Hipertensión e insuficiencia renal ligadas al complejo de esclerosis tuberosa / Hypertension and renal failure linked to tuberous sclerosis complex

La hipertensión arterial (HTA) y la insuficiencia renal (IR) están íntimamente ligadas al riesgo vascular. Presentamos el caso de una mujer hipertensa de 53 anos, diagnosticada de ˜cólico nefrítico un mes antes, remitida para estudio de HTA mal controlada e IR. Ante la exploración física y las pruebas complementarias se diagnostica de esclerosis tuberosa, enfermedad infrecuente, genética, de gran variabilidad clínica que es capaz de originar HTA e IR (AU)

Hypertension and renal failure are very closely related to vascular risk. We present the case of a hypertensive, 53-year-old woman, who had been diagnosed with nephritic spasm one month before being referred to our hospital for study of her ill-controlled hypertension and renal failure. After a physical examination and complementary tests, she was diagnosed with tuberous sclerosis complex, an uncommon genetic disease that is clinically very variable and that can be the cause of hypertension and renal failure (AU)

Malignant uveitis masking a lymphocytic lymphoma

A multitude of diseases can present as posterior bilateral uveitis. In most cases, the cause of pericardial effusion can be determined, but in some instances, the cause is not apparent even after making a systematic and complete diagnostic evaluation. We report here an unusual case of a patient who had a B-cell lymphochytic lymphoma, which presented as bilateral posterior uveitis. The diagnosis by biopsy is described, as is the role of multiple test in the diagnosis of bilateral uveitis (AU)

Crioglobulinemia mixta asociada a infección de catéter ventrículoatrial / Mixed crioglobulinemia related to ventriculoatrial infection

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Tuberculosis y cáncer. Experiencia de un hospital general / Tuberculosis and cancer. Experience of a general hospital

Tuberculosis y cáncer son dos procesos que pueden aparecer interrelacionados. Se estudia la asociación entre ambas entidades. Se han revisado de forma retrospectiva los casos diagnosticados microbiológicamente de tuberculosis en el Hospital General Universitario de Elche desde 1999 a 2002. En seis pacientes coexistía neoplasia y tuberculosis. Se diagnosticaron 105 casos de tuberculosis, 6 de los cuales (5,7 por ciento) tenían una neoplasia. Cuatro tuvieron tuberculosis pulmonar, uno pleuropulmonar y otro urinaria. Los dos pacientes con carcinoma broncogénico tuvieron un diagnóstico sincrónico de tuberculosis pulmonar. El diagnóstico de la neoplasia previo al de tuberculosis fue en dos casos (cáncer de mama e hipernefroma), y posterior en otros dos (cáncer de mama y de colon). La mitad de los pacientes fallecieron. En los pacientes con neoplasia la posibilidad de coexistencia de tuberculosis no es despreciable, tanto previo al diagnóstico, concomitantemente, o tras el mismo (AU)

[Appropriate hospitalization in patients with human immunodeficiency virus infection according to the Appropriateness Evaluation Protocol criteria. Factors related to the inappropriateness]. / Adecuación del ingreso hospitalario en pacientes con infección por el virus de la inmunodeficiencia humana según los criterios del Appropriateness Evaluation Protocol. Factores implicados con la inadecuación.

BASIS: To know the factors associated with the inadequate admissions in patients with human immunodeficiency virus (HIV) infection. PATIENTS AND METHODS: The adaptation of 710 hospital admissions of patients with HIV infection through the Appropriateness Evaluation Protocol criteria in two hospitals of the Comunidad Valenciana since 1995 to 1997 was analyzed. RESULTS: One hundred twenty-eight (18%) admissions were considered inadequate. The proportion of inadequate admissions was significantly higher in patients admitted because of constitutional syndrome (OR: 4.12; CI 95%: 2.11-8.05), or because of digestive symptoms (OR: 2.33; CI 95%: 1.46-3.88), and in patients admitted in facilities without day hospital (OR: 2.38; CI 95%: 1.39-3.89). Furthermore, other situations associated with the inappropriateness were the patients with a disease not related to AIDS (OR: 3.13; CI 95%: 1.93-5.08), the patients with oral or esophageal candidiasis (OR: 6.25; CI 95%: 3.08-12.7), the patients with a hospital stay less than 8 days (OR: 2.55; CI 95%: 1.57-4.01), or the patients who no died (OR: 3.61; IC 95%: 1.20-10.82). CONCLUSIONS: The reason for the admission and the availability of a day hospital unit had influence in the inadequate hospital admissions in this study.

[Epidemiology of yeast colonization and oropharyngeal infection other than Candida albicans in patients with HIV infection]. / Epidemiología de la colonización e infección orofaríngea por levaduras diferentes de Candida albicans en los pacientes con infección por el VIH.

BACKGROUND: An increasing frequency of opportunistic fungal infections in immunosuppressed patients in recent years. Concurrent with this finding, it has been noted an increasing use of fluconazole. In addition, non-Candida albicans species (NCAS), most of which are fluconazole-resistant have been increasing isolated. The aim of this study was to investigate the epidemiology of colonization and infection due to NCAS in HIV-infected patients. PATIENTS AND METHODS: A cross sectional study was conducted with HIV-infected patients in different stages, who were attended at two hospitals in Alicante, Spain. We assessed the prevalence and microbiology of oropharyngeal colonization and infection due to Candida spp., and its fluconazole susceptibility patterns. To determine the clinical risk factors for the development of fluconazole resistance, we carried out a case-control study with prevalent cases. RESULTS: We studied 168 strains from 153 patients. NCAS were isolated in 32 (21%) of them, 25 (77%) were colonized, and 5 (26%) had infection due to NCAS. The most common isolate was Candida glabrata (n = 15). MICs were significantly higher for NCAS than for Candida albicans species, with a MIC50 of 16 and 0.25 microgram/ml, respectively, and a MIC90 of 128 micrograms/ml and 8 micrograms/ml (p = 0.0001). The median CD4 cell count in patients with NCAS was 0.06 x 10(9)/l, and 0.19 x 10(9)/l patients with Candida albicans (p = 0.009). Overall, 56% of the patients with NCAS and 41% of the patients with Candida albicans had been treated with fluconazole (p = 0.1). CONCLUSIONS: NCAS are isolated in a high proportion of HIV infected patients. Most of the NCAS have a decreased susceptibility to fluconazole. The only risk factor associated with the acquisition of NCAS in HIV-infected patients is an advanced immunosuppression.