the literature]. / Amiloidosis secundaria a pielonefritis xantogranulomatosa: presentación de un caso y revisión de la literatura.

Xanthogranulomatous pyelonephritis (XGP) is a rare entity characterized by the formation of inflammatory renal masses rich in macrophages loaded with lipids. It is usually secondary to repeated urinary infections and urinary obstruction due to stones, which produce slow destruction of the renal parenchyma, requiring nephrectomy. It may sometimes be associated to secondary amyloidosis that leads to the appearance of a nephrotic syndrome. We have conducted a search in the Medline database between the years 1967 and 2003 and we only found 6 cases in adults and 3 cases in pediatric patients with amyloidosis secondary to xanthogranulomatous pyelonephritis. During this same period, there are more than 570 citations that include more than 1,000 patients with isolated XGP, so that we estimate that amyloidosis that complicates a XGP should be less than 1% of all the XGP cases. We present a case of XGP in a 51 year old female patient associated to amyloidosis that initiated with nephrotic syndrome, analyzing the clinical characteristics of the 9 previous cases. We compared their clinical characteristics with those of 51 patients with xanthogranulomatous pyelonephritis without amyloidosis of a large classical series in order to characterize this clinical picture better.

Amiloidosis secundaria a pielonefritis xantogranulomatosa: presentación de un caso y revisión de la literatura / Amyloidosis secondary to xanthogranulomatous pyelonephritis: a case report and review of the literature

La pielonefritis xantogranulomatosa (PXG) es una rara entidad caracterizada por la formación de masas renales inflamatorias ricas en macrófagos cargados con lípidos, habitualmente secundaria a infecciones urinarias de repetición y a obstrucción urinaria por cálculos, que produce destrucción lenta del parénquima renal precisando nefrectomía. Ocasionalmente puede asociarse a amiloidosis secundaria que induce la aparición de un síndrome nefrótico. Hemos realizado una búsqueda en la base de datos Medline entre los años 1967 y 2003 y sólo hemos encontrado 6 casos en adultos y 3 en pacientes pediátricos que presentarán una amiloidosis secundaria a una PXG. En este mismo período de tiempo hay más de 570 citas que incluyen a más de 1.000 pacientes con PXG aislada, por lo que estimamos que la amiloidosis que complica a una PXG debe ser menor de un 1% de todos los casos de PXG. Presentamos un caso de PXG en una paciente de 51 años asociado a amiloidosis que comenzó con síndrome nefrótico, analizamos las características clínicas de los 9 casos previos y las comparamos con las de 51 pacientes con PXG sin amiloidosis de una serie clásica numerosa con objeto de caracterizar mejor este cuadro clínico

Xanthogranulomatous pyelonephritis (XGP) is a rare entity characterized by the formation of inflammatory renal masses rich in macrophages loaded with lipids. It is usually secondary to repeated urinary infections and urinary obstruction due to stones, which produce slow destruction of the renal parenchyma, requiring nephrectomy. It may sometimes be associated to secondary amyloidosis that leads to the appearance of a nephrotic syndrome. We have conducted a search in the Medline database between the years 1967 and 2003 and we only found 6 cases in adults and 3 cases in pediatric patients with amyloidosis secondary to xanthogranulomatous pyelonephritis. During this same period, there are more than 570 citations that include more than 1,000 patients with isolated XGP, so that we estimate that amyloidosis that complicates a XGP should be less than 1% of all the XGP cases. We present a case of XGP in a 51 year old female patient associated to amyloidosis that initiated with nephrotic syndrome, analyzing the clinical characteristics of the 9 previous cases. We compared their clinical characteristics with those of 51 patients with xanthogranulomatous pyelonephritis without amyloidosis of a large classical series in order to characterize this clinical picture better

Hipomagnesemia e insuficiencia cardíaca / Hypomagnesemia and cardiac failure

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Assessing clinical probability of organic disease in patients with involuntary weight loss: a simple score.

