Birdshot- like retinocoroidopatía como comienzo de la enfermedad de Whipple / Birdshot-like retinochoroidopathy as onset of Whipple's disease

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[Jejunal intestinal metastases, a form of presentation of pulmonary carcinoma]. / Metástasis intestinales yeyunales, forma de presentación de un carcinoma pulmonar.

Primary tumors of the small intestine are rare, and metastatic ones are even rarer. It is exceptional for small bowel metastases to manifest before the primary tumor. The clinical presentation may require surgical resection motivated by intestinal perforation, hemorrhage or intestinal obstruction-subocclusion. Survival is scarce and generally does not exceed 20 weeks, regardless of the treatment performed.

Metástasis intestinales yeyunales, forma de presentación de un carcinoma pulmonar / Jejunal intestinal metastases, a form of presentation of pulmonary carcinoma

Los tumores primarios de intestino delgado son muy infrecuentes, siendo todavía más raros los metastásicos. Es excepcional que las metástasis de intestino delgado se manifiesten antes que el tumor primario. La presentación clínica puede requerir una resección quirúrgica intestinal motivada por perforación, hemorragia, obstrucción-suboclusión intestinal e incluso invaginación intestinal. La supervivencia, es escasa y generalmente no supera las 20 semanas, independientemente del tratamiento que se realice (AU)

Primary tumors of the small intestine are rare, and metastatic ones are even rarer. It is exceptional for small bowel metastases to manifest before the primary tumor. The clinical presentation may require surgical resection motivated by intestinal perforation, hemorrhage or intestinal obstruction-subocclusion. Survival is scarce and generally does not exceed 20 weeks, regardless of the treatment performed (AU)

Disfunción ventricular transitoria o síndrome de Tako-Tsubo. A Propósito de un caso / Transient ventricular dysfunction or Tako-Tsubo syndrome. Report of a case

El síndrome de Tako-Tsubo, o disfunción ventricular transitoria, es una entidad que se caracteriza por ser clínicamente indistinguible del síndrome coronario agudo, con elevación enzimática y extensa acinesia anterior, pero sin alteraciones significativas en las arterias coronarias y con recuperación de las alteraciones segmentarias en las semanas siguientes. Presentamos el caso de un paciente ingresado en nuestro servicio que cumplía las características diagnósticas de este síndrome (AU)

The Tako-Tsubo syndrome, or transient ventricular dysfunction, is a clinical entity that is characterised by being clinically indistinguishable from acute coronary syndrome, with increased enzyme levels and extensive anterior akynesia, but without significant changes in the coronary arteries and with recovery of the segmental changes within the few ensuing weeks. We report the case of a patient admitted to our Service who fulfilled the diagnostic features for this condition (AU)

Síndrome de secreción inadecuada de hormona antidiurética por tratamiento con clorpropamida / Syndrome of inappropriate secretion of antidiuretic hormone due to treatment with chlorpropamide

La clorpropamida es un antidiabético oral cuyo uso se ha asociado a la producción de hiponatremia y síndrome de secreción inadecuada de ADH (SIADH). Es un fármaco que va quedando cada vez más relegado, debido a sus efectos secundarios; sin embargo, conviene conocerlos, ya que todavía no es infrecuente encontrar a pacientes, fundamentalmente ancianos, en tratamiento con este fármaco. Se describe un nuevo caso de SIADH asociado a la utilización de clorpropamida

Chlorpropamide is an oral antidiabetic agent whose use has been associated to production of hyponatremia and syndrome of inappropriate secretion of antidiuretic hormone (SISAH). This is a drug that is being used increasing less due to its side effects. However, it is important to know them because it is not infrequent to find patients, basically the elderly, who are being treated with this drug. A new case of SISAH associated to the use of chlorpropamide is described

La ventilación mecánica no invasiva domiciliaria en el paciente EPOC / Non-invasive home mechanical ventilation in the COPD patient

