Síndrome antisintetasa y fenómeno de Raynaud unilateral / Antisynthetase syndrome and unilateral Raynaud's phenomenon

Presentamos un paciente con un síndrome antisintetasa que 3 años antes había sido diagnosticado de un fenómeno de Raynaud unilateral. Dicho cuadro se interpretó como ocupacional, y se trató mediante simpatectomía torácica. El paciente permaneció escasamente sintomático hasta el desarrollo de la clínica articular y muscular 3 años después (AU)

[Tuberculin test in HIV infection]. / Prueba de la tuberculina en infección por HIV.

BACKGROUND: Intravenous infected-HIV drug abusers (IDAP/HIV+) are known to have a higher risk of tuberculosis (TB) than others. The effectiveness of tuberculin testing (Mantoux) in the detection of the TB infection in HIV(+) patients is probably lower than HIV(-) individuals. The aim of this paper is to assess tuberculin testing in the active search of cases of TB infection in IDAP individuals and their differences between HIV(+) and HIV(-) ones. METHODS: We studied 332 patients with intravenous drug use belonging to a therapeutic community and to in-patients. Tuberculin testing was performed on all of them. They were examinated if had been previously vaccinated with BCG and we carried out the counting of linfocites CD4 in HIV(+) ones. In the cases of negative tuberculin skin test a second test was administered after 7 days. The patients were grouped in HIV(+) and HIV(-) and the variables were statistically assessed by the chi 2 and a logistic regression model. RESULTS: Tuberculin testing resulted positive in 16.9% IDAP/HIV(+) in comparison with 39.9% of IDAP/HIV(-). The induration size was significantly smaller in HIV(+) than HIV(-) individuals. In both cases, we found that in BCG vaccinated patients positive tuberculin testing was significantly lower than negative tuberculin. The booster effect was detected in 8.9% of HIV(+), whereas in HIV(-) not BCG vaccinated it was of 21.4% and in HIV(-) BCG vaccinated it increased to 30.9%. When the level of the linfocites CD4 exceeds 500/mm3 in HIV(+) the percentage of Mantoux test (+) equals HIV(-) individuals. CONCLUSIONS: A decrease in sensitivity of tuberculin testing in the diagnosis of TB infection in IDAP/HIV(+) was detected. A high percentage of booster effect in IDAP was also demonstrated. We recommend the performance of tuberculin testing at the beginning of HIV infection.

[Intrasplenic pseudocyst and ascites as complications of exacerbated chronic pancreatitis]. / Pseudoquiste intraesplénico y ascitis como complicaciones de una pancreatitis crónica reagudizada.

A patient with chronic alcoholism displayed significant ascites and a splenic pseudocyst, after relapsing chronic pancreatitis. The pathogenic possibilities are commented. The break of pancreatic ducts, with extravasation of enzymes, that would reach adjacent structures, is a common mechanism to both complications. The authors suggest aspirative puncture for the definitive diagnosis, following splenectomy and distal pancreatectomy as the safest treatment.

[Giant cell arteritis: temporal arteritis, rheumatic polymyalgia]. / Arteritis de células gigantes: arteritis temporal, polimialgia reumática.

Fourteen patients have been diagnosed for Giant Cell Arteritis by temporal biopsy or clinical criteria in the last five years. Two of them started with atypical symptoms. Polymyalgia Rheumatica was the commonest symptom (71%). Two patients (14%) had an irreversible blindness in eye one. Histologic changes of arteritis were shown by temporal biopsy in 8 cases, one of which had no cranial manifestations. A raised ESR was a constant finding (100%) followed by a alpha-2 globulin increase (93%) and anaemia (57%). One patient had rare complication of this disease: an aortic arch syndrome. The whole group responded well to the treatment.

[Early prognosis of acute pancreatitis (author's transl)]. / Aproximación al pronóstico precoz en la pancreatitis aguda.

One hundred patients with acute pancreatitis are studied. The results in 90 cases were "favorable or very favorable", in ten cases "unfavorable or death". Various different characterisitics were analyzed statistically in relationship to the two types of outcome: sex, clinical histories, and results of physical examination. Furthermore, the individual relationships between age, main initial analytic parameters, and later development were determined. In our experience neither age nor sex, considered individually, showed a significant relationship to the seriousness of the disease. Having had pancreatitis previously proved to be a favorable factor (p less than 0.005). None of the other factors in the case histories showed any bearing of the later course of the condition. Findings in physical examination which were signs of unfavorable prognosis included jaundice (p less than 0.001), low blood pressure (p less than 0.001), tachycardia (p less than 0.005), intestinal paresia (p less than 0.001), pain following decompression (p less than 0.025), and abdominal tenderness (p less than 0.05). Abnormalities in ECG (p less than 0.005), marked leukocytosis (p less than 0.0005), hyperglycemia (p less than 0.02), hypocalcemia (p less than 0.05), and high values for the coefficient of amilase/creatinine clearance (p less than 0.01) also suggested an unfavorable course.