[Persistent intestinal bleeding secondary to pancreatic metastasis from renal cell carcinoma].
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Biomedical subjects
Publications and source records attributed to J García Castaño.
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The relationship between bariatric surgery and gastric cancer is conjectural. We present a 52-year-old woman with BMI 45 operated initially by a Lap-Band procedure complicated by gastric wall erosion of the band 9 months later. She was re-operated and the band was removed. She subsequently underwent a Roux-en-Y gastric bypass. 5 years after, gastric carcinoma was discovered in the gastric pouch. Because of varied symptoms following bariatric surgery, patients may not present promptly with symptoms related to a gastric carcinoma.
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BACKGROUND: To analyse clinical manifestations, diagnosis and management in the "body packer syndrome". MATERIAL AND METHODS: We collected 215 patients who had ingested packets of cocaine. RESULTS: Bowel obstruction, haemorrhagic complications and seizures were observed in 5.1, 4.2 and 2.3%, respectively. Toxic manifestations of cocaine occurred in 4 patients. CONCLUSIONS: Radiographs of abdomen are necessary for diagnosis and follow-up. Close surveillance in necessary to identify intestinal obstruction or acute intoxication by cocaine.
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BACKGROUND: The aim of this study was to analyze clinical manifestations and treatment aspects of alcohol withdrawal syndrome. MATERIAL AND METHODS: A retrospective study of 212 clinical records. RESULTS: The commonest withdrawal effects were tremulousness (68.7%) 7 agitation (67.3%) and hallucinations (46%). Most patients were male. The 64% recognize a period of relative or absolute abstinence less than two days, and a 67.8% have been previous incident of withdrawal syndrome. The commonest complications during hospital stay were rhabdomyolysis (26%). Time of symptoms were three days and mean of hospitalization were 14 days. The treatment used was the correction of fluid and electrolyte imbalance (93%) and B vitamins (98%). In relation to the use of drugs, in 84% of our patients we used benzodiazepines with longer-acting, and clomethiazole in 50% of cases. Mortality were 0.9%. CONCLUSIONS: Patient with alcohol withdrawal syndrome was a male, previously drinker, with a period of abstinence less than two days. In addition to tremulousness and agitation, in our series, we wish to emphasize higher frequency of hallucinations, and the incidence of complications as rhabdomyolysis, despite of such response of treatment is good and mortality is low.
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Cocaine intake growth is a well-known fact, and that involves the appearance of unknown or forgotten complications. We have wanted to make a checking of neurologic complications due to the intake of this drug, make a special point of the physiopathological mechanisms and stopping at those related to treatment. We also want to contribute with our experience with regard to these processes.
We studied the clinical characteristics and the initial supplementary test available in the emergency service, in aged patients with community-acquired pneumonia, as well as their mortality prognosis value. We assessed 190 patients attended consecutively during one year. Clinical, analytical and radiological data were registered. The parameters associated to a higher mortality were: age, absence of thoracic pain, reduction in the level of consciousness, leukocytosis, increased urea levels, aminotransferases, lactate dehydrogenase and reduction in prothrombin activity and pH. The data associated to a greater relative risk were: age above 80 years, absence of thoracic pain, prothrombin activity lower than 70% and ALT < 40 U/l. The presence of three to four of these variables had a sensitivity of 62% and a specificity of 94% in the prediction of mortality. In the multivariable analysis, the following variables remained significative: age, obnubilation and decrease of prothrombin. We stress the relevance of a high clinical suspicion, given the frequency of these cases with little symptomatology, in order to allow for an early treatment and the identification of right risk patients at the initial assessment.
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The development of rhabdomyolysis is a complications of acute intoxications, although its actual incidences is unknown. We had studied the frequency and differential characteristics of the patients with such complications. A prospective study was conducted with 200 patients admitted to a General Hospital from an urban area due to acute intoxication, recording the etiology of the intoxication, motivation and analytical characteristics of the patients with rhabdomyolysis compared to their patients without rhabdomyolysis. The incidence of rhabdomyolysis was 7.7%. Among the patients with rhabdomyolysis, ludic motivation (59%) and etiology associated to drug abuse (heroin 30%, cocaine 24%) were more frequent compared to the patients without rhabdomyolysis. Twenty per cent of the patients consuming cocaine and 17% of the patients consuming heroin developed rhabdomyolysis. Acute rhabdomyolysis was, thus, a significant complication of acute intoxications, associated to the consumption of illegal drugs and, at least in our cases, with a good evolution regarding the renal function.
The prognostic influence on mortality of parameters available in an emergency Unit is studied in patients with acquired community pneumonia (ACP) requiring hospitalization. Three hundred and thirty patients admitted consecutively from the emergency unit of a general hospital were evaluated. Radiological, analytical, clinical, and demographic data were recorded. The parameters associated with greater mortality were: age, absence of thoracic pain, obnubilation, hypotension, elevation in urea, GOT, GPT, LDH, decrease in prothrombin activity, pO2, pH, albumin, and the affectation of more than one lobe in a radiography of the thorax. Considering the parameters associated with a higher relative risk (age > 65 years, urea > 50 mg/dl, LDH > 460 U/l and prothrombin < 70%), the presence of three or four of these variables shaved a sensibility of 59 percent and a specificity of 93 percent in predicting mortality. In the multivariant analysis remained as significant: age, obnubilation, elevation in LDH, and decrease in the activity of prothrombin and pH. Appropriate knowledge of the prognostic factors in CAP allows for early determination of patients who require special attention in both diagnosis and in treatment upon hospitalization.
The increase of cocaine consumption is a common new item in the medical literature and in the national press and, hence, it does not surprises us any more. However, we are seeing every day the appearance of unknown or forgotten complications. In this paper, we review the cardiovascular complications due to the consumption of this drug, stressing the physiopathological mechanisms and the therapeutical aspects. In addition, we describe our experience with the management of these patients.