[Nutritional support in terminally ill situation. Ethical dilemmas]. / El soporte nutricional en la situación de enfermedad terminal. Dilemas éticos.

Malnutrition is a common complication in terminally ill situation. Artificial nutritional support in these patients create a host of ethical conflicts with difficult solutions. In this paper we give simple suggestions that might the help care provider in making a viable clinical decision. However, each case should be treated in an individualized manner taking into consideration the ratio between risks and benefits of this treatment. The patient's wishes should have the highest priority.

El soporte nutricional en la situación de enfermedad terminal. Dilemas éticos / Nutritional support in terminally ill situation. Ethical dilemmas

La malnutrición es un problema frecuente en la situación de enfermedad terminal. La indicación de un soporte nutricional artificial en estos pacientes crea conflictos éticos de difícil solución. En este trabajo se sugieren líneas de actuación sencillas que puedan servir de orientación clínica, si bien la toma de decisiones debe ser siempre individualizada, teniendo en cuenta el balance entre riesgos y beneficios de esta modalidad de tratamiento. Se debe dar una máxima prioridad a los deseos del paciente (AU)

Malnutrition is a common complication in terminally ill situation. Artificial nutritional support in these patients create a host of ethical conflicts with difficult solutions. In this paper we give simple suggestions that might the help care provider in making a viable clinical decision. However, each case should be treated in an individualized manner taking into consideration the ratio between risks and benefits of this treatment. The patient’s wishes should have the highest priority (AU)

[Polyarteritis nodosa associated with hepatitis C virus]. / Panarteritis nodosa asociada al virus de la hepatitis C.

BACKGROUND: To study the seroprevalence of hepatitis C virus in a cohort of six patients with a diagnosis of polyarteritis nodosa (PAN). METHODS: There have been included six patients with a diagnosis of PAN, carrying out a serodiagnosis of hepatitis B virus (VHB) and C (VHC) this last one by means of the following methods: ELISA, RIBA-II and PCR. RESULTS: These cases (50%) showed exclusive positivity to VHC by means of the three ways of diagnosis, two cases showed positivity to VHB (33.3%), one case (16.6%) showed positivity to both virus (VHB and (VHC) and one case didn't show positivity virus. CONCLUSIONS: It is probable a ethipatogenic relation between hepatitis C virus and polyarteritis nodosa, our sample doesn't show any difference from that written in the literature. The positive rheumatoid factors can give false positive for VHC by means of the technique ELISA because of this it is necessary to confirm the positive by means of the techniques RIBA-II and PCR.

[Splenic abscess following gynecologic infection with complete response to antibiotic treatment]. / Absceso esplénico tras infección ginecológica con respuesta completa al tratamiento antibiótico.

A 37 year old woman is presented with solitary splenic abscess, without involvement of other organs, in the context of septic abortion. Splenic abscess were effectively treated with 21 days of antibiotic administration, not was necessitated splenectomy and percutaneous drainage. Emphasis is laid on its rarity of solitary splenic abscess in the course of gynecologic infection, and complete response to antibiotic treatment.

[Calcification of auricular cartilages in a patient with adrenal insufficiency: presentation of a case and review of the literature]. / Calcificación de los cartílagos auriculares en un paciente con insuficiencia suprarrenal: aportación de un caso y revisión de la literatura.

Suprarenal insufficiency is the systemic disease more frequent associated to auricular cartilage calcification. Physiopathologic mechanism of this phenomenon remain without elucidate, several hypothesis have been postulated. We introduce one patient male attached of Addison's disease with external ear bilateral calcification. We review 20 case related in literature, postulating that low levels of cortisone, established in acute or chronic form, can cause a maintained or transitory hypercalcemia, calcium deposit in predisposed physically-chemically tissue: deficient peripheral vascularization and susceptibility to external aggression like traumatisms or cold.

[Neutrophilic dermatosis in ulcerative colitis occurring in advanced age]. / Dermatosis neutrofílicas en colitis ulcerosa de comienzo en edad avanzada.

