[Pulmonary Langerhans'-cell histiocytosis]. / Histiocitosis pulmonar de células de Langerhans.

Pulmonary Langerhans'-cell histiocytosis belongs to a spectrum of diseases characterized by monoclonal proliferation and infiltration of organs by Langerhans' cells. It is an uncommon interstitial lung disease of unknown etiology occurring almost exclusively in cigarette smokers. It s course in adults is variable and unpredictable, ranging from benign self-limiting types with spontaneous regression to slowly progressive malignant disease that leads to respiratory failure and death. We report one patient diagnoses of pulmonary Langerhans' cell histiocytosis who experimented an objective radiographic improvement and disappearance of symptoms after smoking cessation.

[Whipple's disease. Two new cases of an underdiagnosed disease]. / Enfermedad de Whipple. Dos nuevos casos de una enfermedad infradiagnosticada.

Whipple's disease is a rare systemic infectious disease caused by the bacterium Tropheryma whippelii. Early diagnosis is essential. Whipple's disease is potentially fatal but responds dramatically to antibiotic treatment. The diagnosis is confirmed by means of polymerase chain reaction (PCR) technology. This analysis may be useful for monitoring the efficacy of therapy. The recommended treatment al present is administration of cotrimoxazole twice daily for one year. When CNS involvement occurs, it is recommended initial treatment with daily parenteral administration of streptomycin 1 g and 1.2 million units of benzyl penicillin (Penicillin G) over a period of 14 days.

[Immunoglobulins and non-organ-specific antibodies in alcoholic liver cirrhosis]. / Immunoglobulinas y anticuperpos no organoespecíficos en la cirrosis hepática alcohólica.

The quantitative alterations of serum immunoglobulins and their relationship with functional liver alterations, and the incidence of non organ-specific antibodies have been studied in patients with alcoholic cirrhosis. The study was performed in 52 patients with alcoholic cirrhosis, and 30 healthy subjects were used as controls. Main findings were: increased serum IgA, IgG, and IgM in cirrhosis (p less than 0.001), increased IgA in liver failure (p less than 0.005), and increased IgM in patients with portal hypertension (p less than 0.001). Regarding non organ-specific antibodies, antinuclear antibodies were found in 28 % of the cases, and anti-smooth muscle antibodies in 9 %. No relationship could be established between antibody positivity and quantitative alterations of the serum immunoglobulins.

[Alcoholic liver cirrhosis, portal hypertension, and behavior of different lymphocyte populations]. / Cirrosis hepática alcohólica, hipertensión portal y comportamiento de las diversas poblaciones de linfocitos.

There is no clear explanation for the known fact that peripheral levels of T lymphocytes are decreased in alcoholic hepatic cirrhosis. Cellular immune deficiency in cirrhosis has been attributed to this phenomenon. In order to confirm this observation and clarify its cause, the different lymphocyte populations of the peripheral blood of 52 patients with alcoholic hepatic cirrhosis and of 30 control subjects were studied. Absolute lymphocyte counts were decreased in cirrhotic patients (p less than 0.05) due to a marked reduction of T lymphocytes (p less than 0.001). Furthermore, T lymphocytes and, to a lesser degree, B lymphocytes, but not the remaining lymphocyte populations (referred to as "other lymphocytes" in this study), were decreased in relation to the existence of portal hypertension. Thus, a significant reduction of T and B lymphocytes (p less than 0.001) exists in cirrhotics with portal hypertension with respect to those without portal hypertension. The sequestering action of the hypertrophic spleen in patients with portal hypertension could be responsible for this phenomenon.

[Prognosis of patients with irritable intestine syndrome. A prospective study with 1 year follow-up]. / Pronóstico de los pacientes con síndrome del intestino irritable. Estudio prospectivo con seguimiento de un año.

