[Screening program for the early diagnosis of colorectal cancer in the Canary Islands: presentation of a case]. / Programa de diagnóstico precoz de cáncer colorrectal en Canarias. A propósito de un caso.

Colorectal cancer is the second leading cause of cancer death in Spain. The main objective of screening programs is the early detection, or even prevention of the development, of colon cancer, as well as the mortality that results from it. If caught early, it is easy to treat and the chances of cure are high. In 2009 only six regions in Spain, among which included the Autonomous Community of the Canary Islands, started this screening program. We report the case of a patient, who after screening for colorectal cancer, was diagnosed with adenocarcinoma of the rectosigmoid.

Programa de diagnóstico precoz de cáncer colorrectal en Canarias. A propósito de un caso / Screening program for the early diagnosis of colorectal cancer in the Canary Islands: presentation of a case

El cáncer colorrectal es la segunda causa de muerte por cáncer en España. Los programas de cribado tienen como principal objetivo detectar precozmente o, mejor aún, prevenir la aparición de cáncer de colon y reducir la mortalidad que de él se deriva. Si se detecta a tiempo, es fácil de tratar y las posibilidades de curación son elevadas. Solo 6 comunidades autónomas de España, entre las que se encuentra la canaria, pusieron en 2009 en marcha este programa de cribado. Presentamos el caso de un paciente que tras el cribado de cáncer colorrectal fue diagnosticado de adenocarcinoma de unión recto-sigma (AU)

Colorectal cancer is the second leading cause of cancer death in Spain The main objective of screening programs is the early detection, or even prevention of the development, of colon cancer, as well as the mortality that results from it. If caught early, it is easy to treat and the chances of cure are high. In 2009 only six regions in Spain, among which included the Autonomous Community of the Canary Islands, started this screening program. We report the case of a patient, who after screening for colorectal cancer, was diagnosed with adenocarcinoma of the rectosigmoid (AU)

[Palliative care in Primary Care: presentation of a case]. / Cuidados paliativos en atención primaria. A propósito de un caso.

We present a case of a patient diagnosed with glioblastoma multiforme refractory to treatment. Glioblastoma multiforme is the most common primary brain tumour and unfortunately the most aggressive, with an estimated mortality of about 90% in the first year after diagnosis. In our case the patient had reached a stage of life where quality of life was importsnt, with palliative care being the only recourse. The family is the mainstay in the provision of care of terminally ill patients, and without their active participation it would be difficult to achieve the objectives in patient care. We must also consider the family of the terminally ill in our care aim, as its members will experience a series of changes that will affect multiple areas where we should take action.

[Onset of myasthenia gravis in primary care. Presentation of a case]. / Debut de miastenia gravis en atención primaria. A propósito de un caso.

Myasthenia gravis is an autoimmune disorder of neuromuscular transmission involving the production of autoantibodies directed against skeletal muscle receptors, in most cases of acetylcholine. Clinically it is characterized by the appearance of muscle weakness after prolonged activity, which tends to recover after a period of rest, or administration of acetylcholinesterase inhibitors. It is a relatively rare disease, although the prevalence has increased by improved diagnosis and increased longevity of the population. The diagnosis can be based on evidence after it is suspected using pharmacological, immunological or electrophysiology tests. Treatment can be divided into: symptomatic, short term and long term. We report the case of a patient who complained of diplopia, this muscle weakness being the most common initial symptom of the disease.

Cuidados paliativos en atención primaria. A propósito de un caso / Palliative care in primary care: presentation of a case

Presentamos el caso de una paciente diagnosticada de glioblastoma multiforme con fracaso terapéutico. El glioblastoma multiforme es el tumor cerebral primario más común y lamentablemente el de comportamiento más agresivo, estimándose su mortalidad en aproximadamente el 90% en el primer año posterior a su diagnóstico. En nuestro caso la paciente había llegado a una etapa de la vida donde era importante la calidad de atención, siendo los cuidados paliativos en estos momentos el único recurso. La familia es un pilar básico en la provisión de cuidados del paciente terminal; sin su participación activa difícilmente se van a alcanzar los objetivos marcados en atención al enfermo. Debemos considerar a la familia del enfermo terminal también nuestro objeto de atención, ya que se van a desarrollar en sus miembros una serie de alteraciones que afectan a múltiples esferas donde debemos actuar (AU)

