[Lung adenocarcinoma feigning an interstitial lung disease in a 30-year-old man]. / Adenocarcinoma de pulmón simulando una enfermedad pulmonar intersticial en un varón de 30 años.

A case of a 30-year-old man is presented. He had a past medical history of asthma and presented with cough, shortness of breath, fever and chest pain. The chest X-ray showed cardiomegaly and a interstitial pattern. The echocardiogram revealed a severe pericardial effusion that required performing a pericardiocentesis. A CT scan showed mediastinal adenopathies and reticulonodular interstitial pattern. A bronchoscopy could not be completed because of non-tolerance. Finally a lung biopsy allowed us to reach a final diagnosis of lung adenocarcinoma. Following, some aspects of lung cancer in young people are commented, especially its incidence, histology, symptoms and a prognosis. A few aspects of the interstitial lung disease are also addressed and the differential diagnosis with lymphangitic carcinomatosis.

[Four cases of malaria in travellers. An emerging disease]. / Cuatro casos de paludismo en viajeros. Una enfermedad emergente.

Four cases of malaria in patients who had travelled to Equatorial Guinea the previous weeks and had not received prophylaxis are presented. There were three men and one woman, two natives of Equatorial Guinea who had been living in Spain for a long time and the other two Spanish. Following a 15-30 day trip in Equatorial Guinea they all presented with fever, shivering, headache and diarrhea( two cases) five to ten days after their return. Only one patient presented splenomegaly. The thick blood smear showed plasmodia in all patients and P. falciparum was identified in only two patients. All of them were treated with doxycycline and quinine sulfate with a favourable outcome. Only one of the patients needed hospitalization. Following some aspects of the epidemiology, symptoms, diagnosis and treatment of this emerging disease are presented.

[Colon lymphoma as a cause of fever of unknown origin]. / Linfoma de colon como causa de fiebre de origen desconocido.

We present a case of a 49 year old man who presented with a 2 month history of fever, nausea vomiting and weight loss (10 kg). He was admitted to the Hospital with the diagnosis of fever of unknown origin. A CT scan showed a wide thickening of the colonic wall (transverse colon and hepatic flexure) suggesting a colon tumor, and a solid mass in the left liver lobe. A colonoscopy was performed showing a circumferential neoplasm and biopsies were taken. The histopathology was informed as a diffuse large B cell lymphoma. Primary colon lymphoma is a rare gastrointestinal tumor that represents less than 1% of the gastrointestinal lymphomas. Based on this case, we reviewed the most recent articles about gastrointestinal lymphomas.

[Phylephebitis due to diverticulitis]. / Pileflebitis secundaria a diverticulitis.

A case of a 52 year-old-male, with past medical history of renoureteral crisis and recurrent episodes of abdominal pain, is presented. The patient presented to the Emergency Department with abdominal pain (similar to previous episodes), fever and abnormal liver function test (marked elevation of gammaglutamyltranspeptidase and alkaline phosphatase). An abdominal ultrasound was performed showing hepatomegaly, and enlarged spleen and an echogenic material that suggested a thrombosis. A CT scan confirmed the thrombosis of the inferior mesenteric vein extending up to the splenic vein and the portal vein. It also showed a large number of diverticulum. Surgery was performed in order to rule out an acute diverticulitis. A phylephlebitis, infective suppurative thrombosis of the portal vein and its branches (inferior mesenteric vein and splenic vein) was found due to an acute diverticulitis with neither perforation nor abscess. A ligature of the inferior mesenteric vein and a Hartmann procedure with resection of the diseased colon, and end colostomy and creation of a rectal stump, were performed. A favourable outcome was obtained with antibiotics and anticoagulation. Some aspects of the aetiology, symptoms, diagnosis and treatment of this unusual complication of diverticulitis are also presented.

[Carcinoma of the Fallopian tube: a case]. / Un caso de carcinoma de trompa de Falopio.

The case of a 43-years old woman with previous history of mental retardation and major depressive syndrome, consulting for metrorrhagia is presented. At physical examination a right adnexal mass was detected on palpation. Transvaginal echography showed a 3-cavity cyst in right ovary. A surgical intervention with total hysterectomy and dual adnexectomy was performed. Pathological study showed proliferative endometrium, bilateral follicular cysts and well differentiated serous adenocarcinoma located at fallopian tube. The patient refused adjuvant chemotherapy, a close follow-up is ongoing in outpatient Oncology Unit. Then some epidemiologic, etiologic, clinica, diagnostic and therapeutic issues related to this rare tumour are discussed.

