[Pulmonary hypertension secondary to multiple pulmonary thromboembolisms due to thrombosis of the right subclavian vein]. / Hipertensión pulmonar secundaria a tromboembolismos pulmonares múltiples por trombosis de la vena subclavia derecha.

Deep venous thrombosis of the upper limbs is a rare entity which is usually associated to a high number of risk factors, with an incidence of 12.4% approximately, although the development of associated fatal complications is rare. We present the case of a patient without known risk factors who, in the course of a thrombosis at the right subclavian vein, developed very severe pulmonary hypertension secondary to multiple pulmonary embolism.

Interleukin-1 in alcoholic cirrhosis of the liver: the influence of nutrition.

Interleukin-1 (IL-1) is a cytokine produced by the macrophage-monocyte system that has important effects on immunological responses and inflammatory reactions. Several clinical studies have shown that severe protein energy malnutrition adversely effects cell-mediated immune responses and the functional state of macrophages. The objective of this study was to analyse IL-1 production by adherent cells stimulated in vitro with lipopolysaccharide B (LPS) from patients with alcoholic cirrhosis of the liver and its possible relationship with nutritional states. Forty-five patients with alcoholic cirrhosis and 28 healthy donors were investigated. A combined index of nine anthropometric and biochemical parameters was used to evaluate nutritional status of cirrhotic patients, allowing a distinction to be made between those patients with acceptable nutrition (group I: 40%), those with slight malnutrition (group II: 37.7%), and those with severe malnutrition (group III: 22.3%). IL-1 activity was significantly lower in the cirrhosis patients than in the controls (P less than 0.001). This activity also was significantly lower in samples obtained from cirrhotics with severe malnutrition than in those with acceptable nutrition (P less than 0.05); the combined index and the sole anthropometric index gave the same results, suggesting that malnutrition may play a role in the immunoregulatory disturbances in the pathogenesis of alcoholic liver disease.

[Natural killer (NK) cells and interleukin 2 (IL-2) in Crohn disease]. / Células natural killer (NK) e interleucina 2 (IL-2) en la enfermedad de Crohn.

An analysis was made of spontaneous Natural Killer (NK) activity, the proportion of NK cells and Interleukin 2 (IL-2) production in response to a phytohemagglutinin (PHA) using isolated mononuclear peripheral blood cells from 27 patients with Crohn's disease (CD) and 27 healthy controls. The results obtained showed a decrease in NK activity in comparison with the control group (p less than 0.05), occurring mainly in patients in whom the disease was in an active phase (p less than 0.005), with no apparent relationship to the proportion of NK cells. IL-2 production was, however, similar to that of the healthy controls. A positive correlation between spontaneous NK activity and IL-2 production was evident. The origin of these findings is controversial, suggesting that other factors with a negative modulating effect may inhibit NK function.

[The multiple-admissions patient in internal medicine as a special type of hospital readmission]. / El paciente multingresado en medicina interna como tipo especial de readmisión hospitalaria.

A considerable number of patients treated in hospitals register several readmissions, this being special cause for concern, not only from a clinical point of view but also in respect of the management of resources. This article analysed the clinical, epidemiological and resources variable associated with patients classified as "multiadmitted". The aim of the study is determine the possible factors which predispose the multiadmission. Multiadmitted patients are defined as those who are admitted twice in a period of 12 months or those admitted 3 times in 5 years. The type of the study carried out involved control cases. We selected 1099 admissions during a period of a year at an internal medicine department of a third-level hospital. Among the various results, we would highlight the fact that 34% of the patients were multiadmitted. The main characteristics were: mean age of 8 years older than the others, patients afflicted with chronic diseases of high prevalence (most of them of the respiratory, cardiovascular, gastrointestinal or endocrine systems). The most frequent diseases were COLD (Chronic Obstructive Lung Disease), cardiomyopathies, and chronic liver disease).

[A morbidity study in a general internal medicine service in a third-level hospital]. / Estudio de la morbilidad en un servicio de medicina interna general en un hospital de tercer nivel.

This study carried out at a type "C" hospital, analyses the actual pathology of 1,052 patients attended to at the internal medicine department during a period of one year. The sex distribution did not show any differences. The median age (64 years) was significantly superior in women. The more frequent diseases were from group VII (cardiovascular: 512 cases) and group VIII (respiratory: 471 cases) according to the 9th edition of the who international diseases classification. The most frequent causes for admission were: respiratory infection (19.5%), cardiac insufficiency (13.8%) and CVA (10.6%). The most frequent baseline diseases were cardiomyopathy (20.4%), chronic obstructive airways syndrome (16%), malignant neoplasia (8.5%) and hepatopathy (7.6%). The risk factors and toxic habits observed were: Chronic bronchitis (19.6%), blood hypertension (15.5%), diabetes (13.5%) and high alcohol intake (10%).