An analysis was made of the prognosis over a one-year follow-up period of a consecutive series of 86 out patients with irritable bowel syndrome (SII) who were treated randomly with an antispasmodic (otilonium) or a tranquilizer (clobazam), and the existence of factors, mainly psychological, that could worsen it was determined with the Zung anxiety test and the Hamilton depression scale. We confirmed that irritable intestine syndrome is a chronic disease, with a mean course of 13 +/- 12.5 years at the time of consultation. A large proportion of patients had permanent problems (58.1%) and did not experience important changes in the intensity of symptoms throughout evolution (68.6%). Although most improved initially with the treatment instated (76.7%), the improvement was rarely complete (11.8%). A year after beginning treatment, 61.6% were the same or worse than before the index consultation. In the group of patients with a good course, the proportion of those that correctly followed medical treatment and of those who had experienced more or less lengthy asymptomatic periods before consultation was significantly larger. In the group of patients with poor evolution, the scores on the Zung anxiety test and Hamilton depression scale were significantly higher than in those who evolved favorably. Neither consultation of a specialist nor the treatment used in this study seem to have contributed to an evident improvement in the prognosis.

[Rhabdomyolysis syndrome and hyperthermia secondary to cocaine and/or ecstasy consumption. Report of 2 new cases and review of the problem]. / Síndrome de rabdomiolisis e hipertermia secundario al consumo de cocaína y/o éxtasis. Comunicación de dos nuevos casos y revisión del problema.

We describe two cases of hyperthermia and rhabdomyolysis related to cocaine and/or ecstasy consumption. The clinical and laboratory findings are characteristic of hyperthermia syndrome in both cases. The first patient consumed cocaine, ecstasy and alcohol and afterwards suffers from hyperthermia and rhabdomyolysis associated with decreased conscious level, labile blood pressure, severe renal insufficiency (needing hemodialysis) and important liver failure. The second patient consumed ecstasy and alcohol with intense physical activity and shows the same but moderate clinical picture rapidly responding to intravenous fluid therapy. The incidence of this drug-induced hyperthermia is low compared to the important use of these illicit drugs. Nevertheless its increasing consumption will lead physicians to attend more patients with this syndrome and other related complications. For this reason we have reviewed and up-dated this problematic subject.

[Immunological changes in chronic osteomyelitis]. / Alteraciones immunológicas en la osteomielitis crónica.

We have studied several aspects of cellular and humoral immunity in 19 patients with chronic osteomyelitis (CO) compared with 11 healthy controls of similar characteristics. Patients with CO showed significantly higher values of GSR, reactive protein C (RPC), IgG and lymphocytes CD3+ and lower values of the CD4+/CD3+ ratio, as well as an hypoergic response to 7 antigens in the different cutaneous hypersensibility tests, compared with healthy controls. The rate of "in vitro" blastic stimulation by different lectins was significantly lower in the group of patients, compared with controls. These changes in the cellular immunity are not correlated with the extent, chronicity and prognosis of the disease, although we did not performed sequential studies of the immunitary condition. None of these immunological markers seem to be a better predictor of the bone infectious activity than the traditional GSR or RPC.

[Hypophysio-adrenal axis in patients with chronic alcoholism]. / Eje hipófiso-suprarrenal en el alcoholismo crónico.

OBJECTIVES: To study the situation of the hypophyso-adrenal axis in patients with chronic alcoholism. METHOD: 24 patients with chronic alcoholism admitted in our Institution with acute delirium were studied. Cortisol am and pm und (ACTH levels, along with hemogram with Wintrobe indexes, patelets number, triglicerides, total and HDL cholesterol, transaminases, alkaline phosphatase and gammaglutamyltranspeptidase were measured in serum. RESULTS: The mean values of ACTH am were 41.2 pcg/ml (normal values 10-80 pcg/ml), of plasma cortisol am 22 mcg/ml (normal values 10-24 mcg/ml) and plasmo cortisol pm 12.3 mcg/ml (normal values 5-12 mcg/ml). CONCLUSIONS: The amount of alcohol consumed by alcoholic patients ist not comparable to that used in animal models, which induced adrenal hyperfunction. Blood ACTH and cortisol levels are not useful as indirect markers of alcoholism. The Wintrobe indexes and serum gammaglutamyltranspeptidase levels are more useful for that purpose.

