[Satellite manifestations of internal diseases]. / Manifestaciones satélites de las enfermedades internas.

AIMS: Define the concept of satellite manifestations (SM) and to determine the number and types of them that appear in the diseases of each one of the subspecialties of the Internal Medicine. METHODS: 290 diseases are reviewed in agreements of Internal Medicine and specialties books and in each one are described the types of SM that they present. RESULTS: The respiratory diseases are the group that more SM presents and the less one the neurological. The most frequent type of SM are dermatological. The diseases that have more variety of types of SM are the endocrinologicals. Analyzing the percentages of every type of SM in relation with the number of diseases of every group, the highest are the dermatological SM in cardiac diseases. CONCLUSIONS: The SM are a very frequent phenomenon in the current medical practice and express the holistic character of the disease. His knowledge is indispensable in the internal medicine and subspecialties, where they can suppose a help in the diagnoses, though a bad knowledge of his reality can mean the opposite.

[Technical project for the management and functioning of an Internal Medicine care unit]. / Proyecto técnico de gestión y funcionamiento de la unidad asistencial de Medicina Interna.

The Internal Medicine Services have a central role in the medical care in our hospital system both as to the volume of patients attended and their variety, reflecting of the preparation and multi-tasking ability of their professionals. The current norms for coverage of heads-of-service demands the presentation of a management project that must test our knowledge, skills and aptitudes for the clinical and medical management and in order to reflect them in a document of commitment with the management and with our fellows who are a part of the care unit. The person in charge of the service, as boss, agent or leader, is the one who must mark the strategic lines, to indicate the aims, to define the projects, to coordinate the tasks and to evaluate the results with other offers to obtain agreed-upon aims controlling the different points of view. Our professional and social commitment is: sharing clinical management with ethics, quality and welfare safety, to offer our patients (consumer or users) the best results (effectiveness), with useful measurements (efficacy) and with the minors drawbacks and costs (efficiency). The aim of this work is to offer the elements that are necessary for the accomplishment and introduction of a project of clinical management in a service of internal medicine, highlighting its methodology and the most important problems than can arise as well as the possible care alternatives.

[Neoplasms of unknown primary site]. / Neoplasias de origen desconocido.

Neoplasms of unknown primary site are tumor diseases, which are diagnosed by the pathologic studies of one of their metastases. The treatment of neoplasms of unknown primary site is not totally established, except in a few situations with specific therapeutical implications, and a better prognosis. The usual treatment of neoplasms of unknown primary site is the empirical chemotherapy with taxanes (paclitaxel or docetaxel) and platines (cisplatin or carboplatin)-based regimens, with different results in the trials.

[Central motor conduction evaluation in glycogenosis type III]. / Evaluación de la conducción motora central en la glucogenosis tipo III.

We report a 20-year-old man affected by glycogenosis type III with distal muscle weakness, more severe in distal leg muscles. The electromyogram showed myopathic features. Nerve conduction studies and central motor conduction after magnetic stimulation of the brain were normal. Our results suggest that there is no involvement of central motor pathways in this disease.

[Liver abscesses due to Klebsiella pneumoniae and acute anterior uveitis]. / Abscesos hepáticos por Klebsiella pneumoniae y uveitis anterior aguda.

Liver abscesses are not very frequent and those produced by Klebsiella spp. are quite exceptional. These germs have been related to the development of acute anterior uveitis (AAU) in patients whose susceptibility has been linked to HLA B27. We present a case of a female, HLA B27 negative, who developed AAU during a course of liver abscesses caused by Klebsiella pneumoniae.

[Detection and clinical course of metabolic multiple vascular risk syndrome]. / El descubrimiento y la evolución del síndrome metabólico de multirriesgo vascular.

