[Brucellar meningitis as a peculiar form of clear fluid meningitis. Clinical study]. / La meningitis brucelar como forma peculiar de meningitis de líquido claro. Estudio clínico.

Out of 200 patients diagnosed of acute of chronic brucellosis, cases were first selected who had neurologic involvement (14%) and then those who had brucellar meningitis (CDC criteria) which corresponds to 4% of the total of the series. The clinical course, evolution time, neurologic manifestations and serologic and bacteriologic characteristics in blood and specifically in the cerebrospinal fluid (CSF). This study was contrasted with the literature review and the conclusion is reached that brucellar meningitis is a peculiar form of clear fluid meningitis, not exceptional in our environment considering the prevalence of brucellosis.

[Acute pancreatitis: clinical and therapeutic study with somatostatin]. / Pancreatitis aguda: estudio clínico y terapéutico con somatostatina.

A clinical and therapeutical study of 47 patients with the diagnosis of acute pancreatitis is reported. According to Ranson's criteria patients were initially classified as suffering from mild (28) and severe (18) acute pancreatitis. Twenty-eight, 11, 7 and 1 patients had biliary, alcoholic, idiopathic and neoplastic causes, respectively, of their conditions. The classification of episodes was made on the basis of clinical manifestations, biologic investigations, and imaging diagnosis, and is shown in the corresponding tables. The therapeutic profile was a randomized double-blind study: perfused somatostatin (SS) versus placebo (P) (physiologic saline 0.9%). The administration of somatostatin in perfusion (250 mcg/h/48 hours) did not improve significantly the parameters used to score the severity, although the mortality rate decreased significantly (p < 0.05) in the group of patients with the severe form of the disease.

[Waist/hip ratio and vascular risk factors in obese and not obese individuals]. / Indice cintura/cadera y factores de riesgo vascular en sujetos obesos y no obesos.

Three groups of men and three groups of women were studied, each one of the three corresponding to obese individuals, overweight and not overweight according to the ratio of corporal mass > or = 30, 25-29.9 and < 25 respectively. In each group two subgroups were made following the waist/hip ratio (< 1 and > or = 1 for men and < 0.8 and > or = 0.8 for women). In each subgroup arterial pressure, basal glucemia, cholesterol and plasmic triglycerides, lipoproteins and insulinemia after a higher than normal oral intake of glucose were determined, comparing results according to waist/hip ratio. Practically all the parameters studied showed greater levels of risk in subjects of both sexes with high waist/hip ratio, both in obese individuals and not obese individuals. This shows the possibility that high waist/hip ratio in associated with risk factors in individuals who are not obese, and this association is considered as a "metabolic lipopathy" present in the intraabdominal visceral adipocyte. The measurement of waist/hip ratio must be recommended in all patients and in medical examinations.

[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.

[The incidence of the antiphospholipid syndrome in the clinical and biological manifestations of systemic lupus erythematosus]. / Incidencia del síndrome antifosfolípido en las manifestaciones clínicas y biológicas del lupus eritematoso sistémico.

In the present investigation a study was made on the incidence of antiphospholipid syndrome (APS) on clinical and biological manifestations in a series or 32 patients (28 females and 4 males with a mean age of 25 years) diagnosed of SLE (ARA criteria) and APS (Harris criteria) compared with a group of 25 patients (19 females and 6 males with a mean age of 38 years) diagnosed of SLE without APS. This entails a selection from 124 patients diagnosed of SLE, and an incidence of 25.8% and 9.7% for ACA and LA, respectively. After a clinical protocol was filled, a complete immunological profile was obtained, with lymphocyte subsets, IL-2 receptor, coagulation study, isotype determination for anticardiolipin antibody (ACA), lupus anticoagulant (LA), serology for syphilis and imaging diagnostic techniques. Comparative results, with an statistic assessment, are shown in tables. It is concluded that SLE + APS population can be considered as definite for a peculiar SLE subtype.

[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.

[Repeated strokes as a sign of multiple cerebral hydatid cysts]. / Hidatidosis cerebral múltiple primaria simulando ictus de repetición.

A female patient with primary multiple cerebral hydatid cysts is described. Initial deterioration was followed several months later by reversible episodes of right hemiparesis, aphasia and sphincteral incontinence. This clinical picture has not been described in the literature and the etiopathogenic mechanism is uncertain.

[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.

[Breast cancer in men. Clinical study of four cases in a department of internal medicine]. / Cáncer de mama en varones. Estudio clínico de cuatro casos en un Servicio de Medicina Interna.

Breast neoplasias among men are rare, its incidence being 1% of all breast cancers in both sexes. We present four cases of breast cancer in men, given their low frequency and rare manifestations. We describe the clinical manifestations, stressing that health education for its detection must be extended to men. We comment as well on the value of hormonal receptor assessment for the prediction of a hormonal treatment in advanced breast cancers.

[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).

[Neoplasms of the extrahepatic bile ducts. A clinical study of 44 cases]. / Neoplasias de vías biliares extrahepáticas. Estudio clínico de 44 casos.

44 clinical cases, histologically diagnosed as suffering from extrahepatic bile duct neoplasia, admitted at the "Hospital Foral de Navarra" during the years 1976 to 1985 and at the "Hospital Clinico Universitario de Salamanca" during the period from 1981 to 1987, were analysed. Our results showed a higher incidence in the female sex. The most important antecedent was biliary stone lithiasis (45.45%). Jaundice and abdominal pain were the most frequent symptoms and liver enlargement accompanied by jaundice were the most frequent clinical signs on physical examination. The data obtained did not show specificity at the diagnosis. The ERCP showed a high rate of diagnosis (71.43%) followed by CT scanning (70%) and percutaneous transhepatic cholangiography (52.63%). The types of surgery most frequently performed were cholecystectomy and choledochoduodenostomy, and the diagnosis of well-differentiated carcinoma was found in 63.64% of the cases. Any therapy performed (surgery, radiotherapy and/or chemotherapy) improved the survival rate.

[Sepsis: clinical course study of 126 patients in an internal medicine department]. / Sepsis: estudio clínico-evolutivo de 126 pacientes en un Servicio de Medicina Interna.

126 cases of sepsis were retrospectively studied in an Internal Medicine Department, giving special attention to the clinical evolution. 67 males and 59 females with a median age of 65 years old were discovered. 92% had one or more diseases, mainly COLD (30%) and diabetes mellitus (28%). The septic sources were urinary (37%) and respiratory (31%). 84% of the germs were gram (-), mainly E. Coli and Proteus sp. A mortality rate of 36% was found, the primary rates being: eighth decade (52%), patients with neoplastic disease (46%), biliary tract diseases (64%), endocarditis (66%), infection by Serratia (60%), Pseudomonas (50%), shock (55%) and DIC (50%). These last two complications were analysed and found to be the more frequent (35% and 6.3% respectively), also being those with higher mortality rate. Finally, the prognostic factors are established based on the results obtained.