ABSTRACT
En ocasiones la hipertransaminasemia enmascara una enfermedad sistémica, por lo que las elevaciones mantenidas a lo largo del tiempo, incluso con una biopsia hepática inespecífica, nos obligan a continuar investigando el origen. Tras varios años sin diagnóstico, la paciente presenta debilidad muscular progresiva. Una analítica desde Atención Primaria nos mostró una gran elevación de creatinfosfocinasa (CPK), por lo que solicitamos un electromiograma, que fue la base de la posterior biopsia muscular, que desveló el diagnóstico de glucogenosis tipo III. De este modo, se acabó relacionando la hipertransaminasemia, no justificada hasta este momento, con esta enfermedad. Aunque en nuestras consultas este tipo de patologías no son las más frecuentes, no por ello debemos olvidar que existen, ya que con una anamnesis dirigida y alguna prueba complementaria sencilla, podemos orientar el diagnóstico, que en ocasiones nos puede sorprender
Hypertransaminasemia sometimes masks a systemic disease. Thus elevations maintained over time, even with a non-specific liver biopsy, makes it necessary for us to continuing investigating the origin. After several years without a diagnosis, the patient has progressive muscular weakness. A laboratory analysis from Primary Health Care showed significant elevation of CPK, so that we requested an electromyogram. This was the basis of the subsequent muscle biopsy, that revealed the diagnosis of type III glycogenosis. In this way, hypertransaminasemia, not justified up to this time, was finally related with this disease. Although this type of diseases is not the most frequent in our consultations, we should not overlook their existence, since we can orient the diagnosis, that can sometimes surprise us, with a directed anamnesis and some simple complementary test
Subject(s)
Female , Adult , Humans , Glycogen Storage Disease Type III/diagnosis , Glycogen Storage Disease Type III/drug therapy , Vitamin B Complex/therapeutic use , Carbamazepine/therapeutic useABSTRACT
BACKGROUND: Studying serological tests into syphilis, German measles, toxoplasma and hepatitis B requested as part of the monitoring of pregnant women and analysing the different activities in the face of the findings. METHODS: A descriptive study. A systematic random process was used to select (1/3) 299 cases of women whose pregnancy had been monitored between 1991 and 1993 in three health centres in Jaen (capital of the province of the same name), which have a catchment population of 66,423 inhabitants. We analyse the differences between the centres using the Chi squared test. RESULTS: A serology of syphilis (R.P.R.) was conducted on 269 pregnant women (90% Standard Error (S.E.): 1.7) all of which proved negative; German measles (ELISA Immunoglobulin (Ig) G, toxoplasm (FIAX IgG and IgM) and (HBsAg in 92% (S.E.: 1.6) German measles antibodies being found in 98% (S.E.: 0.8), the HBsAg proving negative in 99% (S.E.: 0.6) and immunity to toxoplasm existing in 13% (S.E.:2). When the data were analysed, being broken down into the different health centres, notable differences were observed (p > 0.04) in the case of German measles. In the five cases were German measles proved negative, the serology was not repeated once, and on two occasions it was the second pregnancy. They do not appear in the history of preventive medicine. Treatment with spiromycine was initiated for toxoplasmosis, and it lasted for 10 to 21 days for five of the cases, but the infection was not confirmed once, and for two of these it was only determined serologically. CONCLUSIONS: Both the percentage of requests for the first serology and the prevalence are consistent with literature on the subject, with the exception of toxoplasm, whose immunity prevalence was much lower than in other zones. The actions taken in the face of certain results were rather inadequate.
