[Neoplasms of unknown primary site]. / Neoplasias de origen desconocido.

Neoplasms of unknown primary site are tumor diseases, which are diagnosed by the pathologic studies of one of their metastases. The treatment of neoplasms of unknown primary site is not totally established, except in a few situations with specific therapeutical implications, and a better prognosis. The usual treatment of neoplasms of unknown primary site is the empirical chemotherapy with taxanes (paclitaxel or docetaxel) and platines (cisplatin or carboplatin)-based regimens, with different results in the trials.

[Psoas muscle abscess by Streptococcus agalactiae as a of presentation of fever of unknown origin]. / Absceso del músculo psoas-ilíaco por Streptococcus agalactiae como forma de presentación de fiebre de origen desconocido.

We present the case of a patient with precedents of endometrial carcinoma treated by surgery and radiotherapy, which presented a psoas abscess by Streptococcus agalactiae as cause of fever of unknown origin, which answered favorably to the antibiotherapy and surgical drainage.

[Technical project for the management and functioning of an Internal Medicine care unit]. / Proyecto técnico de gestión y funcionamiento de la unidad asistencial de Medicina Interna.

The Internal Medicine Services have a central role in the medical care in our hospital system both as to the volume of patients attended and their variety, reflecting of the preparation and multi-tasking ability of their professionals. The current norms for coverage of heads-of-service demands the presentation of a management project that must test our knowledge, skills and aptitudes for the clinical and medical management and in order to reflect them in a document of commitment with the management and with our fellows who are a part of the care unit. The person in charge of the service, as boss, agent or leader, is the one who must mark the strategic lines, to indicate the aims, to define the projects, to coordinate the tasks and to evaluate the results with other offers to obtain agreed-upon aims controlling the different points of view. Our professional and social commitment is: sharing clinical management with ethics, quality and welfare safety, to offer our patients (consumer or users) the best results (effectiveness), with useful measurements (efficacy) and with the minors drawbacks and costs (efficiency). The aim of this work is to offer the elements that are necessary for the accomplishment and introduction of a project of clinical management in a service of internal medicine, highlighting its methodology and the most important problems than can arise as well as the possible care alternatives.

[Subcutaneous panniculitis at a third level hospital retrospective study of 113 cases]. / Paniculitis subcutáneas en un hospital de tercer nivel: estudio retrospectivo de 113 casos.

INTRODUCTION: The panniculitides or hypodermitis are a wide and heterogeneous group of diseases characterized by the presence of subcutaneous inflammatory nodules located generally in low limbs. OBJECTIVES: Show the clinicopathologic characteristics of the cases diagnosed as panniculitis for a 5 years period; their epidemiology, etiopathogenic factors, evolution and treatment. MATERIAL AND METHODS: A retrospective study of 113 patients diagnosed as panniculitis by histopathologic report of cutaneous biopsy since 1997 to 2001 were performed. RESULTS: The sex proportion was of 4.65 women to every man. The mean age of these patients was 49 +/- 20 years old. 100% had legs affectation, 7.1% in arms, 5.9% in trunk and 0.9% in face. 9.7% presented fever and arthromyialgias, especially in young people (p < 0.05). The etiopathogenic factors implied were tuberculosis, streptococcic pharyngoamygdalitis, sarcoidosis and different drugs. The most frequent histological pattern was septal panniculitis without vasculitis. 24.8% did not realize any treatment; 32.5% took nonsteroideal anti-inflammatory drugs; 31.6% potassium iodide; 16% systemic corticosteroids and 7.1% tuberculostatic drugs. Evolution of the patients was good and independently from the treatment performed. CONCLUSIONS: Panniculitides are a group of diseases with similar clinic, but very heterogeneous in their etiology and histopathologic findings. They are more frequent in women and with more expressive clinic in young people. Up to in the 59.3% of the studied cases a causal etiologic agent was identified. These factors are compatible with the published ones in other previous panniculitis series. When a paniculitis is suspected, the most efficient tool is the clinical diagnosis. Histological confirmation by cutaneous biopsy it must be done when it is possible.

[Characteristics of Kaposi's sarcoma. A retrospective study in a reference hospital]. / Características del sarcoma de Kaposi. Estudio retrospectivo en un hospital de Tercer Nivel.

UNLABELLED: Kaposi's angiosarcoma (SK) is a vascular tumour that affects skin and other organs. Nowadays there is thought that immunosuppression is one of the factors related with its genesis. OBJECTIVES: Show the information corresponding to the distribution of the SK, proportion of subtypes, evolution and therapeutic used. MATERIAL AND METHODS: A 28 cases retrospective study. We obtained the personal background, habits, origin of the VIH when the SK was associated with AIDS, and treatment carry out. Type of SK and location, cutaneous presentation, complications and B symptoms. Treatment, response and adverse effects. Progression of the disease, average time of relapse and survival, and presence of the SK at death. RESULTS: 64% epidemic, 21% classic type and 14% associated with transplants. In 48% of the epidemic cases, the VIH assumed to homosexual habits and 18% to being ADVP. In all there was cutaneous affectation, 46% had affectation of mucouses, 11% adenopathies and 14% visceral extension. 71% received treatment: 40% chemotherapy, 35% radiotherapy and 18% cryotherapy. Progression: 11% became stable, in 50% there was local extension and systemic in 17%. The average survival was of 4.16 +/- 3 years. CONCLUSIONS: SK has a minor incidence in the homosexual population. The high proportion of classic and transplants associated affirm the role of immunosuppression as a predisposing factor. There were numerous local complications that were associated with B symptoms. The cryotherapy was used as the first option in the located forms and in the widespread ones was the chemotherapy.

