[Erectile dysfunction: an insufficiently valued problem in Internal Medicine. Study of patients and related medication]. / Disfunción eréctil: un problema poco valorado en Medicina Interna. Estudio de pacientes y medicación relacionada.

INTRODUCTION: Erectile dysfunction (ED) is a common disease and may be due to psychological or organic causes. It might point to a silent disease and its value could not only be in life quality but also directly resolving the health problem laying beneath. The evaluation of ED begins with sexual records and physical examination which have been reported to have a 95 percent sensitivity, and a 50 percent specificity. Additional diagnostic tests are needed to maximize specificity. Sexual impairment in general Internal Medicine patients has not been sufficiently studied yet. PATIENTS AND METHODS: Unselected ambulatory and hospital admitted patients were interviewed during 2003 using the International Index of Erectile Function (IIEF) ad the Sexual Health Interview for Men (SHIM). The cut-off point was 21. RESULTS: A total of 51 male patients were interviewed, middle age was 65 years old (30-88). Of these, 27 denied sexual activity (group I). Middle age in this group was 64 years old. In the 24 patients with sexual activity (group II) middle age was 61 years old. The IIEF score was less than 45 in 11 patients (groups I and II of erectile dysfunction) The SHIM middle score was 26 points. The score was < 21 in 10 patients (41.6%). Concordance between both test was 90.9%. Risk factors included: tobacco (12 patients), alcohol (9), hypertension (8), and diabetes (7) among others. CONCLUSION: Our investigation seems to show that a great number of patients attended by Internists have sexual impairment (41.6%). None of these were under specific therapy nor consulted for this disease. Middle age is lower among patients with sexual activity as compared with the group without sexual activity. This assessment should be included in the medical interview with the aim of prescribing specific therapy to improve patient's quality of life.

Disfunción eréctil: un problema poco valorado en Medicina Interna. Estudio de pacientes y medicación relacionada / Erectile dysfunction: a non sufficiently valued problem in internal medicine. Study of patients and related medication

Introducción: La disfunción eréctil (DE) es habitual y puede estar relacionada con causas psicológicas u orgánicas. La realización de una historia sexual y la exploración física, demuestran una sensibilidad del 95%, y especificidad del 50% en la determinación de la causa de la DE. Se precisan test diagnósticos adicionales para incrementar la especificidad. No hay información disponible sobre las alteraciones en la función sexual en pacientes de Medicina Interna. Pacientes y métodos: Entrevistas a pacientes no seleccionados tanto ambulatorios como hospitalizados aplicando el Índice Internacional de Disfunción Eréctil (IIDE) y la Entrevista de Salud Sexual para Hombres (ESSH) durante el año 2003. Resultados: Se entrevistaron 51 varones de edad media 65 años (30-88). Entre ellos, 27 negaron actividad sexual (grupo I), la edad media en este grupo fue de 64 años. En los 24 pacientes con actividad sexual (grupo II) la edad media fue de 61 años. El IIDE mostró puntuaciones menores de 45 puntos en 11 pacientes (grupos I y II de disfunción eréctil). La puntuación media para el ESSH fue de 26 puntos. La puntuación fue < 21 en 10 pacientes (41,6%). La concordancia entre ambos test fue del 90,9%. Los factores de riesgo incluían: tabaco (12 pacientes), alcohol (9), HTA (8) y DM (7). Conclusión: Parece existir una alta prevalencia de DE entre los pacientes atendidos por Internistas (41,6%). Ninguno de éstos recibía tratamiento por esta enfermedad ni habían consultado nunca por ello. La edad media es inferior en los pacientes que mantienen actividad sexual. Consideramos necesario incluir esta patología en la anamnesis a todo paciente asistido para posibilitar la prescripción de tratamiento que podría mejorar notablemente su calidad de vida

Introduction: Erectile dysfunction (ED) is a common disease and may be due to psychological or organic causes. It might point to a silent disease and its value could not only be in life quality but also directly resolving the health problem laying beneath. The evaluation of ED begins with sexual records and physical examination which have been reported to have a 95 percent sensitivity, and a 50 percent specificity. Additional diagnostic tests are needed to maximize specificity. Sexual impairment in general Internal Medicine patients has not been sufficiently studied yet. Patients and methods: Unselected ambulatory and hospital admitted patients were interviewed during 2003 using the International Index of Erectile Function (IIEF) ad the Sexual Health Interview for Men (SHIM). The cut-off point was 21. Results: A total of 51 male patients were interviewed, middle age was 65 years old (30-88). Of these, 27 denied sexual activity (group I). Middle age in this group was 64 years old. In the 24 patients with sexual activity (group II) middle age was 61 years old. The IIEF score was less than 45 in 11 patients (groups I and II of erectile dysfunction) The SHIM middle score was 26 points. The score was < 21 in 10 patients (41,6%). Concordance between both test was 90.9%. Risk factors included: tobacco (12 patients), alcohol (9), hypertension (8), and diabetes (7) among others. Conclusion: Our investigation seems to show that a great number of patients attended by Internists have sexual impairment (41.6%). None of these were under specific therapy nor consulted for this disease. Middle age is lower among patients with sexual activity as compared with the group without sexual activity. This assessment should be included in the medical interview with the aim of prescribing specific therapy to improve patient’s quality of life

