[Iron deficiency anemia in hospitalized males and postmenopausal females. Diagnostic approach]. / Anemia ferropénica en varones y mujeres posmenopáusicas hospitalizados. Estrategia diagnóstica.

UNLABELLED: Chronic bleeding from the gastrointestinal tract is assumed to be the most common cause of iron deficiency anemia in men and in postmenopausal women. AIM: The aim of this study was to assess the most frequent causes of chronic gastrointestinal bleeding in patients with iron deficiency anemia and to suggest a diagnostic endoscopic strategy that could be useful in clinical practice. METHODS: We studied 66 patients (48 women and 18 men), with a mean age of 73 who were admitted to our hospital from 1993 to 1996 because of unrelated signs and symptoms. Iron deficiency anemia was detected in a routine laboratory test. Patients had no symptoms of digestive disease. Children, pre-menopausal women and patients with a history of digestive disease of anemia of known origin were excluded. Diagnostic procedures included oral panendoscopy, colonoscopy and, in some cases, contrast radiology. In all patients follow-up was carried out between 3 and 36 months after discharge. Patients were considered to have improved when hemoglobin values were normal, according to standard laboratory values. RESULTS: At least one lesion responsible for anemia was found in 46 patients (70%). Of these 46 patients, 31 presented a lesion in the upper digestive tract and 13 presented a lesion in the lower digestive tract. Colon cancer was diagnosed in eight patients and gastrointestinal cancer in one. In the remaining two patients, peptic ulcer and colo-rectal cancer were found simultaneously. A diagnosis of "minor" lesions was made in 15 patients (23%) and in five patients (7%) no lesions were found that could have caused the bleeding. Both groups (minor lesions and undiagnosed patients) improved with iron therapy. CONCLUSIONS: Upper gastrointestinal lesions were the most frequent cause of iron-deficiency anemia, although colonoscopy is the best procedure for detecting gastrointestinal cancer and should be performed despite evident upper gastrointestinal bleeding.

[Clinical indications for echography in acute pyelonephritis in adult women]. / Indicaciones clínicas de la ecografía en la pielonefritis aguda en mujeres adultas.

BACKGROUND: Echography is a non-invasive procedure which detects abnormalities in kidney and/or urinary tract. OBJECTIVE: To determine whether the routine use of an echography in women with the diagnosis of acute pyelonephritis (APN) provides relevant findings to diagnosis and determines a change in therapy. MATERIAL AND METHODS: A total of 100 patients admitted to the hospital with the diagnosis of APN who had undergone an echography were studied. Seven clinical criteria were evaluated: persistent fever for longer than 72 hours after starting an appropriate antibiotic therapy, episodes of previous urinary tract infections, previous history of kidney stones, anatomic abnormalities in the urinary tract, colic pain, persistent hematuria, and pregnancy. On the basis of these criteria two groups were defined: a) indicated echography (IE), for patients fulfilling at least one the above criteria; b) non-indicated echography (NIE), for patients fulfilling none of the above criteria. RESULTS: IE group was made up of 47 patients, with a normal echography in 18 (38%); the NIE group was made up of 53 women, with a normal echography in 51 of them (96%). The abnormal findings in echography led to a change in therapeutic behaviour in 11 patients in the IE group (23%) and in 2 patients in the NIE group (4%). CONCLUSIONS: The routine use of abdominal echography in women with the diagnosis of APN is not indicated in absence of clinical data supporting the presence of a complicated APN.