[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.

[Impact of AIDS on admissions and mortality in an Internal Medicine Department (1990-1995)]. / Impacto del SIDA en los ingresos y en la mortalidad de un Servicio de Medicina Interna (1990-1995).

OBJECTIVE: To know and analyze the main causes of death in an Internal Medicine Department (MI), as well as the impact of AIDS on admissions and mortality rate in such a Department. MATERIALS AND METHODS: A total of 275 patients out of the 35,521 attended patients from 1990 to 1995 had positive serology to HIV (HIV+). A total of 1,793 deaths were recorded, 42 of which were attributed to AIDS. Clinical and epidemiologic parameters were studied; also, management parameters associated with death were investigated (particularly, those caused by this disease). RESULTS: The overall mortality rate was 5.04%, where as the mortality rate among HIV+ in patients was 15.27%; the primary causes of death were cardiovascular, tumoral, and respiratory disease by decreasing frequency. AIDS was the first cause of death in patients aged less than 35 years. As for AIDS, the number of admissions on account of this disease had a progressive increase along the study period; the mean age of dead patients (31.6 years) tended to increase in the last few years and to be significantly higher among men (6 years); the mean of hospital stay among HIV+ patients (14.16 days) tended to decrease in the last few years. CONCLUSIONS: AIDS has had a progressive increase and has become the primary cause of hospital death in IM, in patients aged less than 35 years. As the experience with this disease increases, the mean stay of HIV+ patients decreases, although it tends to increase in patients who ultimately die, possibly because of the social changes in the last few years, as disease, and particularly death, is intended to become separated from family home.

[Increase of gamma-glutamyltranspeptidase in patients with compensated hypoalphalipoproteinemia and type IIa dyslipidemias]. / Elevación de gammaglutamiltranspeptidasa en pacientes con hipoalfalipoproteinemia y dislipemias tipo IIa compensadas.

Twenty-one asymptomatic patients presenting isolated elevations of gamma-glutamyltranspeptidase (GGT) were studied over the previous 10 years with all the findings being accidental. No other analytical alterations were demonstrated. Ingestion of alcohol, drugs or another type of toxic substance, diabetes, neurologic disease or neoplasm were discarded. Echography of the liver and the biliary tract was normal. In the first nine patients studied, liver biopsy was performed being normal or with minimum unspecific alterations. In two patients endoscopic retrograde cholangiography was carried out with no alterations being observed. Lipid study was performed in all the patients with alpha hypolipoproteinemia being found in 15 patients, compensated type II lipid profile in 5 and a normal lipid profile in one. To the author's knowledge there have been no reports of this lipid disorder causing elevations in GGT. However, on being the only abnormality found in these patients the authors believe that this may be the cause although the mechanism is unknown.