Infiltrados pulmonares en paciente en tratamiento con glucocorticoides / Pulmonary infiltrates in patients under treatment with glucocorticoids

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[Intravascular lymphomatosis. A report of three cases]. / Linfomatosis intravascular. Descripción de tres casos.

Intravascular lymphomatosis (IVL) is a rare malignancy characterized by a proliferation of atypical lymphoid cells occluding small blood vessels (venules, capillaries and small arteries). The symptoms are caused by embolisms due to massive proliferation. Nervous system and skin are the most common sites of involvement but all organs may be involved, although it is typified by the absence of malignant cells in lymphoid tissues. We describe three cases of IVL: first patient was a 57 years old man with rapidly progressive dementia and neurological involvements and second case of a 69 years old man hospitalised with predominant symptoms in the lung (cough, dyspnea and fever), and a woman presenting as fever of unknown origin (FUO) with systemic inflammatory response syndrome. In all cases that we reported have been diagnosed post-mortem because of rapid progression of a multisystem disease and the absence of pathognomonic clinical manifestations. Diagnosis can be made using biopsy of one of the involved organs. In conclusion, we propose that IVL should be included in the differential diagnosis of acute confusional state, dementia or other unexplained neurological manifestations, fever of unknown origin, vasculitis, occult neoplasia or infections with signs of a systemic disease and marked elevation of serum lactate dehydrogenase (LDH).

Linfomatosis intravascular. Descripción de tres casos / Intravascular lymphomatosis. A report of three cases

La linfomatosis intravascular (LIV) es una neoplasia poco frecuente caracterizada por la proliferación de células linfoides atípicas en la luz de pequeños vasos (vénulas, capilares y arteriolas). La sintomatología está causada por fénomenos trombóticos debido a la oclusión de los vasos por células tumorales. Los órganos más afectados son el sistema nervioso y la piel, aunque puede estar involucrado cualquier otro sistema, sin afectación de los tejidos linfoides. Presentamos tres casos de LIV: el primero se trata de un varón de 57 años que debuta con demencia y síntomas neurológicos; un segundo caso en un paciente de 69 años con manifestaciones predominantemente pulmonares (tos, disnea y fiebre) y una mujer con fiebre de origen desconocido (FOD) y síndrome inflamatorio sistémico. Dada la ausencia de signos específicos de esta entidad multiorgánica con evolución rápidamente progresiva, su diagnóstico es postmorten en todos nuestros casos. Para su confirmación se precisó de biopsia de uno de los órganos afectados. En conclusión, consideramos la necesidad de plantear el diagnóstico diferencial con el síndrome confusional agudo, demencia o síndromes neurológicos de etiología no filiada, vasculitis, neoplasias ocultas, fiebre de origen desconocido o infecciones con afectación multiorgánica y valores muy elevados de LDH

Intravascular lymphomatosis (IVL) is a rare malignancy characterized by a proliferation of atypical lymphoid cells occluding small blood vessels (venules, capillaries and small arteries). The symptoms are caused by embolims due to massive proliferation. Nervous system and skinare the most common sites of involvement but all organs may be involved, although it is typified by the absence of malignant cells in lymphoid tissues. We describe three cases of IVL: first patient was a 57 years old man with rapidly progressive dementia and neurological involvementsand second case of a 69 years old man hospitalised with predominant symptoms in the lung (cough, dyspnea and fever), and a woman presenting as fever of unknown origin (FUO) with systemic inflammatory response syndrome. In all cases that we reported have been diagnosed postmortenbecause of rapid progression of a multisystem disease and the absence of pathognomonic clinical manifestations. Diagnosis can be made using biopsy of one of the involved organs. In conclusion, we propose that IVL should be inclucled in the differential diagnosis of acute confusional state, dementia or other unexplained neurological manifestations, fever of unknown origin, vasculitis, occult neoplasia or infections with signs of a systemic disease and marked elevation of serum lactate dehydrogenase (LDH)

Respuesta paradójica sistémica a tratamiento tuberculostático, a propósito de un caso / Sistematic paradoxical response to tuberculosis treatment, a case review

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[Hospital detoxification unit: 4-year experience. Environmental factors]. / Unidad de desintoxicación hospitalaria: cuatro años de experiencia. Factores ambientales.

BACKGROUND: To analyze the main features of those patients admitted to the Hospital Detoxification Unit (HDU) and the environmental repercussions on them. MATERIALS AND METHODS: We studied the patients admitted between April 91 and April 95, and revised their medical records with a protocol made for the occasion; the statistical measurements were subjected to the SPSS programme, using the Chi-square test and Fisher's test. RESULTS: Of the 458 patients included in the study, 80% were males and the women showed a lower age average: 25.27 +/- 4.8 (p < 0.01); these women came from separated parents in 26 cases out of 79 (p = 0.03); and of the 130 patients whose siblings took drugs, 39 were females (p < 0.0007); of the 106 patients with a drug-dependent partner 62 were females (p < 0.00001), and this partner was infected in 22 cases (13 females: p < 0.0013); promiscuity/prostitution was present in 12 women out of 26 patients. 71 drank (21 females: p = 0.05). Only 41 patients had a steady job (40 males: p = 0.0009). 191 patients had been in prison, 116 of whom were males (p = 0.018) and 176 were awaiting trial, 102 of whom were given a therapeutic discharge (p = 0.05). Correlating the time of addition on admission to their age, the correlation rate is 0.58 (p < 0.00001). 291 patients had a therapeutic discharge and 29 were forced to leave, 28 of whom were males (p = 0.04). CONCLUSIONS: The females in our sample are younger than the males and seen to be more influenced by environment, whereas the males show both a higher professional security and a higher criminal activity.