Masquerade syndrome: An eye problem as a manifestation of a more sinister disease. / Síndrome de mascarada: un problema ocular como manifestación de un mal mayor.

A middle-aged man with cardiovascular risk factors, who suffered from a slight loss of unilateral vision for 6 months. After obtaining a diagnosis of diffuse choroiditis+papillitis within a probable masquerade syndrome, the patient was referred to outpatient Internal Medicine where this diagnosis was confirmed as an extended neoplastic disease.

Influence of admission blood pressure on mortality in patients with acute decompensated heart failure.

OBJECTIVES: To determine the relationship between admission blood pressure (BP) and prognosis in patients hospitalized for acute decompensated heart failure (HF). BACKGROUND: The relationship between BP admission blood pressure and outcomes in decompensated HF is controversial. It has been suggested that this presentation may be a specific disorder, but their mechanisms and clinical relationships are poorly defined. METHODS: We evaluated the association between initial BP (systolic, diastolic and mean BP) with readmission and mortality, as well as potential interactions with age, clinical characteristics, renal function, left ventricular dysfunction, comorbidities and treatment. By using Cox regression models the association between each outcome and BP was tested. RESULTS: A total of 581 patients (77.5-years-old, range 51-100) were included. At admission, mean BP in quartiles was 77.09 mm Hg (53.3-85.0) (Q1); 91.46 mm Hg (85.0-96.7) (Q2); 103.41 mm Hg (96.7-109.9) (Q3) and 124.79 mm Hg (109.9-209.0) (Q4). Median duration of follow-up was 8 months [95% confidence interval (CI) 5.2-11.1]. Mortality was 15.5% (Q1), 9.2% (Q2), 12.6% (Q3) and 7.3% (Q4). Interquartile hazard ratio (95% CIs) for mortality was 0.40 (0.19-0.85) P=0.017. Body mass index (BMI) was higher in Q4 29.59 k/m2 than in Q1 28.25 k/m2 (P=0.018). There were no differences in age, clinical antecedents, renal function, comorbidities or severity of HF between groups. CONCLUSION: Higher mean BP at admission is associated with significantly lower mortality during follow-up, in patients hospitalized for HF. With the exception of BMI, positively correlated with blood pressure, this relationship is independent of other clinical factors and medications.

Bloqueo aurículo-ventricular completo como signo de afección cardíaca en paciente con esclerodermia / Complete atrioventricular block as sign of cardiac involvement in patient with scleroderma

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Favismo: una entidad a tener en cuenta en la zona mediterránea / Favism: a disease to keep in mind in the Mediterranean area

Se denomina favismo a la hemólisis aguda que se desarrolla tras la ingestión de habas o el polen de estas1. Los síntomas se desarrollan horas después de la ingestión, siendo comunes las náuseas, vómitos, malestar y vértigo. A estos síntomas le sigue una hemólisis. El favismo en el área mediterránea se debe a una variante de la glucosa-6-fosfato deshidrogenasa (G6PDH)1. Para su diagnóstico es fundamental una completa anamnesis, exploración física y la determinación de la actividad enzimática para la G6PDH. Los pacientes deben ser educados con unos consejos dietéticos y deben conocer la posibilidad de crisis hemolíticas agudas ante determinadas infecciones y exposición a determinados fármacos o tóxicos

Favism is called acute hemolysis that has developed after intake of fava beans or their pollen1. The symptoms develop hours after intake. The common symptoms are nausea, vomits, malaise and vertigo. Hemolysis follows these symptoms. Favism in the Mediterranean area is due to a variant of glucose-6-phosphate-dehydrogenase (G6PDH)1. A complete anamnesis, physical examination and measurement of enzyme activity for G6PDH are essential for its diagnosis. The patients should be educated with dietary advise and should know the possibility of acute hemolytic episodes when there are certain infections and exposure to certain drugs or toxics

Dolicoectasia basilar e ictus de repetición: dos nuevos casos / Basilar dolichoectasia and repeated strokes: two new cases