[Study on bacteremia in the service of Internal Medicine of a group 2 hospital. Analysis of recent three years]. / Estudio de las bacteriemias en el Servicio de Medicina Interna de un hospital de grupo 2. Análisis de los tres últimos años.

INTRODUCTION: Bacteremia remains one of the most relevant problems in infectious disease. The interest of this study was to know the presentation and development pattern of bacteremia in our environment, in order to best prevent and treat this entity. PATIENTS AND METHOD: A retrospective, no interventional study, on significant bacteremia detected in the Service of Internal Medicine of a secondary level hospital over three years was carried out. Through the study length, from January 1 2001 until December 31 2003, 4,719 blood cultures were processed by the Service of Microbiology; of these, 1964 (41.6%) were submitted by the Service of Internal Medicine. Results were positive in 336 (17.1%); of these, 18 (24.1%) correlated with episodes of true bacteremia, and 255 (75.9%) were deemed as contaminations. RESULTS: Overall, 81 episodes of true bacteremia were studied, from 77 patients (4 patients presented with 2 episodes). An incidence rate of 28.25 episodes per 1000 hospital admissions was estimated. Mean age was 72 years (95% CI: 68.62-75.38). Males over 60 years-old were predominant (51.9%). Bacteremia was community-acquired in 75.3% of cases, and nosocomial in 24.7%. Commonest baseline diseases were elevated arterial blood pressure and diabetes mellitus. Bacteremia development was mostly related to genitourinary and vascular handling. Most of them were nephrourological (42.0%), respiratory (19.8%) and abdominal (13.6%) in origin. In our environment, Escherichia coli (33.0%) and Staphylococcus coagulase-negative (15.9%) were the most commonly isolated pathogens. Empiric antibiotic therapy was correct in 86.2% of cases; third generation cephalosporins were the most used. Overall mortality rate was 16% (13 patients), and bacteraemia-related mortality was 61%. CONCLUSIONS: A high incidence of bacteremia episodes is noteworthy, as compared with series from other centers. The percentage of episodes due to Staphylococcus coagulase-negative was significant, as it is the rule in recent years; thus, a thoroughly assessment of potential contaminants, as well as staff training in extraction techniques becomes necessary.

[Lupus vulgaris. Treatment with 3 drugs]. / Lupus vulgar. Tratamiento con tres drogas.

We report two cases of lupus vulgaris one of them on scar of scrofuloderma. We review the treatment of the skin tuberculosis (TBC) and we observed the favorable development to the total regression, using rifampin-isoniazid-pyrizinamide in the first two months and rifampin-isoniazid the four months left to complete six months of global therapy. We discard the monotherapy as treatment for this disease.

[Buerger's disease starting in the upper extremity. A favorable response to nifedipine treatment combined with stopping tobacco use]. / Enfermedad de Buerger de inicio en extremidad superior. Respuesta favorable al tratamiento con nifedipina asociado a la supresión del tabaco.

A case of a 38-year-old smoker male who had vasoconstriction and instep claudication of the right hand, is presented. After a year of evolution, he experienced the same alteration on the left foot. He was diagnosed as suffering from thromboangiitis obliterans, by means of angiography. After oral nifedipine treatment, combined with cessation of smoking, all symptoms and trophics regressed.

[Erythematous reticular mucinosis associated with breast cancer]. / Mucinosis reticular eritematosa asociada a cáncer de mama.

A case of reticular erythematous mucinosis of histology and atypical localization in a patient with breast cancer, is presented. This patient had a history of benign tumors of muscular origin localized in uterus and stomach. We focus on the rareness of this syndrome and its association with other tumors, a point not shown in the literature.

[Significance of angina in patients with aortic valvulopathy]. / Significación de la angina en los pacientes con valvulopatía aórtica.

We have analyzed coronary arteriographies of 170 patients, 120 with isolated aortic stenosis and 50 with isolated aortic failure. Patients with stenosis showed higher frequency of angina (73% versus 54%, p = 0.0223). No significant differences were observed with respect to the incidence of the coronary artery disease (26.7% versus 31.8%, p = 0.18). The presence of angina was significantly more specific in aortic failure (specificity 52.4% versus 31.8% in aortic stenosis, p = 0.039). Among the patients with less than 56 years of age, the probability of developing coronary artery disease in absence of angina was 6.3% (1 out of 16), the confidence interval ranging from 1.5% to 30.2%. Our results do not support any modification of the conventional criteria for conducting coronary arteriographies in patients with aortic valvulopathy.