Cistitis enfisematosa / Emphysematous cistitis

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[Pure autonomic failure: case and discussion]. / Fallo autonómico puro: un caso y discusión.

Pure autonomic failure is an a very infrequent disease, included in the group of sinucelopathies with multisystemic atrophy and Lewy disease. We present a case admitted at our service for orthostatics syncopes, and a review of the disease, its diagnosis and its treatment.

Fallo autonómico puro: un caso y discusión / Pure autonomic failure: case and discussion

El fallo autonómico puro es una entidad rara, englobada en el conjunto de sinucleopatías al que pertenecen la atrofia multisistémica y la enfermedad de cuerpos de Lewy. A continuación presentamos un caso atendido en nuestro servicio donde ingresó para estudio de síncopes ortostáticos. Realizamos posteriormente una revisión de la enfermedad, su diagnóstico y su tratamiento

Pure autonomic failure is an a very infrecuent disease, included in the group of sinucelopathies with multisistemic atrophy and Lewy disesase. We present a case admitted at our service for orthostatics syncopes, and a review of the disease, its diagnosis and its treatment

Macroamilasemia y enfermedad celíaca / Macroamylasemia and celiac disease

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Megacolon tóxico como presentación de la enfermedad de Crohn / Toxic megacolon as presentation of Crohn disease

Presentamos un paciente joven, sin antecedentes de enfermedad inflamatoria intestinal (E.I.I.), que debutando como una Gastroenteritis aguda, evolucionó en los días siguientes hasta un megacolon tóxico. El paciente acudió a urgencias previamente por presentar náuseas, vómitos, fiebre alta y deposición líquida, explosiva y abundante sin productos patológicos. Fue tratado con dieta, reposición hidroelectrolítica por vía oral y antiadiarreicos de tipo opiáceo sin remisión clínica. Ingresó por añadirse rectorragia al cuadro descrito, evolucionando en los tres días siguientes hacia un megacolon tóxico que obligó a una cirugía urgente en la que se evidenciaron perforaciones en el colon. El diagnóstico anatomopatológico fue: enfermedad de Crohn. Aún en ausencia de antecedentes de E.I.I., se llegó al diagnóstico con los datos clínicos, analíticos y de la radiología simple de abdomen; siendo imposible confirmarlo mediante una colonoscopia, debido al riesgo de perforación. En estos casos, la cirugía precoz puede salvar la vida del paciente (AU)

[Toxic megacolon presenting as Crohn's disease]. / Megacolon tóxico como presentación de la enfermedad de Crohn.

We introduce a young patient, without history of inflammatory bowel disease (I.B.D.) who started with an acute gastroenteritis, which in the following days progressed to a toxic megacolon. The patient had come to hospital with nausea, vomiting, fever and liquid, explosive diarrhoea without pathologic products. There was no clinical remission with astringent diet, hydroelectrolitic reposition and antidiarrheic opiates. The patient was admitted in hospital when he had blood in the diarrhoea. This progressed to a toxic megacolon in three days and the patient had to be operated on urgently. The surgeons found perforations in the colon and the pathologists diagnosed Crohn disease. Even without previous E.B.D. history we reached the diagnosis from the clinical and analytical data and the plain abdominal radiology. It was impossible to confirm the diagnosis with a colonoscopy because of the high risk of perforation. In cases like this, early surgery may save the life of the patient.

[Favorable response to vinblastine in an idiopathic case of Evans Syndrome]. / Respuesta favorable a vinblastina en un caso idiopático de Síndrome de Evans.

Evan's Syndrome (ES) may develop in isolation or associated to other autoimmune diseases, solid tumors and lymphoproliferative syndromes. This type of processes can be refractory to the usual medication, that is, to corticoids and splenectomy. High doses of Immunoglobulins (polyvalent IgG) and immunosuppressive drugs are therapeutical alternatives that have been used with different results. We present a case of idiopathic ES refractory to high doses of corticoids and IgG, showing complete remission after the administration of two infusions of vinblastin. We believe that vinblastin is a very useful therapeutical alternative in the cases of ES refractory to the usual treatment.

[Assessment of mononucleosis syndromes in the emergency service of the Hospital 12 of October]. / Valoración de síndromes mononucleósicos en el Servicio de Urgencias del Hospital 12 de Octubre.

We studied all the cases with suspicion of Mononucleosis Syndrome admitted at the Emergency Service of the Hospital 12 de Octubre from october to december of 1992. The selection was conducted on the basis of clinical criteria, being the more frequent observations fever, faringitis and adenopathies. Signs and symptoms were compared with other series without observing any significant differences. The diagnosis was confirmed through the quick detection of Heterophil antibodies (50% +), conducting afterwards specific serologic test for the most frequent germs. We conclude that the Mononucleosis Syndrome is an infection whose diagnosis, treatment and out-patient follow-up can be made by a Primary Health Care Team.

[The superior vena cava syndrome in retrosternal goiter]. / Síndrome de vena cava superior en un bocio retroesternal.

A case of superior vena cava syndrome in an 82-year-old woman who had been suffering from multinodular hyperfunctioning goiter for a long time is presented. The goiter was partially intrathoracic, benign, but affecting the superior mediastinum. The patient decided not to be operated on because of personal fears and the slow growth produced developments of collateral prethoracic circulation. The etiology of superior vena cava syndrome is of malignant tumor origin in 95% of cases. This case is presented because of its rareness, and the literature is reviewed.