[Outpatient establishment and initial management of treatment with intraduodenal levodopa-carbidopa infusion in advanced Parkinson's disease]. / Instauracion ambulatoria y manejo inicial del tratamiento con infusion intraduodenal de levodopa-carbidopa en la enfermedad de Parkinson avanzada.

INTRODUCTION: Treatment with intraduodenal levodopa-carbidopa infusion is one of the three therapies currently available for advanced Parkinson's disease. It optimizes the benefit of antiparkinsonian treatment by counteracting the negative effect of erratic gastric emptying on the absorption of oral levodopa. The purpose is to describe our outpatient protocol of treatment establishment. PATIENTS AND METHODS: In our unit we have implemented a protocol for the treatment with intradoudenal levodopa-carbidopa infusion without admission based on the development of a multidisciplinary circuit among the Neurology Service, the Digestive Endoscopy Unit and the Home Hospitalization Unit. RESULTS: Over one and a half year, we treated five patients with advanced Parkinson's disease. All of them remain on the medication and no significant side effect has taken place. CONCLUSION: The outpatient onset install of this treatment saves costs and avoids the negative impact of admission on the patient with advanced Parkinson's disease, in the same way that favors their adaptation and tolerability to it.

TITLE: Instauracion ambulatoria y manejo inicial del tratamiento con infusion intraduodenal de levodopa-carbidopa en la enfermedad de Parkinson avanzada.Introduccion. El tratamiento con infusion intraduodenal de levodopa-carbidopa es una de las tres terapias de que disponemos en la actualidad en la enfermedad de Parkinson avanzada. Optimiza el beneficio del tratamiento antiparkinsoniano al contrarrestar el efecto negativo que provoca el vaciado gastrico erratico sobre la absorcion de la levodopa oral. El objetivo es describir nuestro protocolo de instauracion del tratamiento de modo ambulatorio. Pacientes y metodos. En nuestra unidad hemos implementado un protocolo de instauracion del tratamiento con infusion continua de levodopa-carbidopa intestinal sin necesidad de ingreso hospitalario gracias al desarrollo de un circuito multidisciplinar entre el propio servicio de neurologia, la unidad de endoscopia digestiva y la unidad de hospitalizacion a domicilio. Resultados. En año y medio se trato a cinco pacientes con enfermedad de Parkinson avanzada. Todos ellos continuan con el tratamiento y no han tenido complicaciones significativas. Conclusion. La instauracion ambulatoria del tratamiento ahorra costes y evita el impacto negativo del ingreso en el paciente con enfermedad de Parkinson avanzada, de la misma manera que favorece su adaptacion y tolerancia a aquel.

Cuidados paliativos en pacientes trasplantados de órgano sólido / No disponible

No disponible

Ingresos en HADO desde el Servicio de Urgencias / No disponible

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Hospital at home for acute respiratory patients.

BACKGROUND: The issue of "hospital at home" (HAH) for acute respiratory patients is one that is still being debated, partly because economic, cultural and health service differences between locations imply that HAH schemes need to be tailored to local situations. The aim of the present study was to analyze the feasibility and effectiveness of HAH for patients with acute respiratory disease at our institution. METHODS: Of all the patients admitted to our institution via the emergency department during a 34-day subject enrollment period, 25 with diagnoses of respiratory infection, pneumonia, pulmonary insufficiency or exacerbated chronic obstructive pulmonary disease who were living within 25 km of our center and who were willing to receive HAH care were assigned to HAH. Fifty sex-matched controls with the same diagnoses were given conventional hospital care (CHC) as inpatients. The dependent variables evaluated included time to discharge, readmissions within 3 months and deaths within 3 months. RESULTS: There were no significant differences between the HAH and CHC groups with regard to age, diagnoses, physical and analytical findings, or co-morbidity, or with regard to deaths (HAH 16%, CHC 10%) or readmissions (HAH 17%, CHC 24%). Time to final discharge was significantly shorter for HAH patients (7 days) than for CHC patients (12 days). Some 95% of the HAH patients were satisfied and would choose HAH again. CONCLUSIONS: HAH seems feasible for appropriately selected acute respiratory disease patients presenting in our emergency department. It frees hospital beds for other patients, its readmission and mortality rates are no higher than for conventional hospitalization, and, in general, it is favorably evaluated by patients.

[Statin-induced rhabdomyolysis and renal failure: also with fluvastatine]. / Rabdomiolisis y fallo renal por estatinas: también con fluvastatina.

Hydroximetilglutaril-coenzima A reductase inhibitors (statin) have the potential to cause rhabdomyolysis. However, fluvastatin is rarely associated with rhabdomyolysis when compared to other statins. Differences in biochemical and pharmacokinetic properties between fluvastatin and the other statins have been invocated in order to explain the apparent comparative safety of fluvastatin. We present a case of rhabdomyolysis with acute renal failure in a patient receiving fluvastatin and, following the Karch-Lasagne algorithm, we present evidence that this case was an adverse reactions to fluvastatin.

