Clinical decisions in patients with diabetes and other cardiovascular risk factors. A statement of the Spanish Society of Internal Medicine / Decisiones clínicas en pacientes con diabetes y otros factores de riesgo cardiovascular. Una declaración de la sociedad española de medicina interna

Although the mortality associated to cardiovascular diseases (CVD) has been reduced in the last decades, CVD remains the main cause of mortality in Spain and they are associated with an important morbidity and a huge economic burden. The increasing prevalence of obesity and diabetes could be slowing down the mortality reduction in Spain. Clinicians have often difficulty making clinical decisions due to the multiple clinical guidelines available. Moreover, in the current context of economic crisis it is critical to promote an efficient use of diagnostic and therapeutic proceedings to ensure the viability of public health care systems. The Spanish Society of Internal Medicine (SEMI) has coordinated a consensus document to answer questions of daily practice with the aim of facilitating physicians’ decision-making in the management of diabetes and cardiovascular risk factors from a cost-efficiency point of view (AU)

Aunque la mortalidad asociada a enfermedades cardiovasculares (ECV) se ha reducido en las últimas décadas, las ECV siguen siendo la causa principal de mortalidad en España y están asociadas a una morbilidad importante y una enorme carga económica. La creciente prevalencia de obesidad y de diabetes podría estar frenando la reducción en la mortalidad en España. Los médicos suelen tener mucha dificultad en la toma de decisiones clínicas debido a las múltiples guías clínicas disponibles. Por otro lado, en el contexto actual de la crisis económica es imprescindible promover un uso eficaz de los procedimientos diagnósticos y terapéuticos para garantizar la viabilidad de los sistemas de salud pública. La Sociedad Española de Medicina Interna (SEMI) ha desarrollado un documento de consenso para responder a las dudas que surgen en la práctica rutinaria con el objetivo de facilitar a los médicos la toma de decisiones en el control de la diabetes y en los factores de riesgo cardiovascular desde el punto de vista de la rentabilidad (AU)

Clinical decisions in patients with diabetes and other cardiovascular risk factors. A statement of the Spanish Society of Internal Medicine.

Although the mortality associated to cardiovascular diseases (CVD) has been reduced in the last decades, CVD remains the main cause of mortality in Spain and they are associated with an important morbidity and a huge economic burden. The increasing prevalence of obesity and diabetes could be slowing down the mortality reduction in Spain. Clinicians have often difficulty making clinical decisions due to the multiple clinical guidelines available. Moreover, in the current context of economic crisis it is critical to promote an efficient use of diagnostic and therapeutic proceedings to ensure the viability of public health care systems. The Spanish Society of Internal Medicine (SEMI) has coordinated a consensus document to answer questions of daily practice with the aim of facilitating physicians' decision-making in the management of diabetes and cardiovascular risk factors from a cost-efficiency point of view.

[Transient ischemic attack due to Lambl's excrescence. Report of a case and review of the literature]. / Accidente isquémico transitorio secundario a excrecencia de Lambl. Descripción de un caso y revisión de la literatura.

We describe a 42-year-old man presenting in the emergency department with transient ischemic attack without cardiovascular risk factors. Systemic disease and hypercoagulability substract was discarded. Only transesophageal echocardiography could confirm the presence of a Lambl's excrescence in the aortic valve (valvular strand). We review clinical management and new therapeutic options in stroke prevention used in this unusual source of cardiac embolism.

Accidente isquémico transitorio secundario a excrecencia de Lambl. Descripción de un caso y revisión de la literatura / Transient ischemic attack due to Lambl s excrecence. Report of a case and review of the literature

Describimos el caso de un varón de 42 años, sin factores de riesgo cardiovasculares conocidos que presentó un accidente isquémico transitorio. Se descartó enfermedad sistémica y sustrato de hipercoagulabilidad como causa del mismo. Sólo mediante un estudio ecocardiográfico transesofágico se pudo confirmar una excrecencia de Lambl localizada en la válvula aórtica (strand valvular). Se realiza una revisión acerca del manejo clínico y las nuevas opciones terapéuticas en la prevención del ictus de esta inusual fuente cardioembólica

We describe a 42-year-old man presenting in the emergengy departament with transient ischemic attack without cardiovascular risk factors. Systemic disease and hypercoagulability substract was discarded. Only transesophageal echocardiography could confirm the presence of a Lambl’s excrescence in the aortic valve (valvular strand). We review clinical management and new therapeutic options in stroke prevention used in this unusual source of cardiac embolism

[What is the opinion of Spanish internists on osteoporosis?]. / 'Qué opinan los internistas españoles de la osteoporosis?

