Derrame pleural y una 'espina de rosal' en el esputo / Pleural effusion and a <> in the sputum specimen

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Actualización: esclerosis múltiple / Multiple sclerosis

Desde que hace más de 100 años Carswell, Cruveilhier y especialmente Charcot que en 1868 ofrece la primera descripción detallada de lo que él llamó "esclerosis en placas", hasta la actualidad, la esclerosis múltiple sigue siendo un desafío para los investigadores y médicos que se dedican a tratarla. Sin embargo, la aparición de nuevos medios diagnósticos, como la resonancia magnética nuclear (RMN), y de nuevos tratamientos como el interferón beta 1 a y 1 b han supuesto un importante cambio en el pronóstico y la calidad de vida de estos pacientes. El médico de familia debe sospechar esta patología en pacientes con alteraciones piramidales, déficits sensoriales o sensitivos recientes, con el fin de remitirlos tempranamente a centros en los que se pueda completar el diagnóstico e iniciar un tratamiento, así como de atender las complicaciones y posibles secuelas de esta patología (AU)

[Mortality in an internal medicine department within a third-level hospital; twenty years experience]. / Mortalidad en un servicio de medicina interna de un hospital de tercer nivel; 20 años de experiencia.

OBJECTIVES: To know and to analyze the main causes of death in an Internal Medicine Department (IM) and the mortality rate in such a Department. MATERIALS AND METHODS: From 1977 to 1996, a total of 77,310 patients were attended in the service under analysis. There were a total of 4,720 deaths. Clinical and epidemiological variables were analyzed so do management parameters related to inpatient deaths. RESULTS: Global mortality rate was 6.1%; the number of admissions increased along the study, whereas mortality rate tended to decrease. Median age was 72.8 years in death patients, and this age tended to increase during the period of study. Women's age was greater than men's one. The causes of the demise were cardiovascular (stroke and cardiopathy), neoplasm and respiratory disease, in that order. Neoplastic diseases were the leading death cause in men as they were in patients younger than 65 years-old, and AIDS was the main reason of death in patients younger than 35 years. Finally, 28.7% who died had been inpatients for no more than 48 hours. CONCLUSIONS: We can conclude that deaths in our IM department affect, as a rule, elderly patients with cardiovascular or neoplastic disease. Moreover, AIDS has experienced an increasing frequency, so it had became the first cause of death in patients under the age of 35. The old age of patients who die in our service, the great percentage of early deaths and the fact that the motive was, in the majority of the patients, a terminal disease, support the idea that new social customs tend to remove illness and death from family home, approving demise as a hospital event.