Riñón «en herradura», adenocarcinoma renal / No disponible

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[Comorbidity, anemia and response to erythropoiesis stimulating agents in chronic hemodialysis]. / Relación entre comorbilidad, anemia y respuesta a derivados eritropoyéticos en pacientes incluidos en programa de hemodiálisis periódicas.

INTRODUCTION: Patients treated with haemodialysis have a high prevalence of co-morbidity that induces a elevate mortality risk. On the other hand, these patients have anaemia whose treatment is based in erythropoiesis stimulating agents. To date there are not enough studies to determine if co-morbidity alters erythropoietin response and the relationship between co-morbidity, response to treatment of anaemia and resistance to erythropoiesis-stimulating agents. OBJECTIVES: We have the following objectives: i) to study the prevalence of associated diseases in patients treated with haemodialysis in our Hospital Unit and to evaluate the co-morbidity Charlson Index, ii) to know the degree of anaemia control, dose and response to erythropoiesis-stimulating agents, and iii) to determine the relationship with co-morbidity and anaemia treatment. PATIENTS AND METHODS: We designed a retrospective study in stable haemodialysis treated patients. We calculated the Charlson co-morbidity index adjusted to age and we analysed levels of haemoglobin in the 6 months before study, dose of erythropoiesis-stimulating agents and its resistance index defined as doses of erythropoiesis-stimulating agents/weight (kg)/week/haemoglobin (g/dL). The different variables included in Charlson index were considered as independent variables and the index to repose to erythropoiesis-stimulating agents as a dependent variable, using bivariant and multivariate statistical analysis. RESULTS: We included 58 patients (31 males and 27 females), median age of 69.5 years (range 24-88), mean haemodialysis 83.7 months. Mean Charlson index was 7.4 +/- 2.8 (range 2-13). Comorbidity-age Charlson index was 2 in 3.4% of patients; 10.3% had 3 or 4 points; 43.2% between 5 and 7 and 43,1% 8 or more. Mean haemoglobin levels was 11,7+/-1,2 g/dL. Mean erythropoiesis-stimulating agents dose was 163.7+/-114.5 IU/kg/week and resistance index 14.1+/-9.7. Most of patients (57%) had a IRE value higher than 10. Fourteen patients (24%) had haemoglobin less than 11 g/dL, and 3 of them (5.1%) received erythropoiesis-stimulating agents more than 300 IU/kg/week. Nine subjects (15.5%) was treated with high dose of erythropoiesis-stimulating agents (>300 IU/kg/week): 3 of them had Hb>or=11 g/dL and 6 had Hb<11 g/dL. We did not found that the intensity of Charlson index is related with the degree of anaemia control or response to erythropoiesis-stimulating agents. CONCLUSIONS: Although the co-morbidity index is high and the response to erythropoiesis-stimulating agents is inadequate. In our study there is not relationship between these conditions.

Relación entre comorbilidad, anemia y respuesta a derivados eritropoyéticos en pacientes incluidos en programa de hemodiálisis periódicas / The relationship between comorbidity, anemia and response to erythropoiesis-stimulating agents in chronic hemodialysis

Introducción: Los pacientes en hemodiálisis presentan un elevado número de patologías asociadas. Por otro lado, la mayoría reciben derivados eritropoyéticos como tratamiento de la anemia. No hay estudios que indiquen si el grado de comorbilidad influye en la respuesta a los derivados eritropoyéticos. Objetivos: Estudiar la comorbilidad de los pacientes de una unidad de hemodiálisis hospitalaria, cuantificarla mediante el índice de comorbilidad de Charlson, conocer el control de anemia, la respuesta a derivados eritropoyéticos y, finalmente, evaluar la relación entre comorbilidad y control y tratamiento de la anemia. Pacientes y métodos: Realizamos un estudio retrospectivo. Incluimos 58 pacientes en hemodiálisis del Hospital General de Ciudad Real. Recogimos datos de la historia clínica para calcular el índice de comorbilidad de Charlson. Analizamos las cifras de hemoglobina y las dosis de derivados eritropoyéticos en los seis meses previos y calculamos el índice de resistencia a derivados eritropoyéticos. Las distintas entidades incluidas en el índice de comorbilidad y el propio índice de comorbilidad se consideraron variables independientes y el índice de resistencia a derivados eritropoyéticos como variable dependiente, mediante análisis uni y multivariante. Resultados: Edad media 69,5años; 53,4% varones; tiempo medio en hemdiálisis 83,7meses. El índice de Charlson medio fue 5,2 ± 2,4 (2-11) y el ajustado a la edad 7,4 ± 2,8 (2-13). La hemoglobina media fue 11,7 ± 1,2 g/dL. El 24,1% presentaban hemoglobina inferior a 11 g/dL. La media del índice de resistencia a derivados eritropoyéticos fue 14,1 ± 9,7. No observamos que los valores del índice de Charlson se relacionaran con el grado de anemia ni con la resistencia a derivados eritropoyéticos. Conclusiones: En nuestra muestra existe una elevada comorbilidad asociada y un porcentaje importante de pacientes con anemia no controlada. No hemos encontrado relación entre la comorbilidad y el control de la anemia ni el grado de respuesta a derivados eritropoyéticos (AU)

