Hemosuccus pancreaticus. A propósito de un caso / Hemosuccus pancreaticus. A case report

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Nodular regenerative hyperplasia of the liver and cutaneous T-cell lymphoma: an unreported association.

Nodular regenerative hyperplasia of the liver -a type of noncirrhotic portal hypertension- is a rare condition of unknown etiopathogenesis that has been associated with multiple disorders, including diverse types of hematologic disease. We report the case of a 36-year-old female patient diagnosed with cutaneous T-cell lymphoma of the mycosis fungoides variety, staged as T2N0M0B0, where a transjugular liver biopsy demonstrated the presence of nodular regenerative hyperplasia with a hepatic venous pressure gradient of 15 mm Hg. The study was triggered by the incidental radiologic finding of hepatomegaly with indirect evidence of portal hypertension. We are not aware of any previous reports on the association of nodular regenerative hyperplasia with mycosis fungoides in the medical literature.

Beneficio de la instauración de guardias de neurología de presencia física en un hospital general / Benefit of the implementation of on-call neurology physicians in a general hospital

Introducción. En la mayoría de hospitales españoles no existe neurólogo de guardia (NG). Hemos realizado este trabajo para intentar demostrar el beneficio que aporta esta figura a la asistencia sanitaria. Métodos. Estudio prospectivo realizado en el Complejo Hospitalario Universitario de Albacete que recoge datos sobre el primer año de funcionamiento de las guardias de neurología (2004). Comparamos además el número de ingresos de patología cerebrovascular aguda (PCVA) de ese año con respecto a 2003. Resultados. El NG valoró a 2.745 pacientes (7,6 por día). El 73,1% de las llamadas provinieron de urgencias y en el rango horario de 15 a 22 h. La PCVA fue la patología más atendida y se recibieron 118 avisos para valorar trombólisis. Se realizaron 323 estudios de neurosonología de forma urgente. De los pacientes vistos en urgencias, el 45,7% fueron ingresados y el 30,1% remitidos a consultas de neurología. Se produjo una disminución significativa de ingresos de pacientes con infarto cerebral en 2004 respecto a 2003 (12,3% menos) pese a un aumento del número de pacientes con PCVA ingresados en neurología en detrimento de los que lo hicieron en otros servicios. La estancia hospitalaria media de los pacientes con PCVA fue menor en neurología que en medicina interna. Conclusiones. El NG aporta mayor calidad asistencial, reduce ingresos hospitalarios innecesarios y potencia el servicio de neurología. Es necesaria la instauración de guardias de neurología de presencia física durante 24 h en todos aquellos centros que presten atención a enfermos urgentes y dispongan de servicios de neurología

Introduction. Most Spanish hospitals have no oncall neurologist (OCN) for emergency patients. This study was designed to highlight the benefits in patient management when an OCN system is implemented. Methods. We conducted a prospective study in the University Hospital of Albacete during the first year of OCN implementation (2004). We also compared stroke patients admissions from emergency department (ED) in 2004 with respect to 2003. Findings. OCN attended 2,745 patients (7.6 per day), 73.1% of these calls coming from ED between 3 PM and 10 PM. Acute stroke was the most frequent consultation. A total of 118 calls were made to determine the need for thrombolytic therapy and 323 emergency neurosonologic examinations were performed by the OCN during the duty. A total of 44.8% of the attended patients were admitted and 30.1% were referred to outpatient clinics. Our hospital had a significant decrease (12.3%) in stroke patients admissions over 2004 compared with 2003 despite an actual increase of total admissions in the neurological ward. The mean hospital stay of stroke patients was shorter in the neurology department than in the internal medicine one. Conclusions. OCN improves the quality of attention to the neurological patient, reduces the number of unnecessary hospital admissions and increases the status of the neurological department. Implementation of on-call neurology physicians for 24 hours is necessary in all those sites that provide care to emergency patients and have neurology services

[Benefit of the implementation of on-call neurology physicians in a general hospital]. / Beneficio de la instauración de guardias de neurología de presencia física en un hospital general.

INTRODUCTION: Most Spanish hospitals have no oncall neurologist (OCN) for emergency patients. This study was designed to highlight the benefits in patient management when an OCN system is implemented. METHODS: We conducted a prospective study in the University Hospital of Albacete during the first year of OCN implementation (2004). We also compared stroke patients admissions from emergency department (ED) in 2004 with respect to 2003. FINDINGS: OCN attended 2,745 patients (7.6 per day), 73.1% of these calls coming from ED between 3 PM and 10 PM. Acute stroke was the most frequent consultation. A total of 118 calls were made to determine the need for thrombolytic therapy and 323 emergency neurosonologic examinations were performed by the OCN during the duty. A total of 44.8% of the attended patients were admitted and 30.1% were referred to outpatient clinics. Our hospital had a significant decrease (12.3%) in stroke patients admissions over 2004 compared with 2003 despite an actual increase of total admissions in the neurological ward. The mean hospital stay of stroke patients was shorter in the neurology department than in the internal medicine one. CONCLUSIONS: OCN improves the quality of attention to the neurological patient, reduces the number of unnecessary hospital admissions and increases the status of the neurological department. Implementation of on-call neurology physicians for 24 hours is necessary in all those sites that provide care to emergency patients and have neurology services.

First year clinical experience with six levonorgestrel rods as subdermal contraception.

Previous clinical experience with six levonorgestrel subdermal capsules showed a very good contraceptive effectiveness and continuation rate, but with a high proportion of bleeding disturbances, particularly of increased bleeding. It was hypothesized that bleeding could be reduced by higher plasma levels of the steroid, using subdermal rods instead of capsules, as rods have been shown to have a release rate 3 or 4 times that of the capsules. Fifty volunteers were enrolled in a study of the clinical performance of 6 subdermal levonorgestrel rods. Results were compared with a previous experience with 100 volunteers who wore 6 levonorgestrel capsules for a year in the same clinic. Requirement for volunteers to enter the study were the same for capsules and rods. The proportion of women wearing 6 subdermal rods who had increased bleeding was about one half as for the women using 6 levonorgestrel capsules. On the other hand, women using rods had about twice the incidence of amenhorrea, and about four times more hypomenorrhea (4 days or less of bleeding in a 90-day period). There were no pregnancies among the rod users and the discontinuation rate for medical reasons was not higher than for capsule users in the same clinic.

PIP: Because subdermal implants of levonorgestrel (NG) were shown in previous trials to be effective contraceptives but bleeding irregularities limited acceptability, it was hypothesized that bleeding could be reduced by higher plasma levels of the steroid, which was accomplished by using subdermal rods instead of capsules, since rods have been shown to have a release rate 3 or 4 times that of capsules. 50 volunteers were recruited and enrolled in the study of clinical performance of 6 subdermal NG rods. Results were compared with a previous experience with 100 volunteers who wore 6 NG capsules for 1 year in the same clinic. The proportion of women wearing 6 subdermal rods who had increased bleeding (the main bleeding complaint with the NG capsules) was about 1/2 as for the NG capsule study. However, women using rods had 2 times the incidence of amenorrhea, and 4 times more hypomenorrhea (4 days or less of bleeding in a 90-day period). No pregnancies were recorded among rod users, and discontinuation for medical reasons was no higher than for capsule users in the same clinic. Rod removal was laborious and difficult compared with capsule removal.