Pancitopenia secundaria a intoxicación por metotrexato en paciente anciano / Pancytopenia secondary to methotrexate poisoning in an elderly patient

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Encefalopatía tras neumonía por Legionella pneumophila / Encephalopathy after Legionella pneumophila pneumonia

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Encefalitis de Bickerstaff: a propósito de un caso / Bickerstaff encephalitis: a case report

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Adolescente con astenia: a propósito de un caso / No disponible

Mujer de 15 años de edad que consulta a su médico de cabecera por astenia, prurito generalizado y caída del cabello en los meses de verano. Se realiza una analítica general que pone de manifiesto una anemia ferropénica en una paciente con antecedentes de hipermenorrea, por lo que se le prescribe hierro oral. A las 3 semanas acude al Servicio de Urgencias del hospital por un empeoramiento clínico (se añade disnea con mínimos esfuerzos y ortopnea). En la analítica se observa una leucocitosis con desviación a la izquierda y en la radiografía de tórax patrón de insuficiencia cardíaca y masa mediastínica supracardíaca. Ingresa en el Servicio de Medicina Interna y tras realizar una tomografía computarizada(TC) de tórax, pericardio centesis, una punción aspiración con aguja fina (PAAF) guiada por TC y biopsia por toracoscopia se le diagnostica un linfoma mediastínico primario tipo B de células grandes esclerosante. Con corticoides, un tratamiento hormonal y quimioterapia durante 2 años se produce una resolución completa de la enfermedad (AU)

A 15-year old woman consulted her medical practitioner due to asthenia, generalized itching and hair loss in the summer months. The general laboratory analysis showed iron deficiency anemia in the context of a patient with a background of hypermenorrhea. Oral iron was prescribed. At3 weeks, she came to the hospital emergency due to clinical deterioration (dyspnea on minimum efforts and orthopnea).The laboratory tests showed leukocytosis and left deviation and the chest X-ray showed a pattern of heart failure and supracardial mediastinal mass. She was admitted to the Internal Medicine Department and was diagnosed of primary mediastinal large-B-cell lymphoma with sclerosis after a Chest CT scan, pericardio centesis, CT-guided FNAB and biopsy by thoracoscopy. Complete resolution of her disease was obtained after 2 years with corticoids, hormonal therapy and chemotherapy (AU)

Neuropatía pudenda: a propósito de un caso / No disponible

La neuropatía pudenda o atrapamiento del nervio pudendo fue descrito por primera vez en 1987. Se presenta con un dolor neuropático perineal y/o pelviano, que se agrava al sentarse y disminuye o desaparece al estar de pie, habitualmente no suele presentarse al acostarse (pueden dormir) y que puede asociarse a disfunción urinaria, anal e incluso sexual. El nervio pudendo tiene tres ramas terminales en diferente proporción de fibras motoras, sensitivas y autonómicas. Por ello, su atrapamiento puede causar signos y síntomas tanto a nivel sensitivo, como motor o autonómico (en total se estima que el 30% es autonómico, y el 70% es somático,50% sensitivo y 20% motor). Su diagnóstico es básicamente clínico y se confirma con la compresión del nervio pudendo en la electromiografía. El tratamiento consiste en el autocuidado, infiltraciones perineurales y cirugía de descompresión del nervio (AU)

Pudendal neuropathy or pudendal nerve entrapment wasfirst described in 1987. It presents with a perineal neuropathicand/or pelvic pain, which worsens when the subject is sitting and decreases or disappears when the subject is standing, It is usually absent at bedtime (the individual can sleep) and may be associated with urinary, anal and even sexual dysfunction. The pudendal nerve has three terminal branches in different proportions of motor, sensitive and autonomic fibers. Hence, its entrapment can cause sensitive, motor or autonomic signs and symptoms (as a whole, it is estimated that 30% is autonomic, 70% somatic, the latter divided into 50% sensitive and 20% motor). Its diagnosis is essential clinical and it is confirmed with the compression of the pudendal nerve in the electromyography. Treatment consists in self-care, perineural infiltrations and decompression nerve surgery (AU)

Coxalgia prolongada en el tiempo: a propósito de dos casos / Prolonged coxalgia: two case reports