We present a case of a patient diagnosed with glioblastoma multiforme refractory to treatment. Glioblastoma multiforme is the most common primary brain tumour and unfortunately the most aggressive, with an estimated mortality of about 90% in the first year after diagnosis. In our case the patient had reached a stage of life where quality of life was importsnt, with palliative care being the only recourse. The family is the mainstay in the provision of care of terminally ill patients, and without their active participation it would be difficult to achieve the objectives in patient care. We must also consider the family of the terminally ill in our care aim, as its members will experience a series of changes that will affect multiple areas where we should take action (AU)

Debut de miastenia gravis en atención primaria. A propósito de un caso / Onset of myasthenia gravis in primary care. Presentation of a case

La miastenia gravis es un trastorno de carácter autoinmune, de la transmisión neuromuscular que involucra la producción de autoanticuerpos dirigidos contra receptores músculo-esqueléticos, en la gran mayoría de los casos de acetilcolina. Clínicamente se caracteriza por la aparición de debilidad muscular tras una actividad prolongada, que tiende a la recuperación tras un periodo de descanso o con la administración de fármacos anticolinesterásicos. Es una enfermedad relativamente poco común, aunque la prevalencia ha aumentado por la mejoría en el diagnóstico y aumento de la longevidad de la población. El diagnóstico puede apoyarse tras su sospecha en pruebas farmacológicas, inmunológicas o en electrofisiología. El tratamiento puede dividirse en: sintomático, tratamiento a corto plazo y a largo plazo. Presentamos el caso clínico de una paciente que acude a consulta con la única clínica de diplopia, siendo esta debilidad muscular el síntoma inicial más común de la enfermedad (AU)

Myasthenia gravis is an autoimmune disorder of neuromuscular transmission involving the production of autoantibodies directed against skeletal muscle receptors, in most cases of acetylcholine. Clinically it is characterized by the appearance of muscle weakness after prolonged activity, which tends to recover after a period of rest, or administration of acetylcholinesterase inhibitors. It is a relatively rare disease, although the prevalence has increased by improved diagnosis and increased longevity of the population. The diagnosis can be based on evidence after it is suspected using pharmacological, immunological or electrophysiology tests. Treatment can be divided into: symptomatic, short term and long term. We report the case of a patient who complained of diplopia, this muscle weakness being the most common initial symptom of the disease (AU)

[Diagnosis of multiple myeloma in primary care. Suspicion with an appropriate clinical history]. / Diagnóstico de mieloma múltiple en atención primaria. Sospecha ante una historia clínica adecuada.

Monoclonal gammopathies are a group of disorders characterized by stable or progressive clonal proliferation of plasma cells producing similar immunoglobulins. Multiple myeloma is characteristic of the presence of bone marrow infiltration by plasma cells, osteolytic lesions, and M component in serum or urine. As cancer cells multiply, they can cause pain and destruction of bone, and if affecting the spine, they can press on nerves causing pain and paresthesias. In patients of advanced age (average 69 years) with bone pain not associated with trauma, and which does not improve with treatment, a differential diagnosis should be performed with multiple myeloma. This should include, at least, a full blood count, biochemistry, total protein, protein electrophoresis, immunofixation, and radiographs of painful areas.

[Primary presentation of non-hodgkin lymphoma. Report of a case]. / Manifestación primaria de linfoma no hodgkiniano. A propósito de un caso.

Lymphomas are the most common non-epithelial tumors of the head and neck and its incidence has increased in recent decades. Around 10% are extranodal lymphomas, and in more than half of the cases are located in Waldeyer's lymphatic ring. The most common presenting symptoms are odynophagia and dysphagia (68%), and symptoms suggestive of oropharyngeal cancer such as cough, hoarseness, earache, feeling of occupation in the back of the mouth, throat or neck. In non-Hodgkin lymphomas in this location, B symptoms (weight loss, fever and sweating) are rare (5%). The histological subtype of each individual lymphoma affects the evaluation, therapy and prognosis.