Introducción. La dolicoectasia vertebrobasilar (DEB) se define como la elongación, dilatación y tortuosidad de las arterias de la circulación cerebral posterior. La prevalencia es baja, al igual que la incidencia de ictus secundarios. El tratamiento es controvertido. Las manifestaciones clínicas dependen del territorio vascular afectado, tamaño del aneurisma y compresión de las estructuras adyacentes. Se manifiesta habitualmente por cuadros isquémicos focales del territorio posterior. Los avances en las técnicas de neuroimagen y su extensión a hospitales de nivel básico han incrementado el diagnóstico de DEB. Caso clínico. Presentamos dos casos de DEB manifestada como ictus de repetición. Se optó por el tratamiento antiagregante como opción terapéutica por motivos clínicos y sociales. Conclusión. La DEB es una rara entidad que se manifiesta más frecuentemente como cuadros isquémicos en personas de edad avanzada. La antiagregación plaquetaria puede ser una opción válida en estos pacientes

Introducction. Dolichoectasia vertebrobasilar (DEB) is defined as dilatation and winding of posterior brain circulation. The prevalence is low, as the same as incidence of secondary strokes. The treatment is controversial. The clinical manifestation depend on the vascular territory involved, aneurysm size and compression of adjacent structures. Often it is presented as strokes of vertebrobasilar territory. Advance in neuroimaging technique and the access to primary hospital have increased the diagnostic of DEB. Clinical cases. We report two cases of DEB its present as repeated strokes. Platelet antiagregation was select in basis to social and clinical reason. Conclusion. DEB is a rare entity. Frequently it present as strokes in elderly patients. Platelet antiagregation can be a reasonable therapeutic option

[Venous thromboembolic disease in a rural area of Southern Extremadura (Spain)]. / Enfermedad tromboembólica venosa en un área ruraldel sur de Extremadura (España).

OBJECTIVE: To study the characteristics of the venous thromboembolic disease (VTD) in a rural area of Southern Extremadura (Spain). MATERIAL AND METHODS: Prospective observational study of all patients diagnosed by objective methods of VTD in the only hospital in our area from November 2002 to November 2004. RESULTS: Seventy-six patients were diagnosed of VTD: 35 (46.1%) with pulmonary thromboembolism and 41 (53.9%) with isolated deep vein thrombosis (DVT). The median age was 72.4 years (range 35-94 years), 51 (67.1%) were older than 70 years, and 43 (56.6%) were women. The annual incidence of VTD was 0.63 per 1,000 persons (0.74 per 1,000 persons in women and 0.54 per 1,000 persons in men). Thirty-seven patients (48.7%) had "idiopathic" VTD. After a median follow-up of 5.5 months with anticoagulant therapy, 13 patients (17.1%) had dead. Comorbidity and non "idiopathic" VTD were significantly more frequent in the dead patients. Three patients (3.9%) presented probable recurrence, and all of them died. There were 4 cases (5.3%) of non-fatal severe hemorrhage. Nine patients with isolated DVT did not require hospitalization, and there was no event in the follow-up. CONCLUSIONS: The incidence of VTD may be lower in our area than in other geographical areas. VTD affects more frequently to elderly and women, and almost half of cases are "idiopathic". The mortality is high, and it is related to the existence of comorbidity and non "idiopathic" VTD. The recurrences and the severe hemorrhages are not exceptional during the anticoagulant therapy. The ambulatory treatment of isolated DVT may be an option in selected patients.