Unidades de Ictus y Medicina Interna / Stroke and Internal Medicine Units

No disponible

[Health impact of 2003 heat wave at Hospital de Riveira (A Coruña)]. / Impacto de la ola de calor de 2003 en el Hospital de Riveira (A Coruña).

OBJECTIVES: Last summer 2003 took place an atmospheric situation considered as a heat wave. Importance of environmental factors in chronic diseases is well known, but few works analyse those of heat excess as we do in this paper. METHODS: We studied the effects of high temperatures on admission and mortality in Riveira, A Coruña, Spain, during the period from July 15th to August 15th 2003. RESULTS: Mean maximum temperature in this period was 26.1 degrees C. One hundred and thirty seven patients were admitted, age ranges between 16 and 93 years old. Sixteen died. Fifty four admissions (38.7%) were identified as related with heat wave and of those patients, 8 died. No heat stroke cases were identified. Main risk factors in our heat related admitted population, were previous lung disease and overweight. CONCLUSION: Heat related pathology is difficult to evaluate although it is quite important. It seems to be necessary to take measures in order to identify population at risk and reduce the effects related to this environmental factor since high risk patients are quite common in our daily practice.

Impacto de la ola de calor de 2003 en el Hospital de Riveira (A Coruña) / Health impact of 2003 heat wave at Hospital de Riveira (A Coruña)

Objetivo: El pasado verano de 2003 se vivió una situación atmosférica considerada como ola de calor. Es conocida la importancia de los factores ambientales sobre enfermos portadores de patologías crónicas, aunque existen pocos trabajos que analicen los derivados del exceso de calor, como los que estudiamos en este documento. Método: Evaluamos el impacto de las altas temperaturas en los ingresos y la mortalidad en el área de Riveira, A Coruña, durante el periodo entre el 15 de julio y el 15 de agosto de 2003. Resultados: La temperatura media máxima en este periodo se fue de 26,1 ºC. Durante este periodo ingresaron 137 pacientes de edades comprendidas entre los 16 y los 93 años. Fallecieron 16 pacientes. Se identificaron 54 casos de ingresos relacionados con efecto del calor (38,7%), con 8 fallecimientos en este grupo. Ningún caso pudo atribuirse a golpe de calor. Los principales factores de riesgo identificados en los ingresados por efecto del calor, fueron patología pulmonar previa y obesidad. Conclusión: Si bien los efectos del calor son difíciles de evaluar, su importancia es clara. Es necesario adoptar medidas para identificar la población de riesgo y reducir los efectos por este fenómeno atmosférico dado que los pacientes de riesgo son altamente prevalentes en nuestra práctica diaria

Objectives: Last summer 2003 took place an atmospheric situation considered as a heat wave. Importance of environmental factors in chronic diseases is well known, but few works analyse those of heat excess as we do in this paper. Methods: We studied the effects of high temperatures on admission and mortality in Riveira, A Coruña, Spain, during the period from July 15th to august 15th 2003. Results: Mean maximum temperature in this period was 26.1 ºC. One hundred and thirty seven patients were admitted, age ranges between 16 and 93 years old. Sixteen died. Fifty four admissions (38, 7%) were identified as related with heat wave and of those patients, 8 died. No heat stroke cases were identified. Main risk factors in our heat related admitted population, were previous lung disease and overweight. Conclusion: Heat related pathology is difficult to evaluate although it is quite important. It seems to be necessary to take measures in order to identify population at risk and reduce the effects related to this environmental factor since high risk patients are quite common in our daily practice

Liver disease in heavy drinkers with and without alcohol withdrawal syndrome.

