Assessing clinical probability of organic disease in patients with involuntary weight loss: a simple score.

BACKGROUND: Involuntary weight loss (IWL) is a frequent complaint with a difficult diagnosis. Any one of a number of different diseases may be the source of the symptom. However, there is no universal clinical protocol that can help physicians study this complex syndrome. METHODS: In March 1998, we defined a diagnostic protocol for the study of IWL. IWL was defined as an involuntary and documented weight loss of at least 5% of the usual body weight in the previous 3 months. We analyzed 78 consecutive patients with IWL who came to our clinic between March 1998 and December 2000. RESULTS: An organic disease was found in 56% of cases; cancer, metabolic and digestive diseases were the most common entities. Psychiatric problems were found in 33% of cases. After extensive study, an idiopathic group of 11% was identified. The variables that were independently predictive of a final diagnosis of organic disease were: age>50 years (OR: 8.6, CI 95%: 1.7-43.6), psychiatric symptoms (OR: 0.2, CI 95%: 0.1-0.8), smoking (OR: 14.3, CI 95% 2.3-74), the presence of guide symptoms (OR: 8.0, CI 95%: 1.8-34.4), and anemia (OR: 3.1, CI 95%: 2.5-387). Sixteen percent of the patients died, more often those suffering from organic diseases. Based on multivariate regression coefficients, a clinical risk score was established. CONCLUSIONS: IWL is a complex and frequent syndrome with a 16% rate of mortality during the first year. A protocol based on clinical data can help in the management of IWL. Our clinical prediction rule may help physicians to identify those patients with IWL who are likely to have an underlying organic disease.

Evidence of hepatitis C virus antibodies in the cryoprecipitate of patients with mixed cryoglobulinemia.

OBJECTIVE: To describe the clinical features of 8 patients with mixed cryoglobulinemia and hepatitis C virus (HCV) infection. METHODS: A clinical study of the patients was performed. Anti-HCV antibodies were determined by ELISA and confirmed by immunoblot (RIBA) in the sera and in the cryoprecipitate. RESULTS: All patients had liver dysfunction, while most had arthralgias and/or arthritis, purpura, peripheral nervous system involvement and renal disorders. Cryocrits ranged from 1 to 6%. Six patients had type III mixed cryoglobulinemia and the remaining 2 had type II. History of blood transfusion was recorded in 2 patients. Hepatitis B virus (HBV) markers were negative in all sera samples. The cryoprecipitate of 7 patients was negative for HBV markers, but anti-HCV antibodies were positive by both ELISA and RIBA. CONCLUSION: After reviewing published reports and discussing the possible role that hepatitis C virus plays in the pathogenesis of mixed cryoglobulinemia, we conclude that HCV may stimulate immune complex formation and produce cryoglobulinemia. Therefore its investigation is recommended before the diagnosis of "essential" mixed cryoglobulinemia is established.

[Dermatomyositis, Sjögren's syndrome and vasculitis: an infrequent overlapping connective disease]. / Dermatomiositis, síndrome de Sjögren y vasculitis: una conectivopatía de superposición poco frecuente.

A dermatomyositis case with Sjögren's syndrome, Leucocytoclastic vasculitis, and sclerodermiform features is presented. This is a peculiar over lapping connectivepathy in which clinical features of three multisystemic diseases are together. The association of dermatomyositis with Sjögren's syndrome is very rare.

Temporal arteritis: a form of systemic panarteritis.

The case is reported of a patient with giant cell arteritis affecting several organs. The triggering cause of death was a brainstem infarction due to basilar artery thrombosis. The necropsy showed the systemic character of the disease affecting the coronary, bronchial, and ovarian arteries.

[Capillaroscopy in vasculitis]. / Capilaroscopia en las vasculitis.

A prospective study of the capillaroscopy changes in 15 patients afflicted with vasculitis is presented. 2 of them had classic polyarteritis nodos (PAN), 3 had Churg-Strauss allergic angiitis and granulomatosis, 2 had hypersensitivity vasculitis (HV), 6 had giant-cell arteritis (GCA) and 2 had polyangiitis overlap syndrome (POS). Periungual capillaroscopy (PC) showed isolated changes in 11 patients (73%). We observed more changes in those cases with active disease (83% vs. 67%); they were mainly microhemorrhage (without any statistical significance). There were no more findings in patients with a more generalised affliction (nervous system, kidneys and/or skin) than in the others. In conclusion, the capillaroscopy findings were few and non-specific. PC is a diagnostic method of negligible value in this type of disease.

[Giant-cell arteritis: the clinico-biological manifestations and the complications secondary to steroid treatment]. / Arteritis de células gigantes: manifestaciones clínico-biológicas y complicaciones secundarias al tratamiento esteroideo.

The analysed clinico-biological manifestations, evolutive course and treatment of 30 patients with GCA are presented. The most frequent symptoms were fever and headache. 33% of patients had FOD criteria. 26% had various visual alterations. All patients were initially treated with steroids. Of the 26 patients followed up, 21 (81.7%) experienced some sort of complication: Cushing iatrogenic, osteoporosis, vertebrae collapse, aseptic necrosis of the femur head, arterial hypertension, diabetes mellitus, hyperlipidemia, steroid myopathy. 6 patients were treated with cyclophosphamide, following severe complications secondary to steroid therapy, and all of them had a good clinical evolution.

[Systemic vasculitis as a cause of fever of unknown origin]. / Vasculitis sistémicas como causa de fiebre de origen desconocido.

A prospective clinical study (1974-1988) was carried out in 33 patients with several types of systemic vasculitis (SV) presenting as fever of unknown origin (FUO) according to the 1961 Petersdorf and Beeson's criteria. Histological confirmation, either from biopsy or necropsy, was available in all cases. The types of SV with FUO were: panarteritis nodosa (PAN) (14 cases), giant cell arteritis (GCA) (13 cases), and overlapping polyangiitic syndrome (OPS) (6 cases). In PAN, the clinical features associated with fever at the onset of the disease were remarkably nonspecific: constitutional symptoms (85%), arthromyalgia (50%), nonspecific abdominal pain (28%), and irritative cough (28%). In the whole course of the cases of GCA a significantly smaller frequency of presentation of local arterial symptoms and polymyalgia rheumatica (p less than 0.01) was found in the subgroup of patients with FUO than in those without it. As regard laboratory data, a higher increase of serum alkaline phosphatase (p less than 0.05) was found in the cases of PAN and OPS with FUO. Striated muscle biopsy and arteriography were the most useful investigations in the diagnosis of PAN. The study that gave the diagnosis in the cases of GCA was temporal artery biopsy.