[Case finding of iron overload in a university hospital]. / Búsqueda activa de casos de sobrecarga de hierro en un hospital universitario.

BACKGROUND: The epidemiologic importance of iron overload disorders and the clinical lack of its diagnosis led us to an active search of cases among the hospitalized patients in a general university hospital. This situation will make it possible to have a larger and earlier number of diagnosis together with a preventive intervention and an effective treatment. PATIENTS AND METHODS: A transverse study was performed on patients admitted to a fifteen beds ward in the internal medicine department. They have all been applied, without exclusion criteria, the iron metabolism parameters survey. The transferrin saturation (TS), due to its sensitivity, specificity and positive predictive value, has been considered appropriate for the phenotypic screening of the iron overload disorders. Subjects with fasting TS of 45% or more were considered as risk population. RESULTS: The study comprised 117 patients with an average age of 69.9 +/- 15.04. The high-risk population rate was 13.8% with an average age of 60.8 +/- 20.17, as compared to the low-risk population with an average age of 71.3 +/- 13.7 (p < 0.05). The most outstanding illnesses associated to the high-risk population are chronic hepatitis and diabetes mellitus (31.25%). An 18.7% of the cases show undernourishment. CONCLUSIONS: The iron overload is a prevalent illness whose early diagnosis requires a high clinical suspicion. The active search among the hospitalized patients, who have been made a TS, benefits the new cases detection. The TS is a screening technique with a high diagnostic profitability if you evaluate correctly the false positives. For that reason, we think the TS has to be included within the analytic requests which patients are made when admitted to hospital.

[Cutaneous erythematous rash as first manifestation of T-cell prolymphocytic lymphatic leukemia]. / Erupción cutánea eritematosa como primera manifestación de leucemia linfática prolinfocítica de células T.

We present a case of a man 84 years-old, whose presentation feature was a cutaneous inespecific rash, and was diagnosed of T prolymphocytic leukaemia (T-PLL). In this review we analyze actual aspects concerning biology, diagnosis, classification, prognosis and treatment of this rare mature T cell leukaemia.

[Osteoporosis in patients admitted to an internal medicine service of a university general hospital]. / Osteoporosis en pacientes ingresados en un servicio de medicina interna de un hospital de tercer nivel.

OBJECTIVE: To ascertain the incidence of osteoporosis and epidemiological factors in patients admitted to an Internal Medicine Service of a University General Hospital in Madrid, Spain. We also took into account the reasons for admission, associated diseases, and the preventive and therapeutic diagnostic implications. PATIENTS AND METHODS: The analytical, descriptive, retrospective and transversal study of one hundred patients over fifty years of age admitted to an internal medicine service during 1997, obtaining in addition to the clinical discharge report, epidemiological data with regard to the radiological diagnosis of osteoporosis, the reason for admission, past history, the prevention and treatment of the initial complaint as well as the osteoporosis previous diagnosis. RESULTS: 26% of those patients included in the survey had radiologic criteria of osteoporosis although only in 1 per cent of them had osteoporosis been diagnosed previously. The main risk factors, apart from the age and sex, are the associated illnesses which cause malnutrition and immobilization, and the use of drugs, especially heparin. CONCLUSIONS: Osteoporosis is a condition common in patients above 50 especially women, who are admitted to an Internal Medicine Service. A quarter of those patients admitted have osteoporosis. Very few are diagnosed and treated. In this group of patients apart from the habitual risk factors, are added those for the associated disease generally chronic, and the treatment they receive. During their stay in the hospital osteoporotic patients are three times more likely to receive heparin and other drugs which aggravate osteoporotic, than non osteoporotic patients. For that reason the risk of fractures is greater and the need for prospective diagnostic studies is even more necessary in this group of patients.

[Primary hemochromatosis in asymptomatic young patients]. / Hemocromatosis primaria en jóvenes asintomáticos.

