[Neurological involvement in systemic sclerosis]. / Manifestaciones neurológicas en la esclerosis sistémica.

INTRODUCTION: Systemic sclerosis (SS) is recognized as the connective tissue disease which less frequently presents neurological complications; in recent studies it is demonstrated, however, that neurological involvement in SS is more frequent of what it had been assumed. PATIENTS AND METHODS: Clinical neurological exploration was done in 26 patients with definitive SS; an electroneurogram was carried out in 23 cases in order to determine the prevalence of central neurological pathology and of peripheral neuropathy, to define its characteristics, and to investigate possible associations with clinical parameters and with autoimmunity. RESULTS: 23 cases (88%) were females and 3 cases (12%) males; the median age was 57.5 12.0 (SD) years, while the median age to the diagnosis was 51.3 12.3 (SD) years and the median period of natural history of disease was 6.2 3.1 years. Seven patients (26.9%) showed involvement of the CNS, being the headache and the neuropsychiatric manifestations the most common conditions (11.5%). Peripheral neuropathy prevalence was 39.1% (9 cases); according to the distribution of the injury, the polyneuropathy prevailed in 30.4% of cases. With regard to the functional selectivity, the sensitive-motor forms were most frequent (55.6%); according to the most involved structure, the axonal neuropathy was most common (44.4%).Discussion. The possible pathogenic mechanisms of the neurological pathology in this disease are discussed.

[Plasma concentrations of fibronectin in septic, hypovolemic, and cardiogenic shock. Prognostic usefulness of their variation]. / Concentraciones plasmáticas de fibronectina en el shock séptico, hipovolémico y cardiogénico. Utilidad pronóstica de sus variaciones.

BACKGROUND: Fibronectin is a protein with opsonic capacity. Its plasma level is diminished in septic shock. The aim of the present was to study its behavior in other types of shock. METHODS: A prospective study of 60 patients in shock (septic, hypovolemic and cardiogenic) was carried out. Serial plasma levels of fibronectin were determined in these patients over a period of 72 hours. The values of the cases which evolved favorably were compared with the values of those which did not. RESULTS: In all the cases, the plasma levels of fibronectin were diminished within a minimum of approximately 12 hours with a tendency to recovery of initial values being observed within 72 hours, except in cases in which the evolution of the patient was poor. In these cases fibronectin values remained diminished in such statistical significant. CONCLUSIONS: Plasma levels of fibronectin behave similarly in the three types of shock studied (septic, hypovolemic and cardiogenic). Serial determination of fibronectin provides a good prognostic index in patients with shock.

[Lyme disease: 4 reported cases in the Autonomous Community of Aragon]. / Enfermedad de Lyme: cuatro casos descritos en la Comunidad Autónoma de Aragón.

Lyme's disease (LD) is a multisystemic infection due to Borrelia Burgdorferi transmitted through the byte of a vector arthropod of the Ixodes genre. Until now we do not know exactly which is the geographical distribution in our setting, no case have been published in the Aragon Community. We present four patients diagnosed of Lyme's disease following clinical and serological criteria (IFI) according to the recommendations of the Spanish Group for the study of Lyme's disease. A patient with Chronic Migratory Erythema (ECM); two others in stage II--one with predominant dermal lesions and other with predominant neurological symptoms--and finally, a patient in stage III with polyarticular symptoms and with antecedent of having showed a lymphocytic meningoencephalitis.

[Expediency of hospital admission for acute diarrhea syndrome in a short-stay unit]. / Oportunidad de ingreso hospitalario del síndrome de diarrea aguda en una unidad de corta estancia.

We present the results of a 187 cases acute diarrhea study managed in the Short Stay Unit of Clinic Universitary Hospital of Zaragoza during 1987-1988. To that aim, we designed an actuation protocol which included the gathering of several data, the realization of complementary studies and the evolutive pursuit. The coproculture resulted positive in a 54.5% of cases and Salmonella was the microorganism more frequently isolated. Most of the species were sensible to common antibiotics and all of them sensible to norfloxacin. Nearly a third part of patients developed some kind of complication. Therefore we infer that acute diarrhea may be subsidiary of diagnosis and treatment in Short Stay Units.

[Use of antimicrobial agents and prevalence of infection at the Clinical University Hospital of Zaragoza]. / Estudio del consumo de antimicrobianos y de prevalencia de infección en el Hospital Clínico Universitario de Zaragoza.

Two cross-sectional prevalence studies have been performed on april 10 and June 12, 1986, at the Hospital Clínico Universitario of Zaragoza in order to gather information about the use and consumption of antimicrobial drugs and the degree of hospital infection. On these days, of the 726 and 717 patients admitted to the hospital, 29.3% and 26.3% were treated with antimicrobial drugs and, of these, 31.4% and 23.8% respectively, with associate drugs (above all empirical purposes and for respiratory infections), aminoglycosides being the most common. The indication of antimicrobial drugs was distributed in the following manner on both days: prophylactic 28.7% and 25.1%, empirical 42.3% and 56.9% and therapeutical 27.9% and 17.6%. The prophylactic treatments were correct in 46.1% and 36.6% of the cases, and of those 74.3% and 71.6% were for surgical prophylaxis; the average time was 3.5 and 4.5 days on each day studied. The most commonly used antimicrobial drugs were, in decreased order: gentamicin, amoxycilin, ampicillin, cefoxitin, pipemidic acid and cefamandol. The consumption was 1.36 and 1.29 drugs per patient on each day. The most common routes of administration were I.V. and oral. The intervals and dosages were generally respected. The most frequent were respiratory and urinary infections, and of these, 21% and 32% of the respiratory infections were nosocomial as were 23% and 32% of the urinary infection. 7.1% and 4.3% of the patients admitted developed a hospital-acquired infection on each day. The most frequent isolated germs were Escherichia coli and Pseudomonas aeruginosa. There were no adverse reactions to the antimicrobial drugs documented.

[Bisalbuminemia and pseudobisalbuminemia: clinical significance (author's transl)]. / Bisalbuminemia y seudobisalbuminemia: significación clinica.

Two cases of bisalbuminaemia are hereby studied: a congenital case and an acquired or transitory case. In the first one, this hereditary disturbance is studied on four affected members of one Spanish family, being associated in two of them with multiple lipomatosis. This kind of association is considered as casual. As in most of the informed cases, ours belongs to the slow kind. The second case deals with a bisalbuminaemia of transitory character or pseudobisalbuminaemia which, appeared in a woman in the course of an acute pancreatitis of biliolithiasic origin, with a pancreatic pseudocyst and pleural effusion, the evolution in the inflamatory pancreatic process being advantageous in spite of the prsence of bisalbuminaemia. Briefly revised, are exposed the causes of this interesting and rare alteration in the electrophoretic fractioning of plasmatic proteins: congenital, and adquired causes due to administration of betalactamines and during the course of acute pancreatitis.