The potential associations between the factors making up the vascular multi-risk metabolic syndrome (VMMS) or syndrome X (hypertension, diabetes, lipidic disorders, hyperinsulinemia and obesity) are studied: a) in patients with recent cerebral infarct or acute myocardial infarct; b) in patients hospitalized for the management of their hypertension, diabetes or obesity; c) at two years of evolution since the initial diagnosis of hypertension, diabetes or obesity. The results confirm that the VMMS, either complete or incomplete, is detected starting from the clinical management of any of its components (hypertension, diabetes, obesity) or complications (cerebral or myocardial infarct). These results and the ones regarding the evolution at two years of the risk factors associations, allows a discussion of the physiopathologic reality of the VMMS as an entity or a causal association.

[Psoas muscle abscess by Streptococcus agalactiae as a of presentation of fever of unknown origin]. / Absceso del músculo psoas-ilíaco por Streptococcus agalactiae como forma de presentación de fiebre de origen desconocido.

We present the case of a patient with precedents of endometrial carcinoma treated by surgery and radiotherapy, which presented a psoas abscess by Streptococcus agalactiae as cause of fever of unknown origin, which answered favorably to the antibiotherapy and surgical drainage.

[Case finding of iron overload in a university hospital]. / Búsqueda activa de casos de sobrecarga de hierro en un hospital universitario.

BACKGROUND: The epidemiologic importance of iron overload disorders and the clinical lack of its diagnosis led us to an active search of cases among the hospitalized patients in a general university hospital. This situation will make it possible to have a larger and earlier number of diagnosis together with a preventive intervention and an effective treatment. PATIENTS AND METHODS: A transverse study was performed on patients admitted to a fifteen beds ward in the internal medicine department. They have all been applied, without exclusion criteria, the iron metabolism parameters survey. The transferrin saturation (TS), due to its sensitivity, specificity and positive predictive value, has been considered appropriate for the phenotypic screening of the iron overload disorders. Subjects with fasting TS of 45% or more were considered as risk population. RESULTS: The study comprised 117 patients with an average age of 69.9 +/- 15.04. The high-risk population rate was 13.8% with an average age of 60.8 +/- 20.17, as compared to the low-risk population with an average age of 71.3 +/- 13.7 (p < 0.05). The most outstanding illnesses associated to the high-risk population are chronic hepatitis and diabetes mellitus (31.25%). An 18.7% of the cases show undernourishment. CONCLUSIONS: The iron overload is a prevalent illness whose early diagnosis requires a high clinical suspicion. The active search among the hospitalized patients, who have been made a TS, benefits the new cases detection. The TS is a screening technique with a high diagnostic profitability if you evaluate correctly the false positives. For that reason, we think the TS has to be included within the analytic requests which patients are made when admitted to hospital.

[Determination of insulin in saliva and its correlation with plasma insulin. Assessment of the possible participation++ of the salivary glands in the production of the hormone]. / Determinación de insulina en saliva y su correlación con la insulina plasmática. Valoración de la posible intervención de las glándulas salivares en la producción de la hormona.

The finding of immunoreactive insulin (IRI) in saliva and an insulin-like protein, similar to pancreatic insulin and with the same biological activities, suggest that both products are pancreatic insulin stored and/or eliminated in the salival manner or an extrapancreatic hormone synthesis, bearing in mind the features which both glands share. The aim of this study is to ascertain whether the amount of insulin from saliva depends on plasmatic insulin and, if so, whether this is a form of elimination. Our results pointed out that the amount of insulin in saliva is similar to the plasmatic insulin in those patients with normal pancreatic function. The oral glucose tolerance test was carried out on 20 patients. The maximum insulin level was produced at the same time as maximum serum glucose level, taking place 60 minutes later. These data, support the concept that salival insulin is a product of the elimination more than synthesis by salival glands, however we can not exclude the possibility of synthesis by the salival gland without direct studies, the ideal test being the immunocytochemist.

[Importance of plasma fibronectin in vascular diseases of diabetic patients]. / Importancia de la fibronectina plasmática en la enfermedad vascular del diabético.

Fibronectin (Fn) is a glycoprotein secreted principally by vascular endothelial cells and its main function is to maintain the adhesion between the various cells and the substrates. Owing to these two features, the glycoprotein participates in several pathologies affecting blood vessels, such as atherosclerosis and diabetes mellitus (DM). In this paper, we studied the quantitative differences of this protein in diabetic patients with associated macro and microangiopathy.