Diagnóstico de mieloma múltiple en atención primaria. Sospecha ante una historia clínica adecuada / Diagnosis of multiple myeloma in primary care. Suspicion with an appropriate clinical history

Las gammapatías monoclonales constituyen un grupo de trastornos caracterizado por la proliferación clonal estable o progresiva de células plasmáticas, produciendo inmunoglobulinas iguales entre sí. Es característico del mieloma múltiple la presencia de infiltración de la médula ósea por células plasmáticas, de lesiones osteolíticas y de componente M en suero u orina. A medida que las células cancerosas se multiplican, pueden causar dolor y destrucción de hueso, si se afectan los de la columna, pueden ejercer presión sobre los nervios provocando dolor y parestesias. Ante un paciente de edad avanzada con dolor intenso óseo, no asociado a traumatismo, que no mejora con tratamiento, debemos realizar diagnóstico diferencial del mieloma múltiple solicitando: hemograma, bioquímica, proteínas totales, proteinograma, inmunofijación y radiografías de zonas dolorosas como mínimo (AU)

Monoclonal gammopathies are a group of disorders characterized by stable or progressive clonal proliferation of plasma cells producing similar immunoglobulins. Multiple myeloma is characteristic of the presence of bone marrow infiltration by plasma cells, osteolytic lesions, and M component in serum or urine. As cancer cells multiply, they can cause pain and destruction of bone, and if affecting the spine, they can press on nerves causing pain and paresthesias. In patients of advanced age (average 69 years) with bone pain not associated with trauma, and which does not improve with treatment, a differential diagnosis should be performed with multiple myeloma. This should include, at least, a full blood count, biochemistry, total protein, protein electrophoresis, immunofixation, and radiographs of painful areas (AU)

Manifestación primaria de linfoma no hodgkiniano. A propósito de un caso / Primary presentation of non-hodgkin lymphoma. Report of a case

Los linfomas son los tumores no epiteliales más comunes de cabeza y cuello y su incidencia se ha incrementado en las últimas décadas. El 10% de los linfomas tienen inicio extraganglionar, localizándose en más de la mitad de los casos en el anillo linfático de Waldeyer. Los síntomas de presentación más frecuentes son la odinofagia y la disfagia (68%), y síntomas indicativos de cáncer de orofaringe como tos, disfonía, otalgia, sensación de ocupación en la parte posterior de la boca, faringe o cuello. En los linfomas no hodgkinianos con esta localización, los síntomas B (pérdida de peso, fiebre y sudoración) son más raros (5%). El subtipo histológico particular de cada linfoma influye en la evaluación, terapia y pronóstico (AU)

Lymphomas are the most common non-epithelial tumors of the head and neck and its incidence has increased in recent decades. Around 10% are extranodal lymphomas, and in more than half of the cases are located in Waldeyer's lymphatic ring. The most common presenting symptoms are odynophagia and dysphagia (68%), and symptoms suggestive of oropharyngeal cancer such as cough, hoarseness, earache, feeling of occupation in the back of the mouth, throat or neck. In non-Hodgkin lymphomas in this location, B symptoms (weight loss, fever and sweating) are rare (5%). The histological subtype of each individual lymphoma affects the evaluation, therapy and prognosis (AU)

Sospecha de enfermedad de Hirayama. A propósito de un caso en Atención Primaria. Revisión clínica / Suspected hirayama disease. Presentation of a case and a clinical review

La enfermedad de Hirayama, o atrofia muscular juvenil distal de una extremidad superior, es una mielopatía cervical. Afecta principalmente a los adolescentes varones, caracterizándose por la debilidad muscular progresiva y atrofia distal de una extremidad superior, seguida de la parálisis de lenta evolución. Aunque la causa sigue siendo poco clara, hallazgos neuropáticos y radiológicos sugieren un desplazamiento hacia delante del saco dural posterior cervical durante la flexión del cuello, causando la compresión de la médula cervical, produciendo cambios atróficos y enfermedad isquémica del cuerno anterior. Desde que la flexión del cuello fue reconocida como causa de la enfermedad, han sido empleados como tratamientos: las ortesis cervicales, la fusión vertebral y la duraplastia asociada a fusión. Una buena comprensión de la enfermedad de Hirayama es fundamental porque el reconocimiento precoz y el tratamiento eficaz pueden detener el deterioro progresivo (AU)

Hirayama's disease, or juvenile muscular atrophy of distal upper extremity, is a cervical myelopathy. It affects adolescent males, and is characterized by progressive muscle weakness and atrophy of the distal upper extremities, followed by slow paralysis. Although the cause remains unclear, radiological findings suggest neuropathic forward displacement of the posterior cervical dural sac during neck flexion, causing compression of the cervical cord, resulting in atrophic changes and ischemic disease of the medullar anterior horn. Since the bending of the neck was recognized as a cause of the disease, cervical orthosis, spinal fusion, and duraplasty combined with fusion, have been proposed as treatment. A solid understanding of Hirayama disease is critical as early recognition and effective treatment can stop the deterioration (AU)