The Neutrophilic dermatosis (ND) is considered as an independent entity with diverse clinical manifestations among which there are: gangrenous pyoderma, nodous erythema, Sweets Syndrome, vesiculopustula eruptions associated to ulcerous colitis and intestinal short circuit syndrome with or without short circuit. Histologically, they are characterized by infiltration of polymorphonuclear neutrophils, generally at the dermic level, but also at the epidermic. They are usually associated to systemic diseases, especially to chronic intestinal inflammatory disease. Our aim was to describe two forms of clinical presentation of neutrophilic dermatosis: gangrenous pyoderma and vesiculopustula eruption, associated to ulcerous colitis starting at advances ages.

[Visceral and cutaneous Kaposi sarcoma in a patient with rheumatoid arthritis under steroid treatment]. / Sarcoma de Kaposi visceral y cutáneo en paciente con artritis reumatoide en tratamiento esteroideo.

We present the case of a patient under corticosteroid therapy (Deflazacort) developing a cutaneous Kaposi's Sarcoma. In a latter study performed due to the presence of digestive syndrome, a gastric Kaposi's sarcoma was detected. We review the cases published in the literature of patients with rheumatoid pathology under corticosteroid therapy.

[Schoenlein-Henoch purpura associated with spiramycin and with important digestive manifestations]. / Púrpura de Schönlein-Henoch asociada a espiramicina y con importantes manifestaciones digestivas.

Schönlein-Henoch purpura is a vasculitis due to hypersensitivity characteristic of the infancy that affects preferably small vessels. The etiology is unknown, although it has been related to allergic reactions to drugs, infections, vaccines and insecta bites. An adult with a Schönlein-Henoch purpura after receiving spiramicin is presented, beginning with epigastric pain and vomiting and the purpura appearing subsequently.

[Acute ascites as the onset of mixed connective tissue disease]. / Ascitis aguda como debut de enfermedad mixta del tejido conectivo.

We present a case of mixed disease of the connective tissue in a 37-year-old woman previously healthy, whose first manifestations were ascites, facial edemas and tibiomalleolars, latter progressing with constitutional syndrome, myalgias, Raynaud's phenomenon and esophagic disorders. In the literature reviewed, we have not found any other case of this type of onset in mixed disease of the connective tissue.

[Polyarteritis nodosa as a cause of sensory motor polyneuropathy.Apropos of a case]. / Poliarteritis nodosa como causa de polineuropatía sensitivomotora. A propósito de un caso.

We present a case of nodose polyarteritis (NPA) in a 65-years-old man with clinical manifestations at the level of the peripherical nervous system (PNS) as a subacute sensorimotor polyneuropathy. We believe that this is an interesting case due to the outlined symptomatology and the first clinical signs, not as common as the multiple mononeuropathy. The diagnosis was established through biopsy of muscle-nerve, without observing aneurysms at the Divas and with negative results for the Hepatitis B markers. Response to corticoid and immunosuppressive therapy was positive.

[Hepatic hemangiomas and rheumatoid arthritis in patients treated with azathioprine]. / Hemangiomas hepáticos y artritis reumatoide en pacientes tratados con azatioprina.

Two clinical cases of patients with rheumatoid arthritis (RA) and poor response to conventional treatment are described. Patients received immunosuppressor treatment with azathioprine (AZA) and developed hepatic hemangiomas without detectable hepatic pathology previous to the treatment with AZA. The hepatic iatrogenesis of AZA is discussed, as well as the etiopathogenic hypothesis regarding hepatic hemangioma.

[Immunosuppressor treatment in temporal arteritis of long-term evolution]. / Tratamiento con inmunosupresores en arteritis de la temporal de larga evolución.

We report a case of rheumatic polymyalgia associated with temporal arteritis, in which clinical-biological symptoms and evolution with steroid or immunosuppressive therapy were analyzed. We confirm the lack of effectiveness of the treatment with AINES, the low response to steroids and the high response to immunosuppressive therapy.

[Mixed hepatopathy due to parenteral gold salts]. / Hepatopatía mixta por sales de oro vía parenteral.

A case of a patient with rheumatoid arthritis (RA) of long evolution associated to dry syndrome, who developed a dissociated cholestasis after parenteral administration of gold salts, is suppression of gold salts. We comment on the clinical, biochemical, and histological features of intrahepatic cholestasis related to gold salts, as well as the evolution and the necessary criteria in order to make the diagnosis. We highlight the normal level of bilirubin, comparing it to that described in the literature.