Absceso retroperitoneal secundario a espondilodiscitis tuberculosa simulando una hernia inguinal incarcerada.

Tuberculosis is the commonest cause of spinal infection worldwide (9-46%). Tuberculosis spondylodiscitis causes multifocal thoracic and lumbar spinal disease, and big paraspinal and psoas abscesses. It is more frequent in people under 40 who had previous tuberculosis infection and from countries where the illness is endemic. Clinic is non-specific and sub-acute. We report the clinical case of a 29-year-old patient who suffered from pericardic tuberculosis in her childhood and who presents a bilateral retroperitoneal abscess due to tuberculosis spondylodiscitis. Her clinical debut began with left inguinal pain and an irreducible mass at this level that simulated an incarcerated inguinal hernia, which is why surgery was indicated. Due to discrepancies between intraoperative findings and the initial diagnosis, the diagnosis and treatment strategy were changed. The purpose of this case report is to emphasize the challenge that the diagnosis of this pathology represents, due to low incidence in our environment and poor clinical features, which results in late diagnosis and late management.

Psoas abscess due to Pasteurella multocida.

Psoas abscess is a pus collection within the muscle compartment. It is a very uncommon entity. It can be primary as a result of haematogenous spread or secondary as a consequence of a direct extension of an infectious focus. Diagnosis is usually delayed because nonspecific clinical presentation. Staphylococcus aureus is the most common organism cultured in this type of abscess. We describe a secondary psoas abscess in an elderly female patient. The patient presented with fever, right groin pain and malaise. Following laboratory, radiological and microbiological analyses the patient was diagnosed as having a psoas abscess due to Pasteurella multocida, which is a Gram negative bacteria, part of the normal oral flora of many animals and can causes human infections after animal scratches or bites. More rarely is to find this organism causing psoas abscesses. Because of insidious clinical presentation, the diagnosis of psoas abscess is a challenge and a high index of suspicion is required. We emphasize the importance of bacteriological confirmation of microorganism involved to choose the correct antibiotics. Percutaneous drainage is the treatment of choice. Open surgical drainage should be reserved if percutaneous drainage fails.

Spigelian hernia. Personal experience and review of the literature.

OBJECTIVE: Spigelian hernia is an uncommon abdominal wall defect. We present our series of patients with Spigelian hernia and a literature review. PATIENTS: We carried out a retrospective review of patients operated on from 2001 to 2008. Epidemiological aspects, diagnostic methods, surgical technique characteristics, morbidity, hospital stay, recurrences and follow up are analyzed. RESULTS: We have treated 39 patients, 25 female and 14 male, with a mean age of 70 years. Left side was the most frequent location. Risk factors were present in 74% of patients. Diagnosis was made clinically in 72% of cases. Open hernioplasty followed by laparoscopic hernioplasty are the most frequent techniques performed. Emergency operation was needed in 20% of patients. Postoperative morbidity is very low. CONCLUSIONS: Diagnosis of Spigelian hernia is basically clinic. The gold standard is TC in doubtful cases. An important percentage of patients will present with an acute complication of the Spigelian hernia as their first symptom. Surgical technique depends on patient characteristics, type of hernia and surgeon experience.

Usefulness of inhaled furosemide in a bronchial asthma attack.

Furosemide administered through repeated dose inhalation has antiinflammatory effects on the airways. We carried out a study to measure the adjuvant effect of this drug with salbutamol inhalation in asthmatic patients presenting an acute or chronic asthma attack. We studied 50 patients, 25 of whom were given salbutamol (0.5%-1 cc) every 12 h and placebo every 12 h. All patients underwent spirometry on the first day and at the end of the treatment (5 days). Peak flow was recorded twice a day as well as daily diuresis and body weight. Peak flow in the morning increased 13.8 l/min in the group given salbutamol and placebo; in group given furosemide, the increase was 2.2 l/min, with statistically significant differences. Peak flow in the evening showed no sizeable differences. The same was true with spirometric variables (FVC, FEV1 and FEF 25-75), which improved greatly in both groups, but without a considerable difference. Diuresis increased in the group given furosemide (510.80 ml; in the group given placebo the increase was 310.20) without a significant difference. Analysis of body weight showed that in the group given furosemide average weight decreased from 140.4 to 138.5 lbs (52.4 to 51.7 kg); in the group given placebo, it increased from 130.3 to 132.6 lbs (48.6 to 49.5 kg). Statistical analysis was significant. We concluded that administering furosemide by inhalation for 5 days as adjuvant treatment to salbutamol in patients presenting with acute or chronic asthma attack is not superior to treatment using salbutamol and placebo.