BACKGROUND: Withdrawal syndrome is a hallmark of alcohol dependence. The characteristics of alcohol consumption, closely related to dependence, could influence the development of alcoholic liver disease. The study aimed to investigate if patients with severe alcohol withdrawal syndrome have a peculiar profile of liver disease. METHODS: The study included 256 heavy drinkers (aged 19-75 years, 70.3% males) admitted to an Internal Medicine Department. Patients admitted for complications of liver disease were not included. Severe alcohol withdrawal syndrome (seizures, disordered perceptions, or delirium) developed in 150 patients (58.6%). Alcohol consumption (daily quantity, duration, and pattern [regular or irregular]) was assessed by questionnaire. Liver biopsy was performed in all cases. RESULTS: Patients with alcohol withdrawal syndrome showed a lower prevalence of liver cirrhosis and a higher prevalence of alcoholic hepatitis than patients without it. The negative association of alcohol withdrawal syndrome with liver cirrhosis persisted after we adjusted for sex, daily intake, duration, and pattern of alcohol consumption. Alcoholic hepatitis was independently associated with the irregular pattern of alcohol consumption, which was closely associated with severe alcohol withdrawal syndrome. CONCLUSIONS: The profile of liver injury is different in heavy drinkers who develop and who do not develop a severe alcohol withdrawal syndrome when admitted to the hospital.

Miositis de cuerpos de inclusión con comienzo respiratorio / Inclusion body myositis with respiratory onset

No disponible

Tomografía axial computarizada toracoabdominal

No disponible

Mixed cryoglobulinaemia and B-cell lymphoma in the absence of hepatitis C virus infection.

Literary data favouring hepatitis C virus infection as an important aetiological agent in mixed cryoglobulinaemia and mixed cryoglobulinaemia-associated lymphoma have been reported. Hepatitis C virus infection does not explain, however, all cases. A case of hepatitic C negative mixed cryoglobulinaemia with B-cell lymphoma is presented and the possible role of hepatitis C virus in the aetiology of lymphoproliferative disorders and the geographical differences reported in the literature are discussed.

Simple adnexal cysts in postmenopausal women: conservative management.

OBJECTIVE: To evaluate the expectant management of asymptomatic small, anechoic, simple ovarian cysts diagnosed by echography in postmenopausal women. To gain insight in the natural history of these cysts. METHOD: Thirty six postmenopausal women with asymptomatic ovarian cysts (from 1.5 to 5.0 cm) diagnosed by ultrasonography and with a CA 125 serum level within the normal range and a non-suspicious color Doppler were followed conservatively. Visits were scheduled at 8-10 weeks of the diagnosis, at 6-month intervals twice and annually thereafter. RESULTS: The follow-up period extended from 4 to 70 months with an average of 31.5 months. There were no cases of cyst enlargement. The cysts remained unchanged in 29 cases (80.5%), decreased in size in four cases (11.1%) and disappeared in three cases (8.3%). CONCLUSION: We think that the possibility of malignant transformation of one of these cysts is remote and the benefits of conservative management greatly outweighs its risks.

[Tuberculosis and HIV infection. Clinical characteristics and diagnosis]. / Tuberculosis e infección por el virus de la inmunodeficiencia humana. Presentación clínica y diagnóstico.

OBJECTIVE: To analyze the clinical characteristics and diagnose of tuberculosis in patients infected by human immunodeficiency virus in our setting. METHODS: We have revised the clinical, microbiological and histological characteristics of 92 cases diagnosed tuberculosis in seropositive patients, during a span time of 128 months. RESULTS: Of them, 71 were male and most of them (81.5%) were intravenous drugs users. The most (93.4%) were sintomatic when tuberculosis was diagnosed mainly fever and general and respiratory sintomatology. The most common signs were the presence of lymphadenopathies and hepatomegaly. The tuberculosis affected mainly pulmonary and ganglionary system. 34 cases had only pulmonary pathology, 24 extrapulmonary, 25 pulmonary and extrapulmonary and 9 miliary. The tuberculosis diagnose was based in microbiologic criteris. The most frequent source, as histologic critery, has been the ganglionary tissue. CONCLUSIONS: The only or associated pulmonary forms are more frequent. The most commonly extrapulmonary form is the ganglionary localization. The most of diagnose methods were obtained from respiratory tract and lymphadenopathy samples.

[Cerebrovascular disease and associated risk factors]. / Enfermedad cerebrovascular y factores de riesgo asociados.

In this report we are analysing the clinical history of 193 patients who were admitted to our medical department due to stroke during a period of two years. The patients were divided into two groups depending on wether they had ischemic or hemorrhagic pathology, analysing the presence of vascular risk factors in both groups. From the obtained results we have to point out, in both groups of patients, hypertension together with mellitus diabetes, giving clear proof of this, being the most frequent association of risk factors. We also have to point out the low percentage of patients with a lack of all the analysed risk factors, being also, that the average age was notably superior than the global.