Diagnóstico de feocromocitoma mediante tomografía computarizada / Diagnosis of pheochromocytoma by computed tomography

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[Spontaneous infectious spondylodiscitis in an internal medicine department: epidemiological and clinical study in 41 cases]. / Espondilodiscitis infecciosa espontánea en un servicio de medicina interna: estudio epidemiológico y clínico de 41 casos.

INTRODUCTION: The clinical-epidemiological characteristics of patients who were diagnosed of spontaneous infectious spondylodiscitis (SIS) in our Internal Medicine Department are analyzed and the related factors associated with the increase of the incidence are evaluated. PATIENTS AND METHODS: A cross-sectional, retrospective study of patients diagnosed of SIS from 1996 to 2005 was conducted. The study was divided in two periods: A (1996-2000) and B (2001-2005) and two main etiologic groups (pyogenic SIS and mycobacterial SIS) were compared. RESULTS: A total of 41 patients were diagnosed of SIS: 13 (31.7%) in period A and 28 (68.3%) in period B. Mean age was 58.5 +/- 17.6 years (range: 29-89). There were 73.2% men and all women presented in period B (0 vs 11, p = 0.008). Backgrounds were: 28 (68.3%) predisposing factors for SIS, 22 (53.6%), previous infections and 23 (56.1%) spinal diseases. There were not changes in the backgrounds during the study. The etiology of SIS was: 26 (63.4%) pyogenic, 12 (29.3%) mycobacterial and 3 (7.3%) brucellar. Patients with pyogenic SIS were older (63.6 +/- 3.2 vs 51.2 +/- 5.1 years, p = 0.035) and had less from onset of symptoms to diagnosis (62 +/- 12 vs 291 +/- 66 days, p = 0.0001) than patients with mycobacterial SIS. Total incidence of SIS and incidence of pyogenic SIS increased significantly during the study: (1.7/1000 admissions/year, p = 0.0057) and (1/1000 admissions/year, p = 0.0476). In the multivariate analysis, time from onset of symptoms to diagnosis was the only variable independently associated with the pyogenic etiological group (OR: 0.985, 95% CI: 0.975, 0.996, p = 0.005). CONCLUSIONS: In our study, the increasing incidence of SIS was related to an increase in pyogenic SIS incidence. Although older age and some backgrounds could be orientative of SIS etiology, these factors did not increase during the study.

Espondilodiscitis infecciosa espontánea en un servicio de medicina interna: estudio epidemiológico y clínico de 41 casos / Spontaneous Infectious Spondylodiscitis in an Internal Medicine Department: epidemiological and clinical study in 41 cases

Introducción. Se analizan las características epidemiológicas y clínicas de los pacientes diagnosticados de espondilodiscitis infecciosa espontánea (EIE) en nuestro Servicio de Medicina Interna, y valoramos los posibles factores relacionados con el aumento de su incidencia. Pacientes y métodos. Estudio transversal, retrospectivo de los pacientes diagnosticados de EIE desde 1996 hasta 2005. Se ha dividido el tiempo de estudio en dos períodos (A: 1996-2000 y B: 2001-2005) y se compararon los principales grupos etiológicos (EIE piógenas y EIE micobacterianas). Resultados. Se diagnosticaron 41 casos de EIE: 13 (31,7%) en el período A y 28 (68,3%) en el período B. La edad media era 58,5 ± 17,6 años (rango: 29-89). Un 73,2% eran varones; todas las mujeres se presentaron en el período B (0 frente a 11, p = 0,008). Los antecedentes fueron: 28 (68,3%) factores predisponentes de EIE, 22 (53,6%) infecciones previas y 23 (56,1%) patologías de columna. No se observaron modificaciones en los antecedentes a lo largo del estudio. La etiología de la EIE fue: piógena en 26 casos (63,4%), micobacteriana en 12 (29,3%) y brucelar en 3 (7,3%). Los pacientes con EIE piógenas tenían más edad (63,6 ± 3,2 frente a 51,2 ± 5,1 años, p = 0,035) y un menor tiempo de demora desde el inicio de los síntomas hasta el diagnóstico (62 ± 12 frente a 291 ± 66 días, p = 0,0001) que los pacientes con EIE micobacteriana. Se observó un aumento significativo de la incidencia total de EIE (1,7 casos por cada 1.000 ingresos al año, p = 0,0057) y de la incidencia de EIE piógenas (uno de cada 1.000 ingresos al año, p = 0,0476). En el estudio multivariante, el tiempo desde el inicio de los síntomas hasta el diagnóstico fue la única variable independientemente asociada al grupo etiológico piógeno (OR: 0,985, IC95%: 0,975; 0,996, p = 0,005). Conclusiones. El aumento significativo en la incidencia de EIE observada en nuestro estudio ha sido a expensas de un aumento significativo en la incidencia del grupo etiológico piógeno. Aunque la edad avanzada y algunos antecedentes puedan ser orientativos de la etiología de la EIE, este tipo de factores no se incrementaron durante el estudio (AU)

