Divertículo gigante de colon sigmoides / Giant diverticulum of the sigmoid colon

El divertículo gigante es una entidad clínica muy poco frecuente, de localización habitual en el colon sigmoides en pacientes mayores de 50 años. Presentamos un caso diagnosticado recientemente en una mujer que se trató de forma conservadora debido a su avanzada edad y alto riesgo quirúrgico (AU)

Giant diverticulum of the sigmoid colon.

The giant colonic diverticulum is a very rare clinical entity usually located in the sigmoid colon of elderly patients. A case of an 87-year-old woman recently treated in our hospital is reported hereinafter. The patient was non-surgically treated due to her advanced age and high surgical risk.

[Interaction of primary and specialized care and the patient in a program for early detection of cancer of the breast]. / Interacción de atención primaria, especializada y paciente en un programa de detección precoz del cáncer de mama.

OBJECTIVE: To describe a method of carrying out an early detection programme (EDP) for breast cancer in a health area, as a coordinated activity between the primary care teams (PCTs) and specialist care. DESIGN: A descriptive, longitudinal study. SETTING: Area II of the Principality of Asturias. This is a predominantly rural and geographically very large area, although it has a high proportion of its population concentrated in several urban nuclei. PARTICIPANTS: The women between 50 and 65 registered as living in the area were chosen: a total of 3548. MEASUREMENTS: The participation, detection and biopsy rates, and the length of delays between different steps in the process were measured. These steps were: performing the mammography, further tests, receipt of the report, referral for treatment if appropriate. MAIN RESULTS: 2562 mammographies were carried out. There was 72.21% reply rate. 14 malign tumours were detected (detection rate 5.46 per 1000). The biopsy rate was 1.25%. The mean delay times were three days from the mammography to the primary care doctor's receiving the report; five days until the results were given to the patient; and 14 days before surgical treatment in case of breast cancer. CONCLUSIONS: The coordination between PCTs and specialist care considerably speeded up the development of the EDP for breast cancer in a large health area with a scattered population. Technically satisfactory results were achieved. The participation of the PC doctor enabled directed anamnesis and physical examination to be available and contributed to greater awareness among the target population.

[Multiple pulmonary nodules as a manifestation of varicella]. / Nódulos pulmonares múltiples como manifestación pulmonar de la varicela.

It is presented the case of pulmonary affectation by varicella in a woman with bronchial asthma. The hemoptysis and the multiple pulmonary nodules presence have been the principal manifestations of this entity. As evolution; to emphasize the of the hemoptysis and the radiological normality.

[Whipple's disease: early diagnosis through articular disease and hyperpigmentation]. / Enfermedad de Whipple: diagnóstico temprano a través de patología articular e hiperpigmentación.

We present a new case of Whipple's disease. The patient have a clinical history of steatorrhea and diarrhea of various years of evolution with hyperpigmentation of skin and mucosae and migratory polyarthralgias with inflammatory sings. The biochemicals analysis for rheumatoid and endocrinological diseases were negatives. A endoscopically yeyunal biopsy was performed and the diagnosis of Whipple's disease was made. We comment this clinical presentation of Whipple's disease with a seronegative inflammatory rheumatological disease. The differential diagnosis with seronegative arthritis was emphasized.

[Truth disclosure to patients diagnosed with cancer]. / Revelación de la verdad a pacientes diagnosticados de cáncer.

OBJECTIVE: To find the sort of information given to cancer patients in PC and the factors which affect the disclosure of the diagnosis. DESIGN: A descriptive crossover study, carried out through a personal interview. SETTING: A county hospital with no oncology service. PATIENTS: All those patients with cancer (histologically confirmed) admitted to the hospital during April and May 1993. MEASUREMENTS AND MAIN RESULTS: Each patient was asked what illness he/she had, who told him/her and where, along with his/her sociodemographic details. Later the date of diagnosis and the site and spread of the tumour were taken from the medical records. Out of 108 patients under study, 8 knew they had cancer, 1 said he/she had a tumour and 11 believed they had "something bad". 7 patients had no information about their illness and 81 gave alternative diagnoses (inflammation, cyst...). Disclosure was more common in the cases of breast cancer, haematological cancer and those diagnosed over 6 months previously. No significant differences regarding the spread of the tumour or the sociodemographic variables were found. CONCLUSIONS: The disclosure of a diagnosis of cancer is the exception, not the rule. Concealment is only abandoned in the case of potentially curable tumours and those which offer a longer life expectancy.