[Giant cell arteritis and polymyalgia rheumatica: diagnosis and evolution of 90 cases]. / Arteritis de células gigantes y polimialgia reumática: diagnóstico y evolución de 90 casos.

OBJECTIVE: To compare the clinical features of giant cell arteritis (GCA) and polymyalgia rheumatic (PMR), and to evaluate the criteria proposed by the American College of Rheumatology in our results. PATIENTS AND METHODS: A retrospective analysis of 90 patients with GCA (n = 57.55 of whom were diagnosed by biops) and PMR (n = 33) diagnosed over the last 10 years. RESULTS: Headache was present in 45 patients (78.94%) with GCA and in 7 (21.21%) with PMR (p < 0.001); polymyalgic syndrome was observed in 15 patients (26.31%) with GCA and in 33 (100%) with PMR (p < 0.001); jaw or tongue claudication was observed in 14 patients (24.57%) with GCA and in 2 (6.06%) with PMR (p < 0.05), and visual disturbances were only present in 9 patients (15.79%) with GCA. The erythrocyte sedimentation rate (ESR) was > or = 50 mm/h in 84 patients (93.33%), and > or = 100 mm/h in 43 of them (51.19%). The ESR became normal (20 Pounds mm/h) in less of 8 weeks after the treatment was started in 64 patients (76.19%). At the time of diagnosis, 61 patients (61.67%) had anemia, which was severe (Hb < 10 g/dl) in 17 cases (27.86%). After steroid treatment 43 patients (70.49%) improved their anemia in less of 12 weeks, and 25 of them (58.13%) in less of 8 weeks. CONCLUSIONS: The cranial symptoms were predictive for a positive temporal artery biopsy. The anemia and its quick normalization after steroid treatment can help to the diagnostic.

Arteritis de células gigantes y polimialgia reumática: diagnóstico y evolución de 90 casos / Giant cell arteritis and polymyalgia rheumatica: diagnosis and evolution of 90 cases

Objetivo: Comparar el cuadro clínico de la arteritis de células gigantes (ACG) y el de la polimialgia reumática (PMR). Valorar los criterios diagnósticos del American College of Rheumatology contrastándolos con nuestros resultados. Pacientes y métodos: Estudio retrospectivo de 90 enfermos diagnosticados de ACG (n = 57,55 diagnosticados por biopsia) y de PMR (n = 33) en los últimos 10 años.Resultados: Presentaron cefalea 45 enfermos (78,94 por ciento) con ACG y 7 (21,21 por ciento) con PMR (p<0,001), síndrome polimiálgico 15 (26,31 por ciento) con ACG y 33 (100 por ciento) con PMR (p<0,001), claudicación mandibular o lingual 14 (24,57 por ciento) con ACG y 2 (6,06 por ciento) con PMR (p<0,05) y alteraciones visuales 9 (15,79 por ciento) con ACG. La VSG fue 50 mm/h en 84 enfermos (93,33 por ciento) y 100 mm/h en 43 de ellos (51,19 por ciento). La VSG se normalizó (£ 20 mm/h) en menos de 8 semanas en 64 enfermos (76,19 por ciento). En el momento del diagnóstico 61 enfermos (61,77 por ciento) presentaron anemia, 17 de ellos (27,86 por ciento) de grado severo (Hb < 10 g/dl). Tras tratamiento esteroideo se recuperaron de la anemia 43 enfermos (70,49 por ciento), todos en menos de 12 semanas y 25 (58,13 por ciento) en menos de 8 semanas. Conclusiones: Los síntomas cefálicos orientaron el diagnóstico en la ACG y son predictivos de biopsia de arteria temporal positiva. La anemia y su rápida normalización tras tratamiento exclusivo con glucocorticoides son datos que pueden ayudar en el diagnóstico de estas entidades. (AU)

[Still's disease: atypical manifestations and potential markers of severe visceral disease]. / Enfermedad de Still: manifestaciones atípicas y posibles marcadores de afectación visceral severa.

We present two patients with Still's disease which, in addition to the typical clinical manifestations, showed rare visceral alterations. The first case referred abdominal pain and a sustained hyperamilasemia was detected. The second case suffered a severe multiple organic failure, characterized by hepatic failure, with electric signs of encephalopathy, hydroelectrolytic disorder, rhabdomyolysis and disseminated intravascular coagulation. During this episode, we detected hyponatremia, reduction of leukocytes and normalization of GSR, modifications already described by other authors in cases similar to these ones, although without considered relevant until now. We comment these results and their value as markers of visceral affectation.