OBJECTIVES: In order to increase our knowledge of adult haemochromatosis epidemiology and its clinical behaviour in young patients, we studied 4 patients from 3 pedigrees with idiopathic haemochromatosis. METHODS: Diagnostic criteria were: 1) Discarding the presence of secondary haemosiderosis. 2) Histological and histochemical confirmation of hepatic iron overload. Mean age at time of diagnosis was 25.2 years. Male/female ratio was 1. RESULTS: All of them were clinically asymptomatic, what shows the main difference with juvenile haemochromatosis, presenting earlier and more aggressively. Physical examination could not find abnormalities in any case. Regarding analytical studies, the main results were as follows: mean serum iron level was 209.5 mg/dl (s = 37.8), transferrin 206 mg/dl (s = 24.5), transferrin saturation was 77.4% (s = 9); ferritin, ASAT & ALAT were abnormal exclusively in the 2 males), the other measurements being between normal limits in all cases. Abdominal MRI showed an impaired hepatic signal in 2 cases. Liver biopsy was accomplished in 3 of them, showing massive deposits of hemosiderin in the hepatocytes in the 2 male cases and chronic hepatitis in one of them. There was no evidence of damage to other organs. Genetic studies showed that the 2 siblings were homozygous for the HFE 845GAEA (C282Y) mutation and in the other 2 cases HLA-A3,B7 was found to be associated. At present, after a year or more, all of them remain asymptomatic, liver function tests and mean serum ferritin levels are within normal limits, IST is < 65%, while Hb continues being > 11 g/dl. CONCLUSIONS: To conclude, we would like to emphasize the extraordinary importance of early diagnosis and careful treatment in this common and remediable illness (otherwise lethal), to reach a normal and symptoms-free lifespan.

[Serum and pulmonary angiotensin converting enzyme as a marker of acute lung injury in an experimental model of adult respiratory distress syndrome]. / La enzima de conversión de la angiotensina (sérica y pulmonar) en un modelo experimental de distrés respiratorio del adulto, como marcador de lesión aguda pulmonar.

OBJECTIVE: To know if the determination of the angiotensin converting enzyme in serum (SACE) and lung (LACE) may be useful as a marker of acute lung injury (ALI) in the adult respiratory distress syndrome (ARDS). METHOD: By reproducing in a experimental model of ALI with oleic acid in dogs which simulate the early stage of ARDS, we have correlated the pathologic and analytical changes observed with the results of the determinations of SACE and LACE. RESULTS: We have found sequential pulmonary lesions (congestion, edema, hemorrhage polynuclear infiltration and thrombosis) and biological alteration (hypoxemia, pulmonary hypertension, early leukopenia and final leukocytosis, thrombopenia and hypofibrinogenemia) that reproduce the typical changes of ARDS, together with the decrease of SACE--slow and progressive--and LACE--abrupt in the onset and maintained during the experiment--. CONCLUSIONS: The LACE is a good marker of the beginning of the lesion because its decrease coincides with the first pathological changes (congestion) and with the hypoxemia, pulmonary hypertension and leukopenia, maintained without changes, during the whole experiment. On the other hand, the SACE corresponds as an inespecifical reactant, marker of acute inflammation and loss of pulmonary endothelium, because its progressive decrease evolutioned with the pathological lesions and the analytical changes. In conclusion, the sequential determination of SACE has a prognostic and evolutive value in comparison with the LACE, which has a diagnostic value from the beginning of the experiment of ALI and maintained throughout.

[Brucellar meningitis as a peculiar form of clear fluid meningitis. Clinical study]. / La meningitis brucelar como forma peculiar de meningitis de líquido claro. Estudio clínico.

Out of 200 patients diagnosed of acute of chronic brucellosis, cases were first selected who had neurologic involvement (14%) and then those who had brucellar meningitis (CDC criteria) which corresponds to 4% of the total of the series. The clinical course, evolution time, neurologic manifestations and serologic and bacteriologic characteristics in blood and specifically in the cerebrospinal fluid (CSF). This study was contrasted with the literature review and the conclusion is reached that brucellar meningitis is a peculiar form of clear fluid meningitis, not exceptional in our environment considering the prevalence of brucellosis.

[Central motor conduction evaluation in glycogenosis type III]. / Evaluación de la conducción motora central en la glucogenosis tipo III.

We report a 20-year-old man affected by glycogenosis type III with distal muscle weakness, more severe in distal leg muscles. The electromyogram showed myopathic features. Nerve conduction studies and central motor conduction after magnetic stimulation of the brain were normal. Our results suggest that there is no involvement of central motor pathways in this disease.

[Acute pancreatitis: clinical and therapeutic study with somatostatin]. / Pancreatitis aguda: estudio clínico y terapéutico con somatostatina.

A clinical and therapeutical study of 47 patients with the diagnosis of acute pancreatitis is reported. According to Ranson's criteria patients were initially classified as suffering from mild (28) and severe (18) acute pancreatitis. Twenty-eight, 11, 7 and 1 patients had biliary, alcoholic, idiopathic and neoplastic causes, respectively, of their conditions. The classification of episodes was made on the basis of clinical manifestations, biologic investigations, and imaging diagnosis, and is shown in the corresponding tables. The therapeutic profile was a randomized double-blind study: perfused somatostatin (SS) versus placebo (P) (physiologic saline 0.9%). The administration of somatostatin in perfusion (250 mcg/h/48 hours) did not improve significantly the parameters used to score the severity, although the mortality rate decreased significantly (p < 0.05) in the group of patients with the severe form of the disease.