Introduction: Patients treated with haemodialysis have a highprevalence of co-morbidity that induces a elevate mortality risk. On the other hand, these patients have anaemia whose treatment is based in eritropoyesis stimulating agents. To date there are not enough studies to determine if co-morbidity alters erythropoietin response and the relationship between co-morbidity, response to treatment of anaemia and resistance to erythropoiesis-stimulating agents. Objectives: We have the following Objectives: i) to study the prevalence of associated diseases in patients treated with haemodialysis in our Hospital Unit and to evaluate the co-morbidity Charlson Index; ii) to know the degree of anaemia control, dose and response to erythropoiesis-stimulating agents, and iii) to determine the relationship with comorbidity and anaemia treatment. Patients and methods: We designed a retrospective study in stable haemodialysis treated patients. We calculated the Charlson co-morbidity index adjusted to age and we analysed levels of haemoglobin in the 6months before study, dose of erythropoiesis-stimulating agents and its resistance index defined as doses of erythropoiesis-stimulating agents/weight (kg)/week/haemoglobin (g/dL). The different variables included in Charlson index were considered as independent variables and the index to repose to erythropoiesisstimulating agents as a dependent variable, using bivariant and multivariate statistical analysis. Results: We included 58 patients(31 males and 27 females), median age of 69.5 years (range 24-88), mean haemodialysis 83,7 months. Mean Charlson index was 7.4 ± 2.8 (range 2-13). Comorbidity-age Charlson index was 2 in 3.4% of patients; 10.3% had 3 or 4 points; 43.2% between 5 and 7 and 43.1% 8 or more. Mean haemoglobin levels was 11.7±1.2 g/dL. Mean erythropoiesis-stimulating agents dose was 163.7 ± 114.5 IU/kg/week and resistance index 14.1 ± 9.7. Most of patients (57%) had a IRE value higher than 10. Forteen patients (24%) had haemoglobin less than 11 g/dL, and 3 of them (5.1%) received erythropoiesis-stimulating agents more than 300 IU/kg/week. Nine subjects (15.5%) was treated with high dose of erythropoiesis-stimulating agents (> 300 IU/kg/week): 3 of them had Hb ≥ 11 g/dL and 6 had Hb < 11 g/dL. We did not found that the intensity of Charlson index is related with the degree of anaemia control or response to erythropoiesis-stimulating agents. Conclusions: Althought in our study the comorbidity index is high and the response to erythropoiesis-stimulating agents is inadequate, there is not relationship between these conditions (AU)

[Characteristics of patients with multiple disease hospitalized in Internal Medicine services]. / Características clínicas diferenciales de los enfermos pluripatológicos hospitalizadosen servicios de Medicina Interna.

INTRODUCTION: Know what proportion of patients hospitalized in the Internal Medicine services have multiple diseases. MATERIAL AND METHODS: We analyzed 400 clinical histories of a random sample of patients admitted to 24 Internal Medicine services of Andalusia. We assessed the diagnostic categories present that make it possible to classify patients as having multiple diseases. RESULTS: One hundred sixty eight patients (42%) were considered as having multiple diseases. The most prevalent diseases in these patients are cardiological and diabetes mellitus. The two main variables that determine that one is a multiple disease patient are age and disease causing the admission. DISCUSSION: A significant percentage of the patients admitted to the Medicine services of the Andalusia public hospitals have multiple diseases.

