[May-Thurner syndrome, diagnosis and treatment: a case report]. / Síndrome de May-Thurner, diagnóstico y tratamiento: a propósito de un caso.

According to scientific evidence, deep venous thrombosis (DVT) is treated with anticoagulation therapy, involving different periods of time depending on the cause. Occasionally, recurrences appear in the same location, with May-Thurner syndrome or Cockett syndrome as one reason, due to compression of the ilio-cava venous system between the vertebral bodies and the arterial system. In these cases, anticoagulation therapy must be maintained during the same time as in the rest of DVT, but as opposed to them, thrombectomy is recommended, with or without the implant of a venous stent in order to avoid recurrence. There is no consensus in the literature regarding the indication of antiaggregation therapy after the anticoagulation therapy period. We present a case of May-Thurner syndrome treated with thrombectomy and the implant of a venous stent, which yielded an optimum management of the disease.

Disfunción ventricular transitoria o síndrome de Tako-Tsubo. A Propósito de un caso / Transient ventricular dysfunction or Tako-Tsubo syndrome. Report of a case

El síndrome de Tako-Tsubo, o disfunción ventricular transitoria, es una entidad que se caracteriza por ser clínicamente indistinguible del síndrome coronario agudo, con elevación enzimática y extensa acinesia anterior, pero sin alteraciones significativas en las arterias coronarias y con recuperación de las alteraciones segmentarias en las semanas siguientes. Presentamos el caso de un paciente ingresado en nuestro servicio que cumplía las características diagnósticas de este síndrome (AU)

The Tako-Tsubo syndrome, or transient ventricular dysfunction, is a clinical entity that is characterised by being clinically indistinguishable from acute coronary syndrome, with increased enzyme levels and extensive anterior akynesia, but without significant changes in the coronary arteries and with recovery of the segmental changes within the few ensuing weeks. We report the case of a patient admitted to our Service who fulfilled the diagnostic features for this condition (AU)

Bronquiolitis obliterante con neumonía organizativa y Coxiella burnetii / Bronquiolitis obliterans with organising pneumonia and Coxiella burnetii

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Asymptomatic gastroduodenal anisakiasis as the cause of anaphylaxis.

A great number of parasites have been reported in fish, but only a few of them are capable of infecting human beings. Anisakiasis or anisakidosis is caused by sea nematodes of the genus Anisakis, with the main implicated species being Anisakis simplex. Infection with Anisakis causes a wide spectrum of clinical manifestations, ranging from symptoms related to the upper and occasionally lower digestive tract to allergic manifestations, mainly urticaria and anaphylaxis. We report a case of asymptomatic gastroduodenal anisakiasis presenting as severe anaphylaxis.

[Drug prescription in internal medicine: an analysis of the influencing factors]. / Prescripción de medicamentos en medicina interna: análisis de los factores de influencia.

BACKGROUND: The amount and quality of drugs prescribed after hospitalization in Internal Medicine and the factors which influence them have been rarely evaluated in Spain. MATERIAL AND METHODS: We study prospectively drugs prescribed in patients hospitalized in Internal Medicine analyzing amount of drugs before admission (BAD), on discharge (DD), end drugs after temporal drugs were removed (ED), drugs prescribed as chronic treatment (CTD), symptomatic drugs (SD), acute-use drugs (AUD) and low therapeutic utility drugs (LTUD). We also evaluated the sort of drugs and the factors implicated in increase or decrease of prescription volume. RESULTS: Two hundred and eighty-five patients were evaluated [164 males, 121 females, mean age 68.08 (SD 15.27)]. They had mean BAD 3.42(SD 2.67)7 DD 3.92 (SD 2.36) (p < 0.001) and ED 3.65 (SD 2.30) (No differences with BAD). The amount of drugs were higher in patients 65 years old and elder (p < 0.001). LTUD were decreased from 62(22%) patients on admission to 21 (7%) on discharge (p < 0.001). Compounded drugs were reduced from 36 (13%) patients to 17 (6%) (p < 0.05). Age older 65, length of stay greater 7 days, need for intravenous administration of drugs, comorbidities and complications during hospitalization all caused increase in prescription volume on discharge. Logistic-regression analysis showed that CTD and AUD were the main causes of increase of drugs while BAD and LTUD were protective. Drugs reduced in higher proportion were mucolytics (p < 0.005) drugs to treat plant-based hyperplasia benign of prostate (p < 0.05), brain vasodilators (p < 0.001) and peripheral vasodilators (p < 0.01). CONCLUSIONS: Hospitalization in Internal Medicine results in an increase of prescription volume though it is short-term. The higher number of drugs is accumulated in elderly. Factors implicated in increasing are length of stay, need for intravascular access, complications during inpatient, drugs to treat acute diseases and chronic use drugs. Low therapeutic utility drugs are used before admission in outpatients.

