[Hematoma of the rectus abdominis. experience of a primary care hospital]. / Hematoma del recto anterior del abdomen: experiencia en un hospital comarcal.

OBJECTIVE: To describe patients diagnosed with hematoma of the rectus abdominis (HRA) muscle. MATERIAL AND METHODS: A retrospective analysis of patients diagnosed with HRA over the past 8 years in our center. RESULTS: A total of 17 patients (9 women) with mean age of 73 years were included in the study. In 52% of the cases the HRA was the cause of hospitalization. Anticoagulant therapy was documented in 70%. More than half of patients treated with low molecular weight heparin had renal insufficiency. In the group receiving oral anticoagulants (OA), 86% had INR greater than 4. Paroxysmal cough appeared in 13. The most common presentation was abdominal pain and palpable mass. CT scan sensitivity was superior to that of the ultrasound. The most common location was the lower right. Treatment was conservative in all but one. Two patients died. Mean decrease in hemoglobin was 4.7 g/dl. Average stay was 19 days. CONCLUSIONS: In our center, HRA almost equally affects both genders and appears in older people with excessive anticoagulation and cough. The clinical presentation, increased diagnostic sensitivity of CT scan and predominance in the right abdominal involvement are similar to other series. Mortality and hospital stay are higher than described.

Hematoma del recto anterior del abdomen: experiencia en un hospital comarcal / Hematoma of the rectus abdominis. experience of a primary care hospital

Objetivo. Describir los pacientes diagnosticados de hematoma del recto anterior del abdomen (HRAA). Material y métodos. Análisis retrospectivo de pacientes diagnosticados de HRAA durante los últimos 8 años en nuestro centro. Resultados. Se incluyen 17 pacientes (9 mujeres) con edad media de 73 años. En el 52% de los casos el HRAA fue la causa del ingreso. El tratamiento anticoagulante se documentó en el 70%. Más de la mitad de pacientes tratados con heparinas de bajo peso molecular tenían insuficiencia renal. En el grupo de los que recibían AO, un 86% tenía un INR superior a 4. La tos paroxística aparecía en 13. La presentación más habitual fue dolor abdominal y masa palpable. La sensibilidad de la TAC fue superior a la ecografía. La localización más frecuente fue la inferior derecha. El tratamiento fue conservador en todos, excepto uno. Dos pacientes fallecieron. El descenso medio de la hemoglobina fue 4,7g/dl. La estancia media fue de 19 días. Conclusiones. En nuestro centro el HRAA afecta casi por igual a ambos sexos y aparece en personas de edad avanzada con exceso de tratamiento anticoagulante y tos. La presentación clínica, mayor sensibilidad diagnóstica de la TAC y predominancia en la afectación derecha del abdomen, es similar a otras series. La mortalidad y la estancia hospitalaria son superiores a lo descrito(AU)

Objective. To describe patients diagnosed with hematoma of the rectus abdominis (HRA) muscle. Material and methods. A retrospective analysis of patients diagnosed with HRA over the past 8 years in our center. Results. A total of 17 patients (9 women) with mean age of 73 years were included in the study. In 52% of the cases the HRA was the cause of hospitalization. Anticoagulant therapy was documented in 70%. More than half of patients treated with low molecular weight heparin had renal insufficiency. In the group receiving oral anticoagulants (OA), 86% had INR greater than 4. Paroxysmal cough appeared in 13. The most common presentation was abdominal pain and palpable mass. CT scan sensitivity was superior to that of the ultrasound. The most common location was the lower right. Treatment was conservative in all but one. Two patients died. Mean decrease in hemoglobin was 4.7g/dl. Average stay was 19 days. Conclusions. In our center, HRA almost equally affects both genders and appears in older people with excessive anticoagulation and cough. The clinical presentation, increased diagnostic sensitivity of CT scan and predominance in the right abdominal involvement are similar to other series. Mortality and hospital stay are higher than described(AU)

[Study of hypertensive very elderly population admitted to a regional hospital]. / Estudio de la población hipertensa muy anciana ingresada en un hospital comarcal.

OBJECTIVES: To analyse the characteristics of the hospitalized very elderly people (age equal or superior to 80 years) with hypertension (HT). PATIENTS AND METHODS: Prospective study including the patients with HT who need hospitalization in our medical institution. Data collected were: demographic, clinical parameters, factors of vascular risk, hygienic-dietetic strategies, pharmacological treatment, cause of hospitalization, and biochemical determinations. RESULTS: There were included 92 very elderly patients (71 women); they represent 14 % of total hospitalized people. Two third parts had not realized academic studies, being 60 % of rural origin. Almost the half (41 %) was diabetic, and 27 % had dyslipidemia. Overall 62 % had 4 or more factors of cardiovascular risk. The hospitalization was related to the HT in the half of the cases, and 61 % had already previously some cardiovascular event. The lifestyle modifications more frequent were: not to smoke (95 %), no alcohol (81 %), and diet without salt (75 %). Diuretics were the most frequent anti-hypertensive agent used. The global mortality was two times superior to the hypertensive population < 80 years in the same period. CONCLUSIONS: The very elderly hypertensive patients of our study are fundamentally women, of rural origin and without academic studies. The above mentioned hospitalization is attributable directly to the HT in the half of the cases. They are a population of high cardiovascular risk, with previous events cardiac and cerebral-vascular. They confess to realize frequently the hygienic-dietetic strategies recommended. The diuretics are the anti-hypertensive agents most used for the HT. Since it was of waiting for the mortality in this group it is high.

