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Presentamos el caso de una paciente de 80 años a la que le fue extirpada una voluminosa tumoración localizada en la región axilar derecha. El diagnóstico histológico fue de carcinoma neuroendocrino primario de piel (carcinoma de células de Merkel). El estudio de extensión realizado encontró un adenoma velloso de sigma con displasia severa. Tras la cirugía se realizó tratamiento de radioterapia. Posteriormente comentamos algunos aspectos clínicos, diagnósticos y terapéuticos de esta infrecuente neoplasia.

Quality of discharge reports is very important for an adequate health care activity. Clinical data of these reports must be comprehensible by patients and in the different levels of Health Services. Presence of abbreviations causes severe shortcomings in the clinical data of these records.We analyzed the presence of abbreviations in the Internal Medicine discharge reports of 7 hospitals of Castilla-La Mancha in the year 1992. We evaluated 835 discharge reports.Abbreviations were found in personal background 72.4%, present disease 31%, physical examination 87.2%, clinical judgement 39.4%, complementary explorations 95.8%, evolution 61.4% and treatment-follow up after discharge 67.4%.These results indicate that abbreviations must be avoided in discharge reports in order to obtain a better communication between patient and doctor and between medical personnel.

We report a case of primary endobronchial non-Hodgkin Lymphoma, an unusual extranodal lymphoma, in a 62 year old patient, which begins with malaise, marked respiratory symptoms and empyema. We especially discuss its diagnostic's criteria and its clinicoradiologic manifestations. We argue over its pathologic, immunohistochemical and cytogenetic features according to the REAL classification of lymphomas. On previous experience and the good response of this case, we propose chemotherapy followed radiotherapy may would be a suitable therapeutic approach.

We analyzed several aspects of the quality (at the level of clinical data) of discharge reports prepared by the Services of Internal Medicine in the hospitals of Castilla-La Mancha, taking into account that these are the end written products of the health care activity. We analyzed 800 reports and we found terms such as "probably, not discarded" in the clinical judgment in 150 reports out of 794 and abbreviations in 370 out of 792. 10.8% of the reports written at discharge (86 out of 794) were waiting for the results, reflecting thus severe shortcomings in the clinical data of these reports, that must be corrected in our area.

The microproteinuria is an increase in the urinary excretion of proteins (non-selective, mainly albumine) undetectable with the routine laboratory tests. The detection of microproteinuria has a relevant role in those diseases causing renal damage and with mechanisms involving the extravasation of proteins at the level of the glomerular ball. Such detection allows a therapeutical action and the evaluation of the results. If the disease is multisystemic, it would also be correlated with lesions in other affected organs.

A severe adverse drug effect secondary to allopurinol ingestion has been described, characterized by fever, eosinophilia, cutaneous rash, hepatic lesion and renal failure, with a high mortality (21-26%) and unknown ethiopathogenicity. In many cases patients had a previous disorder on their renal function (53%) and more than half received allopurinol due to asymptomatic hyperuricemia. We present two new cases and review other 18 patients diagnosed in the last nine years, analyzing the ethiopathogenicity, epidemiological, clinical, therapeutical and preventive aspects.

In a transversal study with an observation period from January 1982 to December 1988, final diagnostics validity in discharge from hospital reports was analyzed, in those patients deceased in a Teaching Internal Medicine Department. We underline the use of terms such as "cardiorespiratory stop" or "possible, probable or could not be ruled out" as final diagnosis in 28.81% on the discharge from hospital reports in 812 deceased patients.