[The effect of different variables in the determination of plasma fibronectin in diabetes mellitus]. / Influencia de diversas variables en la determinación de fibronectina plasmática en la diabetes mellitus.

Fibronectin is a high molecular weight glycoprotein which forms part of the basal membrane and is found in plasma that has suffered quantitative alterations during the development of various pathological processes. The aim of this paper is to study, in diabetic patients, the quantitative seric changes of this protein in relation to diabetes mellitus and the influence of different variables (type of diabetes, weight, sex, age, treatment involved, period of evolution and control of the disease according to glycemia and HbA1c).

[Primary hemochromatosis in asymptomatic young patients]. / Hemocromatosis primaria en jóvenes asintomáticos.

OBJECTIVES: In order to increase our knowledge of adult haemochromatosis epidemiology and its clinical behaviour in young patients, we studied 4 patients from 3 pedigrees with idiopathic haemochromatosis. METHODS: Diagnostic criteria were: 1) Discarding the presence of secondary haemosiderosis. 2) Histological and histochemical confirmation of hepatic iron overload. Mean age at time of diagnosis was 25.2 years. Male/female ratio was 1. RESULTS: All of them were clinically asymptomatic, what shows the main difference with juvenile haemochromatosis, presenting earlier and more aggressively. Physical examination could not find abnormalities in any case. Regarding analytical studies, the main results were as follows: mean serum iron level was 209.5 mg/dl (s = 37.8), transferrin 206 mg/dl (s = 24.5), transferrin saturation was 77.4% (s = 9); ferritin, ASAT & ALAT were abnormal exclusively in the 2 males), the other measurements being between normal limits in all cases. Abdominal MRI showed an impaired hepatic signal in 2 cases. Liver biopsy was accomplished in 3 of them, showing massive deposits of hemosiderin in the hepatocytes in the 2 male cases and chronic hepatitis in one of them. There was no evidence of damage to other organs. Genetic studies showed that the 2 siblings were homozygous for the HFE 845GAEA (C282Y) mutation and in the other 2 cases HLA-A3,B7 was found to be associated. At present, after a year or more, all of them remain asymptomatic, liver function tests and mean serum ferritin levels are within normal limits, IST is < 65%, while Hb continues being > 11 g/dl. CONCLUSIONS: To conclude, we would like to emphasize the extraordinary importance of early diagnosis and careful treatment in this common and remediable illness (otherwise lethal), to reach a normal and symptoms-free lifespan.

[Cutaneous erythematous rash as first manifestation of T-cell prolymphocytic lymphatic leukemia]. / Erupción cutánea eritematosa como primera manifestación de leucemia linfática prolinfocítica de células T.

We present a case of a man 84 years-old, whose presentation feature was a cutaneous inespecific rash, and was diagnosed of T prolymphocytic leukaemia (T-PLL). In this review we analyze actual aspects concerning biology, diagnosis, classification, prognosis and treatment of this rare mature T cell leukaemia.

[Subcutaneous panniculitis at a third level hospital retrospective study of 113 cases]. / Paniculitis subcutáneas en un hospital de tercer nivel: estudio retrospectivo de 113 casos.

INTRODUCTION: The panniculitides or hypodermitis are a wide and heterogeneous group of diseases characterized by the presence of subcutaneous inflammatory nodules located generally in low limbs. OBJECTIVES: Show the clinicopathologic characteristics of the cases diagnosed as panniculitis for a 5 years period; their epidemiology, etiopathogenic factors, evolution and treatment. MATERIAL AND METHODS: A retrospective study of 113 patients diagnosed as panniculitis by histopathologic report of cutaneous biopsy since 1997 to 2001 were performed. RESULTS: The sex proportion was of 4.65 women to every man. The mean age of these patients was 49 +/- 20 years old. 100% had legs affectation, 7.1% in arms, 5.9% in trunk and 0.9% in face. 9.7% presented fever and arthromyialgias, especially in young people (p < 0.05). The etiopathogenic factors implied were tuberculosis, streptococcic pharyngoamygdalitis, sarcoidosis and different drugs. The most frequent histological pattern was septal panniculitis without vasculitis. 24.8% did not realize any treatment; 32.5% took nonsteroideal anti-inflammatory drugs; 31.6% potassium iodide; 16% systemic corticosteroids and 7.1% tuberculostatic drugs. Evolution of the patients was good and independently from the treatment performed. CONCLUSIONS: Panniculitides are a group of diseases with similar clinic, but very heterogeneous in their etiology and histopathologic findings. They are more frequent in women and with more expressive clinic in young people. Up to in the 59.3% of the studied cases a causal etiologic agent was identified. These factors are compatible with the published ones in other previous panniculitis series. When a paniculitis is suspected, the most efficient tool is the clinical diagnosis. Histological confirmation by cutaneous biopsy it must be done when it is possible.

