[Addison's disease: the challenge of an early diagnosis]. / Enfermedad de Addison: el reto de un diagnóstico precoz.

Addison's disease is a set of symptoms which is produced due to the destruction of the suprarenal cortex, of a mainly autoimmune origin, on account of the presence of antibodies which attack it. This destruction takes place in a generally slow manner, causing symptoms to appear in an insidious way, added to the fact that these symptoms tend to be unspecific. Therefore it is easy to understand that its diagnosis at an early stage will be very difficult and is often interpreted as another disease. It is only when the deficit is important and adrenal crisis develop that we can reach the right diagnosis in a situation where the death risk is considerably high. We presented a clinical case as an example of what has been described previously. After several months of progressively deteriorating symptoms and several visits to different medical units, the patient is diagnosed as having an adrenal crisis and is immediately admitted to the intensive care unit.

Direct and combined methods for the determination of chromium, copper, and nickel in honey by electrothermal atomic absorption spectroscopy.

In the present work, direct methods for the determination of chromium, copper, and nickel in honey by electrothermal atomic absorption spectroscopy were developed using experimental design as an optimization tool. Once the optimum conditions for the individual methods were established, a direct method for the combined determination of the three elements was optimized using the response surface tool. Palladium was used as chemical modifier in all cases. Honey was diluted in water, hydrogen peroxide, and nitric acid. Triton X-100 was added to minimize the matrix effect and the viscosity of the sample. The RSD (better than 10%) and the analytical recovery (98-103%) were acceptable for all of the developed methods. Calibration graphs were used in the four methods to determine the concentration of the analytes in the sample. The detection limits of the combined method (0.21, 0.35, and 0.37 microg L(-)(1) for Cr, Cu, and Ni, respectively) were similar to those obtained for the individual methods (LOD = 0.17, 0.21, 0.33 microg L(-)(1) for Cr, Cu, and Ni, respectively). The direct-combined proposed method has been applied to the determination of chromium, copper, and nickel content in representative honey samples from Galicia (northwestern Spain). The concentrations found in the analyzed samples were in the range of (5.75 +/- 0.64)-(26.4 +/- 0.38) ng g(-)(1) of Cr, (79 +/- 7.8)-(2049 +/- 80) ng g(-)(1) of Cu, and (12.6 +/- 1.36)-(172 +/- 6.88) ng g(-)(1) of Ni.

Enfermedad de Addison: el reto de un diagnóstico precoz / Addison´s disease: the challenge of an early diagnosis

La enfermedad de Addison es un cuadro que se produce debido a la destrucción de la corteza suprarrenal, de origen principalmente auto inmune, por la presencia de anticuerpos contra la misma. Dicha destrucción tiene lugar de forma generalmente muy lenta por lo que la aparición de los síntomas es insidiosa, si añadimos el hecho de que estos síntomas suelen ser inespecíficos, es fácil entender que su diagnóstico en fases precoces sea muy difícil, con frecuencia interpretado como otra entidad clínica y sólo cuando el déficit es importante, dando lugar al desarrollo de las crisis adrenales, llegamos al diagnóstico correcto en una situación en la que el compromiso vital no es nada desdeñable. Presentamos un caso clínico ejemplo de lo anteriormente descrito, en el que tras varios meses de clínica progresiva y varias visitas a distintos servicios médicos, se diagnostica finalmente al presentar una crisis adisoniana que hace necesario su ingreso en una Unidad de Cuidados Intensivos

Addison 's disease is a set of symptoms which is produced due to the destruction of the suprarenal cortex, of a mainly autoimmune origin, on account of the presence of antibodies which attack it. This destruction takes place in a generally slow manner, causing symptoms to appear in an insidious way, added to the fact that these symptoms tend to be unspecific, Therefore it is easy to understand that its diagnosis at an early stage will be very difficult and is often interpreted as another disease, It is only when the deficit is important and adrenal crisis develop that we can reach the right diagnosis in a situation where the death risk is considerably high. We presented a clinical case as an example of what has been described previously, After several months of progressively deteriorating symptoms and several visits to different medical units, the patient is diagnosed as having an adrenal crisis and is immediately admitted to the intensive care unit

Insuficiencia respiratoria aguda que precisa ventilación mecánica: debut de una miastenia gravis / Acute respiratory failure that needs mechanical ventilation: first manifestation of a myasthenia gravis

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Coma mixedematoso: ¿nos hemos olvidado de él? / Myxedema coma: we have forgotten it?