Estudio de la población hipertensa muy anciana ingresada en un hospital comarcal / Study of hypertensive very elderly population admitted to a regional hospital

Objetivos: Conocer las características de la población hipertensa muy anciana (edad igual o superior a 80 años) ingresada en nuestro centro hospitalario. Material y métodos: Estudio prospectivo, incluyendo a pacientes con hipertensión (HTA) ingresados en nuestro centro. Se estudiaron: parámetros demográficos, clínicos, factores de riesgo vascular, medidas higiénico-dietéticas, tratamiento farmacológico, causa del ingreso, y determinaciones bioquímicas. Resultados: Se incluyeron 92 pacientes (71 mujeres); representan el 14% de los ingresos. Dos terceras partes no habían realizado estudios académicos; siendo el 60% de procedencia rural. Casi la mitad (41%) eran diabéticos tipo II y un 27 % tenía dislipemia. El 62% tenían 4 o mas, factores de riesgo cardiovascular. El ingreso hospitalario se relacionó con la HTA en la mitad de los casos, y un 61% ya había tenido previamente algún evento cardiovascular. Las medidas higiénico-dietéticas mas frecuentes son: no fumar (95%), no alcohol (81%), y dieta sin sal (75%). Los fármacos más usados son: diuréticos e IECAs. La mortalidad global fue dos veces superior a la de los hipertensos de menos de 80 años. Conclusiones: Los hipertensos muy ancianos ingresados en nuestro centro, son fundamentalmente mujeres, de procedencia rural y sin estudios académicos. Dicho ingreso es atribuible directamente a la HTA en la mitad de los casos. Son una población de alto riesgo cardiovascular, coneventos previos cardíacos y cerebro-vasculares. Confiesan realizar las medidas higiénico-dietéticas recomendadas. Los diuréticos son los fármacos mas utilizados para la HTA. Como era de esperar la mortalidad en este grupo es muy alta

Objectives: To analyse the characteristics of the hospitalized very elderly people (age equal or superior to 80 years) with hypertension (HT). Patients and methods: Prospective study including the patients with HT who need hospitalization in our medical institution. Data collected were: demographic, clinical parameters, factors of vascular risk, hygienic - dietetic strategies, pharmacological treatment, cause of hospitalization, and biochemical determinations. Results: There were included 92 very elderly patients (71 women) ;they represent 14 % of total hospitalized people. Two third parts had not realized academic studies, being 60 % of rural origin. Almost the half (41 %) was diabetic, and 27 % had dyslipidemia. Overall 62 % had 4 or more factors of cardiovascular risk. The hospitalization was related to the HT in the half of the cases, and 61 % had already previously some cardiovascular event. The lifestyle modifications more frequent were: not to smoke (95 %), not alcohol (81 %), and diet without salt (75 %). Diuretics were the most frequent anti-hypertensive agent used. The global mortality was two times superior to the hypertensive population < 80 years in the same period. Conclusions: The very elderly hypertensive patients of our study are fundamentally women, of rural origin and without academic studies. The above mentioned hospitalization is attributable directly to the HT in the half of the cases. They are a population of high cardiovascular risk, with previous events cardiac and cerebral-vascular. They confess to realize frequently the hygienic - dietetic strategies recommended. The diuretics are the anti-hypertensive agents most used for the HT. Since it was of waiting for the mortality in this group it is high

Primary mesenteric liposarcoma of jejunum: presentation like a cystic mass.

This report describes a rare case of intra-abdominal liposarcoma in a 67-year-old woman. The patient presented at Internal Medicine Unit in May 2004, to study of thyroid pathology. The clinical examination was normal, except for the finding of an asymptomatic mass in the abdomen. The patient knew the existence of tumor since time ago, but she confesses to have only occasional discomfort. In the abdominal ultrasonography a solid mass with large cystic component was detected but relation with other organs was not clear. Computed tomography revealed the presence of a mass with solid and cystic components, in contact with small intestine in the left side of abdomen. A complete resection of tumor arising from mesentery of jejunum was performed successfully with end to end anastomosis. The gross specimen was lobulated and measured 8.5 x 7.5 cm. The histopathology analysis showed proliferating lipoblasts with irregular nuclei on a myxoid background, with plexiform vascular pattern, characteristics belongs to myxoid type liposarcoma. The patient is alive and well one year after removal of tumor. The uncommon site and the exceptional cystic morphology of tumor are discussed, and so it must be included the primary mesenteric liposarcoma in the differential diagnosis of intra-abdominal tumors with cystic large areas.

Bloqueo auriculoventricular de primer grado y síncope por consumo de derivados anfetamínicos

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[Study of consultation in an Internal Medicine Department]. / Estudio de la interconsulta en un Servicio de Medicina Interna.

Consultation in Internal Medicine is a common task of the attending labor of the internist in a general hospital and is a relevant link for intrahospital cohesion. In the present work the characteristics of 738 consultations, which represented all consultation request forms received at our Department during a nine-month period, were studied. A 55.4 percentage of consultation forms were requested urgently and 93.6% of them were answered on the same day. Most consultation parts received came from General Surgery and traumatology, with a predominance of cardiologic, pneumologic, infectious and multiple causes. The assessment of the urgency made by the internist coincided with the urgent request only in 38.3% of cases. A clinical follow-up was made for 33.3% of patients and 2% of them were transferred to the Internal Medicine Department. The consultation was repeated for 22.5% of the total of patients. Only in 23.1% of cases an oral link with the referring physician occurred. To remark the relevance of the consultation for the optimization of care quality to our patients and its influence on the inter-relationship between specialists in different fields of medicine.