Escorbuto: una entidad que aún existe en la medicina moderna / Scurvy still exists in modern medicine

El escorbuto es un trastorno nutricional secundario al déficit corporal de vitamina C. Comunicamos el caso de un paciente de 37 años que consulta por lumbalgia e impotencia funcional de ambos miembros inferiores asociadas ahemorragias mucocutáneas. Destacamos que es su antecedente personal de déficit de vitamina C en la ingesta lo que, sumado a las características lesiones cutáneas, permite diagnosticar la enfermedad (AU)

Scurvy is a nutritional disorder due to vitamin C deficiency.We communicate the case of a 37-year-old patient who came to us with lumbar pain and lower limbs disability, asuell as, mucosa and cutaneous hemorrhages.We remark that dietary history leads to a rapid diagnosis when characteristic cutaneous lesions are present (AU)

Persistence with teriparatide in postmenopausal osteoporosis; impact of a patient education and follow-up program: the French experience.

SUMMARY: This study evaluated the 18-month persistence with teriparatide in 5413 postmenopausal osteoporotic women who were enrolled in an education and follow-up program. Analysis showed that the persistence rate was 81.5% for women who follow the program, higher than for existing oral antiresorptive treatments. INTRODUCTION: An education and follow-up program was developed after launch of teriparatide in France in September 2004, to help women to follow the treatment. The objective of this study was to evaluate the persistence with teriparatide in postmenopausal osteoporotic women following this program. METHODS: Data about persistence are available for the period September 2004 to June 2007. Persistence is defined as the percentage of patients still on treatment at the end of the 18-month course, and it has been compared to the data provided by the French universal health insurance system. RESULTS: Since the launch of teriparatide in France in September 2004, 5413 postmenopausal women (mean age 72.3 +/- 14.5 years) with osteoporosis and vertebral fractures (mean 3.9 +/- 2) have participated in the program. The persistence rate at 15 months was 81.5%, and our analysis suggested that a majority of patients completed the 18-month treatment course. The main reason for discontinuation was adverse events (46.7%). Data of the French Universal Health Insurance suggest that the persistence may be close to 0% for women who are not in the program. CONCLUSIONS: Postmenopausal osteoporotic women treated by teriparatide and enrolled in an education and follow-up program have a high persistence rate.

Encefalitis carcinomatosa / Carcinomatous encephalitis

We report a case of carcinomatous encephalitis in a patient with lung adenocarcinoma and confusional syndrome. This is a rare form of brain metastases. We discuss its clinical picture, the importance of suspecting it after a normal computed tomography scan and the miliary typical images at magnetic resonance.

Se comunica un caso de encefalitis carcinomatosa, en un paciente con diagnóstico de adenocarcinoma de pulmón y síndrome confusional. Esta entidad es poco conocida en relación a otras afecciones neurológicas relacionadas al cáncer. Se discute su presentación clínica, se destaca la necesidad de sospecharla aun luego de obtener una tomografía computada normal y sus típicas imágenes miliares en resonancia magnética.

Non-scheduled consultation in oncologic patients. How many of them are true emergencies? An observational prospective study.

Oncologic emergencies have been extensively described and clearly defined. In oncology daily practice, cancer patients seek non-scheduled medical care in situations they perceive as a medical emergency, but which may not be a true emergency. The aim of the study was to identify the main symptoms leading to a non-scheduled consultation (NSC) and their relationship to the type of cancer, and to evaluate whether the diagnosis at discharge of patients admitted as result of a NSC correlates with a true oncologic emergency. This was a prospective observational study. Between July 2002 and April 2003, 365 NSCs were recorded. The most frequent baseline diseases were breast cancer (70), lung cancer (67), gastrointestinal cancer (52), lymphoma (42) and ovarian cancer (22). The most common symptoms for consultation were: fever (84), pain (81), cutaneous manifestations (26), dyspnea (23), bleeding (16) and abdominal distention (16). Overall, 114 of 365 NSCs (31%) resulted in admission. The most frequent symptoms resulting in admission were fever (42), pain (16), dyspnea (11), vomiting (9), neurologic manifestations (7), abdominal distention (6) and anuria (6). At discharge, only 30 patients (26%) admitted after a NSC were diagnosed with a defined oncologic emergency: febrile neutropenia (13), intestinal occlusion (12), obstructive uropathy (4) and abdominal perforation (1). True emergencies were not the most frequent causes of NSC at our institution.

Encefalitis carcinomatosa / Carcinomatous encephalitis

We report a case of carcinomatous encephalitis in a patient with lung adenocarcinoma and confusional syndrome. This is a rare form of brain metastases. We discuss its clinical picture, the importance of suspecting it after a normal computed tomography scan and the miliary typical images at magnetic resonance.(AU)

Se comunica un caso de encefalitis carcinomatosa, en un paciente con diagnóstico de adenocarcinoma de pulmón y síndrome confusional. Esta entidad es poco conocida en relación a otras afecciones neurológicas relacionadas al cáncer. Se discute su presentación clínica, se destaca la necesidad de sospecharla aun luego de obtener una tomografía computada normal y sus típicas imágenes miliares en resonancia magnética.(AU)

Sindrome hemofagocitico asociado a EMTC y crisis renal esclerodermica / Hemophagocytic syndrome associated to mixed connective

Una paciente de 63 años con diagnostico de enfermedad mixta del tejido conectivo (polimiositis, esclerosis sistemica progresiva, RNP+) consulta por episodio de lesiones equimoticas en abdomen, manos y pies con plaquetopenia y laboratorio compatible con coagulopatia por consumo. En la puncion de medula osea se encuentra, celularidad disminuida con serie megacariocitica ausente y abundantes macrofagos con fenomemo de hemofagocitosis

Sindrome hemofagocitico asociado a EMTC y crisis renal esclerodermica / Hemophagocytic syndrome associated to mixed connective

Una paciente de 63 años con diagnostico de enfermedad mixta del tejido conectivo (polimiositis, esclerosis sistemica progresiva, RNP+) consulta por episodio de lesiones equimoticas en abdomen, manos y pies con plaquetopenia y laboratorio compatible con coagulopatia por consumo. En la puncion de medula osea se encuentra, celularidad disminuida con serie megacariocitica ausente y abundantes macrofagos con fenomemo de hemofagocitosis (AU)

A placebo-controlled study of the antidepressant activity of moclobemide, a new MAO-A inhibitor.

Preliminary open trials performed by the authors and others with Moclobemide, a new MAO-A inhibitor, indicated that the drug has a satisfactory antidepressant activity. In the present double-blind study Moclobemide has been compared to placebo in a group of 34 unipolar psychotic or neurotic depressed patients. The mean daily dose of Moclobemide was 297 mg and treatment lasted from two to four weeks. Drug effectiveness was measured by improvements in the Hamilton Rating Scale for Depression (HRSD), Clinical Global Impression (CGI) and 100 mm Visual Analogue Scale (VAS). The results have shown that the active drug was markedly superior to placebo. The mean total score of HRSD was reduced from 41.7 to 16.5 in 18 pts. treated with Moclobemide and from 36.3 to 29.1 in 16 pts. who received placebo. Self-assessment with VAS showed a mean reduction from 82.7 mm to 42.2 mm and from 84.3 to 70.6 mm respectively. Moderate to marked improvement was observed by the CGI in 15 cases treated with Moclobemide and mild to moderate in 5 cases who received placebo. The treatment was well tolerated.