Fundamento. El potencial beneficio de la ventilación mecánica no invasiva en los pacientes EPOC clínicamente estables no es aún bien conocido ni ha sido suficientemente estudiado. Se pretende valorar si la ventilación mecánica no invasiva beneficia a estos pacientes.Material y métodos. Se realiza un estudio transversal valorando la aplicación de la ventilación mecánica no invasiva (BIPAP) domiciliaria durante el descanso nocturno en 23 pacientes EPOC, los cuales se caracterizaban por presentar hipercapnia en la gasometría arterial basal realizada durante la estabilidad clínica. Se realizan revisiones clínicas, gasométricas y espirométricas a los 3, 6 y 12 meses de instaurar dicha terapia. Así mismo se evalúa el número de ingresos por agudización de la patología respiratoria subyacente durante un año.Resultados. Los pacientes incluidos en el estudio tenían una media de edad de 68,83 años. El 60,9% presentaban grado severo de EPOC. El 69,6% del total de la muestra recibían previamente oxigenoterapia continua domiciliaria; de ellos el 75% presentaban EPOC severa o muy severa. Durante el período de tiempo del estudio se objetivó un descenso en el número de ingresos hospitalarios por agudización (0,61±0,15 ingresos anuales de media) respecto al mismo período de tiempo previo a la ventilación mecánica no invasiva (1,07±0,16 ingresos de media) resultando más beneficiados los que presentaban previamente un mayor número de ingresos y los que asociaban comorbilidad. También se aprecia disminución de la presión arterial de dióxido de carbono (PaCO2) en la mayoría de los casos, principalmente aquellos que presentaban al inicio del estudio una PaCO2>63,32 mm de Hg; dicha mejoría se aprecia desde los primeros tres meses de tratamiento

Background. The potential benefits of non-invasive mechanical breathing in clinically stable COPD patients are still not well known, nor have they been sufficiently studied. We evaluate whether non-invasive mechanical ventilation is beneficial to these patients.Methods. A cross sectional study was carried out evaluating the application of non-invasive home mechanical ventilation (BIPAP), during the nocturnal rest in 23 COPD patients, who presented hypercapnia in basal arterial gasometry during clinical stability. Clinical, gasometric and spirometric evaluations were carried out 3, 6 and 12 months after initiating this therapy. Similarly, an evaluation was made of the number of admissions due to worsening of the underlying respiratory pathology during one year.Results. The patients included in the study had an average age of 68.83 years. Sixty point nine percent (60.9%) presented a severe degree of COPD. Sixty-nine point six percent (69.6%) of the total sample had previously received continuous oxygenotherapy at home; 75% of them presented severe or very severe COPD. During the period of time of the study a fall was recorded in the number of hospital admissions due to worsening (0.61±0.15 annual admissions on average) with respect to the period of time prior to the non-invasive mechanical ventilation (1.07±0.16 admissions on average), with greater benefits obtained by those who had previously shown a higher number of admissions and those with associated comorbidity. A reduction was also appreciated in the arterial pressure of carbon dioxide (PaCO2) in the majority of cases, principally those who at the start of the study presented a PaCO2>63.32 mm of Hg; this improvement was appreciated from the first three months of treatment

[Abdominal tuberculosis]. / Tuberculosis abdominal.

Abdominal tuberculosis develops according to a non-specific clinical picture, with a difficult differential diagnosis with respect to other entities of similar semiology. We present the case of a male who was admitted because of abdominal pain, progressive and notable loss of body weight and a fever of two months evolution. The culture from the colon biopsy showed the presence of Koch bacilli.

[Ischemic hepatitis in an 81 year old patient with congenitally corrected transposition of the great arteries]. / Hepatitis isquémica en paciente de 81 años con transposición congénita corregida de grandes vasos.

The congenitally corrected transposition of the great arteries is a rare form of congenital heart disease, with survival beyond the 6th decade of life being rare. Even more unusual is its presentation alone, without any other form of congenital heart disease. Ischemic hepatitis is a rare entity characterized by an elevation of transaminasas and a centrilobular necrosis due to a reduction in hepatic blood flow, generally of reversible evolution. The authors present a case of ischemic hepatitis in an 81-year-old patient with congenitally corrected transposition of the great arteries. The fatal evolution of the episode and the longevity of the patient are both notable. We comment on the clinical and diagnostic aspects of both entities.

