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Resumen Objetivo Determinar la asociacion entre la puntuacion de la escala de Norton (que valora el riesgo de padecer ulceras por presion) y la mortalidad a corto, medio y largo plazo en los pacientes hospitalizados en Medicina Interna. Pacientes y metodos Estudio de cohortes prospectivo, unicentrico, de pacientes ingresados en los meses de octubre de 2010, y enero, mayo y octubre de 2011. Se recogieron la edad, sexo, indice de Barthel, escala de Norton, presencia de ulceras por presion, categoria diagnostica mayor, estancia hospitalaria y peso del grupo relacionado de diagnostico. Se dividio a los pacientes segun las categorias de riesgo de la escala de Norton. El seguimiento fue de 3 anos. Resultados Se incluyeron 624 pacientes con una edad mediana (rango intercuartilico) de 79 (17) anos y una puntuacion mediana en la escala de Norton de 16 (7). Durante el ingreso fallecieron 74 (11,9%) pacientes, a los 6 meses 176 (28,2%), al ano 212 (34,0%), y a los 3 anos 296 (47,4%). La mortalidad fue mayor en las categorias de mas riesgo en la escala de Norton. La puntuacion en la escala de Norton se asocio de forma independiente con la mortalidad a los 6 meses (p Conclusiones La escala de Norton es util para predecir el pronostico a corto, medio y largo plazo en pacientes ingresados en Medicina Interna.

To determine the association between the Norton scale score (which assesses the risk of pressure ulcers) and mortality in the short, medium and long term in patients hospitalised in Internal Medicine departments.A prospective, single-centre cohort study was conducted on patients hospitalised in the months of October 2010 and January, May and October 2011. Data was collected on age, sex, Barthel index, Norton scale, presence of pressure ulcers, major diagnostic category, hospital stay and weight of the diagnosis-related group. The patients were divided according to the risk categories of the Norton scale. The follow-up was 3 years.The study included 624 patients with a median age (interquartile range) of 79 (17) years and a median Norton scale score of 16 (7). During hospitalisation, 74 (11.9%) patients died, 176 (28.2%) died at 6 months, 212 (34.0%) died at 1 year, and 296 (47.4%) died at 3 years. Mortality was greater in the higher risk categories of the Norton scale. The Norton score was independently associated with mortality at 6 months (p.001), at 1 year (p=.005), and at 3 years (p=.002). The areas under the curve of the Norton scale were 0.746 (95% CI 0.686-0.806), 0.735 (95% CI 0.691-0.780) and 0.751 (95% CI 0.713-0.789), respectively (p.001).The Norton scale is useful for predicting the prognosis in the short, medium and long term in patients hospitalized in internal medicine departments.

Chronic cor pulmonale (CPC) in patients with chronic obstructive pulmonary disease (COPD) is a predictor of mortality. ACE inhibitors (ACEIs) improve the symptoms and reduce mortality of left ventricular or congestive failure, however their long term use in patients with CPC has not been tested. The aim of this study is to assess the effect on exercise tolerance and cardiorespiratory function of long term administration of enalapril in patients with CPC.Placebo-controlled, double blind, randomized study. 28 patients (24 men and 4 women, mean age of 68.11 +/- 7.78, range 51-79) with CPC and without exacerbation of their respiratory symptoms at baseline were double blind randomised to receive enalapril or placebo for 6 months, added to their previous therapy. Respiratory function test, exercise tolerance ("six minutes walking test") and isotopic ventriculography were performed at baseline and at the end of the study.At baseline there were no differences in FEV1, FVC, FEV1/FVC and exercise tolerance. Both placebo and enalapril were well tolerated. At the end of the study, patients taking enalapril increased their exercise tolerance an 8.9% (19 m) vs 4.7% (33 m) in the placebo group (p 0.44; 95 percent confidence interval, -41.10 to 91.99). RVEF improved a 6.4% with enalapril but worsened a 7.09% in placebo group (p 0.15; 95 percent confidence interval, -12.87 to 2.10).Long term administration of enalapril do not improve neither exercise tolerance, nor right ventricular (RV) function, although given in increasingly doses is well tolerated and might prevent further worsening in RV systolic function.

Sonography is a useful technique for the study of the Achilles tendon, and specially in the detection of tendon xantomas. Normal sonographic size is not well established, and is essential in the clinical diagnosis of monogenic familial hypercholesterolemia (FH). Possible relationship between Achilles tendon size and plasma lipid concentrations in normolipidemic population is not known.The antero-posterior Achilles tendon diameter (ATD) was measured with high resolution sonography in 100 healthy subjects, 50 males and 50 females, 20-70 years old, 10 subjects for each decade of age and sex. ATD was correlated with age, gender, body mass index, physical activity and lipid and apolipoprotein B plasma concentrations.The ATD was significantly higher in males than in females, 5.32 (standard desviation [SD] 0.48) mm versus 4.91 (SD 0.47) mm (p0.01). In the multivariate analysis, ATD of males was positively associated with total plasma cholesterol (TC) level (p0.01). The ATD in females was positively associated with weight (p0.01).Normal ATD has been defined. Its range is relatively narrow and different in both sexes. Similarities in the histology between vascular and tendinous intersticium probably explain the relationship found between Achilles tendon and TC. Achilles tendon size could be a simple marker of lipid deposition in tissues.

Idiopathic retroperitoneal fibrosis (IRF) is a disease difficult to diagnose. It is considered by different authors of autoimmune origin given its similarity to other connective tissue diseases. We present the case of a female patient diagnosed by a postmortem study, of IRF with multiorgan involvement (lymph nodes, serose tissue, liver, spleen, adrenal glands, thyroid and kidneys) and atypical presentation, not finding other similar cases in the national literature.