Prescripción de medicamentos en Medicina Interna: análisis de los factores de influencia / Drug prescription in internal medicine: analyzing its factors of influence

Fundamento: La cantidad y calidad de los medicamentos prescritos tras la hospitalización en M. Interna y los factores de influencia se ha evaluado en escasas ocasiones. Material y Métodos: Estudio prospectivo de fármacos (F) en pacientes hospitalizados en M. Interna analizando número de F preingreso, al alta, definitivos, F de uso crónico, sintomáticos, de proceso agudo y F de baja utilidad terapéutica y análisis cuantitativo y cualitativo de incremento-reducción de F. Resultados: Analizamos la prescripción de 285 pacientes [(164 varones, 121 mujeres), edad media 68,08 (DE 15,27)]. El número de F preingreso era 3,42 (DE2,67), al alta 3,92 (DE2,36) (p<0,001) y F definitivos una vez retirados F temporales 3,65 (DE2,30) (Sin significación). En los tres apartados el número era mayor en pacientes mayores de 65 años (p<0.001).Los F de baja utilidad terapéutica se redujeron de 62 (22 %) pacientes preingreso a 21(7 %) al alta (p<0,001) y F en asociación de 36 (13 %) pacientes a 17(6 %) (p<0.05). Condicionaron incremento en el volumen de prescripción al alta la edad mayor de 65 años, la estancia media más larga de 7 días, la necesidad de venoclisis, las comorbilidades y la ocurrencia de complicaciones durante la hospitalización. En regresión logística causaron incremento los F de uso crónico y los F para tratar el proceso agudo, sin embargo el mayor volumen de F preingreso y los F de baja utilidad terapéutica fueron factores protectores. Los F con mayor reducción fueron mucolíticos (p<0,005), fitoterapia prostática (p<0,05), vasodilatadores cerebrales (p<0,001) y vasodilatadores periféricos (p<0,01). Conclusiones: El efecto de la hospitalización en M.lnterna es el incremento de fármacos sobre todo por F para tratar el proceso agudo, aunque el tratamiento definitivo no implica cambios en el volumen de prescripción. El mayor número de F se da en pacientes mayores de 65 años. Factores implicados en el incremento de F son la longitud de la estancia media, la necesidad de acceso intravascular, la ocurrencia de complicaciones y los F de uso crónico, y factores protectores son el mayor volumen de F preingreso y los F de baja utilidad terapéutica. Los F en asociación y de baja utilidad terapéutica se utilizan más en el medio ambulatorio (AU)

[Etiological study and diagnosis of anemia in adults over 60 years of age]. / Estudio etiológico y diagnóstico de anemias en adultos de mayores de 60 años.

PURPOSE: Anaemia especially iron deficiency anaemia (IDA) is a worldwide health problem and the most frequent nutritional lack in developing countries. The epidemiology of anaemia in hospitalized patients in Internal Wards is not well-known. PATIENTS AND METHODS: On a retrospective basis we studied 105 patients with haemoglobin levels below 115 g/L. Symptoms, type of anaemia, causing disease, diagnostic procedures, pathologic findings and transfusional schedule were analyzed. RESULTS: Mean haemoglobin was 77.8 (SD 17.9) g/L. Anaemia degree was deeper in women (p < 0.05) and IDA comparatively with chronic disease (CDA) (p < 0.01) and it did not show relation with therapeutic agents which potentially induce anaemia. IDA was the most frequent followed by haemorrhagic anaemia (HA) and CDA. The diagnostic procedure which discovered an underlying disease in most of the cases was upper digestive tract endoscopy, and CDA needed the highest number of diagnostic procedures. There was not relationship between the sort of anaemia and symptoms due to upper digestive tract and endoscopic findings, however low digestive tract symptoms (bleeding and abnormal finger rectal examination) and pathologic findings in colonoscopy had a straight relation (p < 0.05). CONCLUSIONS: IDA is the anaemia most frequently diagnosed in an Internal Medicine Department followed by HA and ACD. Clinical symptoms and the type of anaemia have poor correlation. In IDA upper digestive endoscopy as well as lower digestive tract examination is mandatory. We propose colonoscopy in patients aged more than 50-years whereas barium enema could be employed in younger people.

[The influence of empty-bed days on the median hospital stay in internal medicine]. / Influencia de los días vacíos en la estancia media en hospitalización de Medicina Interna.

BACKGROUND: To evaluate the epidemiology of delays in patients hospitalized in a department of internal medicine in a hospital of third level (high technology, end-stem of Spanish health system), its influences in hospital length of stay and the leading reasons which we named Gap Days. PATIENTS AND METHODS: We studied all patients admitted through emergency ward for internal medicine during Oct 93-June 94. Gap Day was defined as the day passed as inpatient in which no intravenous route, isolation, artificial feeding, fever, impairing of clinic steady-state were needed or waited and any diagnostic tools were used. We counted Gap Day from the second day and from de third day for histopathology that we ordered the explorations. In a nonselected group days of delay to arrive written data were measured while the results were known for personal request. RESULTS: 144 patients had a mean length of stay of 9.52 (SD 5.41) days. Gap Days occurred in 97 (67%) patients (Mean 3.85 SD 2.80) with a mean length of stay 10.71 SD 5.09 days, while patients without Gap Days had a mean length of stay of 7.14 SD 5.29 days (p < 0.001). Patients with higher Gap Days were those with symptoms related to hematological system (p = 0.002), nephrourological system (p = 0.011) and a hematological diagnostic (p = 0.003) on admission. On discharge patients with hematological diagnostic had also higher Gap Days (p = 0.017). They had higher Gap Days also patients with two symptoms or more on admission (3.63 SD 2.96, p = 0.016), patients who lived alone (5.33 SD 3.42, p = 0.050) and patients with no concordance between diagnostic on admission and discharge (4.06 SD 3.41, p < 0.01). In 37 patients written data arrived 2.14 SD 1.06 days later after to know the results for personal request. CONCLUSION: Gap Days are an important factor to prolong the length of stay in internal medicine. They are influenced by number of symptoms on admission, concordance between diagnostics on admission and discharge, hematological diagnostics and some social and functioning hospital factors.