[Epidemic parotitis and Reiter's syndrome]. / Parotiditis epidémica y síndrome de Reiter.

A case of epidemic parotiditis in an adult male affected by Reiter's syndrome, is presented. The symptoms of Reiter's syndrome lasting 3 months after the recovery from epidemic parotiditis. Although descriptions of Reiter's syndrome of viral origin (adenovirus or hepatitis virus) exist, we have not found references of a relation to epidemic parotiditis. The diagnosis criteria of this syndrome is discussed, as well as the study of the epidemic parotiditis. We review the existing theories in order to justify the multiple etiology of this interesting syndrome.

Psoriatic arthritis (PA): a clinical, immunological and radiological study of 180 patients.

We carried out a prospective study of the clinical, laboratory and radiological features of 180 patients with psoriatic arthritis. We initially classified our patients into five groups as described in the publications of Moll and Wright. Thirty-seven per cent had oligoarthritis, 36% polyarthritis, 23% spondarthritis (sacroiliitis and/or spondylitis) and 4% had the mutilans form. The distal joint arthritis type did not exist as an entity and the distal interphalangeal (DIP) joints were affected in all groups. The spondarthritis form includes patients with exclusively axial manifestations and also those who in addition have peripheral arthritis (oligoarthritis, polyarthritis, DIP arthritis). Only 53% of our patients had nail involvement. We found an increase of IgA levels in patients with axial disease. This suggests a relationship between ankylosing spondylitis and psoriatic spondylitis. The HLA-B17/Cw6 association increased in the oligoarticular form. The increase of antigen B17 correlated with the spondarthritic and oligoarthritis forms whereas Cw6 was more important in the oligoarthritis form. An increase of the HLA-B27/Cw1 association and the spondarthritic form was also found. Moreover, we detected a greater incidence of the HLA-B27 antigen in patients with bilateral sacroiliitis (85%) than in patients with unilateral sacroiliitis (22%). Our work revealed that PA is not a harmless disease; 57% of our patients had erosive arthritis while 19% had ARA class III or IV functional impairment.

[Postsurgical meningitis caused by Pseudomonas aeruginosa: study of 15 cases and review of the literature]. / Meningitis postquirúrgica por Pseudomonas aeruginosa: estudio de 15 casos y revisión de la literatura.

OBJECTIVE: Pseudomonas aeruginosa meningitis is a rare condition which is usually associated with pathology in the ORL field, neurosurgery or local neurologic manipulations. The characteristics, epidemiology, and course of this entity were determined. METHODS: Fifteen episodes of nosocomial postsurgical Pseudomonas aeruginosa meningitis occurred between 1989 and 1996 were retrospectively analyzed. RESULTS: A previous cranioencephalic trauma was recorded in 46.6% of patients. The portals of entry included: intraventricular catheter (IC) (12 cases), CSF fistula (2 cases), and craniotomy (1 case). In five occasions (41.6%) the microorganism was also recovered from the intraventricular catheter. Once culture results were available, therapy with active drugs against Pseudomonas was instituted and in 7 occasions was accompanied by the removal of IC. Eight patients eventually cured and two patients relapsed. The absence of cure was significantly associated with non-removal of the IC (p < 0.01). The infection resulted in death in 26.6% of patients. CONCLUSIONS: Postsurgical Pseudomonas aeruginosa meningitis is an entity of growing relevance. It is associated with relevant morbi-mortality. Catheter removal is essential to obtain a favorable outcome.

[Pyogenic hepatic abscess. Review of 59 cases and experience with imipenem]. / Abscesos hepáticos piogénicos. Revisión de 59 casos y experiencia con imipenem.

