[Tumor-associated significant pericardiac effusions: analysis of 18 cases]. / Derrames pericárdicos significativos asociados a tumores: análisis de 18 casos.

Metastatic infiltration is most frequent than primary pericardiac tumors. Most frequent tumors are adenocarcinoma and lymphomas. A retrospective analysis of 18 oncological patients with significant pericardiac effusion (SPE) is carried out. The conclusions of the study are: SPE can be the first manifestation of a neoplasm; frequently, pericardiac tamponade (PT) has a neoplastic origin; thorax is the most frequent localization of the primary tumor; pericardiac fluid (PF) cytology analysis has low diagnostic yield; most useful diagnostic tests are thoracocentesis, thorax computerized tomography (CT) and bronchoscopy; SPE in a neoplasm suggest poor short-term prognosis; poor prognosis variables in this series were primary tumor unfavorable histology, advanced tumor disease and (probably) presentation as PT.

[Analysis of 73 cases of significant pericardiac effusion]. / Análisis de 73 casos de derrame pericárdico significativo.

Seventy-three patients with significant pericardiac effusion (SPE) are analyzed retrospectively. The results concerning etiology, clinical findings, evolution, echocardiography findings and pericardiac effusion (PE) findings are summarized. Conclusions drawn are: 1) the pericardiac effusion (PE) is a difficult diagnosis without the assistance of the echocardiogram; 2) the echocardiogram signs of hemodynamic alterations have prognostic value; 3) the most frequent causes of SPE are: tumors, idiopathic acute pericarditis, and iatrogenesis; 4) in an important percentage of DPS patients the cause is not identified; 5) the clinical presentation as pericardiac tamponade (PT) is most frequent in the tumors; 6) the analysis of the PE has a low yield, which means that diagnostic pericardicentesis is not justified in all patients with SPE; 7) the pericardiac biopsy hasa low diagnostic yield; 8) the predictive mortality factors are: presentation as PT and tumor etiology, and 9) because of the dynamic character of the SPE, it is important to carry out a progress follow-up of it.

Linfadenitis histiocítica necrotizante de Kikuchi / Kikuchi's histiocytic necrotizing lymphadenitis

La linfadenitis histiocítica necrotizante (LHN) o enfermedad de Kikuchi-Fujimoto es una entidad anatomoclínica poco frecuente; afecta preferentemente a mujeres jóvenes e individuos de razas orientales y se caracteriza por fiebre, adenopatías preferentemente cervicales, afectación sistémica y, ocasionalmente, extraganglionar.Se presentan dos casos de LHN en mujeres jóvenes con afectación cutánea y en uno de los casos con meningitis linfocitaria.Se discuten los aspectos etiológicos, la relación de la LHN con las enfermedades colágeno-vasculares (fundamentalmente el lupus eritematoso sistémico [LES]), los problemas del diagnóstico anatomopatológico y las posibilidades terapéuticas (AU)

[Kikuchi's histiocytic necrotizing lymphadenitis]. / Linfadenitis histiocítica necrotizante de Kikuchi.

Necrotizing histiocytic lymphadenitis (NHL) or Kikuchi-Fujimoto disease is an infrequent seen clinicopathologic entity that affects most frequently young women and individuals of eastern races, and that is characterized by fever and adenopathies (basically cervical) and systemic disease even though occasional patients present extranodal disease. We present two young women with NHL and cutaneous affectation, and with lymphocytic meningitis in one of the patients. We discuss the etiology of NHL, the relation of NHL with collagen-vascular diseases (basically systemic erythematous lupus) the problem of the pathologic diagnosis, and the therapeutic possibilities in these patients.

Enfermedad de Still del adulto e hipofisitis linfocitaria

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[Retrospective study of early readmissions at an internal medicine service]. / Estudio retrospectivo de los reingresos precoces de un servicio de medicina interna.

OBJECTIVE: To determine the frequency of hospital re-admissions to an Internal Medicine Department at a Community General Hospital as well as variables associated with them. METHODS: Analysis of hospital discharges during 1997. Data were provided by the Coding and Filing Service, and included sociodemographic data and aspects related to medical care to each patient, as well as discharge DRF according to the HCFA version. A logistic regression model was developed to identify variables independently associated with early re-admission risk (less than 30 days after discharge). RESULTS: The rate of early re-admission was 7.4%. The variables associated with a higher risk of admission included age, a hospital stay longer than the mean at first admission, and AIDS-associated conditions and heart diseases as main discharge diagnoses. CONCLUSIONS: Based on our data, we cannot consider the readmission rates as a reliable index in itself to be assessed negatively, as some re-admissions come unexpectedly and/or are unavoidable.

