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Objective: To determine the clinical manifestations of the relapse of the tuberculosis (TB) in the patients infected by the human immunodeficiency virus (HIV) and the degree of immunodeficiency shown., Material and Method: They are analyzed retrospectively 121 cases, all they HIV+, diagnosed of TB from November of 1985 until December of 1999. All they fulfilled correctly the specific treatment of the tuberculosis., Results: Of 121 studied cases, a total of 13 (10.7%) presented relapse of tuberculosis finally of a mean of 31.8 months (range 1-95). In 7 cases the affectation was pulmonary (2 typical, 5 non typical), in 3 mixed (pulmonary and extrapulmonary) and in 3 extrapulmonary. The clinical sintomatology were present in 92% of the cases and, predominantly, was: fever (92%), cough (69%), sweating, weight loss (61%). Hepatomegaly results be the exploratory finding quite frequent (54%). The mean of CD4+ lymphocytes was 141.7 (range 3-406), in 8 (61%) the lymphocyte counts was inferior to 100 cells/mm3. PPD was positive in 1 case (14%) and with respect to delayed-type hypersensitivity reaction test, it was observed not normoergia in all the cases (100%)., Conclusions: Relapse of the tuberculosis in patient infected by the VIH is presented with a manifested clinical expresivity in the course of a severe degree of immunodeficiency. In certain groups of risk as the intravenous drugs users, it must of be had a high level of suspicion of the relapse of the disease, above all in those patients that show low CD4+ lymphocyte counts.

Objectives: The aim of this work was to assess cellular immunity using the multitest CMI and relate its results with lymphocyte CD4 counts, and the risk to developed active tuberculosis if the multi-test's tuberculosis pápula was positive., Methods: Prospective longitudinal follow-up of 342 IDU patients, 210 infected with HIV-1 and seronegative 132 patients. The cohort study was 165 IDU HIV-1 positive patients (128 men, 37 female). Ages was 18 to 45 years. Study time were 25 months (8-25). Tuberculin skin tests and multitest IMC were performed at baseline and each three months, and screening from active tuberculosis were performed all study when necessary was considered., Results: Actived tuberculosis developed in 9.25 cases per one hundred persons and year from follow-up in the ranges with better immunologic status (Score from PHR > 10 mm). There are an significative correlation between tuberculosis skin test diameter and PHR tuberculin fraction papula., Conclusions: PHR performed with Multitest IMC is an useful test to evaluate cellular immune system, and HIV-1 positive patients with energy in this test or positive tuberculine fraction must be considered to isoniazid (9 months) prophylaxis.

Objective: The aim of this study was to assess risk for developed active tuberculosis in HIV infected IDU oblation and relate with immunodeficiency degree., Methods: Longitudinal follow-up was realized, the period of study was 9 years, in HIV seropositive IDU patients. Control group was HIV seronegative IDU. CD4+ lymphocytes count and cutaneous test (PPd and DHT) were performed at baseline and each three months, them screening from active tuberculosis., Results: Study's population was 165 patients and control group was 69. The average age was 26 and 23.8 respectively. The medium follow-up was 25 months. Active tuberculosis was developed in 9.26 cases per one hundred persons and year from follow-up. It was between 4.92 in cases with more than 500 CD4+ lymphocytes and 3.08 for them with lymphocytes between 50 and 200 per mm3. The incidence tests was 3.99 in PPD negative normoergic patients and 15.87 in PPD negative anergic patients., Conclusions: Risk from active tuberculosis was relactioned with latent infection and immunodeficiency degree. We constated high risk in low CD4+ lymphocytes counts; and degrees from DHT let an approach to tuberculosis production mechanism.

Objectives: To analyse the clinical manifestations and performance of the diagnosis methods in tuberculosis (TB) diagnosed in patients with human immunodeficiency virus infection (HIV), according to the location forms of disease (LF)., Material and Methods: We revised 80 cases of TB diagnosed in patients with infection by HIV. The data were gathered in relation to TB location, the clinical data and the microbiological and histological diagnosed studies. In the statistic analysis the values p < 0.05 were taken into account., Results: The prevalence of LF was: 1) pulmonary forms (PF) 32 (40%), of which 12 were typical pulmonary (TP) and 20 atypical pulmonary (AP); 2) mixed forms (MF) 21 (26%); 3) extrapulmonary forms (EF) 19 (24%), of which 17 were lymphadenitis; 4) miliary tuberculosis (MT) 8 cases (10%). The prevailing symptoms were: fever (71%) mainly in MF and MT, cough (69%), with less frequency in AP, EF and MT (p < 0.05) and adenomegalies especially in EF and MF. The diagnosis was based on the study of the sputum smears and lymph node. The bacilloscope of the spontaneous sputum was 53% with a minor performance in the AP (p < 0.05), while in lymph node the smear for AFB was positive in 78% cases and caseous granulomas were observed in 87%., Conclusions: In our study the major confirmed locations were pulmonary and lymph node, the most important clinical symptoms were fever, cough and adenomegalies. The diagnosis was based, in the most of cases, on the microbiologic and histologic examination of bronchial secretion and lymph node samples.