Estudio de dos pacientes con dolor intenso de cadera, sin causa aparente, que aumenta al caminar o subir escaleras y mejora con el reposo. En la radiografía de caderas se observan signos de inflamación, que se confirman con la ecografía de partes blandas en dicha zona, y que en la resonancia magnética nuclear (RMN) se informan como necrosis avascular de cabeza femoral. El tratamiento en los dos enfermos fue conservador (reposo y antiinflamatorios no esteroideos [AINE], principalmente), resolviéndose ambos casos sin secuelas clínicas, con RMN de control normal y confirmando el diagnóstico de osteoporosis transitoria de cadera

Study of two patients with intense hip pain without apparent cause that increases when they walk and climb stairs, and improves with rest. The hip X-ray shows signs of inflammation, that is confirmed with the soft tissue ultrasonography in that area and the MRI shows it as femoral head avascular necrosis. Treatment of the two patients was conservative (mainly rest and NSAIDs), both cases resolving without clinical sequels, with normal MRI control and in which the diagnosis of transient hip osteoporosis was confirmed

Evaluación de las infiltraciones realizadas en atención primaria / Evaluation of filtrations practised in primary care

Objetivos. Describir la evolución del dolor y de la impotencia funcional en la patología articular y periarticular tras infiltrar con corticoide y anestésico local; analizar el número de altas que se pueden dar en estos pacientes en situación de incapacidad laboral transitoria (ILT) durante la primera semana postinfiltración. Diseño. Estudio de intervención sin grupo control. Emplazamiento. Consultas de un centro de salud semiurbano (ABS Piera). Participantes. Sesenta y cinco pacientes mayores de 18 años de ambos sexos, con afección articular y periarticular. Intervención. Se infiltró localmente con acetónido de triamcinolona y bupivacaína al 2% a 65 pacientes. Mediciones principales. Factores sociodemográficos, diagnóstico, respuesta, número de infiltraciones por paciente, efectos secundarios y número de altas de ILT durante la primera semana postinfiltración. Resultados. Se infiltró predominantemente a varones (57%) con 31-65 años (67,7%), activos (70,7%) en trabajos manuales (78,4%). La tendinitis del manguito de los rotadores (46,2%) y la epicondilitis (27,7%) fueron los diagnósticos más frecuentes. Las medias y el intervalo de confianza (IC) obtenidos en la escala analógica visual (EAV) para el dolor fueron: inicialmente, 8,6 (7,4-9,8); a la semana, 1,4 (1-1,8); a los 3 meses, 2,2 (1,3-3,1), y al año, 2,3 (1,1-3,5). Las medias y el IC del 95% hallados para la impotencia funcional fueron: inicialmente, 8,2 (6,7-9,7); a la semana, 0,9 (0,7-1,1); a los 3 meses, 1,2 (0,9-1,5), y al año, 1,6 (1,4-1,8). El número de infiltraciones por paciente fue 1,6. No hubo efectos secundarios importantes. Se dieron 19 altas en 25 pacientes que estaban en ILT durante la primera semana postinfiltración. Conclusiones. Los pacientes mostraron disminución del dolor y de la impotencia funcional en la afección articular y periarticular después de la infiltración, permitiendo dar un número elevado de altas durante la primera semana postinfiltración

Objectives. To describe the evolution of the pain and the functional impotence in the articular and periarticular pathology after to infiltrate with local corticosteroid and anaesthetic; to analize the number of discharge certificates that maybe to give in the patients with employment transitory incapacity (ETI) during the first week post-infiltration. Design. Intervention without control group. Setting. Semiurban primary care physician's practices (ABS Piera). Participants. Men and women elder than 18 years old, with articular and periarticular pathology. Intervention. Were infiltrated with local triamcinolone acetonid and bupivacain 2% 65 patients. Main measurements. Were gathered socio-demographic factors, diagnostic, response, number of infiltrations for patient, secondary effects, and number of discharge certificates that were given in the patients in ETI situation during the first week post-infiltration. Results. Were infiltrated predominantly men (57%) with 31-65 years old (67.7%), employed (70.7%) in manual works (78.4%). Rotary joint tendinitis (46.2%) and epicondylitis (27.7%) were the most common diagnostics. Mean and CI (95%) obtained in the VAS for pain were: initially, 8.8 (7.4-9.8); week, 1.4 (1-1.8); 3 months, 2.2 (1.3-3.1), and year, 2.3 (1.1-3.5). Mean and CI (95%) found for functional impotence were: initially, 8.2 (6.7-9.7); week, 0.9 (0.7-1.1); 3 months, 1.2 (0.9-1.5), and year, 1.6 (1.4-1.8). The number of infiltrations for patient was 1.6. Hadn't important secondary effects. Were given 19 discharge certificates in 25 patients with ETI in the first week post-infiltration. Conclusions. The patients diminished the pain and the functional impotence in the articular and periarticular pathology after of the infiltration, allowing to give an elevate number of discharge certificates during the first week post-infiltration

