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PROPÓSITO: analizar si el tratamiento con antibióticos por vía oral de modo ambulatorio, resulta eficaz en pacientes con neutropenia febril de bajo riesgo. MATERIAL Y MÉTODOS: estudio observacional, prospectivo de casos clínicos. 10 pacientes incluídos, que cumplían los criterios de neutropenia febril de bajo riesgo, recibieron tratamiento antibiótico con quinolonas, ciprofloxacino en ocho casos y en los otros dos levofloxacino, durante un periodo de 10 a 14 días. En los tres primeros casos incluídos cronológicamente se asoció tratamiento con filgastrim. Se efectuaron revisiones clínicas a las 48 horas y posteriormente cada 48-72 horas, hasta la resolución de la neutropenia febril. RESULTADOS: la fiebre desapareció a las 48 horas en cinco casos, a las 72 horas en otros tres enfermos y persistió febrícula en dos casos, que estimamos secundaria al cáncer y no a la neutropenia. Un nuevo control hematológico a las 48 horas, mostró un recuento de neutrófilos superior a 500 en tres casos y a los 4 días del episodio inicial, cinco de los 6 casos restantes tuvieron un recuento de neutrófilos superior a 500. Ningún paciente precisó ingreso hospitalario y como medida de precaución adicional, decidimos retrasar una semana y reducir al 25% la siguiente administración de quimioterapia. CONCLUSIONES: el tratamiento con antibióticos por vía oral de modo ambulatorio resulta eficaz en los pacientes que presentan neutropenia febril de bajo riesgo, evitándose ingresos innecesarios y complicaciones hospitalarias. PURPOSE: To analyze whether oral antibiotic therapy is effective for patients under outpatient regime having a low risk febrile neutropenia. MATERIAL AND METHODS: An observational, prospective study of 10 patients meeting the criteria of low risk neutropenia is made. Quinolones were administered, emplpying ciprofloxacin in 8 cases and levofloxacin in the other 2 during 10-14 days. The first three cases seen received also filgastrim. The patients were followed-up after 24 hours, and then every 48-72 hours until the febrile neutropenia resolved. RESULTS: Fever disappeared within 48 hours in 5 cases and within 72 hours in 3 patients. A low grade fever remained in 2 cases, that according to the authors was cancer-related and not caused by neutropenia. The hematological control showed a neutrophil count over 500 per mm3 after 48 hours in 3 cases, and 4 days after the beginning of the episode a count over 500 was found in five out of the six remaining patients. No patient required hospitalization. As an additional preventive measure, the next chemotherapy course was delayed one week and the dose reduced to 25% of the total dose. CONCLUSIONS: Oral antibiotic therapy under outpatient regime is effective for patients with low-risk febrile neutropenia, thus avoiding unnecessary hospital admissions and complications.

The Study of Talavera de la Reina analyzes the presence of several cardiovascular risk factors (CVRF) in this city, by means of a cross-sectional study of the population within 1989 and 1990. In this paper, the results on tobacco consumption, as well as the correlation between tobacco consumption and several anthropometric and biochemical parameters, some of which are independent CVRF theirselves, are presented. Seven hundred and two people were evaluated, 332 men and 370 women, with ages between 20 and 79 years, and were randomized according to the current population census. We have carried out a survey to assess smoking habits; physical examination to measure weight and height, systolic and diastolic arterial pressure, blood analysis including total cholesterol, C-HDL, triglycerides and glucose. C-LDL was obtained using the Friedewald-Fredickson formula. Smoking habits among the younger female population is almost equal to male population. Compared by age groups and similar sex, no significant differences were observed related to anthropometric and biochemical parameters between smokers and non-smokers. The lipidic profile of non-smokers against moderate/heavy smokers (smoking 10 or more gr/day) was compared. The presence of an atherogenic profile in 30 to 39-year-old men and in 40 to 49-year-old women was verified, as well as the lower C-HDL levels among younger smokers of both sexes. This provides tobacco with an added value, as it increases the impact of other CVRF in key ages for the pathogenicity of arteriosclerosis.

A case of a 38-year-old smoker male who had vasoconstriction and instep claudication of the right hand, is presented. After a year of evolution, he experienced the same alteration on the left foot. He was diagnosed as suffering from thromboangiitis obliterans, by means of angiography. After oral nifedipine treatment, combined with cessation of smoking, all symptoms and trophics regressed.

The acute phase and long-term evolution of 249 patients diagnosed as having acute myocardial infarction and admitted to our hospital during the period 1981 to 1983, were studied. They were classified in 2 groups: A (non-diabetic patients) and B (diabetic patients). Several variables were analysed in order to determine the differences between both groups. The most accentuated being: diabetic patients, female sex, old age, blood hypertension history, cardiac failure, re-extended infarction. The inter-hospital mortality was higher in group B, mainly as a result of cardiogenic shock and left cardiac failure. An out-patients follow-up of acute phase survivors was carried out, between 1 to 96 months, with mean follow-up of 46.7 month in group A and 38.4 in group B, at 8 years the actuarial rate being 77.3% and 55.9% respectively. We conclude that diabetic patients with myocardial infarction register a higher long- and short-time mortality.

A case of reticular erythematous mucinosis of histology and atypical localization in a patient with breast cancer, is presented. This patient had a history of benign tumors of muscular origin localized in uterus and stomach. We focus on the rareness of this syndrome and its association with other tumors, a point not shown in the literature.

Se presenta el caso de un paciente que inhalo un cuerpo extrano; escasamente sintomatico este episodio; solo pudo realizarse el diagnostico 8 anos mas tarde, tras multiples infecciones pulmonares en ese periodo. Por medio del broncoscopio se consigue extraer dicho cuerpo extrano y presenta una mejoria inicial notable, pero meses mas tarde se aprecia realizar una lobectomia para conseguir mejoria definitiva. Se recuerdan aspectos clinicos, diagnosticos y terapeuticos; recalcandose la importancia del fibrobroncoscopio como medio terapeutico y en ocasiones diagnostico.

El sindrome de las unas amarillas esta constituido por la asociacion de unas amarillas, liniedema y derrame pleural. Habitualmente se asocia a bronquiectasias, bronquitis, sinusitis cronicas e infecciones respiratorias. Se presenta el caso de un paciente de 46 anos afecto de este sindrome asociado a sinusitis cronica junto a diversos aspectos sobre etiopatogenia, cuadros con los que se asocia, alteraciones analiticas encontradas, asi como posibilidades de tratamiento y pronostico de esta rara entidad.

Presentamos los casos de dos pacientes primas-hermanas, con antecedentes de dismenorrea y esterilidad, que padecian un cuadro de larga evolucion, consistente en dolor pleuritico derecho que coincidia con el inicio de sus menstruaciones. En ambas pacientes hemos llegado a constatar doce y tres episodios respectivamente de neumotorax de hemitorax derecho con dicha clinica. En una se practico toracotomia cuyos hallazgos fueron anodinos, resolviendo el cuadro. La otra paciente refiere en sus antecedentes, la desaparicion de su sintomatologia mientras seguia tratamiento supresivo hormonal, con reaparicion del cuadro al suprimir la medicacion por tromboflebitis. Esta paciente rehuso ser intervenida.