Características clínicas diferenciales de los enfermos pluripatológicos hospitalizadosen servicios de Medicina Interna / Characteristics of patients with multiple disease hospitalized in Internal Medicine services

Introducción. Conocer qué proporción de pacientes hospitalizados en los servicios de Medicina Interna son pluripatológicos. Material y métodos. Analizamos 400 historias clínicas de una muestra aleatoria de pacientes ingresados en 24 servicios de Medicina Interna de Andalucía. Valoramos las categorías diagnósticas presentes que permiten clasificar a los enfermos como pluripatológicos. Resultados. Ciento sesenta y ocho pacientes (42%) fueron considerados pluripatológicos. Las patologías más prevalentes en estos enfermos son las cardiológicas y la diabetes mellitus. Las dos variables principales que determinan el ser enfermo pluripatológico son la edad y la patología que motivó el ingreso. Discusión. Un importante porcentaje de los enfermos ingresados en los servicios de Medicina de los hospitales públicos andaluces son pluripatológicos (AU)

Introduction. Know what proportion of patients hospitalized in the Internal Medicine services have multiple diseases. Material and methods. We analyzed 400 clinical histories of a random sample of patients admitted to 24 Internal Medicine services of Andalusia. We assessed the diagnostic categories present that make it possible to classify patients as having multiple diseases. Results. One hundred sixty eight patients (42%) were considered as having multiple diseases. The most prevalent diseases in these patients are cardiological and diabetes mellitus. The two main variables that determine that one is a multiple disease patient are age and disease causing the admission. Discussion. A significant percentage of the patients admitted to the Medicine services of the Andalusia public hospitals have multiple diseases (AU)

[The practice of Internal Medicine in Andalusia follows the evidence-based medicine basic principles]. / La práctica de la Medicina interna en Andalucía se ajusta a la Medicina basada en la evidencia.

BASIS: To know the proportion of medical interventions carried out in the Services of Internal Medicine of the public hospitals of Andalusia based on randomized clinical trials. PATIENTS AND METHODS: We have analyzed the primary treatments prescribed in a random sample of 326 patients admitted to these Internal Medicine services during 1998. RESULTS: One hundred and forty-three of the 326 treatments analyzed (43.9%) were based in clinical trials and 135 (41.4%) were interventions unanimously accepted by the medical community without being based in clinical trials. CONCLUSIONS: Most of the primary Andalusian treatments prescribed in the Internal Medicine services are evidence-based.

La práctica de la Medicina interna en Andalucíase ajusta a la Medicina basada en la evidencia* / The practice of Internal Medicine in Andalusia follows the evidence-based medicine basic principles

Fundamentos. Conocer la proporción de intevenciones médicas llevadas a cabo en los servicios de Medicina Interna de los hospitales públicos de Andalucía basadas en ensayos clínicos aleatorizados. Pacientes y métodos. Hemos analizado los tratamientos principales prescritos en una muestra aleatoria de 326 pacientes ingresados en dichos servicios durante 1998. Resultados. Ciento cuarenta y tres de los 326 tratamientos analizados (43,9 por ciento) estaban basados en ensayos clínicos y 135 (41,4 por ciento) eran intervenciones unánimamente aceptadas por la comunidad médica sin estar basados en ensayos clínicos. Conclusiones. La mayoría de los principales tratamientos prescritos en los servicios de Medicina Interna andaluces se basan en la evidencia (AU)

Megestrol-induced Cushing syndrome.

OBJECTIVE: To report a case of Cushing syndrome associated with megestrol acetate therapy in a patient with renal insufficiency. SUMMARY: A 17-year-old boy with renal insufficiency due to unilateral renal agenesis developed Cushing syndrome and worsening of his renal function after megestrol acetate therapy. The diagnosis was based on clinical and analytical evaluation. DISCUSSION: Megestrol acetate is indicated for the treatment of cachexia associated with AIDS and malignancy. Due to its glucocorticoid activity, megestrol use has resulted in the occurrence of Cushing syndrome in both patient groups. We report the case of a young patient with renal insufficiency due to unilateral renal agenesis who developed Cushing syndrome two months after administration of high-dose (900-mg/d) megestrol acetate for an eating disorder. CONCLUSIONS: The risk of megestrol-induced Cushing syndrome, especially with high doses of the medication, should be considered as a possible adverse effect in patents with renal insufficiency.