Objective: To analyze the clinical characteristics and diagnose of tuberculosis in patients infected by human immunodeficiency virus in our setting., Methods: We have revised the clinical, microbiological and histological characteristics of 92 cases diagnosed tuberculosis in seropositive patients, during a span time of 128 months., Results: Of them, 71 were male and most of them (81.5%) were intravenous drugs users. The most (93.4%) were sintomatic when tuberculosis was diagnosed mainly fever and general and respiratory sintomatology. The most common signs were the presence of lymphadenopathies and hepatomegaly. The tuberculosis affected mainly pulmonary and ganglionary system. 34 cases had only pulmonary pathology, 24 extrapulmonary, 25 pulmonary and extrapulmonary and 9 miliary. The tuberculosis diagnose was based in microbiologic criteris. The most frequent source, as histologic critery, has been the ganglionary tissue., Conclusions: The only or associated pulmonary forms are more frequent. The most commonly extrapulmonary form is the ganglionary localization. The most of diagnose methods were obtained from respiratory tract and lymphadenopathy samples.

In fact patients with human immune deficiency virus infection are in treatment with multidrugs regimen, also in antiretrovirical therapy as profilaxis and treatment opportunist infections and other problems, in other fact the high tase of intravenous drugs users in meta-done programming (one of the principal transmission cause). Consequently is necessary an rational approximation to this problem also in the deepth knowledgment of his mechanisms and his management in the daily clinical practice.

In this report we are analysing the clinical history of 193 patients who were admitted to our medical department due to stroke during a period of two years. The patients were divided into two groups depending on wether they had ischemic or hemorrhagic pathology, analysing the presence of vascular risk factors in both groups. From the obtained results we have to point out, in both groups of patients, hypertension together with mellitus diabetes, giving clear proof of this, being the most frequent association of risk factors. We also have to point out the low percentage of patients with a lack of all the analysed risk factors, being also, that the average age was notably superior than the global.

Isolated Systolic Arterial Hypertension (ISAH) is the most frequent form of AHT in the aged population, resulting in an increase of the cardiovascular risk, mainly at the cerebrovascular level. In this open non-comparative study, we analyze the effect of doxazosin, an alpha-adrenergic blocker in 40 patients older than 60 years, diagnosed of isolated systolic hypertension. After 2 weeks of lavage, the patients received treatment with doxazosin according to a monotherapy scheme, with progressive increase of the dose, from 1 to 16 mg/day during a period of 14 weeks. Doxazosin significantly reduces the systolic and diastolic arterial pressure (p < 0.001) with a therapeutical response in 86.5% of the cases, using an average dose of 3.4 mg/day and without observing modifications in the heart rate. This drug improves the lipidic profile, with a reduction of the plasmatic levels of total cholesterol and cholesterol linked to low density proteins (LDL) with p < 0.05 and a reduction of triglycerides. Among the 40 patients included in the study, 10 (25%) referred side effects; there were 2 drop-outs (5%) and the dose had to be reduced in 2 patients (5%). In conclusion, doxazosin shows its antihypertensive effectiveness in the treatment of isolated systolic hypertension in patients older than 60 years and it is well tolerated by most of the patients, improving at the same time the lipidic profile. Hence, it contributes to the reduction of the cardiovascular morbidity-mortality in this group of patients.

We present the case of a patient with refractory arterial hypertension, during the study of which a renal mass was discovered and diagnosed after the surgical intervention of an oncocytoma. We review the clinical, diagnostic and therapeutic characteristics of this entity. In addition, the lack of a clear association between renal oncocytoma and arterial hypertension is stressed.

Seventy one mild to moderate essential hypertensive patients receiving out-patient treatment with Captopril--inhibitor of the conversion enzyme--during a period of six months, are studied. The therapeutic goal (DAP less than 95 mm Hg.) was reached in 88% of the cases, with just a single Captopril dose of 50 mg/day in 42 patients (59.1%). AP decreased from 174.2/100.2 mm Hg. to 149.2/84.0 mm Hg. (p less than 0.001). Any significant changes in heart rate nor in body weight were observed. Side effects were rare (just in two patients), although their intensity determined in both cases the interruption of treatment. Finally, and improvement in the metabolic profile of patients was observed, with reduction in glucose, cholesterol, triglycerides and uric acid at the end of the study.