[Characteristics of Kaposi's sarcoma. A retrospective study in a reference hospital]. / Características del sarcoma de Kaposi. Estudio retrospectivo en un hospital de Tercer Nivel.

UNLABELLED: Kaposi's angiosarcoma (SK) is a vascular tumour that affects skin and other organs. Nowadays there is thought that immunosuppression is one of the factors related with its genesis. OBJECTIVES: Show the information corresponding to the distribution of the SK, proportion of subtypes, evolution and therapeutic used. MATERIAL AND METHODS: A 28 cases retrospective study. We obtained the personal background, habits, origin of the VIH when the SK was associated with AIDS, and treatment carry out. Type of SK and location, cutaneous presentation, complications and B symptoms. Treatment, response and adverse effects. Progression of the disease, average time of relapse and survival, and presence of the SK at death. RESULTS: 64% epidemic, 21% classic type and 14% associated with transplants. In 48% of the epidemic cases, the VIH assumed to homosexual habits and 18% to being ADVP. In all there was cutaneous affectation, 46% had affectation of mucouses, 11% adenopathies and 14% visceral extension. 71% received treatment: 40% chemotherapy, 35% radiotherapy and 18% cryotherapy. Progression: 11% became stable, in 50% there was local extension and systemic in 17%. The average survival was of 4.16 +/- 3 years. CONCLUSIONS: SK has a minor incidence in the homosexual population. The high proportion of classic and transplants associated affirm the role of immunosuppression as a predisposing factor. There were numerous local complications that were associated with B symptoms. The cryotherapy was used as the first option in the located forms and in the widespread ones was the chemotherapy.

[Paget's disease of bone and basilar impression associated with an Arnold-Chiari type-1 malformation]. / Enfermedad ósea de Paget e impresión basilar asociadas a malformación de Arnold-Chiari tipo I.

The patient, a 78-year-old female with history of headache and progressive gait disturbance for almost one year, was admitted to our department because of dysphagia and dysphonia since three months before. Neurological examination revealed nystagmus, cerebellar ataxia, deafness, and vesical incontinence. No cerebral injuries were detected by computed tomography (CT) scan, although Paget's. Disease of Bone (PDB) was suggested, confirmed by biochemical and scintigraphic studies. The plain skull X-ray showed platybasia. As all the disarrangements were not explained by PDB complications alone, nuclear magnetic resonance imaging (MRI) was performed which demonstrated an Arnold-Chiari malformation (ACM) type I, with mild tonsillar herniation and anterior compression of the brainstem due to basilar impression, without syringomyelia. The association of PDB and ACM is a peculiarity seldom reported. The surgical approach was rejected, but the severity of symptoms and osteitis deformans biochemical activity needed a treatment; it was orientated to modify bone turnover using etidronate, a bisphosphonate, which induced clinical improvement and a decrease in serum alkaline phosphatase as well as in other bone resorption markers, without side effects. The good status and biochemical remission have been maintained a year later.

[Osteoporosis in patients admitted to an internal medicine service of a university general hospital]. / Osteoporosis en pacientes ingresados en un servicio de medicina interna de un hospital de tercer nivel.