OBJECTIVES: To study the different etiopathogenic, microbiological, clinical, evolutive, and therapeutic aspects in patients with pyogenic liver abscesses, with a special emphasis in the usefulness of imipenem-cilastatin therapy. MATERIALS AND METHODS: The clinical records of 59 patients with liver abscesses (45 single abscess and 14 multiple abscesses) diagnosed at our institution in the last eleven years were studied. RESULTS: The most common predisposing conditions included biliary (35.6%) and colon (15.3%) diseases, and abdominal trauma (15.3%). The microorganisms responsible for these abscesses included E. coli, Bacteroides spp., and different streptococci. CT and/or abdominal echography were the diagnostic techniques most commonly used. Twenty-three patients were treated with percutaneous drainage and antibiotics, 22 with surgical drainage and antibiotics, 6 with both types of drainage and antibiotics, and 8 exclusively with antibiotics. Twenty-three patients received imipenem (1 g/IV/8 h) and 29 other antibiotics. Twelve patients died and 9 required admission at the ICU. With regard to patients treated with imipenem, 17 (73.9%) cured, 3 of them (one single abscess and two multiple abscesses) without drainage. Two patients treated with imipenem (8.7%) and 4 treated with other antibiotics (13.8%) relapsed. CONCLUSIONS: Imipenem can be a useful antibiotic in association with percutaneous or surgical drainage for the treatment of pyogenic liver abscesses.

Histiocitosis pulmonar de células de Langerhans / Pulmonary Langerhans´-cell histiocytosis

La histiocitosis pulmonar de células de Langerhans forma parte de un espectro de enfermedades caracterizadas por la proliferación monoclonal y la infiltración de distintos órganos por células de Langerhans. Es una enfermedad pulmonar intersticial de etiología desconocida que ocurre casi exclusivamente en pacientes fumadores. El curso de esta enfermedad en adultos es impredecible, oscilando desde formas benignas autolimitadas, hasta formas malignas con evolución progresiva hacia el fallo respiratorio y la muerte. Presentamos el caso de un paciente diagnosticado de histiocitosis pulmonar de células de Langerhans que presentó una mejoría clínica y radiográfica tras abandonar el hábito tabáquico

Pulmonary Langerhans´- cell histiocytosis belongs to a spectrum of diseases characterized by monoclonal proliferation and infiltration of organs by Langerhans´cells. It is an uncommon interstitial lung disease of unknown etiology occurring almost exclusively in cigarette smokers. It´s course in adults is variable and unpredictable, ranging from benign self-limiting types with spontaneous regression to slowly progressive malignant disease that leads to respiratory failure and death. We report one patient diagnoses of pulmonary Langerhans´cell histiocytosis who experimented an objetive radiographic improvement and disappearance of symptoms after smoking cessation

Enfermedad de Whipple. Dos nuevos casos de una enfermedad infradiagnosticada / Whipple´s disease. Two new cases of an underdiagnosed disease

La enfermedad de Whipple, también conocida como lipodistrofia intestinal, es un proceso infeccioso, multisistémico y poco frecuente, causado por la bacteria Tropheryma whippelii. El diagnóstico precoz es fundamental porque esta enfermedad es potencialmente letal, pero responde espectacularmente al tratamiento antibiótico. El diagnóstico se confirma con la reacción en cadena de la polimerasa (PCR) que también es útil para monitorizar la respuesta al tratamiento. Actualmente el tratamiento recomendado consiste en la administración de cotrimoxazol oral dos veces al día durante un año. Cuando hay afectación del SNC se aconseja iniciar el tratamiento con la administración intramuscular de 1 gramo de estreptomicina asociado a 1,2 MU de bencil penicilina (penicilina G) de forma diaria durante 14 días

Whipple’s disease is a rare systemic infectious disease caused by the bacterium Tropheryma whippelii. Early diagnosis is essential. Whipple’s disease is potentially fatal but responds dramatically to antibiotic treatment. The diagnosis is confirmed by means of polymerase chain reaction (PCR) technology. This analysis may be useful for monitoring the efficacy of therapy. The recommended treatment al present is administration of cotrimoxazole twice daily for one year. When CNS involvement occurs, it is recommended initial treatment with daily parenteral administration of streptomycin 1 g and 1,2 million units of benzyl penicillin (Penicillin G) over a period of 14 days