Rabdomiolisis y fallo renal por estatinas: también con fluvastatina / Statin-induced rhabdomyolysis and renal failure: also for fluvastatine

La rabdomiolisis es un efecto adverso plenamente descrito para los inhibidores de la Hidroximetil-glutaril Coenzima A reductasa (estatinas). Sin embargo la evidencia de esta asociación es menor para la fluvastatina y se ha argumentado que sus diferencias bioquímicas y farmacocinéticas con el resto de estatinas explicaría esta aparente inocuidad comparativa. Presentamos un caso de rabdomiolisis con fallo renal en una paciente que recibía tratamiento con fluvastatina y, mediante el algoritmo de causalidad de reacciones adversas de Karch y Lasagna, proporcionamos evidencia de que se trata de una efecto adverso atribuible a la fluvastatina (AU)

[Association of sarcoidosis, diffuse centroblastic-centrocytic lymphoma and IgM monoclonal gammapathy in the same female patient]. / Asociación de sarcoidosis, linfoma centroblástico-centrocítico difuso y gammapatía monoclonal IgM en una misma paciente.

A case illustrating the infrequent association of sarcoidosis and lymphoma which was also a secretor of a monoclonal IgM paraprotein is described in a 68 year old woman. The first entity manifested by dyspnea corresponded with a bilateral interstitial pneumopathy with restrictive syndrome and was diagnosed by bronchoalveolar lavage and transbronchial biopsy and biopsy prescalenic fat. The lymphoma presented three years later followed by lymphadenopathies and a monoclonal IgM peak being diagnosed by biopsy of an axillary lymph node. In order to relate both entities it has been suggested that prolonged stimulation of the lymphocytes peculiar to the sarcoidosis would cause its malignant transformation.

[Intestinal and gastric cystoid pneumatosis associated with duodenal stenosis]. / Neumatosis cistoide intestinal y gástrica asociada a estenosis duodenal.

We present a case of pneumatosis cystoides of the stomach and intestine, secondary to peptic pyloric ulcer with duodenal stenosis. Clinical symptoms consisted of abdominal pain and intense vomiting; diagnosis was suspected in the radiologic examination of the abdomen (plain film), which showed and abnormal pattern of gas distribution, and later confirmed by barium contrast. The surgical correction of the underlying cause made the lesion disappear. We also review the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of this rare condition.

[Clinical patterns of selective IgA deficiency: 3 case reports]. / Patrones clínicos del déficit selectivo de IgA: a propósito de tres casos.

The selective deficit of IgA is characterised by its clinical variability. This disease can be detected in non-symptomatic patients or associated to multiple diseases of different features. The allergic reactions, recurrent infections, gastrointestinal alterations, autoimmune diseases, and some neoplasias are the most frequent features of this deficit. We present 3 cases with different pathology associated to the common deficit of IgA, giving a view of the wide clinical spectrum of this process.

[Selective deficiency of IgA]. / Déficit selectivo de IgA.

The selective deficit of IgA is the most frequently acquired immunodeficiency. It is important because of this and the variability of the clinical presentation, which might be non-symptomatic or simply show several clinical features. The prognosis depends on the associated clinical affliction. There is no substitute treatment for this immunodeficiency, in which the immunoglobulins administration produces a paradoxical antibody formation against this, and adverse immunological reactions. We reviewed the immunodeficiency in this paper, highlighting the frequency, pathogenia, clinical diversity and therapy.

[Two cases of massive pulmonary embolism associated with estrogen intake. Diagnostic and therapeutic usefulness of pulmonary angiography]. / Dos casos de embolismo pulmonar masivo relacionados con ingesta de estrógenos. Utilidad diagnóstica y terapéutica de la angiografía pulmonar.

Two cases of massive pulmonary embolism observed in patients under estrogen therapy, are presented. We describe the clinical findings, highlighting the value of the arteriography in the diagnosis and the use of fibrinolytic therapy, being successful in both cases.

[Polyneuropathy associated with osteosclerotic myeloma. Excellent response to chemotherapy]. / Polineuropatía asociada a mieloma osteosclerótico. Excelente respuesta a la quimioterapia.

We report a 36-year-old patient with progressive tetraparesis and diffuse osteosclerotic lesions without secretion of a monoclonal component, in whom a diagnosis of non-secreting diffuse osteosclerotic myeloma with POEMS syndrome was made with open rib biopsy. We discuss the clinical, biological, radiological and electrophysiological features of this patient. We analyze the possible pathogenesis of his neurological involvement, with a detailed review of the relevant literature. Finally, we underline the therapeutic success with a combination of cyclophosphamide and prednisone, comparing it with the previous references to this therapeutic modality, and emphasize the validity of our therapeutic approach.

[A diffuse nonsecreting osteosclerotic myeloma with polyneuropathy, organomegalies, endocrinopathies and skin changes]. / Mieloma osteosclerótico difuso no secretante con polineuropatía, organomegalias, endocrinopatía y alteraciones cutáneas.

A patient admitted into hospital suffering from quadriparesis, secondary to distal symmetric sensitive and motor polyneuropathy, is presented. Diffuse osteosclerotic bone changes associated to neurological symptoms were detected and histologically confirmed as non-secreting plasmacytoma, on noting the non-production of paraprotein. Also, there were endocrine, skin and systemic alterations. We comment on the association of these changes as POEMS syndrome, discussing the pathogenesis and giving details of the treatment, emphasizing the excellent response.

[The POEMS syndrome]. / Síndrome P.O.E.M.S.

The rare POEMS syndrome which combines hematology, bone, endocrine, neurology and skin manifestations, associated to a non-frequent osteosclerotic type of multiple myeloma is reviewed. The clinical, analytical, radiologic, immunologic, electrophysiologic and histopathologic features are detailed, as well as the different pathogenetical theories of its several manifestations, in an attempt to unify them. The different treatment schedules following the onset and corresponding prognostic are detailed.