OBJECTIVE: To ascertain the incidence of osteoporosis and epidemiological factors in patients admitted to an Internal Medicine Service of a University General Hospital in Madrid, Spain. We also took into account the reasons for admission, associated diseases, and the preventive and therapeutic diagnostic implications. PATIENTS AND METHODS: The analytical, descriptive, retrospective and transversal study of one hundred patients over fifty years of age admitted to an internal medicine service during 1997, obtaining in addition to the clinical discharge report, epidemiological data with regard to the radiological diagnosis of osteoporosis, the reason for admission, past history, the prevention and treatment of the initial complaint as well as the osteoporosis previous diagnosis. RESULTS: 26% of those patients included in the survey had radiologic criteria of osteoporosis although only in 1 per cent of them had osteoporosis been diagnosed previously. The main risk factors, apart from the age and sex, are the associated illnesses which cause malnutrition and immobilization, and the use of drugs, especially heparin. CONCLUSIONS: Osteoporosis is a condition common in patients above 50 especially women, who are admitted to an Internal Medicine Service. A quarter of those patients admitted have osteoporosis. Very few are diagnosed and treated. In this group of patients apart from the habitual risk factors, are added those for the associated disease generally chronic, and the treatment they receive. During their stay in the hospital osteoporotic patients are three times more likely to receive heparin and other drugs which aggravate osteoporotic, than non osteoporotic patients. For that reason the risk of fractures is greater and the need for prospective diagnostic studies is even more necessary in this group of patients.

[Cytomegalovirus diarrhea as a diagnostic index for AIDS]. / Diarrea por citomegalovirus (CMV) como primera manifestación de SIDA.

We report a case of a male 49 years old, without clinical history, excepting rape in 1996, that was admitted to the Emergency Room of HGUGM because of diarrhea 6 months duration, plus fever (39 degrees C) in the last 2 months. He was diagnosed of infection by the Human Immunodeficiency Virus (HIV), with serum antigenemia (70 cells), and colonic biopsy positives for Cytomegalovirus, and a normal colonoscopy. Cytomegalovirus colitis is the major etiologic infectious agent in patients with AIDS-associated diarrhea, although it can be the diagnostic index for AIDS in a few cases.

[Enterococcal infective endocarditis on native aortic valve]. / Endocarditis infecciosa por enterococo sobre válvula nativa aórtica.

Enterococcal endocarditis accounts for 10% of all bacterial endocardits. The infection progresses in a subacute way and when localized on the aortic valve it has a very poor prognosis since the valve is usually destroyed being death the fatal outcome. We report a case of a patient with infective endocarditis resulting from the implantion of the Enterococcus on the native aortic valve. Nor visk factors or an apparent main gate could be found. The patient was hospitalized after several months of a non especific febrile syndrome. The literature is reviewed. Diagnostic tests and clinical signs are discussed making emphasis on the refractoriness to chemotherapy.

[Comparative study between seric I pepsinogen and seric gastrin, in the differentiation of the different types and localizations of chronic gastritis]. / Estudio comparativo de pepsinógeno I sérico y gastrina sérica en la diferenciación de los distintos tipos y localizaciones de gastritis crónica.

The present work analyzes the serie levels of pepsinogen I (PG I) and gastrin in relation to the histopathological findings with the optical microscope (OM) and electron microscope (EM) of different gastric mucosa biopsies obtained through fibrogastroscopy. 45 patients were studied (19 men and 26 women) with an average age of 63 with different clinical diagnoses documented later by fibrogastroscopy (peptic ulcer, neoplasia etc.), whose previous consent, two biopsies were taken at an antrum level and two biopsies at a fundic-body area level, analyzed later by OM and EM. The anatomopathological criteria followed in order to classify the condition of the mucosa was Whitehead's classification. The PG I and gastrin determination was carried out with RIA against a control group of 25 healthy individuals. Our study allows us to conclude that the normal or high serie concentration of PG I reflects a functional integrity of the fundic-body area, and low levels imply the presence of atrophic chronic gastritis at a fundic-body level. Thus a low level of PG I is a reliable marker of the atrophic condition of the mucosa and it can be considered as a precancerous factor.