Introduction. The clinical-epidemiological characteristics of patients who were diagnosed of spontaneous infectious spondylodiscitis (SIS) in our Internal Medicine Department are analyzed and the related factors associated with the increase of the incidence are evaluated. Patients and methods. A cross-sectional, retrospective study of patients diagnosed of SIS from 1996 to 2005 was conducted. The study was divided in two periods: A (1996-2000) and B (2001-2005) and two main etiologic groups (pyogenic SIS and mycobacterial SIS) were compared. Results. A total of 41 patients were diagnosed of SIS: 13 (31.7%) in period A and 28 (68.3%) in period B. Mean age was 58.5 ± 17.6 years (range: 29-89). There were 73.2% men and all women presented in period B (0 vs 11, p = 0.008). Backgrounds were: 28 (68.3%) predisposing factors for SIS, 22 (53.6%), previous infections and 23 (56.1%) spinal diseases. There were not changes in the backgrounds during the study. The etiology of SIS was: 26 (63.4%) pyogenic, 12 (29.3%) mycobacterial and 3 (7.3%) brucellar. Patients with pyogenic SIS were older (63.6 ± 3.2 vs 51.2 ± 5.1 years, p = 0.035) and had less from onset of symptoms to diagnosis (62 ± 12 vs 291 ± 66 days, p = 0.0001) than patients with mycobacterial SIS. Total incidence of SIS and incidence of pyogenic SIS increased significantly during the study: (1.7/1000 admissions/year, p = 0.0057) and (1/1000 admissions/year, p = 0.0476). In the multivariate analysis, time from onset of symptoms to diagnosis was the only variable independently associated with the pyogenic etiological group (OR: 0.985, 95% CI: 0.975, 0.996, p = 0.005). Conclusions. In our study, the increasing incidence of SIS was related to an increase in pyogenic SIS incidence. Although older age and some backgrounds could be orientative of SIS etiology, these factors did not increase during the study (AU)

Varón de 79 años con nódulos pulmonares bilaterales cavitados / 79 year old male with bilateral cavitary pulmonary nodules

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Acidosis láctica, hipoglucemia severa y hepatoesplenomegalia / Lactic acidosis, severe hypoglycemia and hepatosplenomegaly

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Paraparesia progresiva y antecedente de enfermedad de Paget / Progressive paraparesis and background of Paget’s disease

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[Clinical-biological and radiological study of Wegener's granulomatosis in a university hospital]. / Estudio clínico-biológico y radiológico de la granulomatosis de Wegener en un hospital universitario.

UNLABELLED: Wegener's granulomatosis is a rare systemic vasculitis that fundamentally affects the kidney and respiratory tract. Although the histological findings are very characteristic, they do not occur in all cases, which makes diagnosis difficult. METHODS: The main clinical, biological and radiological characteristics of 13 cases of Wegener's granulomatosis diagnosed in a university hospital of the center of Spain are collected in this present paper. RESULTS: The majority of the patients were men in their 50's. Fever and general syndrome were usual presentations of the disease. Upper respiratory tract (10 cases) and lung involvement (9), followed by renal involvement (8), were the most common. Alveolar infiltrates and bilateral nodules were the most common findings in the X-ray and thoracic CT scan, although the latter permits a greater definition of the lesions. Measurement of antibodies against cytoplasma of the neutrophils (ANCA) was positive in 8 patients (6 cANCA and 2 pANCA). Renal biopsy was used most for the histologic diagnosis, where focal and segmental glomerulonephritis was the most common finding. The majority of the patients received steroids plus cyclophosphamide as induction treatment. CONCLUSIONS: Wegener's disease is a rare systemic vasculitis. The existence of hematuria or respiratory tract involvement in a patient with fever suggests the diagnosis. Conducting a CT scan and ANCAs measurement are useful tools for its diagnosis, since the histology is not definitive.