BACKGROUND: Involuntary weight loss (IWL) is a frequent complaint with a difficult diagnosis. Any one of a number of different diseases may be the source of the symptom. However, there is no universal clinical protocol that can help physicians study this complex syndrome. METHODS: In March 1998, we defined a diagnostic protocol for the study of IWL. IWL was defined as an involuntary and documented weight loss of at least 5% of the usual body weight in the previous 3 months. We analyzed 78 consecutive patients with IWL who came to our clinic between March 1998 and December 2000. RESULTS: An organic disease was found in 56% of cases; cancer, metabolic and digestive diseases were the most common entities. Psychiatric problems were found in 33% of cases. After extensive study, an idiopathic group of 11% was identified. The variables that were independently predictive of a final diagnosis of organic disease were: age>50 years (OR: 8.6, CI 95%: 1.7-43.6), psychiatric symptoms (OR: 0.2, CI 95%: 0.1-0.8), smoking (OR: 14.3, CI 95% 2.3-74), the presence of guide symptoms (OR: 8.0, CI 95%: 1.8-34.4), and anemia (OR: 3.1, CI 95%: 2.5-387). Sixteen percent of the patients died, more often those suffering from organic diseases. Based on multivariate regression coefficients, a clinical risk score was established. CONCLUSIONS: IWL is a complex and frequent syndrome with a 16% rate of mortality during the first year. A protocol based on clinical data can help in the management of IWL. Our clinical prediction rule may help physicians to identify those patients with IWL who are likely to have an underlying organic disease.

[Serotonin syndrome: report of a fatal case and review of the literature]. / Síndrome serotoninérgico: presentación de un caso de evolución letal y revisión de la literatura.

We report here the case of a patient with fluoxetine and selegiline induced serotonin syndrome, which presented as encephalopathy, generalized myoclonias, fever, stiffness and sweating, complicated with acute renal failure, rhabdomyolysis and disseminated intravascular coagulation findings. The patient died 6 days after admission. This syndrome is discussed, with an analysis of its causes, pathophysiology and therapy. A special emphasis is placed on the clinical issues and differential diagnosis with the malignant neuroleptic syndrome and other clinical entities with which it could be mistaken. General recommendations are provided to avoid this poorly characterized syndrome that, as in our patient, may have a fatal outcome.

Síndrome serotoninérgico: presentación de un caso de evolución letal y revisión de la literatura / Serotonin syndrome: report of a fatal case and review of the literature

Presentamos un paciente afectado por un síndrome serotoninérgico inducido por fluoxetina y selegilina que se manifestó con encefalopatía, mioclonías generalizadas, fiebre, rigidez y sudación, se complicó con insuficiencia renal aguda, rabdomiolisis y datos de coagulación intravascular diseminada, falleciendo a los 6 días del ingreso. Discutimos sobre este síndrome analizando sus causas, fisiopatología y su tratamiento. Hacemos un especial hincapié en los aspectos clínicos y en el diagnóstico diferencial con el síndrome neuroléptico maligno y otras entidades con las que puede confundirse y damos recomendaciones generales para evitar la aparición de este síndrome, poco conocido, que como en nuestro paciente puede ser mortal (AU)

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Manejo de la obesidad en atención primaria / Management of obesity in Primary Health Care

La obesidad es uno de los problemas médicos más frecuentes y factor de riesgo para enfermedades como la hipertensión, la diabetes, la artrosis y los eventos cardiovasculares. Es causa de importante morbilidad y mortalidad y genera grandes costes sociales y sanitarios. Además, la obesidad infantil, p recede a gran número de complicaciones metabólicas en la edad adulta. El tratamiento, sobre todo en el síndrome metabólico, debe estar dirigido a la pérdida de peso. Las más recientes recomendaciones se centran en ayudar a los pacientes a perder un 510 por ciento de su peso basal y mantener estas pérdidas a largo plazo. Por esto, escoger el correcto tratamien to es muy importante. En este artículo, se revisan las nuevas recomendaciones sobre la pérdida de peso, y se ofrecen sugerencias para el manejo de estos pacientes. También se discuten las nuevas opciones de tratamiento y su aplicación en Atención Primaria (AU)

[Clenbuterol poisoning. Clinical and analytical data on an outbreak in Móstoles, Madrid]. / Intoxicación por clenbuterol. Datos clínicos y analíticos de un brote epidémico en Móstoles, Madrid.

