Leishmaniasis, una enfermedad emergenteen España: presentación de 5 casos clínicos / Leishmaniasis, an emergent disease. Five clinical cases presentation

La leishmaniasis es un grupo de enfermedades producida por protozoos del genero leishmania, que se transmite al hombre por la picadura de un mosquito.Dependiendo de la especie y del estado inmunológico del huésped, presenta diferentes formas clínicas: cutánea, mucocutánea y visceral.Afecta a 12 millones de personas y el aumento de su incidencia la coloca a la cabeza de las enfermedades emergentes. Contribuyen a su expansiónfactores ambientales, de emigración, e inmigración, y globalización del trabajo y del ocio. También contribuye, la inmunodepresión de las personasinfectadas debida al consumo de medicamentos que alteran la inmunidad o coinfecciones víricas como el HIV. Presentamos los 5 casos de leishmaniasisatendidos en nuestro hospital de Huesca (España), en 2007, que reflejan su incidencia y variabilidad clínica (AU)

Infection whith protozoan parasites of the genus Leishmania causes a variety of clinical diseases called leishmaniases, which is transmited to humanhost by the bite of a sandfly. The clinical manifestation depends on the interaction among series of parasite and host inmunity: cutaneous, mucocutaneousor visceral. Worldwide, an estimated 12 million people are infected with leishmaniases. The number of cases of leishmaniases is increasing,globally at an alarming rate, and the leishmaniases are among in the top the emergent diseases. The ecological chaos, differents phenomena such asmigration, immunosupression caused by drughs and viral infections, globalization of work and leisure contribute to the spread and increase of the disease.We report five cases with leishmaniasis who had been atended in 2007 at our hospital in Huesca (Spain), reflecting its clinical diversity (AU)

[Hypokalemic rhabdomyolysis and tetany as a presentation of celiac disease in an adult]. / Rabdomiolisis hipopotasémica y tetania como forma de presentación de enfermedad celiaca en un adulto.

We describe the case of a 38-year-old man with an hypokalaemic rhabdomyolysis and tetany as a presentation of celiac disease. We discuss the several electrolytic disturbances found in this patient with chronic diarrhoea and malabsorption syndrome and also the treatment which conduced to complete clinical resolution. We conclude that celiac disease should be considered a cause of hypokalaemic rhabdomyolysis.

Rabdomiólisis hipopotasémica y tetania como forma de presentación de enfermedad celíaca en un adulto / Hypokalemic rhabdomyolysis and tetany as a presentation of celiac disease in an adult

Describimos el caso de un paciente de 38 años de edad con una rabdomiólisis hipopotasémica y tetania como forma de presentación de una enfermedad celíaca. Discutimos las diversas alteraciones electrolíticas que presentaba como consecuencia de la diarrea crónica y el síndrome de mal absorción así como el manejo terapéutico que condujo a una evolución clínica favorable. Concluimos que la enfermedad celíaca debería considerarse como una posible causa de rabdomiólisis hipopotasémica (AU)

We describe the case of a 38-year-old man with an hypokalaemicrh abdomyolysis and tetany as a presentation of celiac disease. We disuss the several electrolitic disturbances found in this patient with chronic diarrhoea and malabsortion syndrome and also the treatment which conduced to complete clinical resolution. We conclude that celiac disease should be considered acause of hypokalaemic rhabdomyolysis (AU)

[Atypical presentation of a clinical case of giant cell arteritis]. / Presentación atípica de un caso de arteritis de células gigantes.

We present a very unusual clinical case of giant cell arteritis with uterus involvement, in a women of 66 years old, that began clinical features of pain and functional limitation of shoulders and hip 3 mouth before been operated of uterus prolapse with hysterectomy. Biopsy of uterus found affected arterial vesels with wall sclerosis and granulomatous inflamation with giant cells, without necrosis, involving media and perivascular portions suggesting giant cell arteritis. In a previous reports review, we only found ten similar clinical cases. In that cases, clinical features were no suggestif of the disease. Although the well known tendency of arteritis to involve some specific vascular areas, the case we present is an example of the systemic course of the disease and his difficulty to diagnose.

