[Late diagnosis of Turner syndrome: therapeutic implications]. / Diagnóstico tardío del síndrome de Turner: implicaciones terapéuticas.

We report the case of a patient with Turner's syndrome, whose special peculiarity is that its clinical signs have gone unnoticed despite the presence of several morphological features and functional disorders which must have induced it precociously. It's about a 58 years old patient with an aortic metalic valve in treatment with dicumarinics, who came to emergencies with a severe anemic syndrome because of a peptic ulcer propitiated by the hypoprotrombinaemia. In the physical examination some typical signs of the syndrome were detected. The karyotype verified the existance of Turner (45X0). We insist on the need of an early diagnosis, in order to prevent the short stature and to offer a satisfactory sexual development, and we include an actualization of the different approachments in the therapy and management of the disease.

Diagnóstico tardío del síndrome de Turner: implicaciones terapéuticas / Late diagnosis of Turner syndrome: therapeutic implications

Presentamos el caso de una paciente portadora de Síndrome de Turner, cuya especial peculiaridad es la de haber pasado desapercibido su cuadro clínico, realizándose un diagnóstico tardío, no obstante la presencia de diversos rasgos morfológicos y alteraciones funcionales que debieran haberlo evocado precozmente. Se trata de una paciente de 58 años con prótesis metálica por aorta bicúspide estenótica, en tratamiento con dicumarínicos, que acudió a urgencias con severo síndrome anémico por ulcus péptico sangrante propiciado por hipoprotrombinemia. En la exploración se detectaron una serie de rasgos característicos de la enfermedad. El cariotipo confirmó la presencia de Síndrome de Turner (45 XO). Se insiste en la necesidad de un diagnóstico precoz, única posibilidad de intentar prevenir el déficit estatural y ofrecer un desarrollo madurativo sexual adecuado (AU)

[Tuberculosis as cause of death]. / Tuberculosis como causa de muerte.

Despite the availability of an effective treatment for most cases, tuberculosis (TB) is still a cause of death in our environment. The necropsic sections of patients died because of TB during the 1987-1996 period at Hospital Clínico de San Carlos, Madrid, were reviewed. The investigated data from each patient included age, gender, chronology of suggestive symptoms of TB, degree of histological involvement, radiological pattern in chest X-ray, delay in initiating therapy, concomitant diseases and other alternative diagnosed considered. The delay in diagnosis was the main cause for TB mortality. Advanced age, delay in seeking medical care and the presence of atypical clinical and radiological patterns contributed to the fatal end. Other factors included alcoholism and immunodeficiency.

[Ischemic colitis: a descriptive analysis in a Madrid hospital]. / Colitis isquémica: análisis descriptivo en un hospital madrileño.

BACKGROUND: Ischaemic colitis represents the most common form of intestinal ischaemia and involves more commonly elderly patients with a variety of underlying conditions. This study analyses the epidemiology and clinical characteristics of the disease in our environment. PATIENTS AND METHODS: The IC cases occurred at our institution during the last two years were studied. Twenty-eight cases of IC obtained by reviewing colonoscopy and pathological records were analyzed. RESULTS: The non-occlusive type is the most common presentation form of IC. It affected elderly patients (74 +/- 10 years) with cardiovascular risk factors. Most cases manifested with abdominal pain (68%). In 64% cases, colonoscopy showed ulcerations, located mainly at descending colon and rectosigmoid. The clinical course was generally favourable with conservative measures. The overall mortality rate was 10%. CONCLUSION: The possibility of IC should be considered in the differential diagnosis of elderly patient with abdominal pain and cardiovascular risk factors.