Assessment of the bronchodilator effect of inhaled furosemide compared to salbutamol in asthmatic patients.

To compare the bronchodilator effects of high-dose inhaled furosemide, we studied 80 patients who were nonsmokers presenting some degree of bronchial obstruction. Of these patients, 40 were given salbutamol (1%) aerosol and the remaining 40 were given furosemide aerosol (100 mg). Respiratory functional tests were conducted at 10 min and 30 min, as well as measurement of pulse and blood pressure. Patients in the salbutamol group showed an improvement in forced expiratory volume (FEV1) of 7.9% at 10 min and 30 min, and the group given furosemide improved 6.9% (p > 0.05). Systolic blood pressure showed a slight increase of 2 mmHg in the salbutamol group and a decrease of 6 mmHg in the furosemide group (p < 0.05). The same occurred for diastolic blood pressure (p < 0.05). Pulse increased from 73.7 to 75.2 beats per min in the salbutamol group; however, in the furosemide group, pulse declined from 73.7 to 71.8 beats per min (p < 0.05). We conclude that furosemide at a dose of 100 mg has the same bronchodilator effect as salbutamol, as measured by FEV1 and forced expiratory flow of 25% to 75%. Furosemide was also related with a mild hypotensive effect and drop in pulse.

[The results of school health exams in Montcada y Reixac (Barcelona). The 1991-92 school year]. / Resultados de los exámenes de salud escolar en Montcada y Reixac (Barcelona). Curso 1991-92.

BACKGROUND: The results of the school health examinations (SHE) carried out in school children attending P4 and 1st of EGB (aged between 4 and 8 years) from the public schools of Montcada y Reixac (Barcelona) during the academic year 1991-92 were evaluated. METHODS: 310 school children (157 boys and 153 girls) were studied. The following variables were analysed: weight and height by percentiles (using Tanner's standards): the percentage of vaccinations administered: and the prevalence of anomalies according to the current SHE program in Catalonia. RESULTS: From a general point of view, the weight and height values were higher than expected. The administering of vaccinations was poor (66%: 95% confidence interval (CI) = 61.5%-70.4%). A high prevalence of squinted vision (6.2%: 95% CI = 4.1%-8.2%) and a good absence of caries index (76.7%: 95% CI = 71.1%-82.2%) were observed. During the examination of male genital organs, a higher percentage of non-palpable testicles in the scrotum amongst boys aged 6-8 years versus boys aged 4-5 years was observed (14.9% vs 9.8%). CONCLUSIONS: The weight-and-height standards used and the efficiency of the program for caries prevention were discussed. It was recommended that the reasons for some of the anomalies found be investigated and that more control over routine vaccination certificates be implemented.

Simplified chest tube removal: a new technique.

There is a simple method to remove chest tubes using a transparent adhesive dressing. The dressing provides an inexpensive, comfortable, waterproof, and secure air-tight seal and also allows visualization of any drainage.

Immunological heterogeneity in human melanoma: immunogenic alloantigen expression in autologous host.

A patient presented with a primary melanoma, Level IV, 2.5 mm thick; 30 excised lymph nodes were all negative for tumor. Four local recurrences followed in the ensuing 17 months. Tumor cells cultured at this time were epithelioid. Autoimmunization was followed by a disease-free interval of 15 months. Postimmunization, the patient's lymphocytes destroyed his melanoma cells in culture and were stimulated in mixed cell culture by his irradiated tumor cells. Cells grown from the relapsing tumor were spindle/dendritic with bizarre morphology and were not attacked by his lymphocytes in culture. Using a C' fixation technique, DR antigen profiles of the patient's B-cells and both tumor cell types showed that the immunizing tumor was positive for DR antigens 3, 5, and 8, none of which were present on his B-cells which had DR 2 and 4. Both B-cells and immunizing tumor cells were positive for DQ antigens. The relapsing tumor cells were positive for DR2 and negative for all other D region antigens tested. The evidence suggests that given a melanoma of heterogeneous cell population, autoimmunization against the predominant immunogenic cell inhibits tumor growth but allows the ascendance of a nonimmunogenic tumor cell type.