[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.

[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.

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.

[Pneumococcal pneumonia with bacteremia in adults: a descriptive study from the north-west of Spain]. / Neumonía neumocócica con bacteriemia en adultos: estudio descriptivo en el noroeste de España.

OBJECTIVE: Analysis of adults patients (> 15 years of age) with Bacteremic Pneumococcal Pneumonia (BPP), in the Hospital Complex of Pontevedra. MATERIAL AND METHODS: 83 cases of BPP were studied in the last 6 years (1995-2000). RESULTS: There were 57 men and 26 women. The overall mean age was 56 year-old; in those smaller than 40 years, there was 60% infected by the HIV. The patients' two thirds, had > 1 predisposing condition, highlighted: the cigarette smoking, the alcoholism and the HIV infection. The typical clinical presentation of pneumococcal pneumonia, we find it in 73%. The calculation of the pneumonia severity index (PSI, Fine et al.), it framed half of the patients in the group of low risk of mortality. The resistance to the penicillin in the isolations, was of 31%. The initial antibiotic treatment was modified, in 11% of the cases. The fatal cases (10%) had: superior age to 65 years, presence of mental confusion, a bigger hypoxemia and hypercapnia, admission in the ICU, atypical presentation, existence of pleural effusion and a PSI bigger than 140. CONCLUSIONS: The patient with BPP in our area, presents some similar clinical characteristics to those described in other series; the half is included in the group of low risk of mortality. Apart from other factors already well-known, a superior PSI at 140, is related directly with the mortality.

[Primary actinomycosis of the abdominal wall. Description of 2 cases and review of the literature]. / Actinomicosis primaria de la pared abdominal. Descripción de dos casos y revisión de la literatura.

We report two cases of isolated abdominal wall actinomycosis and review 18 previously reported cases to further characterize the clinical findings and the therapeutic management of this syndrome. This diagnosis would be advocated in patients with a palpable abdominal mass of subacute appearance with a previous history of digestive medical illness, diabetes, abdominal surgery, or prolonged IUD use. In contrast with other actinomycosis locations, remarkable data were a more elevated mean age of patients; a female predominance; a prevalent location of mass in abdominal lower left quadrant; and a shorter duration of symptomatology before to diagnosis. The CT is the first choice for imaging study and percutaneous needle aspiration would be recommended for definite diagnosis. The long-term antibiotic therapy, with or without percutaneous drainage, is the first treatment choice because is very effective and made unnecessary a more invasive surgical management. The prognosis is excellent with adequated treatment.

[Hematogenous meningitis caused by Staphylococcus aureus with sacro-iliitis and multiple abscesses. An infrequent association]. / Meningitis hematogéna por Staphylococcus aureus con sacroileítis y abscesos múltiples. Una asociación infrecuente.

INTRODUCTION: Meningitis due to Staphylococcus aureus (MSA) is an uncommon infectious condition. It forms from 1-9% of all cases of bacterial meningitis, and is characterized by a high morbidity and mortality. Ever since the first publications dealing with this type of meningitis, two basic mechanism have been described for the development of this infection: post-neurosurgical and hematogenous, also known as spontaneous. CLINICAL CASE: Our objective is to present the case of a 65 year old woman who developed hematogenous Staphylococcus aureus meningitis, without any predisposing factors. During clinical investigation, the meningeal infection was seen to be associated with septic arthritis of the right sacro-iliac joint (shown on isotope studies) and with retro-peritoneal and gluteal abscesses (shown on computerized tomography). In this patient the pathological findings were: MSA, retroperitoneal and gluteal abscesses, and unilateral sacro-ileitis. To date such a combination has not been described (Medline search from January 1982 up to june 1996). CONCLUSIONS: After analysis of the pathogenic findings of the MSA directly involved in this case we conclude by emphasizing the following points: 1. It is very important to make a thorough search for a primary infectious focus responsible for MSA, completing the physical examination of the patient with imaging techniques (conventional radiology, CT, isotope studies, etc.). 2. Depending on the primary focus found in an MSA, antibiotic treatment may sometimes have to be complemented by other methods of treatment to avoid subsequent complications.