OBJECTIVE: To conduct an opinion survey on osteoporosis in Spanish internists. METHOD: Survey sent by mail and by personal visit to members of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. RESULTS: A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to densitometry. CONCLUSIONS: The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases.

¿Qué opinan los internistas españoles de la osteoporosis? / What is the opinion of Spanish internists on osteoporosis?

Objetivo. Realizar una encuesta de opinión sobre osteoporosis en internistas españoles. Método. Encuesta remitida por correo y por visita personal a miembros de la Sociedad Española de Medicina Interna. Recogida de datos sobre opinión acerca de la enfermedad, actitud diagnóstica y terapéutica y medios disponibles (analítica general, radiología convencional, marcadores bioquímicos de remodelamiento óseo, densitometría y ultrasonidos) y preferencias a la hora de elegir un determinado tratamiento. Resultados. Contestaron un total de 538 internistas. Más del 90% de los encuestados opina que la osteoporosis es una enfermedad que deben tratar los internistas. El 93% considera que la osteoporosis es una patología prevalente. Más del 80% tiene acceso a una densitometría. Conclusiones. Los internistas españoles opinan mayoritariamente que la osteoporosis es una enfermedad que deben tratar los internistas y que entra en su ámbito de actuación. Por lo general disponen de los medios que necesitan para su estudio y tratamiento. Los bifosfonatos constituyen el fármaco de elección y en la práctica totalidad de los casos indican un suplemento de calcio y vitamina D

Objective. To conduct an opinion survey on osteoporosis in Spanish internists. Method. Survey sent by mail and by personal visit to member of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. Results. A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to a densitometry. Conclusions. The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases

Atelectasia secundaria a tumor carcinoide bronquial / Atelectasis secondary to bronchial carcinoid tumor

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Hemocromatosis primaria en jóvenes asintomáticos / Primary hemochromatosis on asymptomatic young people

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Septic arthritis due to Scedosporium apiospermum: case report and review.

Septic arthritis is a relatively common disease, but reports of septic arthritis caused by fungi are still rare and it is often associated with predisposing factors that reduce cellular immunity (alcoholism, cancer, endogenous or exogenous hypercortisolism, intravenous drug abuse). Articular conditions caused by Scedosporium apiospermum are uncommon. Here we report the case of a 32-year-old immunocompetent male with septic arthritis caused by S. apiospermum and review 12 other cases.

Hemocromatosis y colangiocarcinoma hiliar: descripción de un caso / Hemochromatosis and hilar cholangiocarcinoma: description of a cases

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[Medical rhabdomyolysis in the elderly]. / Rabdomiólisis médica en el anciano.

BACKGROUND: To investigate the characteristics of medical rhabdomyolysis (RM) in the elderly, as well as differences compared with those observed in younger patients. PATIENTS AND METHODS: Prospective study of 56 elderly patients (> or = 65 years) with RM and 73 younger patients (> 7 years and < 65 years) with RM for 43 months. The RM characteristics were analyzed in the elderly group (ERM) and compared with those in the younger group (YRM). RESULTS: Fifty-six elderly patients with RM (38 males and 18 females, with a mean age of 76.3 +/- 7.6 years; range: 65-92 years) and 73 younger patients (57 males and 16 females, with a mean age of 37.9 +/- 15.6 years; range: 13-63 years), made up the 129 patients in the study. The most common cause for RM in the ERM was muscle compression due to immobilization and the multicausative group, both with 9 (16%) cases, followed by respiratory infection with 8 (14.2%) cases. In the YRM, the most common cause was physical exertion with 15 patients (20.5%) and multicausative with 18 patients (24.6%). Myalgia predominated in the YRM group, with 25 vs. 9 (odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.0-7.3; p < 0.05). Acute renal failure (ARF) occurred in 13 patients in the ERM group compared with 4 in the YRM group (OR: 5.2; 95% CI: 1.4-23; p < 0.01). In the logistic regression analysis an association was found between hypoalbuminemia and ARF for the ERM group. In the presence of ARF, both ERM and YRM had decreased serum calcium levels, deeper in YRM and more prolonged in the ERM. Six patients in the ERM died, and four of them had developed ARF. In contrast, none of the two deceased patients in the YRM had the complication of ARF. CONCLUSION: Almost half of cases of RM occur in elderly patients, which is mostly due to muscle compression and infections, particularly in the respiratory tract. Symptoms are usually mild and the development of ARF is more common than in younger patients, and its presence is associated with hypoalbuminemia. Hypocalcemia associated with ARF was less deep in the elderly, but more persistent than in younger patients. Most deceased patients in the elderly group previously developed ARF.