[Acute suppurative thyroiditis and Klebsiella pneumoniae sepsis. A case report and review of the literature]. / Tiroiditis aguda supurada y sepsis por Klebsiella pneumoniae. Presentación de un caso y revisión de la literatura.

The acute suppurative thyroiditis is a rare infection. It affects specially patients with preexisting thyroid gland pathology and its frequency is higher in women. In childhood it's linked to local anatomic defects. The infection used to be located in left thyroid lobe and it's much less usual in right lobe, in both or in isthmus. The most important causal microorganisms are staphylococci (Staphylococcus aureus overcoat) and streptococci (usually Streptococcus pyogenes and Streptococcus pneumoniae), with frequent isolation of mixed flora and anaerobes in the last reported cases. We present the case of a male patient, without previous thyroid disease, who suffered an acute suppurative thyroiditis and Sepsis due to Klebsiella pneumoniae, with right lobe abscess and secondary septic focus formation (kidneys, spleen, lungs), with fatal course despite of medical treatment, favoured or precipitated by the development of serious alcoholic abstinence.

[Clinical and angiographic expression of myocardial ischemia in stable angina as a function of its coronary reserve]. / Expresión clínica y angiográfica de la isquemia miocárdica en la angina estable en función de su reserva coronaria.

We have studied the distribution of the coronary reserve, evaluated by serial effort tests, in patients with proved coronaropathy, determining the correlation between clinic (effort and mixed angina) and coronary reserve (fixed and variable), assessing angiographic findings in function to that reserve. We took 120 patients with stable angina to whom 2 effort tests were performed, basal and after vasodilator drugs. It was considered variable reserve if in the second test the S-T descend improved greater than or equal to 1 mm for a similar of greater double product and fixed when it didn't improve. In all patients coronarography was performed. Seventy two patients (60%) showed fixed reserve, 58 with effort angina (80%) and 14 (20%) with mixed. Forty eight showed variable reserve, 40 (80%) with mixed angina and 8 (17%) with effort. The group with fixed reserve had a greater S-T max. descent (2.9 +/- 0.9 vs 2.2 +/- 0.4) (p less than 0.001), a lower double product max. (221 +/- 44 vs 284 +/- 37) (p less than 0.001) and a lower maximal oxygen consumption (MVO2 7 +/- 2 vs 11 +/- 2) (p less than 0.001) than the variable reserve group. Considering the angiography, the fixed reserve group had more number of vessels affected (1.9 +/- 0.7 vs 1.4 +/- 0.5) (p less than 0.01), a higher angiographic score (4.88 +/- 2.4 vs 2.2 +/- 1.2) (p less than 0.001), a lower ejection fraction (59 +/- 8.5 vs 65 +/- 7.5) (p less than 0.001), more multivessel and descending anterior artery lesion than the variable reserve group.(ABSTRACT TRUNCATED AT 250 WORDS)