Medicina Interna

Medicina, Mexico

Medicina Interna

Medicina, Mexico
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PubMed | Medicina Interna, Gastroenterologia, Radiologia e Imagen and Patologia
Type: | Journal: Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva | Year: 2017

Schwannomas (or neurilemmomas) are slow-growing mesenchymal neoplasms of the peripheral nerve sheath that may arise at almost any anatomical site. Mesentery schwannoma is extremely rare, with less than ten previously described cases. We present the case of a 38-year-old woman with arterial hypertension and chronic kidney disease with an abdominal painless mass of two years duration and an inconclusive pre-operative clinical diagnosis; she was successfully treated by complete surgical resection of the mass. The aim of this report is to recognize the possibility of schwannomas in the differential diagnosis of abdominal slowly growing tumors.

Herreros B.,Hospital Universitario Fundacion Alcorcon | Palacios G.,Hospital Universitario Fundacion Alcorcon | Pacho E.,Medicina Interna
Revista Clinica Espanola | Year: 2012

The limitation of the therapeutic effort (LTE) consists in not applying extraordinary or disproportionate measures for therapeutic purposes that are proposed for a patient with poor life prognosis and/or poor quality of life. There are two types. The first is to not initiate certain measures or to withdraw them when they are established. A decision of the LTE should be based on some rigorous criteria, so that we make the following proposal. First, it is necessary to know the most relevant details of the case to make a decision: the preferences of the patient, the preferences of the family when pertinent, the prognosis (severity), the quality of life and distribution of the limited resources. After, the decision should be made. In this phase, participatory deliberation should be established to clarify the end of the intervention. Finally, if it is decided to perform an LTE, it should be decided how to do it. Special procedures, disproportionate measures, that are useless and vain should not be initiated for the therapeutic objective designed (withdraw them if they have been established). When it has been decided to treat a condition (interim measures), the treatment should be maintained. This complex phase may need stratification of he measures. Finally, the necessary palliative measures should be established. © 2011 Elsevier España, S.L. All rights reserved.

The literature is continually growing and this is exponential. Therefore it is necessary to have assessors on the quality of writings; in the United States, for forty years and in Spain, already has this type of lists of recommended books and medical journals. In Mexico there is still not the same and, judging from certain statements published in the national media, as discussed in this article, it is imperative and desirable that as soon as you tell them.

Asero R.,Ambulatorio di Allergologia | Tedeschi A.,U.O. Allergologia e Immunologia Clinica | Cugno M.,Medicina Interna
American Journal of Clinical Dermatology | Year: 2013

Chronic urticaria is a distressing disease that affects up to 1 % of the general population at a time point in life and may severely worsen the quality of life. First-line treatment has been based on antihistamines, and presently relies on the use of non-sedating, second-generation antihistamines; following the recommendations of the recent international guidelines, in patients who do not respond to antihistamines at licensed doses, the daily dosage of these drugs can be increased up to fourfold. Nonetheless, a significant proportion of patients with chronic urticaria remain poorly controlled; in these cases, alternative therapeutic approaches have to be considered. This article critically reviews all of the third- and fourth-line treatment options suggested for patients whose disease is refractory to antihistamines, including systemic corticosteroids, leukotriene receptor antagonists, several different anti-inflammatory drugs (dapsone, sulfasalazine, hydroxychloroquine), various immunosuppressive drugs (calcineurin inhibitors, methotrexate, cyclophosphamide, azathioprine, mycophenolate mofetil), intravenous immunoglobulin, and newer treatment options, such as omalizumab and other biologic drugs. In addition, the article examines possible future treatment options based on recent findings about pathogenic mechanisms, and considers the treatment of antihistamine- unresponsive urticaria in special conditions such as children and pregnancy/lactation. The evidence supporting the use of several of the discussed drugs is presently limited and thus insufficient to recommend their routine use; as a consequence, such compounds should be considered only in specific cases and in adequate settings. © 2013 Springer International Publishing Switzerland.

Brucato A.,Medicina Interna | Previtali E.,Medicina Interna | Ramoni V.,Medicina Interna | Ghidoni S.,Medicina Interna
Scandinavian Journal of Immunology | Year: 2010

Perfusion of human foetal heart with anti-Ro/SSA antibodies induces transient heart block. Anti-Ro/SSA antibodies may cross-react with T- and L-type calcium channels, and anti-p200 antibodies may cause calcium to accumulate in rat heart cells. These actions may explain a direct electrophysiological effect of these antibodies. Congenital complete heart block is the more severe manifestation of so-called "Neonatal Lupus". In clinical practice, it is important to distinguish in utero complete versus incomplete atrioventricular (AV) block, as complete AV block to date is irreversible, while incomplete AV block has been shown to be potentially reversible after fluorinated steroid therapy. Another issue is the definition of congenital AV block, as cardiologists have considered congenital blocks detected months or years after birth. We propose as congenital blocks detected in utero or within the neonatal period (0-27 days after birth). The possible detection of first degree AV block in utero, with different techniques, might be a promising tool to assess the effects of these antibodies. Other arrhythmias have been described in NL or have been linked to anti-Ro/SSA antibodies: first degree AV block, in utero and after birth, second degree (i.e. incomplete block), sinus bradycardia and QT prolongation, both in infants and in adults, ventricular arrhythmias (in adults). Overall, these arrhythmias have not a clinical relevance, but are important for research purposes. © 2010 Blackwell Publishing Ltd.