The selective deficit of IgA is characterised by its clinical variability. This disease can be detected in non-symptomatic patients or associated to multiple diseases of different features. The allergic reactions, recurrent infections, gastrointestinal alterations, autoimmune diseases, and some neoplasias are the most frequent features of this deficit. We present 3 cases with different pathology associated to the common deficit of IgA, giving a view of the wide clinical spectrum of this process.

Alcohol withdrawal syndrome (AWS) is an admission problem and can also occur in hospitalized patients. We endeavoured to ascertain the exact epidemiology and hospital cost of AWS based on a review of the charts of patients admitted during 1986, 1987, 1988 (total = 78). The statistical analysis of the differences was performed by chi-square test with a significant level = or less than of 0.05. The results were: total hospital prevalence of AWS = 2.44%, hospital prevalence by season = 3.33% (spring), 2.04% (summer), 2.28% (fall), 2.19% (winter). Outpatients presentation = 79.49%, highlighting fever syndrome of unknown origin (FSUO) (16.4%) and pneumonia (11.48%); hospital presentation = 20.51% focusing acute pancreatitis (31.25%) and pneumonia (25%) as first causes of admission. The significant association between FSUO and spring and winter (84.62%); relation male: female = 5.5: 1; mean age = 42.57 years; decade distributions = 1st decade 0%, second = 1.28%, third = 11.64%, fourth = 35.90%, fifth = 24.36%, sixth = 16.67%, seventh = 8.97%, eighth = 1.28%, ninth = 0%; mean admission time = 14.12 days; total hospital cost of out-patients presentation = 15.087.370 pesetas.

The selective deficit of IgA is the most frequently acquired immunodeficiency. It is important because of this and the variability of the clinical presentation, which might be non-symptomatic or simply show several clinical features. The prognosis depends on the associated clinical affliction. There is no substitute treatment for this immunodeficiency, in which the immunoglobulins administration produces a paradoxical antibody formation against this, and adverse immunological reactions. We reviewed the immunodeficiency in this paper, highlighting the frequency, pathogenia, clinical diversity and therapy.

The rare POEMS syndrome which combines hematology, bone, endocrine, neurology and skin manifestations, associated to a non-frequent osteosclerotic type of multiple myeloma is reviewed. The clinical, analytical, radiologic, immunologic, electrophysiologic and histopathologic features are detailed, as well as the different pathogenetical theories of its several manifestations, in an attempt to unify them. The different treatment schedules following the onset and corresponding prognostic are detailed.

The biological and clinical features and prognostic factors of 65 patients affected by alcoholic hepatitis were studied. All patients had an ethanol intake higher than 80 gr/day during at least 3 years. 22 patients were female and 43 male with a mean age of 45 +/- 11.7 years. 19 had acute hepatitis (29.2%), 2 had acute hepatic insufficiency (3%), one had acute cholestasis (1.5%), 14 had chronic hepatopathy (21.5%). 29 patients had the diagnosis (44.6%) confirmed by histologic analysis. All patients had liver enlargement, 25 had jaundice and 4 had fever. The hepatic biopsies showed steatosis in 53 cases, centrilobular sclerosis in 32 cases and cirrhosis in 19.8 patients developed hepatic encephalopathy, 3 had renal insufficiency, and 4 died. The levels of albumin (P = 0.0043), total bilirubin (P = 0.0003), prothrombin (P = 0.0001) and the development of hepatic encephalopathy or/and renal insufficiency were the parameters to define the group of patients with bad evolution, the IgA also being significant. The low mortality of our studied (6.1%) can be justified by the diagnosis at non-symptomatic stage. We recommend a liver biopsy in all patients with chronic alcoholism and liver enlargement, or biologic markers suggesting alcoholic hepatopathy.

A patient admitted into hospital suffering from quadriparesis, secondary to distal symmetric sensitive and motor polyneuropathy, is presented. Diffuse osteosclerotic bone changes associated to neurological symptoms were detected and histologically confirmed as non-secreting plasmacytoma, on noting the non-production of paraprotein. Also, there were endocrine, skin and systemic alterations. We comment on the association of these changes as POEMS syndrome, discussing the pathogenesis and giving details of the treatment, emphasizing the excellent response.