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)

[Descriptive study of autopsies of internal medicine department at the hospital of Barbastro and clinico-pathological correlation]. / Estudio descriptivo de las autopsias del Servicio de Medicina Interna del Hospital Comarcal de Barbastro y correlación clínico-patológica.

BACKGROUND: To review the autopsies of Internal Medicine Department at the Hospital of Barbastro and to compare clinical and pathological diagnosis. MATERIAL AND METHODS: Retrospective study of 51 consecutive autopsies performed between April 1989 to December 1996 is carried out. Clinico-pathological correlation is stablished with the underlying cause of death distinguishing among concordance and severe (with adverse impact on survival) or mild discrepancy. RESULTS: The autopsy rate was 6.6% in that period. 70.5% were male. The median of the age was 70. Severe yatrogenia was found in one case. Respiratory diseases (23.5%) followed by cardiovasculars (19.6%) and infections (17.6%) were the most frequents underlying cause of death. Pulmonary thromboembolism was demonstrated in 37.2%, being massive only in 7.8%. Discrepancies were found in 31% of cases, 25% mild and 6% severe. CONCLUSIONS: Our data are similar to other studies but differ essentially in a lesser number of severe discrepancies in our findings and also in the frequency of the groups of diseases (there are more infections and tumours in other series) attributed to the hospital features and to the oldness of the studied population, among others.

[Wegener's granulomatosis in the elderly. Report of 3 cases]. / Granulomatosis de Wegener del anciano. Descripción de tres casos.

Wegener's Granulomatosis (W.G.) is a systemic vasculitis which the usual age of presentation is the fourth and fifth decades. It seldom appears in the aged patients and it often exists a greater delay in the diagnosis time and in the beginning of therapy in them. We present three cases of W.G. in aged patients (66, 79 and 80 years). One case was diagnosed in the autopsy and the two others had a favourable evolution after therapy. We insist on the need of using all the available tools in order to confirm the W.G. diagnostic, in spite of the aging. The therapy of these patients must be as vigorous as in the young patients in order to avoid the development of renal failure, the most important cause of death in this disease.

[Hospital mortality at the internal medicine service of a local hospital]. / Estudio de mortalidad hospitalaria en el Servicio de Medicina Interna de un hospital comarcal.

We conducted a retrospective study of the hospital mortality in a service of Internal Medicine at the Hospital de Barbastro during the years 1991 and 1992, recording 97 deaths during 1991 and 87 during 1992, with a mortality rate of 6.7% and 6.6% respectively. The mean age was 77.2% +/- 9 years with a 93% > or = 65 years. The average length of stay of the dead patients was 8.9 days. Cardiovascular diseases were the most frequent cause of death (41.85%), followed by respiratory diseases (17.93%) and neoplasias (15.76%). CVA was the single most frequent disease (17.9%). Ten autopsies (5.4%) were performed. In 16 cases (8.6%), we obtained data suggesting iatrogenesis, which in 7 cases (3.8%) clearly contributed to the direct cause of death.

[Gastric ulcers: a rare manifestation of secondary syphilis]. / Ulceras gástricas: una rara manifestación de sífilis secundaria.

Gastric lesions in the progression of syphilis are very rare and they have several forms of presentation resembling lesions of different nature. We describe a case of secondary syphilis in an heterosexual patient, with persistent gastric ulcers and hepatic affection, in which the evolution and the observations with laparotomy suggested neoplasia. In the gastric biopsy, an infiltration of plasmatic and neutrophil cells was observed and in the hepatic biopsy, necrotic nodules and granulomas. The spirochaeta-specific tinction, although not indispensable, confirms the diagnosis of gastric syphilis. The previous presence of a syphilitic chancre and typical cutaneous lesions are of great help in suspecting a luetic process.