El coma mixedematoso es una situación de hipotiroidismo extremadamente grave, que se caracteriza por tener un pronóstico muy grave con una mortalidad elevada; por ello ha de considerarse una emergencia médica y sospecharlo clínicamente para poder reconocerlo precozmente e instaurar el tratamiento adecuado, preferentemente en una Unidad de Cuidados Intensivos. Presentamos un caso que se corresponde a lo descrito clásicamente en los textos de Medicina y que se pudo resolver con éxito inicialmente, aunque posteriormente presentó una hemorragia cerebral fatal (AU)

Golpe de calor / Heat stroke

El golpe de calor es una emergencia médica y causa tratable de fracaso multiorgánico (FMO). Se caracteriza por un incremento de la temperatura corporal central por encima de 40ºC y alteraciones del sistema nervioso central donde predomina la encefalopatía y es típico el coma. Es fundamental el diagnóstico precoz y, si no se toman las medidas iniciales oportunas, la tasa de mortalidad es muy alta (hasta el 70%). Las dos formas habituales de presentación son: 1ºen relación con el ejercicio en ambientes calurosos (que afecta fundamentalmente a individuos jóvenes sanos) y 2º la forma clásica (que afecta a ancianos o individuos con enfermedades debilitantes) durante intensas olas de calor. Puede clasificarse dentro de los síndromes inducidos por el calor ambiental y su presentación es consecuencia del fracaso del sistema termorregulador. El tratamiento se basa en el enfriamiento inmediato junto con el soporte de órganos y sistemas (AU)

Heat stroke is a medical emergency and a treatable cause of multiorganicfailure (MOF). It is caracterized by an increase in central bodytemperature (above 40oC) and alterations in the central nervous system where encephalopathy is predominate and comatous states are typical. An early diagnosis is vital and if the right initial measures are not taken the death rate tends to be very high (according to different series arround70%). It is habitually found in two types. Firstly in relation to exercise in hot atmospheres (which affects young healthy people fundamentally) and secondly the more classical situation (which affects young healthly people fundamentally)and secondly the more classical situation (which affects the elderly or people with weakening illnesses) during severe heat weaves. It can be classified within syndromes induced by the heat in the atmosphere and occurs as a consequence of a thermo regulating system failure. The treatment is based on an immediate cooling process and supportive measures view to recovering all organs from their state of insufficiency (AU)

Comparison of palladium-magnesium nitrate and ammonium dihydrogenphosphate modifiers for cadmium determination in honey samples by electrothermal atomic absorption spectrometry.

The occurrence of certain trace elements, such as cadmium, in honey bee can be considered as an indication of environmental pollution. In the present work, two methods for Cd determination in honey by electrothermal atomic absorption spectrometry, using palladium-magnesium nitrate and ammonium dihydrogenphosphate as chemical modifiers, have been developed. In none of these cases honey samples required pretreatment. Honey was diluted in water (20% w/v), and hydrogen peroxide, nitric acid, and Triton X-100 were added to minimize the matrix effect. For the first method, 21.6 microg of palladium and 4.5 microg of magnesium were added as chemical modifier; for the second method, 60 microg of ammonium dihydrogenphosphate were employed. The limits of detection obtained were 0.32 ng g(-1) for ammonium dihydrogenphosphate method and 0.54 ng g(-1) for palladium-magnesium nitrate method. The characteristic mass was 0.7 and 1.0 pg for ammonium dihydrogenphosphate and palladium-magnesium nitrate methods, respectively. The relative standard deviation (<10%) and the analytical recovery (98-105%) were comparable in both methods. The optimised methods were applied to the determination of the cadmium content in unpolluted Galician honey samples. Cd has been detected the analysed samples in the range (n.d.-4.3 ng g(-1)).

[Primary actinomycosis of the abdominal wall. Description of 2 cases and review of the literature]. / Actinomicosis primaria de la pared abdominal. Descripción de dos casos y revisión de la literatura.

We report two cases of isolated abdominal wall actinomycosis and review 18 previously reported cases to further characterize the clinical findings and the therapeutic management of this syndrome. This diagnosis would be advocated in patients with a palpable abdominal mass of subacute appearance with a previous history of digestive medical illness, diabetes, abdominal surgery, or prolonged IUD use. In contrast with other actinomycosis locations, remarkable data were a more elevated mean age of patients; a female predominance; a prevalent location of mass in abdominal lower left quadrant; and a shorter duration of symptomatology before to diagnosis. The CT is the first choice for imaging study and percutaneous needle aspiration would be recommended for definite diagnosis. The long-term antibiotic therapy, with or without percutaneous drainage, is the first treatment choice because is very effective and made unnecessary a more invasive surgical management. The prognosis is excellent with adequated treatment.

Tromboembolismo pulmonar y viajes de larga duración. ¿Se debería realizar tratamiento anticoagulante preventivo en estos pacientes? / No disponible

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[Pulmonary mycetoma]. / Micetoma pulmonar.

Ten cases of pulmonary mycetoma diagnosed in our service between 1985-1992 were retrospectively studied. Clinical methodology followed in the study is commented and the different therapeutic options are reviewed, so the literature concerning this process. The unspecificity of serum precipitins with Aspergillus is emphasised.

[Pleural effusion as the only manifestation of cryptococcosis in an AIDS patient]. / Derrame pleural como única manifestación de criptococosis en un paciente con SIDA.

Cryptococcosis is often seen in immunodeficient patients, including those with AIDS. It usually affects mainly the respiratory tract and central nervous system. We present a rare case of pleural involvement with no sign of disease at other sites. A review of the literature yields only three other similar cases. We discuss the diverse clinical manifestations of cryptococcosis, particularly those found in the respiratory tract.