Derrame pleural izquierdo en paciente con insuficiencia cardíaca / Left pleural effusion in patient with heart failure

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Mujer de 49 años con fiebre y esplenomegalia / A 49-year-old woman with fever and splenomegaly

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Nuevos instrumentos en la gestión de listas de espera quirúrgica: la consulta pre-quirúrgica y la lista de ingreso inmediato / No disponible

Descripción de dos instrumentos de gestión de listas de espera quirúrgicas cuyos principales efectos son: disponibilidad, reducción cuantitativa, acortamiento de la estancia preoperatoria y demora quirúrgica media (AU)

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[Systemic necrotizing vasculitis in autopsy]. / Vasculitis necrosante sistémica en la autopsia.

OBJECTIVE: To analyze the characteristics of systemic necrotizing vasculitis observed in necropsy emphasizing the non-diagnosed cases until necropsy and to identify the reasons of clinical confusion. MATERIALS AND METHODS: Necropsies of adult patients performed in Hospital General La Paz, Madrid, from 1966 to 1977 were reviewed. Clinical manifestations, analytical changes and involvement of different organs were analyzed. The correspondence degree between clinical and necropsic diagnoses was studied. RESULTS: A total of 18 cases of necrotizing vasculitis were observed out of 3,980 necropsies. The most common clinical manifestations were fever and general syndrome (60%). The organs most commonly involved were kidney (94%) and gastrointestinal tract (56%). Diagnosis was revealed by necropsy in 39% of cases; in these cases, the incidence of heart failure and peripheral neuropathy was significantly lower, whereas digestive hemorrhage and liver, pancreas, adrenal gland, and bladder involvement was significantly higher. CONCLUSIONS: Systemic necrotizing vasculitis in underdiagnosed, which can be partly explained by the lack of specificity of the most common symptoms and the paucity of characteristic clinical and organ-specific manifestations which leads to confusion with more prevalent conditions.

Vasculitis necrosante sistémica en la autopsia / Systemic necrotizing vasculitis in necropsy

Objetivo. Análisis de las características de las vasculitis necrosantes sistémicas observadas en la autopsia con énfasis en los casos no diagnosticados hasta la misma e identificar los motivos de confusión clínica. Material y métodos. Se revisaron las autopsias de adultos realizadas en el Hospital General La Paz de Madrid entre 1966-1997; se analizaron las manifestaciones clínicas, alteraciones analíticas y afectación de los diferentes órganos y se estudió el grado de correspondencia entre cada diagnóstico clínico y necrópsico. Resultados. En 3.980 autopsias se encontraron 18 casos de vasculitis necrosante sistémica. Las manifestaciones clínicas más frecuentes fueron fiebre y síndrome general (60 por ciento). Los órganos más frecuentemente afectados fueron riñón (94 por ciento) y tracto gastrointestinal (56 por ciento). En el 39 por ciento de los casos fue la autopsia la que reveló el diagnóstico; en estos casos la incidencia de insuficiencia cardíaca y neuropatía periférica fue significativamente más baja, mientras que la hemorragia digestiva y la afectación de hígado, páncreas, suprarrenales y vejiga fue significativamente mayor. Conclusiones. Las vasculitis necrosantes sistémicas se infradiagnostican; contribuyen a ello la inespecificidad de los síntomas más frecuentes, induciendo confusión con entidades más prevalentes y la escasez de manifestaciones clínicas características y órgano específicas (AU)

Elementos necesarios para la realización de un proyecto técnico de gestión / Necessary elements for carrying out a technical management project

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[Hashimoto's thyroiditis and Sjögren syndrome. Association or autoimmune multiple syndrome?]. / Tiroiditis de Hashimoto y síndrome de Sjögren. Asociación o síndrome múltiple autoinmune?

A case of Hashimoto's thyroiditis associated with incomplete Sjögren's syndrome is revised. Both immune disorders are together not just as a casual event, but literature says that common mechanisms could have something to be. Previous publications express that autoimmune thyroid dysfunction is frequently associated with primary Sjögren's syndrome and should be sought clinically and by laboratory test in all these patients.

Tiroiditis de Hashimoto y síndrome de Sjögren. ¿Asociación o síndrome múltiple autoinmune? / Hashimoto's thyroiditis and Sjögren´s Syndrome. Association or multiple autoimmune syndrome?

Se describe un caso de tiroiditis de Hashimoto (TH) asociado a síndrome de Sjögren (SS) incompleto. Ambas enfermedades inmunológicas no sólo se encuentran asociadas como un hallazgo casual, sino que existen datos en la literatura que implican a mecanismos etiopatogénicos comunes. Publicaciones previas manifiestan que la disfunción tiroidea autoinmune está frecuentemente asociada al SS primario y debería ser investigada, clínica y analíticamente, en todos estos pacientes. (AU)

[The polyangiitis overlap-Schönlein-Henoch purpura-PAN syndrome: a case of more than a rare association]. / Síndrome poliangeítico de solapamiento púrpura de Schönlein Henoch-PAN: un caso más de una rara asociación.

A fifty-four-years old male with palpable purpura, polyarthritis and nephritic syndrome is presented. The renal biopsy disclosed mesangial proliferation with IgA deposits. During hospitalization abdominal pain and upper digestive bleeding also presented. Digital angiography showed splenic artery microaneurysms. Then it's a new case of polyangiitis overlap with mixed features of Schönlein-Henoch purpura and polyarteritis nodosa. Differential diagnosis between several vasculitic associations in a patient is discussed.

[Capillaroscopy in vasculitis]. / Capilaroscopia en las vasculitis.

A prospective study of the capillaroscopy changes in 15 patients afflicted with vasculitis is presented. 2 of them had classic polyarteritis nodos (PAN), 3 had Churg-Strauss allergic angiitis and granulomatosis, 2 had hypersensitivity vasculitis (HV), 6 had giant-cell arteritis (GCA) and 2 had polyangiitis overlap syndrome (POS). Periungual capillaroscopy (PC) showed isolated changes in 11 patients (73%). We observed more changes in those cases with active disease (83% vs. 67%); they were mainly microhemorrhage (without any statistical significance). There were no more findings in patients with a more generalised affliction (nervous system, kidneys and/or skin) than in the others. In conclusion, the capillaroscopy findings were few and non-specific. PC is a diagnostic method of negligible value in this type of disease.

[Giant-cell arteritis: the clinico-biological manifestations and the complications secondary to steroid treatment]. / Arteritis de células gigantes: manifestaciones clínico-biológicas y complicaciones secundarias al tratamiento esteroideo.

The analysed clinico-biological manifestations, evolutive course and treatment of 30 patients with GCA are presented. The most frequent symptoms were fever and headache. 33% of patients had FOD criteria. 26% had various visual alterations. All patients were initially treated with steroids. Of the 26 patients followed up, 21 (81.7%) experienced some sort of complication: Cushing iatrogenic, osteoporosis, vertebrae collapse, aseptic necrosis of the femur head, arterial hypertension, diabetes mellitus, hyperlipidemia, steroid myopathy. 6 patients were treated with cyclophosphamide, following severe complications secondary to steroid therapy, and all of them had a good clinical evolution.