Estudio retrospectivo de los reingresos precoces de un servicio de medicina interna / Retrospective study of early readmissions to an Internal Medicine Department

Objetivo. Determinar la frecuencia del reingreso hospitalario en un servicio de Medicina Interna de un Hospital General de la Comunidad, así como las variables asociadas al mismo. Métodos. Análisis de las altas durante el año 1997. Los datos fueron facilitados por el Servicio de Codificación y Archivo, incluyendo características sociodemográficas y aspectos relacionados con el proceso asistencial de cada paciente, así como sus GRD al alta según la versión HCFA. Se construyó un modelo de regresión logística para identificar las variables que se asocian independientemente con el riesgo de reingresar precozmente (menos de 30 días tras el alta). Resultados. La tasa de reingresos precoces es del 7,4 por ciento. Las variables asociadas a un mayor riesgo de reingreso fueron la edad, una estancia superior a la media en el primer ingreso, así como la patología asociada con el síndrome de inmunodeficiencia adquirida (SIDA) y la cardiopatía como diagnósticos principales al alta. Conclusiones. Con los datos obtenidos no podemos considerar la tasa de reingresos como un índice fiable de calidad en sí mismo que deba ser valorado negativamente, ya que algunos reingresos son inesperados y/o inevitables. (AU)

Linfoma Malt gástrico que debuta como entropión bilateral / MALT lymphoma of the stomach debuting as bilateral entropion

Propósito: Los linfomas MALT de bajo grado suelen estar localizados y ello condiciona, en parte, su buen pronóstico. Material y métodos: Describimos un paciente con un linfoma MALT gástrico de bajo grado, que debutó con un entropion bilateral, estando en estadio IV en el estudio de extensión. Su respuesta al Clorambucil fue excelente, sobreviviendo 8 años. Resultados: El estudio morfológico e inmunofenotípico de la biopsia conjuntiva¡ fueron claves para el diagnóstico. El estudio de extensión, incluyendo otros territorios extranodales, mostraron el tumor primario, su multicentricidad y diseminación. Conclusiones: Los linfomas MALT primarios pueden debutar en otro territorio extranodal y ser asintomáticos. Un estadio avanzado no siempre implica un mal pronóstico (AU)

[Recurrent orchiepididymitis, 6 months after likely miliary tuberculosis]. / Orquiepididimitis recurrente, seis años después de una probable tuberculosis miliar.

OBJECTIVE: To underscore the difficulty and importance of early diagnosis in tuberculous epididymo-orchitis. METHODS: Herein we describe a male patient with a history of fever for a long period, constitutional symptoms and retinal exudates that had been diagnosed and treated as systemic candidiasis instead of miliary tuberculosis. Six years later the patient presented with acute epididymo-orchitis. One year thereafter he developed contralateral epididymo-orchitis with a more torpid course. The patient did not respond to conventional treatment. Sterile pus was detected in urine; cultures and bacilli studies were negative. Testicular US findings were compatible with the condition and disclosed an abscessed area which was functioned and the diagnosis was made. RESULTS: The patient was treated with pirazinamide for two months and isoniacid and rifampicin for 12 months. However, the patient developed sterility. CONCLUSIONS: Tuberculous epididymo-orchitis can present acutely and can be confused with infection from other more common pathogens, or subacutely and confused with tumors. In many cases there is no previous patient or family history and chest x-ray, bacilloscopies and cultures can be negative. Tuberculosis must be considered due to its increasing incidence. US-guided fine needle punction-aspiration biopsy is very useful for diagnosis, which has to be made as early as possible to avoid sterility.

[Carcinomatous lymphangitis. Clinical study of 10 cases]. / Linfangitis carcinomatosa. Estudio clínico de 10 casos.

We analyze the clinical characteristics, the diagnostic criteria and the radiological aspects of 10 cases of Carcinomatous Lymphangitis. The quickly progressing exercise dyspnea and the constitutional syndrome were the most frequent symptoms. In nine patients, the tumor was previously unknown. The image methods (adbominal CAT and Echography) and the fibrobronchoscopic exam allowed a correct diagnosis. The most frequent neoplasia had a pulmonary origin and the most frequent histology was adenocarcinoma. The histological tests (bronchial and transbronchial biopsies) were more effective for the diagnosis than the cytological test (bronchoalveolar lavage, bronchoaspiration and bronchial brushing), although these were complemented. The radiology showed a reticulo-linear pattern in all the cases. The finding of macroscopic disorders in the fibrobronchoscopy, the presence of a local infiltration or a node/mass image in the thoracic radiography were highly suggestive of primary pulmonary neoplasia.