Presentación atípica de un caso de arteritis de células gigantes / Atypical presentation of a clinical case of a giant cell arteritis

Presentamos un caso muy poco frecuente de arteritis de células gigantes con afectación uterina, en una mujer de 66 años de edad, que inició clínica de dolor y limitación funcional en cintura escapular y pelviana 3 meses antes de ser operada de histerectomía por prolapso uterino. En la biopsia de cuerpo uterino se detecta vasos arteriales con esclerosis de pared e inflamación granulomatosa con células gigantes, sin necrosis, afectando capas media y perivascular, compatible con arteritis de células gigantes. En la revisión de la literatura tan solo hemos encontrado la publicación de una decena de casos similares. En ellos la clínica tampoco hacía sospechar la presencia de la enfermedad. A pesar del tropismo bien conocido de la arteritis de células gigantes por ciertos territorios vasculares, el caso que presentamos muestra el carácter sistémico de la enfermedad y la dificultad diagnóstica

We present a very unusual clinical case of giant cell arteritis with uterus involvement, in a women of 66 years old, that began clinical features of pain and functional limitation of shoulders and hip 3 mouth before been operated of uterus prolapse with hysterectomy. Biopsy of uterus found affected arterial vesels with wall sclerosis and granulomatous inflamation with giant cells, without necrosis, involving media and perivascular portions suggesting giant cell arteritis. In a previous reports review, we only found ten similar clinical cases. In that cases, clinical features were no suggestif of the disease. Althougt the well known tendency of arteritis to involve some specific vascular areas, the case we present is an example of the systemic course of the disease and his dificulty to diagnose

[Descriptive study of autopsies of internal medicine department at the hospital of Barbastro and clinico-pathological correlation]. / Estudio descriptivo de las autopsias del Servicio de Medicina Interna del Hospital Comarcal de Barbastro y correlación clínico-patológica.

BACKGROUND: To review the autopsies of Internal Medicine Department at the Hospital of Barbastro and to compare clinical and pathological diagnosis. MATERIAL AND METHODS: Retrospective study of 51 consecutive autopsies performed between April 1989 to December 1996 is carried out. Clinico-pathological correlation is stablished with the underlying cause of death distinguishing among concordance and severe (with adverse impact on survival) or mild discrepancy. RESULTS: The autopsy rate was 6.6% in that period. 70.5% were male. The median of the age was 70. Severe yatrogenia was found in one case. Respiratory diseases (23.5%) followed by cardiovasculars (19.6%) and infections (17.6%) were the most frequents underlying cause of death. Pulmonary thromboembolism was demonstrated in 37.2%, being massive only in 7.8%. Discrepancies were found in 31% of cases, 25% mild and 6% severe. CONCLUSIONS: Our data are similar to other studies but differ essentially in a lesser number of severe discrepancies in our findings and also in the frequency of the groups of diseases (there are more infections and tumours in other series) attributed to the hospital features and to the oldness of the studied population, among others.

Estudio descriptivo de las autopsias del Servicio de Medicina Interna del Hospital Comarcal de Barbastro y correlación clínico-patológica / Descriptive study of autopsies of internal medicine department at the hospital of Barbastro and clinico-pathological correlation

Fundamento: Revisión de las autopsias del servicio de Medicina Interna (MI) del Hospital de Barbastro y comparación de los diagnósticos clínicos y patológicos. Material y métodos: Estudio retrospectivo de 51 autopsias consecutivas realizadas desde abril de 1989 a diciembre de 1996. La correlación clínico patológica se estableció con la causa básica de muerte (CBM) diferenciando entre concordancia y discrepancia grave (el diagnóstico en vida hubiera supuesto un cambio en el pronóstico) o leve. Resultados: La tasa de autopsias de MI en este periodo es de 6,6 porciento. El 70,5 porciento fueron varones. La media de la edad fue de 70 años. Se comprobó yatrogenia grave en 1 caso. La autopsia fue completa (incluyendo cavidad craneal) en el 70,5 porciento. Las enfermedades respiratorias (23,5 porciento) seguidas de las cardiovasculares (19,6 porciento) y de las infecciosas (17,6 porciento) representaron las CBM más frecuentes. Se comprobó tromboembolismo pulmonar en el 37,2 porciento aunque sólo en el 7,8 porciento fue masivo. Hallamos discrepancias en el 31 porciento de los casos, el 25 porciento leves y el 6 porciento graves. Conclusiones: Nuestros datos se aproximan a los de otros estudios pero difieren fundamentalmente, en el menor número de discrepancias graves encontradas por nosotros y en la frecuencia de los grupos de enfermedad (mayor número de enfermedades infecciosas y tumores en otras series) lo que atribuimos, entre otras causas a las características del hospital y al envejecimiento de la población estudiada (AU)

[Wegener's granulomatosis in the elderly. Report of 3 cases]. / Granulomatosis de Wegener del anciano. Descripción de tres casos.