Enfermedad tromboembólica venosa en un área rural del sur de Extremadura (España) / Venous thromboembolic disease in a rural area of southern Extremadura (Spain)

Objetivo: Estudiar las características de la enfermedad tromboembólica venosa (ETV) en un área rural del sur de Extremadura (España).Material y métodos: Estudio observacional prospectivo de todos los pacientes diagnosticados mediante métodos objetivos de ETV en el único hospital de nuestro área entre noviembre de 2002 y noviembre de 2004. Resultados: Se diagnosticaron 76 casos de ETV: 35 (46,1%) con tromboembolismo pulmonar (TEP) y 41 (53,9%) con trombosis venosa profunda (TVP) aislada. La edad media fue 72,4 años (rango 35-94 años), 51 (67,1%) tuvieron más de 70 años, y 43 (56,6%) fueron mujeres. La incidencia anual de ETV fue de 0,63 por 1.000 habitantes (0,74 por 1.000 habitantes en mujeres y 0,54 por 1.000 habitantes en hombres).Treinta y siete pacientes (48,7%) presentaron ETV “idiopática”. Tras un seguimiento medio de 5,5 meses con tratamiento anticoagulante, 13 pacientes (17,1%) habían fallecido. La existencia de comorbilidad y ETV no “idiopática” fueron significativamente más frecuentes en los pacientes fallecidos. Tres pacientes (3,9%) tuvieron una probable recidiva, y todos fallecieron. Hubo 4 casos (5,3%) de hemorragia grave no fatal. Nueve pacientes con TVP aislada no precisaron ingreso hospitalario, y no hubo ningún evento en el seguimiento. Conclusiones: La incidencia de ETV puede ser menor en nuestro área que en otras zonas geográficas. La ETV afecta más frecuentemente a ancianos y a mujeres, y casi la mitad de los casos son “idiopáticos”. La mortalidad es elevada, y se relaciona con la existencia de comorbilidad y ETV no“idiopática”. Las recidivas y las hemorragias graves no son excepcionales durante el tratamiento anticoagulante. El tratamiento ambulatorio de la TVP aislada puede ser una opción en pacientes seleccionados

Objective: To study the characteristics of the venous thromboembolic disease (VTD) in a rural area of Southern Extremadura (Spain). Material and methods: Prospective observational study of all patients diagnosed by objective methods of VTD in the only hospital in our area from November 2002 to November 2004. Results: Seventy-six patients were diagnosed of VTD: 35 (46.1%) with pulmonary thromboembolism and 41 (53.9%) with isolated deep vein thrombosis (DVT). The median age was 72.4 years (range 35-94 years), 51 (67.1%) were older than 70 years, and 43 (56.6%) were women. The annual incidence of VTD was 0.63 per 1,000 persons (0.74 per 1,000 persons in women and 0.54 per 1,000 persons in men). Thirtyseven patients (48.7%) had “idiopathic” VTD. After a median follow-up of 5.5 months with anticoagulant therapy, 13 patients (17.1%) had dead. Comorbidity and non “idiopathic” VTD were significantly more frequent in the dead patients. Three patients (3.9%) presented probable recurrence, and all of them died. There were 4 cases (5.3%) of non-fatal severe hemorrhage. Nine patients with isolated DVT did not require hospitalization, and there was no event in the follow-up. Conclusions: The incidence of VTD may be lower in our area than in other geographical areas. VTD affects more frequently to elderly and women, and almost half of cases are “idiopathic”. The mortality is high, and it is related to the existence of comorbidity and non “idiopathic” VTD. The recurrences and the severe hemorrhages are not exceptional during the anticoagulant therapy. The ambulatory treatment of isolated DVT may be an option in selected patients

Disección de aorta: a propósito de dos casos / Aortic disection: two cases review

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Alopecia aguda asociada a empiema por actinomices / Acute alopecia associated to empyema caused by actinomyces

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Aplasia pulmonar: un hallazgo infrecuente en adultos / Pulmonary hypoplasia: an infrecuent disease in adults

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Hipertensión arterial con alta variabilidad / Arterial hypertension with high variation

La hipertensión arterial esencial es la entidad que el clínico trata con más frecuencia en la práctica diaria.Los pacientes con gran variabilidad de la presión arterial (PA) representan un problema terapéutico y, con mayor frecuencia aún, un enigma diagnóstico. Se presenta un caso de enferma con crisis hipertensivas severas seguidas de baches hipotensivos en la cual, tras comprobarse la elevada variabilidad de su PA mediante medición ambulatoria de la presión arterial, se descubrió en el estudio posterior la existencia de una trombosis del seno transverso (AU)

[Antineutrophil cytoplasmic antibodies (ANCA): clinico-pathologic correlations iin a series of 82 cases]. / Anticuerpos frente al citoplasma de los neutrófilos (ANCA): correlaciones clínico-patológicas de una serie de 82 casos.

