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The Guadalajara University Hospital Study on the quality of communication with immigrant population is a pilot experience that once finished and its success assessed could be extended to other health centers and to others JCCM provinces, and could even coordinate the translation of materials at regional level. Without a doubt the health center would decrease the risk of errors in communication, saving time and consequently money if professionals for increase the process of communication were hired, with quality assurances and materials for the users translated into the most requiered languages, and cultural informative materials for health professionals, all of them areas we are already working on. For the formation of skilled personal, we are working in a pocket guide in several languages; for the user we have an admission guide in Arab and English, protocols and informed consents, as well as informative pamphlets in several languages. The situation has been and is similar in other European countries but measures have been taken or are being taken for paying more attention to linguistic problems. According to our data in Spain no support service for health professionals or for patients is available in this regard, being implied that those involved should resolve the communicative conflicts with effort and time.

Objectives: 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., Methods: 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., Results: 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%., Conclusion: 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 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.

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.

We present a patient with acute pancreatitis that was specially persistent from a biochemical viewpoint, derived from a duodenal sarcomatous tumor of immunoblastic type that narrowed the second duodenal segment for a length of about 8 centimeters. We discuss the possible role of tumoral neoformations in the production of pancreatitis due to increased intraluminal pressure distal to the Vater ampulla, or to occlusion of the Oddi sphincter or the Wirsung duct. We review the existent literature.

The understanding of the causes for hyperamylasemia is of great importance when focusing on the differential diagnosis of acute pancreatitis. Among the causes for hyperamylasemia, special interest is given to macroamylasemia not only because it is poorly understood, but also because we are lacking national studies. In this disorder, the amyl binds to another serum substance, varying from one patient to another, and forms a macromolecular complex. The biochemical characteristics of clinical interest as well as its prevalence are discussed. Its etiopathogenesis and clinical implications are unknown, requiring different methods for its detection that will give better efficacy and reproducibility.