[Tuberculosis epidemiological study in a third level hospital during 2001]. / Estudio epidemiológico de la tuberculosis en un hospital de tercer nivel en el año 2001.

OBJECTIVES: Estimate the incidence and epidemiological and clinical characteristics of Tuberculosis (TB), analyzing the influence of factors such as: HIV infection, immigration, chronic diseases and styles of life. MATERIAL AND METHODS: Retrospective study of patients who have diagnosed of active TB (microbiological results positive) and latent tuberculosis (Mantoux positive) during the year 2001 in the Gregorio Marañon Hospital. The variables include epidemiological, microbiological, clinical and therapeutic features. RESULTS: We registered 78 patients with TB at hospital, with estimated incidence in health area of 11, 14 cases per 100,000 habitants. The mean age of were 41.98 years; with 43.6% HIV infected patients and 9% immigrants. The sputum was the sample most used for the microbiological diagnosis, we detected resistance in 30% of samples analyzed. The HIV infected patients had more frequent TB from reactivation (p=0,016). The primary site of disease was pulmonary (78%). One pulmonary infiltrate was more frequent in the thoracic X-ray. The 56% of our HIV infected patients had normal thoracic X-ray (p <0,05). The treatment more common was with four drugs and the 75% of our patients fulfilled the treatment; the HIV infected patients leaves the treatment more frequent. The global mortality was 9%. CONCLUSIONS: Actually, in Madrid, the persons with HIV infection, injection drug abuse, immigration and elders in residential home were higher risk of infection for TB. For strict control of disease is need early diagnosis and supervision of treatment .

[Cardiovascular complications due to cocaine]. / Complicaciones cardiovasculares por cocaína.

The increase of cocaine consumption is a common new item in the medical literature and in the national press and, hence, it does not surprises us any more. However, we are seeing every day the appearance of unknown or forgotten complications. In this paper, we review the cardiovascular complications due to the consumption of this drug, stressing the physiopathological mechanisms and the therapeutical aspects. In addition, we describe our experience with the management of these patients.

[Structural changes of the erythrocyte membrane in myelodysplastic syndromes]. / Alteraciones estructurales de la membrana eritrocitaria en los síndromes mielodisplásicos.

Myelodisplasic syndromes (MS) is a group of hematological alterations with well-known clinical, diagnosis, prognosis and therapeutic features. The etiology is still, however, unclear. Following the hypothesis of the lesion of the pluripotential cell, we have studied the composition of red cell membrane in 5 patients afflicted with MS (1 with refractory anemia; 3 refractory anemia plus excessive blast count and 1 chronic myelomonocytic leukemia). The red cells of the patients afflicted with MS has morphological alterations at examination in fresh. The most frequently observed being acanthocytosis and macrocytosis. Structurally, they showed an increase in the cholesterol/phospolipids (C/P) quotient, which was responsible for the increase of the cell area and macrocytosis. Meanwhile, the high level of sphingomyelin (SP) and its depletion of phosphatidil-ethanol-amine (PEA), justify the double population of red cells; one of which being acantocytes and the other has and aquired mutation of the genetic code, which confirms the chromosomic alterations widely described. We feel that our findings confirmed the hypothesis of the effects of an oncogen on the genoma of the mother cell, which can be causal of some acute leukemias and other genetically confirmed alterations.

[Cardiac tamponade in a woman with primary hypothyroidism]. / Taponamiento cardiaco en una mujer con hipotiroidismo primario.

Pericardial effusion is not infrequent as a manifestation of hypothyroidism, however, cardiac tamponade is exceptional in these patients. We report a case of a female patient with cardiac tamponade that in the forward workshop was diagnosed of primary hypothyroidism. A brief presentation of clinical history is reported. The literature's review emphasizes the rarity of this case, the importance of the knowledge of triggering factors to establish a precious diagnosis and satisfactory clinical evolution with hormonal treatment without recurrences of the cardiac tamponade after pericardiocentesis is performed, although the resolution of the pericardial effusion is usually slow.

[Charcot-Marie-Tooth disease, dilated myocardiopathy and cardiac conduction disorders]. / Enfermedad de Charcot-Marie-Tooth, miocardiopatía dilatada y trastornos de la conducción cardiaca.

