[Etiologic spectrum of solitary constitutional syndrome]. / Espectro etiológico del síndrome general solitario.

OBJECTIVE: To know the spectrum of diseases responsible for the solitary constitutional syndrome in our setting. This syndrome was defined as a clinical picture characterized by the presence of asthenia, anorexia, and weight loss of at least 5% of body weight in the last six months, not associated with any other symptom or sign suggesting the diagnosis of an organ or system disease. PATIENTS AND METHODS: All patients diagnosed of the solitary constitutional syndrome (328) in a tertiary-care level teaching hospital between January 1991 and December 1996. RESULTS: Fifty-two (170) percent of patients with solitary constitutional syndrome were males and 48% (158) females. The mean age was 65.4%, ranging from 15 to 97 years. The average of the monthly estimated weight loss was 3 to 4 kilograms. A total of 115 (35%) malignant neoplasms and 5 (1.5%) benign tumors were diagnosed. The most common malignant tumors corresponded to the digestive tract (51.3% of the total malignant tumors). The second cause in frequency of the solitary constitutional syndrome corresponded to psychiatric diseases, with a total of 80 patients (24.3%). A total of 116 non-neoplastic organic diseases were detected, with digestive tract diseases --mainly peptic disease-- being the most common cause in this group. After follow-up, only in twenty cases were we unable to detect the underlying disease responsible for the syndrome. In nine of these, the solitary constitutional syndrome was self-limited. Forty-four percent of patients had at least another concomitant disease and in 24% of patients more than one associated condition was found. CONCLUSION: The most common diseases responsible for the solitary constitutional syndrome were, by decreasing frequency, malignant tumors, psychiatric disorders, and non-malignant organic diseases located in the digestive tract. A better knowledge of the etiological spectrum of this syndrome might be useful for a more efficient management of these patients.

Espectro etiológico del síndrome general solitario / Etiologic spectrum of solitary constitutional syndrome

Objetivo. Conocer el espectro de enfermedades responsables del síndrome general solitario en nuestro medio. Hemos definido este síndrome como 'el cuadro clínico caracterizado por la presencia de astenia, anorexia y adelgazamiento de al menos el 5 por ciento del peso corporal en los últimos 6 meses, no acompañado de ningún síntoma o signo que oriente al diagnóstico del padecimiento de una enfermedad propia de un determinado órgano o sistema'. Pacientes y método. Todos los pacientes diagnosticados de síndrome general solitario (328) en un hospital universitario de tercer nivel, durante el período comprendido entre enero de 1991 a diciembre de 1996.Resultados. El 51,8 por ciento (170) de los pacientes con síndrome general solitario eran varones y el 48,2 por ciento (158) mujeres. La media de la edad fue de 65,4 años, con unos limites de 15 y 97 años. La media de la pérdida estimada de peso mensual se situó entre los 3 y 4 kg/mes. Se diagnosticaron 115 neoplasias malignas (35 por ciento) y 5 tumores benignos (1,5 por ciento). Los tumores malignos más frecuentes fueron los del aparato digestivo (el 51,3 por ciento del total de neoplasias malignas). La segunda causa en frecuencia del síndrome general solitario fueron las enfermedades psiquiátricas, con un total de 80 pacientes (24,3 por ciento). Se detectaron 116 enfermedades orgánicas no neoplásicas, representando las enfermedades del aparato digestivo, principalmente la enfermedad péptica, la causa más frecuente de este grupo. Tras el período de seguimiento solamente en 20 casos no se logró poner de manifiesto un cuadro clínico que justificase su causa. De ellos, en 9 el síndrome general solitario fue autolimitado. El 43,9 por ciento de los pacientes presentaban al menos otra enfermedad acompañante a la entidad responsable de este síndrome y en el 23,6 por ciento de ellos se encontró más de un proceso asociado. Conclusión. Las enfermedades más frecuentemente responsables del síndrome general solitario fueron, por este orden, las neoplasias malignas, los procesos psiquiátricos y las enfermedades orgánicas no malignas del aparato digestivo. Quizá un mejor conocimiento del espectro etiológico de dicho síndrome en nuestro medio pueda ayudar a un manejo más eficiente de estos pacientes (AU)

Síndrome "lupus-like" como forma de presentacion de un adenocarcinoma pulmonar / "Lupus like" syndrome as presentation of pulmunary carcinoma

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[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.

[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).

[Appropriateness of admissions to an internal medicine service at a tertiary hospital]. / Adecuación de los ingresos en un servicio de medicina interna de un hospital de tercer nivel.

In the present study, clinical, epidemiological and management factors influencing the appropriateness of the 1076 admissions to a general Internal Medicine Section during one year are evaluated. 184 admissions (17%) corresponded to patients who did not meet the AEP (Appropriateness Evaluation Protocol) criteria for appropriateness. A remarkable finding was the low incidence of patients with inadequate admission in spite of social pressure, which we interpret as a consequence of an excessive demand for care and the subsequently low availability of hospital beds. Inadequate admission was more common in the younger age group than in patients over 64 years. Cardiovascular and respiratory disorders were more common among adequate admissions, whereas infective, neoplastic, and poorly defined conditions were more common among inadequate admissions. There were no differences in hospital stay between both groups. The patients who had been previously admitted had more commonly adequate admissions. A reduction in the inadequacy index could be achieved if diagnostic investigations were more speedily performed and a temporal hospitalization unit previous to admission were available.

[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%).

[Mortality at an internal medicine department of a tertiary hospital]. / Mortalidad en medicina interna de un hospital de tercer nivel.

The clinical and epidemiological variables as well as conduct parameters, attributable to death cases of the 1,052 patients cared for during one year in an Internal Medicine Department are analyzed. The mortality rate was 11.6%. We may point out in our results the elevated mean age (75.5 +/- 11.2 years) and the high incidence of repeated admissions (46%) among death cases. The mean and median hospital stay values were lower in the patients who died than in those that survived. The more frequent basic causes of death were stroke (27%), chronic obstructive pulmonary disease (15%) and neoplasias (14%). When analyzing the different conditions within one patient, cardiovascular diseases were most often found amongst those who died (73%). Gastrointestinal and infectious diseases were on the contrary associated to a low mortality rate.