OBJECTIVE: To report the clinical manifestations and analytical findings in an epidemic outbreak of acute food poisoning with clenbuterol. MATERIALS AND METHODS: The clinical manifestations, physical examination findings and results of complementary tests are reported of fifteen patients performed by veal liver contaminated with clenbuterol. The clinical course of patients at 72 hours is reported. A quantitative measurement of clenbuterol in urine specimens from patients and in a veal liver specimen was performed by high pressure liquid chromatography (HPLC). RESULTS: The male/female distribution of patients was 7/8 respectively, with age ranging from 6 to 44 years. Symptoms appeared after 30 minutes to 2 hours of having ingested veal liver in 93% of cases. Patients presented at the Emergency Department with tremors, palpitations, anxiety, malaise, nausea, and pruritus as the most common complaints. On physical examination tachycardia was noted in 100% of cases. The analytical data included mild hypokaliemia (66%) and leukocytosis (28%). Only one patient required hospital admission on account of an hypertensive crisis. After 72 hours, 67% of patients were asymptomatic. The remaining patients had mild symptoms which included headache, myalgia, asthenia and anorexia. Serum potassium values returned to normality (p < 0.05). Urine measurements of clenbuterol were positive for all analyzed cases (50 +/- 42 ng/ml). The concentration of clenbuterol in a veal liver sample was 500 ppb. CONCLUSION: Clenbuterol poisoning should be suspected when symptoms of adrenergic hyperstimulation occur after the ingestion of meal, usually liver. Common symptoms include tachycardia and mild hypopotasemia. Diagnosis is confirmed by quantitative measurement of clenbuterol in urine. Most patients improve spontaneously shortly afterwards.

[Spontaneous peritonitis in a cirrhotic patient with a cat: Pasteurella multocida infection of the ascitic fluid]. / Peritonitis espontánea en un cirrótico con gato: infección por Pasteurella multocida del líquido ascítico.

Spontaneous peritonitis due to Pasteurella multocida is exceptional. As far as we know only 11 other cases have been reported. We describe a 45 year old patient who presented with a spontaneous Pasteurella multocida peritonitis as the first complication of a previously undiagnosed cirrhosis. The patient used to play with his pet cat, not recalling having ever sustained any injury. Cultures of the cat's mouth grew the same strain of Pasteurella multocida than was found in the patient's ascitic fluid. The clinical findings of the previous cases, most of which were also related to non traumatic exposure to domestic animals, are here described. Pasteurella multocida in one potential agent in the cirrhotic patient presenting with spontaneous peritonitis, especially if in close contact with animals, cats being the most often carriers.

[Abdominal tuberculosis today. A review of 46 cases]. / Tuberculosis abdominal en la época actual. Revisión de 46 casos.

The clinical features, radiological and therapeutic response of 46 cases of abdominal tuberculosis (AT) seen at a university hospital are presented. Diagnosis was anatomopathologic in 39 cases (85%) and clinical with response to tuberculostatic in 7 cases (15%). Most of the patients did not have history nor exposition to tuberculosis. Both sexes were similar affected, mean age 43 years old, between 11 and 79. Clinical manifestations were no specific, the most frequent fever (65%), abdominal pain (63%) and constitutional syndrome with asthenia, anorexia and weight loss (63%). Thorax radiograph was normal in 50% and PPD negative in 42%, so in 10% of patients both tests were negative. More than half of the patients had other disease. 82% of patients were cured with tuberculostatic. 18% of patients died. AT seen now is different from classic descriptions. Is not a complication of pulmonary tuberculosis (PT) as it was to be in the past. Thinking in AT only in patients with PT make most patients lead without diagnosis.

Spontaneous tension pyopneumopericardium--a case with recovery after surgery.

Tension pyopneumopericardium is a rare condition with a very high mortality. The majority of cases are due to perforation of oesophagus or bronchi into the pericardial cavity. We report a patient with spontaneous pyopneumopericardium who survived with antibiotic treatment and surgical drainage.