OBJECTIVE: Antineutrophil cytoplasmic antibodies (ANCA) have been described in a great variety of diseases in addition to the ANCA-associated systemic vasculitis (Wegener's granulomatosis (WG), microscopic polyangiitis (MPA) and Churg-Strauss syndrome (CSS)) and the pauci-immune rapidly progressive glomerulonephritis (RPGN). The objective of this work is to describe the clinical-pathological diagnosis of a series of patients with ANCA. MATERIAL AND METHODS: Retrospective review of patients with positive ANCA by indirect immunofluorescence in our hospital between January 1997 and December 1998. RESULTS: We identify 82 patients with ANCA. Six cases (7.3%) showed a C-ANCA pattern, 19 (23.2%) a P-ANCA pattern and 57 (69.5%) an atypical pattern. Eight patients (9.7%) had an ANCA-associated systemic vasculitis (5 WG, 2 MPA and 1 SCS). Four patients (4.9%) had a pauci-immune RPGN without systemic vasculitis. One only case (1.2%) in our series presented a C-ANCA pattern without evidence of an ANCA-associated systemic vasculitis or a pauci-immune RPGN. CONCLUSIONS: The atypical pattern is the most frequent in patients with ANCA. A minority of patients with ANCA have an ANCA-associated systemic vasculitis (WG, MPA or SCS) or a pauci-immune RPGN. The occurrence of a C-ANCA pattern is exceptional in patients without an ANCA-associated systemic vasculitis or a pauci-immune RPGN.

Epidemiología de los tumores broncopulmonares en un área sanitaria de Extremadura (suroeste de Extremadura) / Epidemiology of bronchopulmonary tumors in a sanitary of Extremadura (southwest of Extremadura)

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Anticuerpos frente al citoplasma de los neutrófilos (ANCA): correlaciones clínico-patológicas de una serie de 82 casos / Antineutrophil cytoplasmic antibodies (ANCA): clinical-pathological correlates of a serie of 82 cases

Objetivo: Los anticuerpos frente al citoplasma de los neutrófilos (ANCA) se han descrito en una gran variedad de entidades además de en las vasculitis asociadas a ANCA [granulomatosis de Wegener (GW), poliangeítis microscópica (PAM) y síndrome de Churg-Strauss (SCS)] y en la glomerulonefritis rápidamente progresiva (GNRP) pauci-inmune.El objetivo de este trabajo es decribir los diagnósticos clínico-histológicos de una serie de pacientes con ANCA.Material y métodos: Revisión retrospectiva de los pacientes con positividad para los ANCA mediante inmunofluorescencia indirecta en nuestro hospital entre enero de 1997 y diciembre de 1998.Resultados: Identificamos 82 pacientes con ANCA. Seis casos (7,3 por ciento) presentaron un patrón C-ANCA, 19 (23,2 por ciento) un patrón P-ANCA y 57 (69,5 por ciento) un patrón atípico. Ocho pacientes (9,7 por ciento) tuvieron una vasculitis asociada a ANCA (5 GW, 2 PAM y 1 SCS). Cuatro pacientes (4,9 por ciento) tuvieron una GNRP pauci-inmune sin vasculitis sistémica. Un único caso (1,2 por ciento) en nuestra serie presentó un patrón C-ANCA sin evidencia de vasculitis asociada a ANCA o GNRP pauci-inmune.Conclusiones: El patrón atípico es el más frecuente en pacientes con ANCA. Una minoría de pacientes con ANCA tiene una vasculitis asociada a ANCA (GW, PAM o SCS) o una GNRP pauci-inmune. La presencia de un patrón C-ANCA es excepcional en pacientes sin vasculitis asociada a ANCA o GNRP pauci-inmune. (AU)