Enfermedad tromboembólica venosa: a propósito de un caso / Venous thromboembolic disease: Presentation of a case

La enfermedad tromboembólica venosa incluye en su espectro clínico tanto la trombosis venosa profunda como el tromboembolismo pulmonar, la cual es habitualmente una complicación de la trombosis venosa profunda. Es una enfermedad relativamente frecuente con importante morbimortalidad y que requiere un proceso diagnóstico preciso. Se han identificado numerosos factores de riesgo para la enfermedad tromboembólica venosa; hay evidencia de que el riesgo de enfermedad tromboembólica se incrementa proporcionalmente al número de factores de riesgo predisponentes presentes. El médico de atención primaria debe conocer los factores de riesgo y sospechar la presencia de enfermedad tromboembólica venosa ante un cuadro clínico compatible. El tratamiento de elección de esta enfermedad es la anticoagulación. Presentamos el caso de un paciente con factores de riesgo cardiovascular que acude por dolor en miembro inferior derecho y disnea que es derivado a urgencias hospitalarias con la sospecha de enfermedad tromboembólica venosa, fibrilación auricular rápida y derrame pleural (AU)

Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis. It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation. We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion (AU)

[Suspected Hirayama disease. Presentation of a case and a clinical review]. / Sospecha de enfermedad de Hirayama. A propósito de un caso en Atención Primaria. Revisión clínica.

Hirayama's disease, or juvenile muscular atrophy of distal upper extremity, is a cervical myelopathy. It affects adolescent males, and is characterized by progressive muscle weakness and atrophy of the distal upper extremities, followed by slow paralysis. Although the cause remains unclear, radiological findings suggest neuropathic forward displacement of the posterior cervical dural sac during neck flexion, causing compression of the cervical cord, resulting in atrophic changes and ischemic disease of the medullar anterior horn. Since the bending of the neck was recognized as a cause of the disease, cervical orthosis, spinal fusion, and duraplasty combined with fusion, have been proposed as treatment. A solid understanding of Hirayama disease is critical as early recognition and effective treatment can stop the deterioration.

[Venous thromboembolic disease: presentation of a case]. / Enfermedad tromboembólica venosa: a propósito de un caso.

Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis. It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation. We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion.

[Subphrenic abscess in the context of low back pain and reading analytics in the primary care consultations]. / Absceso subfrénico en el contexto de lumbalgia y lectura analítica en la consulta de atención primaria.

The subphrenic space is defined as the area below the diaphragm and above the transverse colon. Most abscesses are due to direct subphrenic contamination associated with, surgery, local disease, or trauma, but the cause still remain undefined or unknown. It is a disease rarely diagnosed in primary care. About 55% of subphrenic abscesses are located on the right side, with 25% on the left, and 20% are multiple. These can be extended to the thoracic cavity, which sometimes produce empyema, lung abscess, or pneumonia. The mortality of subphrenic abscess is between 11%-31%, and may be due to uncontrolled infection, malnutrition, and complications of prolonged hospitalization, such as nosocomial infections. Ultrasound or computed tomography-guided percutaneous drainage is now the preferred treatment, combined with antibiotics.

Absceso subfrénico en el contexto de lumbalgia y lectura analítica en la consulta de atención primaria / Subphrenic abscess in the context of low back pain and reading analytics in the primary care consultations

El espacio subfrénico se define como la zona situada debajo del diafragma y encima del colon transverso. La mayoría de los abscesos subfrénicos se deben a contaminación directa relacionada con la cirugía, enfermedad local o traumatismo, pero persisten aún los de causa no definida o desconocida. Es un trastorno poco frecuente diagnosticado en atención primaria. Alrededor del 55% de los abscesos subfrénicos asientan en el lado derecho, el 25% en el izquierdo y el 20% son múltiples. Estos se pueden extender a la cavidad torácica, donde producen en ocasiones empiema, absceso pulmonar o neumonía. La mortalidad de los abscesos subfrénicos oscila entre el 11 y el 31%, y se debe a la infección no controlada, desnutrición y complicaciones de la hospitalización prolongada, como infecciones nosocomiales. El drenaje percutáneo bajo guía ecográfica o tomografía computarizada representa hoy el tratamiento de elección junto con los antibióticos (AU)

The subphrenic space is defined as the area below the diaphragm and above the transverse colon. Most abscesses are due to direct subphrenic contamination associated with, surgery, local disease, or trauma, but the cause still remain undefined or unknown. It is a disease rarely diagnosed in primary care. About 55% of subphrenic abscesses are located on the right side, with 25% on the left, and 20% are multiple. These can be extended to the thoracic cavity, which sometimes produce empyema, lung abscess, or pneumonia. The mortality of subphrenic abscess is between 11%-31%, and may be due to uncontrolled infection, malnutrition, and complications of prolonged hospitalization, such as nosocomial infections. Ultrasound or computed tomography-guided percutaneous drainage is now the preferred treatment, combined with antibiotics (AU)

[Lipoid pneumonia: presentation of a case]. / Neumonía lipoidea: a propósito de un caso.