[Adverse drug reactions: Naranjo's and Venulet's algorithms]. / Reacciones adversas medicamentosas: algoritmos de Naranjo y Venulet.

Prospective evaluation of adverse drug experiences (ADE) in patients admitted in the Respiratory Section of a General Hospital. 32 ADE's were collected (14.6%). Mean age and stay-length were longer in ADE group but with no statistical significance. Theophyllines, beta-mimetics and antibiotics were the more frequent responsibilities of ADE's. ADE's class more frequently reported was epigastralgia-nausea in 40.6%, followed by dermic disorders in 18.75%. No deaths were attributed to ADE's ans only 9 required an specific treatment. Using Naranjo's and Venulet's algorithms we have found them as non-comparable tests.

[Epidemiology of community-acquired pneumonia in the Health Area I of Navarra]. / Epidemiología de las neumonías adquiridas en la comunidad del Area de Salud I de Navarra.

BACKGROUND: During one year (1988), a protocol study of the community-acquired pneumonias was carried out in patients referred to the Hospital Virgen del Camino in Pamplona (Health Area I or Northern Navarra), so as to have an epidemiological and microbiological knowledge of this disease in this geographic area. METHODS: A clinical protocol, microbiological investigation, 3 blood cultures, Gram stain and sputum culture and serological tests at admission and 20 days later (complement fixing antibodies and indirect immunofluorescence) were carried out. Chest radiographs were carried out on admission, on the third and seventh hospital days and subsequently depending on the evolution. RESULTS: The causative organism was found in 141 of the 225 included patients (62%). Two or more organisms were identified in 19 (8%). In 84 (38%) no microorganism was found. The results for the causative organisms and their frequency were: Pneumococcus 12%, mycoplasma 12%, other bacteria (including Legionella) 11%, Q fever 8%, viruses 7%, and psitaccosis 4%. In 59% of patients there was an underlying disease and 39% developed complications. 4% of patients died. CONCLUSIONS: 22% of the community acquired pneumonias were cared for in the hospital, representing 6% of the admissions to the Internal Medicine Service. The etiologic diagnosis was made in 62% of the community-acquired pneumonias. 23% were of bacterial origin (including Legionella) and 31% were nonbacterial. There was a high incidence of pneumonias caused by Mycoplasma pneumoniae and Coxiella burnetii.

[Endobronchial tuberculosis]. / Tuberculosis endobronquial.

Eight hospitalized patients with endobronchial tuberculosis are reported. Diagnosis was reached in six patients by the demonstration of acid-alcohol resistant bacilli in the bronchial aspirate. In the fifth patient microscopic examination of the bacteria in the liquid obtained by aspiration of a paraspinal abscess was positive. In the last patient diagnosis was established by the positive growth in Lowenstein's medium of lymph node extracts. The clinical, radiologic, endoscopic and microbiologic features are discussed.

Laparoscopic findings in two adults with chickenpox.

We report the laparoscopic findings in two previously healthy adults with chickenpox and hepatic involvement. Both patients were admitted to hospital with severe upper right quadrant abdominal pain coinciding with the skin rash. Liver function tests were abnormal. In case 1, round lesions with a necrotic center, 2 mm in diameter, in both hepatic lobes were observed. Morphologically they resembled the rash on the skin. Numerous granular lesions were also demonstrated. In case 2, laparoscopic examination was performed recently when the cutaneous rash had faded. Granular images were scarce; there was enlargement of the liver capsule with small depressed areas of pink color. These lesions were considered similar to those found in case 1, although in a more advanced stage of scarring and resolution. Both patients made a good recovery.

Laparoscopic findings in eight cases of liver fascioliasis.

Laparoscopic findings observed in eight patients with fascioliasis are described, five cases in the invasive or acute phase of liver distomatosis, and three cases in the chronic phase. In all cases yellowish-white nodules of 1 to 4 mm in diameter were seen on the liver surface, and in four patients they also appeared on the parietal peritoneum. Close to these nodules, ribbed or vermiform formations of a color and consistency similar to that of the nodules were observed in five patients. It is thought that these findings correspond to parasitic microabscesses in contact with intrahepatic bile ducts. Other findings were areas of capsular thickening, adhesions, dilation of subcapsular lymph vessels and flattened zones of a cicatricial aspect. This last feature appeared only in the chronic form of the disease.