[Mortality in an internal medicine department within a third-level hospital; twenty years experience]. / Mortalidad en un servicio de medicina interna de un hospital de tercer nivel; 20 años de experiencia.

OBJECTIVES: To know and to analyze the main causes of death in an Internal Medicine Department (IM) and the mortality rate in such a Department. MATERIALS AND METHODS: From 1977 to 1996, a total of 77,310 patients were attended in the service under analysis. There were a total of 4,720 deaths. Clinical and epidemiological variables were analyzed so do management parameters related to inpatient deaths. RESULTS: Global mortality rate was 6.1%; the number of admissions increased along the study, whereas mortality rate tended to decrease. Median age was 72.8 years in death patients, and this age tended to increase during the period of study. Women's age was greater than men's one. The causes of the demise were cardiovascular (stroke and cardiopathy), neoplasm and respiratory disease, in that order. Neoplastic diseases were the leading death cause in men as they were in patients younger than 65 years-old, and AIDS was the main reason of death in patients younger than 35 years. Finally, 28.7% who died had been inpatients for no more than 48 hours. CONCLUSIONS: We can conclude that deaths in our IM department affect, as a rule, elderly patients with cardiovascular or neoplastic disease. Moreover, AIDS has experienced an increasing frequency, so it had became the first cause of death in patients under the age of 35. The old age of patients who die in our service, the great percentage of early deaths and the fact that the motive was, in the majority of the patients, a terminal disease, support the idea that new social customs tend to remove illness and death from family home, approving demise as a hospital event.

[Impact of AIDS on admissions and mortality in an Internal Medicine Department (1990-1995)]. / Impacto del SIDA en los ingresos y en la mortalidad de un Servicio de Medicina Interna (1990-1995).

OBJECTIVE: To know and analyze the main causes of death in an Internal Medicine Department (MI), as well as the impact of AIDS on admissions and mortality rate in such a Department. MATERIALS AND METHODS: A total of 275 patients out of the 35,521 attended patients from 1990 to 1995 had positive serology to HIV (HIV+). A total of 1,793 deaths were recorded, 42 of which were attributed to AIDS. Clinical and epidemiologic parameters were studied; also, management parameters associated with death were investigated (particularly, those caused by this disease). RESULTS: The overall mortality rate was 5.04%, where as the mortality rate among HIV+ in patients was 15.27%; the primary causes of death were cardiovascular, tumoral, and respiratory disease by decreasing frequency. AIDS was the first cause of death in patients aged less than 35 years. As for AIDS, the number of admissions on account of this disease had a progressive increase along the study period; the mean age of dead patients (31.6 years) tended to increase in the last few years and to be significantly higher among men (6 years); the mean of hospital stay among HIV+ patients (14.16 days) tended to decrease in the last few years. CONCLUSIONS: AIDS has had a progressive increase and has become the primary cause of hospital death in IM, in patients aged less than 35 years. As the experience with this disease increases, the mean stay of HIV+ patients decreases, although it tends to increase in patients who ultimately die, possibly because of the social changes in the last few years, as disease, and particularly death, is intended to become separated from family home.

[Long-course pneumonia as manifestation of transphrenic migration of a calcified hydatid cyst]. / Neumonía de larga evolución como manifestación de una migración transfénica de un quiste hidatídico calcificado.

The hydatidosis disease, which is caused by the larva of the granulosus equinococcus, is still a common zoonosis in countries like Spain. The observation of a calcified hydatid cyst of the liver in an asymptomatic patient suggest a very long clinical latency period of the disease. Acute complications have been reported. We present the case of a patient with clinical symptoms of nonresolving pneumonia and an old calcified hydatid cyst of the liver. The first approach to the diagnosis of community-acquired pneumonia was inconclusive. The high clinical suspect of equinococcus infection added to the bronchoscopy findings, computed tomographic (CT) study and serological test, permitted the correct preoperative diagnosis. The surgical removal confirmed the diagnosis of transphrenic migration of a hydatid cyst ruptured to the bronchial tree.

[Bronchioloalveolar carcinoma]. / Carcinoma bronquioloalveolar.

We studied 14 patients with bronchioalveolar carcinoma during the last 14 years. In all cases we evaluated the clinical history, the radiologic presentation, and the diagnostic procedures. The mean age of presentation of the illness was 58.5 years. The incidence of smokers was 35%. The time interval from clinical manifestations to diagnosis was 3,3 months. The most frequent symptoms were cough (57%) and dyspnea (43%). The 21% of the cases were asymptomatic. Two patients (14%) had copious amounts of sputum (bronchorrhea). The most revealing radiologic pattern was of alveolar type (43%), followed by multiple pulmonary nodules (29%) and solitary pulmonary nodule pattern (21%). The diagnosis was based in specimen obtained from transbronchial biopsy, bronchoalveolar lavage, transthoracic aspiration biopsy, thoracotomy, or during the necropsy study. Transbronchial biopsy was a sensitive diagnostic method. The 64% of patients were in a extent disease when the diagnosis was established.

[Choroidal metastases as the form of presentation of 2 bronchiolo-alveolar carcinomas]. / Metástasis coroideas como forma de presentación de dos carcinomas bronquioloalveolares.

We report here two cases presenting with visual symptoms secondary to choroidal metastases, without any other remarkable systemic symptom. After an exhaustive investigation in both patients the diagnosis was obtained of bronchoalveolar carcinoma as primary tumor responsible for such lesions. Bronchoalveolar carcinoma is a type of pulmonary adenocarcinoma which rarely begins with clinical symptoms attributable to metastases and even rarer of choroidal location. The presence of such choroidal lesions are usually associated with visual clinical symptoms and they are a diagnostic challenge when manifested as the presenting symptoms. Therapy is directed to the primary tumor usually associated with palliative radiotherapy of choroidal metastases. Their presence implies a poor survival rate.