Estudio clínico-biológico y radiológico de la granulomatosis de Wegener en un hospital universitario / Clinical-biological and radiological study of Wegener's granulomatosis in a university hospital

La granulomatosis de Wegener es una rara vasculitis sistémica que afecta fundamentalmente al riñón y las vías respiratorias. Aunque los hallazgos histológicos son muy característicos, no se presentan en todos los casos, lo que en ocasiones dificulta el diagnóstico. Métodos. En el presente trabajo se recogen las principales características clínicas, biológicas y radiológicas de 13 casos de granulomatosis de Wegener diagnosticados en un hospital universitario del centro de España. Resultados. La mayoría de los pacientes fueron varones en la quinta década de la vida. La fiebre y el síndrome general fueron presentaciones habituales de la enfermedad. La afectación de la vía respiratoria superior (10 casos) y la pulmonar (9) seguidos de la renal (8) fueron las más habituales. Los infiltrados alveolares y los nódulos bilaterales fueron los hallazgos más habituales en la radiografía y tomografía computarizada (TC) torácica, aunque esta última permite una mayor definición de las lesiones. La determinación de anticuerpos frente al citoplasma de los neutrófilos (ANCA) fue positiva en 8 pacientes (6 cANCA y 2 pANCA). La biopsia renal fue la más utilizada para el diagnóstico histológico, donde la glomerulonefritis focal y segmentaria fue el hallazgo más habitual. La mayoría de los pacientes recibieron esteroides más ciclofosfamida como tratamiento de inducción. Conclusiones. La enfermedad de Wegener es una vasculitis sistémica infrecuente. La existencia de hematuria o afectación de la vía respiratoria en un paciente con fiebre sugiere el diagnóstico. La realización de TC y la determinación de los ANCA son herramientas útiles para el diagnóstico, ya que la histología no es definitiva

Wegener's granulomatosis is a rare systemic vasculitis that fundamentally affects the kidney and respiratory tract. Although the histological findings are very characteristic, they do not occur in all cases, which makes diagnosis difficult. Methods. The main clinical, biological and radiological characteristics of 13 cases of Wegener's granulomatosis diagnosed in a university hospital of the center of Spain are collected in this present paper. Results. The majority of the patients were men in their 50's. Fever and general syndrome were usual presentations of the disease. Upper respiratory tract (10 cases) and lung involvement (9), followed by renal involvement (8), were the most common. Alveolar infiltrates and bilateral nodules were the most common findings in the X-ray and thoracic CT scan, although the latter permits a greater definition of the lesions. Measurement of antibodies against cytoplasma of the neutrophils (ANCA) was positive in 8 patients (6 cANCA and 2 pANCA). Renal biopsy was used most for the histologic diagnosis, where focal and segmental glomerulonephritis was the most common finding. The majority of the patients received steroids plus cyclophosphamide as induction treatment. Conclusions. Wegener's disease is a rare systemic vasculitis. The existence of hematuria or respiratory tract involvement in a patient with fever suggests the diagnosis. Conducting a CT scan and ANCAs measurement are useful tools for its diagnosis, since the histology is not definitive

Osteomalacia, síndrome de Fanconi y paraproteinemia monoclonal / Osteomalacia, Fanconi Syndrome and Monoclonal Paraproteinemia

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[Cost-effectiveness of computerized axial tomography in the diagnosis of traditional clinical picture of fever of unknown origin]. / Rentabilidad de la tomografía axial computarizada en el diagnóstico de la fiebre de origen desconocido clásica.

Diagnostic strategy in fever of unknown origin has been changing in recent decades. The objective of this study is to define the role of thoracoabdominal computerized axial tomography in the first diagnostic stage. A sample of 24 patients with classical fever of unknown origin from our hospital Internal Medicine department was selected between January 1995 and December 2002. Cost-effectiveness of diagnostic thoracoabdominal computerized axial tomography compared to that of abdominal echography was analyzed; the information obtained with both diagnostic techniques for the final diagnosis was also evaluated. Computerized axial tomography contributed data suggestive of the diagnosis in 10 of 24 patients (41.7%); abdominal echography only gave orienting information to the diagnosis in 2 cases (8%). In 9 (90%) of the 10 patients with computerized axial tomography specific alterations, a conclusive definitive diagnosis (with analysis of biological sample) was possible. Accordingly, the use of this technique is justified at the beginning of the study of the classical fever unknown origin in order to orient the clinician to resort to other more directed and specific diagnostic techniques and with higher diagnostic cost-effectiveness.

