[Intermediate Care Units dependent on Internal Medicine in a hospital without an Intensive Care Unit]. / Unidad de Cuidados Intermedios dependiente de Medicina Interna en un hospital sin Unidad de Cuidados Intensivos.

Intermediate care units are considered a solution for care of patients who require superior care than those in a normal hospitalization ward but are not amenable to intensive therapy. We present our experience with an open model, with a responsible person of the ward appointed to the Internal Medicine Department, that could be assumed in other hospitals without Intensive Care Unit in which these units would also avoid unnecessary transfers or make it possible to optimize them so that these are done under better conditions.

[Internal jugular thrombophlebitis: complications of the cervical oncological surgery. A case report]. / Tromboflebitis de la yugular interna: complicación de la cirugía oncológica cervical. Presentación de un caso.

Internal jugular vein thrombophlebitis is an infrequent complications, associated in the past to pharyngeal and amygdaline infections but related today to the use of catheters and intravenous drugs. The present paper reports the case of a patient who underwent total laryngectomy and functional neck dissection, developing recurrent neumonias and sepsis in the postoperative period which were secondary to an homolateral jugular thrombophlebitis. A physical exploration with no findings and the poor resolution of CT scan and ultrasound due to postsurgical alterations, lead to a late diagnosis and fatal evolution, in spite of the medical and surgical treatment.

[Detection of HIV antibodies in saliva using a rapid diagnostic immunoenzyme assay]. / Detección de anticuerpos anti-VIH en saliva con un enzimoinmunoensayo de diagnóstico rápido.

The usefulness of an enzyme-immunoassay (EIA) monotest (TESTPACK HIV-1/HIV-2, ABBOTT) was evaluated in the rapid diagnosis of anti-HIV antibodies in whole saliva in an intravenous drug abuser population (IVDA). Anti-HIV antibodies were simultaneous and prospectively measured in serum and whole saliva from 70 IVDA patients. To improve the sensitivity of the test 100 microliters of saliva were added instead of the recommended serum volume. In the 35 seropositive subjects saliva yielded a distinct positive result (Sensitivity=1), and in the 35 seronegative subjects a negative result (Specificity = 1). A statistically significant association between serum and saliva antibody levels was observed. These findings show the usefulness of a EIA monotest with whole saliva as an alternative sample to serum in the measurement of HIV-antibodies in high-risk patients.

[Tuberculosis and HIV infection. Evaluation of 132 cases]. / Tuberculosis e infección por VIH. Evaluación de 132 casos.

Tuberculosis is currently one the more frequent opportunistic infections in patients infected by Human Immunodeficiency Virus (HIV) in our setting. Its extrapulmonary localization is considered as diagnostic of the Acquired Immunodeficiency Syndrome (AIDS). We have evaluated the epidemiological, clinical, microbiological, histological and immunological characteristics of 120 patients in the Asturias region who had a tuberculosis diagnosed in any localization, during the period between 1984 and 1991, belonging to a series of 570 patients infected by HIV. Pulmonary types were comparatively analyzed to the extrapulmonary and disseminated ones. Tuberculosis was pulmonary only in 44 occasions (PT), in 36 it was extrapulmonary (EPT) and in 52 disseminated (DT). The more frequent risk factor for the HIV infection was the parenteral consumption of drugs (78.8%). The final diagnosis was microbiologic in 81% of the cases, while bacilloscopia was positive in 62% of the cases. The histologic study showed the presence of granulomas in 86% of the tissues studied and necrosis in 81%. EPT and DT were related with a worse immune situation, bigger mortality rates attributed to tuberculosis and worse survival (p 0.069). Tuberculosis in patients infected by HIV appears mainly in CDVP, being its symptoms the normal ones; but extrapulmonary forms are clearly predominant and within this group those with a ganglionar localization. Normal diagnostic procedures yield a good result. EPT and DT are significantly related to a more severe immunodeficiency in comparison with PT. Survival and prognosis are better in the PT group.