Tuberculosis abdominal / Abdominal tuberculosis

La tuberculosis abdominal cursa con un cuadro inespecífico, con difícil diagnóstico diferencial respecto a otras entidades de similar semiología. Presentamos el caso de un varón que ingresa por presentar dolor abdominal, pérdida progresiva y notoria de peso corporal y fiebre de dos meses de evolución. El cultivo de la biopsia de colon mostró presencia de bacilo de Koch

Abdominal tuberculosis develops according to a non-specific clinical picture, with a difficult differential diagnosis with respect to other entities of similar semiology. ;;We present the case of a male who was admitted because of abdominal pain, progressive and notable loss of body weight and a fever of two months evolution. The culture from the colon biopsy showed the presence of Koch bacilli

Hepatitis isquémica en paciente de 81 años con transposición congénita corregida de grandes vasos / Ischemic hepatitis in an 81 year old patient with congenitally corrected transposition of the great arteries

La transposición corregida de grandes vasos es una malformación congénita cardiaca extraordinariamente inusual, con muy escasa supervivencia por encima de la sexta década. Todavía más rara es su presencia sin otras anomalías cardiacas asociadas.La hepatitis isquémica es una entidad poco frecuente caracterizada por una elevación de transaminasas y necrosis centrolobulillar debida a una reducción del flujo hepático, generalmente de evolución reversible. Se presenta un caso de hepatitis isquémica de curso fulminante en un paciente de 81 años con transposición corregida de grandes vasos. Destacan tanto la tórpida evolución de la hepatitis, como la longevidad del paciente. Comentamos los aspectos clínicos y diagnósticos de ambas entidades

Small bowel intussuspeption is an unusual pathology in the adult. Most commonly, it is secondary to intestinal wall organic disorders. ;;A complete small bowel obstruction is the most frequent clinical presentation, which requires emergency surgery in many cases. The preoperative diagnosis is infrequent. ;;The best treatment is surgical resection

[Non-invasive home mechanical ventilation in the COPD patient]. / La ventilación mecánica no invasiva domiciliaria en el paciente EPOC.

BACKGROUND: The potential benefits of non-invasive mechanical breathing in clinically stable COPD patients are still not well known, nor have they been sufficiently studied. We evaluate whether non-invasive mechanical ventilation is beneficial to these patients. METHODS: A cross sectional study was carried out evaluating the application of non-invasive home mechanical ventilation (BIPAP), during the nocturnal rest in 23 COPD patients, who presented hypercapnia in basal arterial gasometry during clinical stability. Clinical, gasometric and spirometric evaluations were carried out 3, 6 and 12 months after initiating this therapy. Similarly, an evaluation was made of the number of admissions due to worsening of the underlying respiratory pathology during one year. Results. The patients included in the study had an average age of 68.83 years. Sixty point nine percent (60.9%) presented a severe degree of COPD. Sixty-nine point six percent (69.6%) of the total sample had previously received continuous oxygenotherapy at home; 75% of them presented severe or very severe COPD. During the period of time of the study a fall was recorded in the number of hospital admissions due to worsening (0.61+/-0.15 annual admissions on average) with respect to the period of time prior to the non-invasive mechanical ventilation (1.07+/-0.16 admissions on average), with greater benefits obtained by those who had previously shown a higher number of admissions and those with associated comorbidity. A reduction was also appreciated in the arterial pressure of carbon dioxide (PaCO2) in the majority of cases, principally those who at the start of the study presented a PaCO2>63.32 mm of Hg; this improvement was appreciated from the first three months of treatment.

Coma e insuficiencia respiratoria tras fractura de fémur y tibia / Coma and respiratory insufficiency after fracture of femur and tibia

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Episodios paroxísticos simpáticos secundarios a anoxia cerebral / Paroxysmal symphatetic storms after brain anoxia

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Reacción febril tras toma de talidomida / Fever in treatment with thalidomide

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Meningitis en la primoinfección por el virus de la inmunodeficiencia humana / Meningitis in the acute human immunideficiency virus infection

La primoinfección aguda por el virus de la inmunodeficiencia humana (VIH) se manifiesta con una clínica muy inespecífica (síndrome mononucleósico...), siendo asintomática en muchas ocasiones. Presentamos el caso de un varón de 22 años con una meningoencefalitis de causa inicialmente no filiada, en el que todos los estudios realizados para averiguar su etiología, incluyendo la serología para VIH, resultaban inicialmente negativos. El diagnóstico definitivo de meningoencefalitis por VIH se obtuvo mediante pruebas de detección directa del virus, como la antigenemia p 24 y la Reacción en Cadena de Lapolimerasa (PCR) (AU)