We describe the case of two brothers with Charcot-Marie-Tooth disease, dilated cardiomyopathy and disorders in the cardiac conduction. We review the literature in order to find physiological grounds for these associations. Despite the absence of consolidated data on this question, the genetic grounds could play some role here. In this sense, our cases contribute with the novelty that the disease affects two brothers. This has never been described before and could contribute, along with future observations, to clarify some etiopathogenic aspects of the disease.

[An ACTH-secreting carcinoid tumor of the thymus. A report of a new case]. / Tumor carcinoide de timo secretor de ACTH. Presentación de un nuevo caso.

Carcinoid tumour of the thymus is a rare condition, with less than a hundred cases reported in the literature. Diagnosis is complex as they are usually asymptomatic. We describe a case of a severe Cushing syndrome developed in a 51-year-old man. The diagnosis of a thymic carcinoid was established. Three years ago, the patient was treated by surgical resection of an anterior mediastinal mass. A massive tumour dissemination was detected by MIBG and CT image techniques. Both techniques are currently considered useful for this kind of diagnosis. ACTH secretion was detected immunohistochemically. Although the treatment with SMS-201-995 octreotide was effective in controlling the clinical symptoms, the patient died three months later with extensive metastases. The carcinoid tumours of the thymus associated to Cushing syndrome are aggressive tumours and usually produce local and distant metastases.

[Thrombotic thrombocytopenic purpura: the need of an early treatment]. / Púpura trombocitopénica trombótica: necesidad de un tratamiento precoz.

Two patients affected by thrombotic thrombocytopenic purpura (TTP) are treated with plasmapheresis, fresh frozen plasma infusion, steroid and inhibitors of platelet aggregation with an impaired final stage: the first patient died during a plasmapheresis session and the other had a good evolution, obtaining complete recovery, maintained a year later. We discuss the clinical features and highlight the needs for early treatment with all the latest therapies.

[Rhabdomyolysis and cocaine consumption: presentation of 13 cases]. / Rabdomiolisis y consumo de cocaína: presentación de 13 casos.

We present 13 cases taken care at the Emergency Service, whose diagnosis was acute rhabdomyolysis related to consumption of illicit drugs. In all cases, the presence of cocaine in the urine was detected. Clinical features, other associated factors and complications are described, stressing the etiopathogenic mechanism of presentation of cocaine-related rhabdomyolysis.

[Pancreatitis and inappropriate ADH secretion syndrome associated with amiodarone]. / Pancreatitis y síndrome de secreción inadecuada de ADH asociados a amiodarona.

We describe a case of hepatotoxicity, pancreatitis and inappropriate ADH secretion syndrome developed in a patient receiving chronic amiodarone treatment, not related to other causes. Hepatic toxicity is a well known condition. Inappropriate ADH secretion syndrome has not been described yet and there has been a single case-report of pancreatitis in the literature reviewed.

[Pustulosis of Sneddon Wilkinson disease and multiple myeloma]. / Pustulosis de Sneddon Wilkinson y mieloma múltiple.

A case of subcorneal pustular dermatosis is described, this disease is not very common. Its origin remains unknown, there are some data that indicate an immunological basis because of its associations to hematological disorders and others autoimmune diseases. The diagnosis is based on clinic suspects and the histopathological analysis. The differentiation among other dermatosis like pustular psoriasis, due to its therapeutic implication and evolution. This patient developed an IgA-K myeloma after nine years of evolution, a very common finding in this disease. It has not definitive treatment, being corticosteroids and sulfonamides more effective. The prognosis depends on the appearance of complications and associated processes.

[Progressive external ophthalmoplegia]. / Oftalmoplejia externa progresiva.

Progressive external ophthalmoplegia is a myopathic alteration of slow progression which affects the extrinsic ocular muscles; ptosis of the eyelid being the most characteristic sign. Nowadays, it is included as type of muscular dystrophy. Even though mitochondrial changes have been described, they are not specific to this disease. 2 cases are described in this paper, commenting on clinical, electromyographic and pathological aspects.

[A gluteal mass as the initial manifestation of a calcified hepatocarcinoma]. / Masa glútea como manifestación inicial de un hepatocarcinoma calcificado.

A patient is reported who had a mass in the gluteal region of three years evolution that turned out to be a metastasis of hepatocarcinoma. The peculiarities of this case are commented, as well as the unusual form of presentation of the hepatocarcinoma. The prolonged clinical evolution and the presence of calcifications in the primitive tumor should be emphasized.