[Screening and effectiveness evaluation of a brief intervention in risk drinkers seen in primary health care]. / Evaluación del cribado y la efectividad de una intervención breve en bebedores de riesgo atendidos en consultas de atención primaria.

AIMS: To evaluate the screening, the effectiveness of an antialcoholic brief intervention for risk drinkers, the acceptation level to participate in this study, and the analytical parameters evolution associated to the alcohol consumption after of the intervention. DESIGN: Longitudinal prospective intervention study of 1 year of duration. SETTING: 5 urban primary care physician's practices. PARTICIPANTS: Of an aleatory pattern of 681 patients, men and women of 18-65 years old, were selected 78 risk drinkers. Patients with exclusion criteria (n=10), didn't wanted to participate (n=24) and had suspicion of alcoholic dependence syndrome (ADS) (n=11), didn't participated in this intervention. INTERVENTIONS: Were offered antialcoholic brief counselling with written supporter and were followed with alcohol consumption rate and analytical control at 2 and 12 months. MAIN MEASURES: Was estimated the prevalence of risk drinkers, the acceptation level to participate in this study, alcohol consumption and risk drinkers decreased at 2 and 12 months, analytical parameters evolution after of the intervention. RESULTS: Prevalence of risk drinkers: 11.5% (95% confidence interval [CI], 8.3%-14.7%). Acceptation level to participate in this study: 64.7%. Significative alcohol consumption decreased at 2 and 12 months (P<.05). Risk drinkers decreased: at 2 months were 57.6% (95% CI, 50.3%-64.9%; P=.01) and at 12 months were 42.4% (95% CI; 35.9%-48.9%) (P=.003). GGT, MCV, cholesterol, and triglycerides significative decreased. CONCLUSIONS: Low prevalence of risk drinkers without suspicion of ADS in our setting; high effectiveness of antialcoholic brief counselling and high acceptation level to participate in this study; reduction of the GGT, MCV, cholesterol, and triglycerides after of the intervention.

Evaluación del cribado y la efectividad de una intervención breve en bebedores de riesgo atendidos en consultas de atención primaria / Screening and effectiveness evaluation of a brief intervention ub risk drinkers seen in primary health care

Objetivos. Evaluar el cribado y la efectividad de una intervención breve antialcohólica, el grado de aceptación y la evolución de los parámetros biológicos asociados con el consumo de alcohol tras la intervención. Diseño. Estudio prospectivo longitudinal de intervención de 1 año de duración. Emplazamiento. Cinco consultas de atención primaria urbanas. Participantes. De una muestra aleatoria de 681 sujetos de ambos sexos y de edad de 18-65 años, se seleccionó a 78 bebedores de riesgo. Los que cumplían criterios de exclusión (n = 10), no aceptaban participar (n = 24) y presentaban sospecha de síndrome de dependencia alcohólica (n = 11) no participaron en el estudio. Intervenciones. Se ofrecía un breve consejo antialcohólico apoyado con soporte escrito, y se realizaba un seguimiento a los 2 y 12 meses mediante la cuantificación del consumo de alcohol y un control analítico. Mediciones principales. Se estimó la prevalencia de bebedores de riesgo, el grado de aceptación a participar en el estudio, la disminución del consumo de alcohol y de bebedores de riesgo a los 2 y 12 meses, y la evolución de los parámetros analíticos tras la intervención. Resultados. La prevalencia de bebedores de riesgo fue del 11,5% (intervalo de confianza [IC] del 95%, 8,3-14,7%). El grado de aceptación a participar en el estudio fue del 64,7%. Se observó un decremento significativo (p < 0,05) en el consumo de alcohol a los 2 y 12 meses, así como una disminución de los bebedores de riesgo, que a los 2 meses fue del 57,6% (IC del 95%, 50,3-64,9%; p = 0,01) y a los 12 meses del 42,4% (IC del 95%, 35,9-48,9%; p = 0,003). Asimismo, se produjeron disminuciones significativas en las concentraciones de GGT, VCM, colesterol y triglicéridos. Conclusiones. Se observa una baja prevalencia de bebedores de riesgo sin sospecha de síndrome de dependencia alcohólica en nuestro medio, así como una elevada efectividad del consejo breve antialcohol y del grado de aceptación a participar en el estudio. Se apreció una disminución de las concentraciones de GGT, VCM, colesterol y triglicéridos tras la intervención