We report a case of lipoid pneumonia treated in our Health Centre. It is a disease that occurs rarely, but is important in Primary Care. This condition has been known since 1925, when it was first described by Laughlen, who described a case of lipoid pneumonia secondary to an injection of oil in the nasopharyngeal area. Today it is a rarity, and it is most frequently associated with the use of oil-based nasal drops (which are now decreasing in use). Its aetiology may be endogenous or exogenous. Although the pathological diagnosis is generally the most important, sometimes a lesion in the chest X-ray can lead us to suspect it due to the patient's history. This was a case of acute lipoid pneumonia in a young patient, who periodically performed as a "fire eater".

Neumonía lipoidea: a propósito de un caso / Lipoid pneumonia: presentation of a case

Se presenta un caso de neumonía lipoidea atendida en nuestro centro de salud. Se trata de una enfermedad rara que es importante conocer en atención primaria para poder pensar en ella. Esta entidad se conoce desde 1925, cuando fue descrita por primera vez por Laughlen, quien describió un caso de neumonía lipoidea secundaria a una inyección de aceite en la zona nasofaríngea. En la actualidad constituye una rareza, siendo su causa más frecuente la utilización de gotas nasales con aceites en su composición (cada vez en menor uso). Su etiología puede ser endógena y exógena. Aunque el diagnóstico anatomopatológico suele ser la mayor parte de las veces el más relevante, el estudio de una lesión radiológica en puede, en ocasiones, hacer sospechar el cuadro en función de los antecedentes del paciente. El caso que aquí se presenta es el de una neumonía lipoidea aguda en paciente joven que realizaba actuaciones esporádicas como «tragador de fuego»(AU)

We report a case of lipoid pneumonia treated in our Health Centre. It is a disease that occurs rarely, but is important in Primary Care. This condition has been known since 1925, when it was first described by Laughlen, who described a case of lipoid pneumonia secondary to an injection of oil in the nasopharyngeal area. Today it is a rarity, and it is most frequently associated with the use of oil-based nasal drops (which are now decreasing in use). Its aetiology may be endogenous or exogenous. Although the pathological diagnosis is generally the most important, sometimes a lesion in the chest X-ray can lead us to suspect it due to the patient's history. This was a case of acute lipoid pneumonia in a young patient, who periodically performed as a “fire eater”(AU)

Schwannoma retroperitoneal / Retroperitoneal Schwannoma

Los schwannomas, también llamados neurilemomas, son un raro tipo de tumores en el organismo y aún menos frecuente en la cavidad retroperitoneal. Se originan en las células de Schwann del nervio periférico. El schwannoma retroperitoneal es un tumor raro y representa del 0,7 al 2,7% de todos los schwannomas. Es de crecimiento lento, se acompaña de escasa sintomatología, y es frecuentemente un hallazgo radiológico incidental. Aunque se trata de un tumor histológicamente benigno, no debemos estimar el daño que puede ocasionar por compresión de estructuras vecinas, así como su infrecuente aunque posible transformación maligna. En el caso que presentamos se ha producido como hallazgo casual tras una exploración sistemática del paciente realizada para valoración de su hipertensión arterial, siendo el hallazgo principal la masa abdominal (AU)

Retroperitoneal Schwannomas are rare and they account for 0.7 to 2.7% of all Schwannomas. They are slow growing tumours, and their location in the retroperitoneum is associated with poor clinical symptoms, and is often an incidental radiographic finding. Although it is a histologically benign tumour, we must not under-estimate the damage caused by compression of adjacent structures, as well as the rare but possible malignant transformation. We present this case as a casual finding after a systematic examination of the patient performed for assessment of his hypertension, with an abdominal mass being the principal finding. Schwannomas, also called neurilemmomas, are a rare type of tumour in the body and even more rare in the retroperitoneal cavity. They arise from Schwann cells of the peripheral nerves (AU)