Tirotta D.,Medicina Interna | Durante V.,Medicina Interna
European Annals of Allergy and Clinical Immunology | Year: 2014

Common Variable Immunodeficiency (CVID) is one of the most common causes of Primary Immunodeficiency Disorders (PIDs) and of Primary Hypogammaglobulinemia in adulthood. Clinical features include variable combinations of infectious diseases, autoimmune diseases, lymphoproliferative disorders and gastrointestinal diseases. In this case report, delayed detection of the disease had a negative prognostic impact, despite prompt antibiotic and replacement therapy. The unfavourable prognosis was due to multi-organ failure (namely lungs, heart and liver) and to a number of chronic and acute infectious diseases. © 2014, EDRA LSWR. All Rights Reserved.

The symbol of medicine, like any other science, has a range of both historical and ethical values. The Rod of Aesculapius (Asclepius), with a serpent, has traditionally been the symbol of scientific medicine, but for about half a millennium, often taken as a symbol of medicine, the Caduceus of Hermes (Mercury) with two entwined snakes and two wings, this being the usual symbol of commerce. The doctors know their own emblem and its historical origin and meaning, must be of academic interest and not just a curiosity.

Chronic obstructive pulmonary disease (COPD) is one of the main causes for admission to an internal medicine ward, due to exacerbations of the disease itself or to comorbidities leading to dyspnea as an intriguing symptom. In many cases, a diagnosis of COPD is made only on clinical grounds, but well-accepted guidelines strongly suggest measuring the lung function to diagnose and stage such a common disease. Problems with the equipment, its use and data interpretation lead to underuse spirometry in general and in patients in internal medicine in particular. ©Copyright A. Sacchetta, 2014.

Perez Miranda M.,Medicina Interna
Revista Clinica Espanola | Year: 2010

Two erroneous concepts have been developed over the last two decades In the Spanish medical literature and clinical practice: a) "mature minor," supposed subject whose rights prevail over those of his/her parents and b) "legal age for health care-related decisions" (16 years), really non-existent in our legal regulations. Several thoughts are given concerning the legislations that have been offered with respect to the "legal-age for health care-related decisions". © 2009 Elsevier España, S.L. All rights reserved.

PubMed | University of Rome La Sapienza, Medicina Interna, SapienzaUniversity of Rome, RiUniti Hospital and San Pietro Fatebenefratelli Hospital
Type: Journal Article | Journal: Internal and emergency medicine | Year: 2016

Vitamin D deficiency has been reported in patients with chronic inflammatory conditions, such as rheumatic and inflammatory bowel diseases (IBD). We evaluated the role of biologic therapy on vitamin D, calcium and parathormone (PTH) levels. This cross-sectional study enrolled consecutive patients with either rheumatic diseases or IBD who underwent an ambulatory visit. Patients receiving vitamin D/calcium supplementation were excluded. Vitamin D deficiency or insufficiency was diagnosed when values were <20ng/mL and 21-29ng/ml, respectively. Patients were sub-grouped according to biologic therapy. A multivariate analysis was performed. Two-hundred patients, including 136 with a rheumatic disease (M/F 37/99; mean age 60.712.9years) and 64 with IBD (M/F 41/23; Mean age 49.613.1years) were enrolled. Vitamin D deficiency/insufficiency was detected in as many as 63.5% patients, being 61.8 and 67.2% in patients with either rheumatic diseases or IBD, respectively. The prevalence of vitamin D deficiency/insufficiency was higher in those receiving biologics than other therapies (78.3 vs 43.2%; p<0.0001), in either rheumatic diseases (78.7 vs 41%; p<0.0001) or IBD (75 vs 50%; p=0.03) group. At multivariate analysis, only biologic therapy was independently associated with vitamin D deficit (OR 4.61; p=0.001). Patients with vitamin D deficiency/insufficiency had hypocalcemia more frequently than controls (22.8 vs 10.9%; p=0.03), while PTH values did not differ significantly. This study finds that the prevalence of vitamin D deficiency/insufficiency was very high in patients with either rheumatic diseases or IBD receiving a biologic therapy.

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