Aims. To evaluate the screening, the effectiveness of an antialcoholic brief intervention for risk drinkers, the acceptation level to participate in this study, and the analytical parameters evolution associated to the alcohol consumption after of the intervention. Design. Longitudinal prospective intervention study of 1 year of duration. Setting. 5 urban primary care physician's practices. Participants. Of an aleatory pattern of 681 patients, men and women of 18-65 years old, were selected 78 risk drinkers. Patients with exclusion criteria (n=10), didn't wanted to participate (n=24) and had suspicion of alcoholic dependence syndrome (ADS) (n=11), didn't participated in this intervention. Interventions. Were offered antialcoholic brief counselling with written supporter and were followed with alcohol consumption rate and analytical control at 2 and 12 months. Main measures. Was estimated the prevalence of risk drinkers, the acceptation level to participate in this study, alcohol consumption and risk drinkers decreased at 2 and 12 months, analytical parameters evolution after of the intervention. Results. Prevalence of risk drinkers: 11.5% (95% confidence interval [CI], 8.3%-14.7%). Acceptation level to participate in this study: 64.7%. Significative alcohol consumption decreased at 2 and 12 months (P<.05). Risk drinkers decreased: at 2 months were 57.6% (95% CI, 50.3%-64.9%; P=.01) and at 12 months were 42.4% (95% CI; 35.9%-48.9%) (P=.003). GGT, MCV, cholesterol, and triglycerides significative decreased. Conclusions. Low prevalence of risk drinkers without suspicion of ADS in our setting; high effectiveness of antialcoholic brief counselling and high acceptation level to participate in this study; reduction of the GGT, MCV, cholesterol, and triglycerides after of the intervention

[Evaluation of infiltrations performed in primary care]. / Evaluación de las infiltraciones realizadas en atención primaria.

OBJECTIVES: To describe the evolution of the pain and the functional impotence in the articular and periarticular pathology after to infiltrate with local corticosteroid and anaesthetic; to analize the number of discharge certificates that maybe to give in the patients with employment transitory incapacity (ETI) during the first week post-infiltration. DESIGN: Intervention without control group. SETTING: Semiurban primary care physician's practices (ABS Piera). PARTICIPANTS: Men and women elder than 18 years old, with articular and periarticular pathology. INTERVENTION: Were infiltrated with local triamcinolone acetonid and bupivacain 2% 65 patients. MAIN MEASUREMENTS: Were gathered socio-demographic factors, diagnostic, response, number of infiltrations for patient, secondary effects, and number of discharge certificates that were given in the patients in ETI situation during the first week post-infiltration. RESULTS: Were infiltrated predominantly men (57%) with 31-65 years old (67.7%), employed (70.7%) in manual works (78.4%). Rotary joint tendinitis (46.2%) and epicondylitis (27.7%) were the most common diagnostics. Mean and CI (95%) obtained in the VAS for pain were: initially, 8.8 (7.4-9.8); week, 1.4 (1-1.8); 3 months, 2.2 (1.3-3.1), and year, 2.3 (1.1-3.5). Mean and CI (95%) found for functional impotence were: initially, 8.2 (6.7-9.7); week, 0.9 (0.7-1.1); 3 months, 1.2 (0.9-1.5), and year, 1.6 (1.4-1.8). The number of infiltrations for patient was 1.6. Hadn't important secondary effects. Were given 19 discharge certificates in 25 patients with ETI in the first week post-infiltration. CONCLUSIONS: The patients diminished the pain and the functional impotence in the articular and periarticular pathology after of the infiltration, allowing to give an elevate number of discharge certificates during the first week post-infiltration.