Rentabilidad de la tomografía axial computarizada en el diagnóstico de la fiebre de origen desconocido clásica / Cost-effectiveness of computerized axial tomography in the diagnosis of traditional clinical picture of fever of unknown origin

La estrategia diagnóstica en la fiebre de origen desconocido ha ido cambiando en las últimas décadas. El objetivo de este estudio es consolidarla tomografía axial computarizada toraco- abdominal en la primera etapa diagnóstica. Se obtuvo una muestra de 24 pacientes con fiebre de origen desconocido clásica seleccionados en el Servicio de Medicina Interna de nuestro hospital entre enero de1995 y diciembre de 2002. Se estudió la rentabilidad diagnóstica de la tomografía axialcomputarizada toracoabdominal frente ala ecografía abdominal, y la información que ambas proporcionaban para el diagnóstico final. La tomografía aportó datos sugestivos del diagnóstico en 10 de 24 pacientes (41,7%); la ecografía abdominal sólo dio información orientadora al diagnóstico en dos casos (8%). De los 10 pacientes con alteraciones específicas en la tomografía axial computarizada, se llegó a un diagnóstico definitivo concluyente (con análisis de muestra biológica) en9 de ellos (90%). Por tanto, está justificado el uso de esta técnica al inicio del estudio de la fiebre de origen desconocido clásica para orientar al clínico a recurrir de forma dirigida a otras técnicas más específicas y con mayor rentabilidad diagnóstica

Diagnostic strategy in fever of unknown origin hasbeen changing in recent decades. The objective of this study is to define the role of thoracoabdominal computerized axial tomography in the first diagnostic stage. A sample of 24 patients with classical fever of unknown origin from our hospital Internal Medicine department was selected between January 1995 and December 2002. Cost effectiveness of diagnostic thoracoabdominal computerized axial tomography compared to that of abdominal echography was analyzed; the information obtained with both diagnostic techniques for the final diagnosis was also evaluated. Computerized axial tomography contributed data suggestive of the diagnosis in10 of 24 patients (41.7%); abdominal echography only gave orienting information to the diagnosis in 2 cases (8%). In 9 (90%) of the 10 patients with computerized axial tomography specific alterations, a conclusive definitive diagnosis (with analysis of biological sample) was possible. Accordingly, the use of this technique is justified at the beginning of the study of the classical fever unknown origin in order to orient the clinician to resort to other more directed and specific diagnostic techniques and with higher diagnostic cost-effectiveness

[Imaging advances in the diagnosis of neuroendocrine tumors]. / Avances en la localización de los tumores neuroendocrinos con las ténicas de imagen.

We present two cases of neuroendocrine tumors: insulinoma and glucagonoma. Several diagnostic procedures are analysed including those useful to localize the tumor and its possible metastasis, as ultrasound, computed tomography, magnetic resonance imaging, angiography, endoscopic ultrasonography and somatostatin receptor scintigraphy. We suggest that the work up should begin with lesser invasive procedures such as CT and In111-labelled pentetreotide scan.

Computed tomography findings of peritoneal tuberculosis: systematic review of seven patients diagnosed in 6 years (1996-2001).

OBJECTIVE: The aim of this study was to describe the computed tomography (CT) findings in patients with demonstrated peritoneal tuberculosis (TB) and their concordance with the three types from the traditional classification (wet, fibrotic, and dry plastic). METHODS: We reviewed the CT images of all patients with microbiologically proven peritoneal tuberculosis over a 6-year period (1996-2001). RESULTS: Seven patients were included. Ascites was present in 5 patients (free ascites in 3 patients and loculated in 2). Involvement of the mesentery was found in 5 patients, the omentum in 4, and the parietal peritoneum in 3. Tuberculous lymphadenitis was the most common associated finding (6 patients). Two patients had hepatic lesions. The fibrotic type was found in all the patients, and 5 patients had an association of the fibrotic and wet types. None of the patients had lesions consistent with the dry plastic type. CONCLUSION: Peritoneal tuberculosis is best described as a combination of ascites, peritoneal lesions, and lymphadenopathy, rather than the three types from the traditional classification.

Avances en la localización de los tumores neuroendocrinos con las técnicas de imagen / Imaging advances in the diagnosis of neuroendocrine tumors

Se comunican dos tumores neuroendocrinos pancreáticos, un insulinoma y un glucagonoma. Basados en esta experiencia se revisan las distintas técnicas que posibilitan la localización del tumor y sus eventuales metástasis, como son los untrasonidos, la TAC, la RM, la angiografía, la ultrasonografía endoscópica y la gammagrafía con I111-pentatreotide. Se hace notar la conveniencia de comenzar por los procedimientos menos invasivos como son la TAC y la gammacámara con octreotide (AU)

Fiebre y hemorragia cerebral: un diagnóstico angiográfico / Fever and brain haemorrhage: an angiographic diagnosis

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