Wegener's Granulomatosis (W.G.) is a systemic vasculitis which the usual age of presentation is the fourth and fifth decades. It seldom appears in the aged patients and it often exists a greater delay in the diagnosis time and in the beginning of therapy in them. We present three cases of W.G. in aged patients (66, 79 and 80 years). One case was diagnosed in the autopsy and the two others had a favourable evolution after therapy. We insist on the need of using all the available tools in order to confirm the W.G. diagnostic, in spite of the aging. The therapy of these patients must be as vigorous as in the young patients in order to avoid the development of renal failure, the most important cause of death in this disease.

[Hospital mortality at the internal medicine service of a local hospital]. / Estudio de mortalidad hospitalaria en el Servicio de Medicina Interna de un hospital comarcal.

We conducted a retrospective study of the hospital mortality in a service of Internal Medicine at the Hospital de Barbastro during the years 1991 and 1992, recording 97 deaths during 1991 and 87 during 1992, with a mortality rate of 6.7% and 6.6% respectively. The mean age was 77.2% +/- 9 years with a 93% > or = 65 years. The average length of stay of the dead patients was 8.9 days. Cardiovascular diseases were the most frequent cause of death (41.85%), followed by respiratory diseases (17.93%) and neoplasias (15.76%). CVA was the single most frequent disease (17.9%). Ten autopsies (5.4%) were performed. In 16 cases (8.6%), we obtained data suggesting iatrogenesis, which in 7 cases (3.8%) clearly contributed to the direct cause of death.

[Gastric ulcers: a rare manifestation of secondary syphilis]. / Ulceras gástricas: una rara manifestación de sífilis secundaria.

Gastric lesions in the progression of syphilis are very rare and they have several forms of presentation resembling lesions of different nature. We describe a case of secondary syphilis in an heterosexual patient, with persistent gastric ulcers and hepatic affection, in which the evolution and the observations with laparotomy suggested neoplasia. In the gastric biopsy, an infiltration of plasmatic and neutrophil cells was observed and in the hepatic biopsy, necrotic nodules and granulomas. The spirochaeta-specific tinction, although not indispensable, confirms the diagnosis of gastric syphilis. The previous presence of a syphilitic chancre and typical cutaneous lesions are of great help in suspecting a luetic process.

[Cystic lymphangioma]. / Linfangioma quístico.

Lymphangioma is a benign, congenital type of tumour which can be classified as a malformation of the lymphatic vessels with an enlargement and a proliferation of same. It is divided, depending on the calibre of the vessels, into Capillary, Cavernous and cystic. 80% of these lesions are located in the neck; 50% of these cases are already evident at the moment of birth and 90% prior to the 2nd year of life. Its treatment is surgical but, due to the large number of digitations present, its complete removal is difficult to achieve, thereby giving rise to frequent relapses. We are submitting the case of a three and a half-year-old girl who was operated on in our department. With this, we would like to contribute to a greater knowledge of this pathology.

[Osteoma of the mastoid]. / Osteoma de mastoides.

Osteoma of the mastoid is a osseous, benign and infrequent tumour. To date approximately 50 such cases in the world, and 7 cases in Spain have been described. Clinically this tumours are asymptomatic, except by cosmetic deformities, and are usually unsuspected roentgenographic findings. Treatment is surgical through a postauricular approach. A case of osteoma of the mastoid and a review of the literature is presented.

[Pharyngeal keratosis]. / Queratosis faríngea.

A case of keratosis pharyngis is presented. This disease is infrequent, benign and of etiology unknown. Clinically present horny outgrowths in the lymphatic tissue of the pharynx, but without symptoms. The horny projections sooner or later disappear spontaneously in months or years, however tonsillectomy seems to be indicated in all cases in which the symptoms are worrying the patient, who present an evident "cancerophobia" frequent symptom of this disease.