[Predictive factors for inappropriate hospital stays in an internal medicine department]. / Factores predictivos de estancias no adecuadas en un servicio de medicina interna.

BACKGROUND: We aimed to know which factors are associated with inappropriate stays in an internal medicine department. SUBJECTS AND METHOD: We included 1,046 hospitalisations and evaluated the justification of the admission using the Appropriateness Evaluation Protocol. RESULTS: 176 (16.8%) stays were considered inappropriate. In a multiple regression model, variables defining an inappropriate stay were the number of days in hospital, diagnosis on admission and the weekly day. CONCLUSION: There are determining factors for inappropriate stays in an internal medicine department.

Síndrome de Sjögren primario asociado a hepatitis autoinmune / Primary Sjögren ´s syndrome associated to autoimmune hepatitis

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[Factors associated with inappropriate hospitalization at an internal medicine department]. / Factores asociados a ingresos inadecuados en un servicio de medicina interna.

BACKGROUND: To determine the factors associated with inappropriate admissions in an Internal medicine department. SUBJECTS AND METHOD: We included 1,993 admissions. The justification for the admissions was evaluated using the Appropriateness Evalutation Protocol. RESULTS: 187 (9.4%) admissions were considered inappropriate. The likelihood of an inappropriate admission was higher as long as the patient was younger than 65 years of age (OR, 1.94; (95%) IC, 1.32-2.85) and the admission had been programmed from the outpatients clinic (OR, 10.58; (95%) IC, 2.79-40.1). Clinical diagnosis also influenced the inappropriateness of admissions. CONCLUSION: Age, diagnosis and source of patients determine inappropriate admissions in an internal medicine department.

Reingresos hospitalarios en Medicina Interna y estancia media

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[What do the internal medicine residents of Anadalusia think of their specialty? Survey results]. / Qué opinan los residentes de medicina interna de Andalucía de su especialidad? Resultados de una encuesta.

BACKGROUND: To know the opinion of andalusian Internal Medicine (IM) residents about different subjects of their specialty, and their biomedical investigation activities. PATIENTS AND METHODS: A questionnaire with codified answers, facilitated to 64 IM residents of Andalusia. RESULTS: 69% of residents referred that IM was the specialty they wished to adhere at first choice. A 61% of residents would advice choosing IM as specialty to physicians with the exams for becoming a resident just passed. Best merit of IM for 89% of people was the global sight of the patient, and worst one for 37.5% was its tendency to fragmentation. 47% of residents consider that the role of the specialty will grow in the future. CONCLUSIONS: Our questionnaire reflects some of the contradictions that IM as a specialty is living, and probably show the rely of future internists to some future propositions about the specialty.

¿Qué opinan los residentes de Medicina Interna de Andalucía de su especialidad? Resultados de una encuesta / What do andalusian internal medicine residents thing abort their speciality?: results of a questionnaire

Objetivos: Valorar la opinión de residentes de medicina interna (MI) de Andalucía sobre diferentes aspectos de su especialidad, así como sus actividades de investigación biomédica. Material y métodos: Encuesta con respuestas codificadas a 64 residentes de MI de Andalucía. Resultados: Un 69% de los residentes confesó que la MI era la especialidad que deseaban realizar como primera opción. Un 61 porciento aconsejaría elegir la MI como especialidad a un médico que ahora aprobara el examen de médico interno residente. La principal virtud de la MI para un 89% de los encuestados es la visión global del enfermo y para un 37,5 porciento su tendencia a la fragmentación el principal defecto. Un 47% de los residentes consideran que la presencia de la especialidad aumentará en el futuro. Conclusiones: Nuestra encuesta refleja algunas de las contradicciones que está viviendo la especialidad de MI y probablemente señala el apoyo de los futuros internistas a algunas propuestas de futuro sobre la especialidad (AU)