[Diagnostic utility of Osler's nodules in infectious endocarditis among parenteral drug users]. / Utilidad diagnóstica de los nódulos de Osler en la endocarditis infecciosa en usuarios de drogas por vía parenteral (UDVP).

BACKGROUND: The objective of study is to describe of clinic, microbiological and histological data of five cases of infective endocarditis (IE) with Osler's nodes in intravenous drug users. PATIENTS Y METHODS: Prospectively, 43 cases of IE in intravenous drugs users was revised. In 4 patients, a aspirate puncture of Osler's node was performed and in one patient a biopsy of Osler's node was done with Gram's stain and culture of specimen. RESULTS: From 43 episodes of IE, 33 were right-side IE, 9 left-side y 1 right and left side. No patients with right-side IE presented Osler's nodes, however five of 10 (50%) patients with left-side endocarditis. In all of cases gram positive cocci were observed in Gram's strain and Staphylococcus aureus growth on culture of lesion with the same antibiotype than isolated from blood culture. One case a cutaneous biopsy was performed, and inflammatory infiltrate with necrosis was found. CONCLUSIONS: The Gram's strain and culture of specimen aspirated from Osler's nodes were of high utility in the diagnosis of IE in intravenous drugs users. The presence of Osler's nodes in a patient with infective endocarditis must be suggest that the location in left-side. These data suggest that Osler's nodes in infective endocarditis by S. aureus in intravenous drugs users was originated by microvascular septic emboli.

[Specific mortality rates by DRG and main diagnosis according to CIE-9-MC at a level-II hospital]. / Tasas específicas de mortalidad por GRD y diagnóstico principal según la CIE-9-MC en un hospital de II nivel.

INTRODUCTION: The in hospital mortality is a marker of health care quality. It can be evaluated according by the principal diagnosis of disease or by Diagnosis Related Groups (DRG). OBJECTIVES: Know and to analyze the in hospital mortality and mortality rate (MR) in the patients admitted in the Hospital Morales Meseguer (Murcia) of II level of the INSALUD during 1999. METHODOLOGY: Study of the minimum basic group of data into the hospital. RESULTS: The MR was 3.8% of 508 deaths analyzes, 56.7% corresponded a male. The MR was equal in male (3.6%) and females (3.9%). The medium of age into deaths was 77 years. The numbers of deaths inpatients under 80 years was higher in males (n = 197; 65%) than in lower in female (n = 102; 35%)(p = 0.002). The addition of deaths of Internal Medicine and Intensive Care Unit represent a 70% of cases of deaths occurred in the hospital. The MR was higher in Intensive Care Unit (10.5%) followed by Hematology (6.9%) and Internal Medicine (6.1%). Ten DRG represents of 50% of the causes of deaths, and all of them were DRG of medical categories. The DRG more frequents was 541, Respiratory disorders with complication (n = 61, MR 12.8%), followed by DRG 533. Specific cerebrovascular disorders without Transit isquemic accident (n = 33; MR 34.7%), DRG 123 Acute myocardical infarction (AMI) with death (n = 31; MR 100%), DRG 014 Others disorders of nervous system (n = 27; TM: 10.3%) y DRG 552 Disorders of digestive tract without esophagitis, gastroenteritis and not complicated ulcer (n = 27; MR: 31.0). The main diagnostic more frequent was cerebrovascular diseases (n = 60, MR 12.2%), pneumonia-bronchopneumonia (n = 52, MR 10.9%), chronic obstructive lung disease (n = 36, MR 7.1%), AMI (n = 33, MR 11.5%), and neoplasia of digestive tract (n = 26; MR 8.5%). The MR of woman with AMI (19.5%) was higher than man (7.7%) (p = 0.005), the MR in woman with abdominal hernia (4.3%) was higher than man (0.6%) (p = 0.01), and MR of pyelonephritis and urinary infection in man (4.9%) was higher than woman (0%) (p = 0.008). CONCLUSIONS: The mortality and MR by DRG and main diagnostic is an indicator than permit to know and monitoring the quality of health care.

[Infective endocarditis in intravenous drug users. Study of 34 cases]. / Endocarditis infecciosa en usuarios a drogas por vía intravenosa. Estudio de 34 casos.

OBJECTIVE: Infective endocarditis (IE) in injection drug users (IDU) have a special etiologic, epidemiological and clinical characteristics different to IE in the general population. The clinical and evolutive features of a group of IE in IVD are reported. METHODS: A retrospective analysis was made of 34 episodes (24 patients) of IE in IDU in the Catagena Area (Murcia, Sapin). RESULTS: A total 34 episodes, 18 was males (75%) and 6 (25%) females with a age media of 26.1 years (DE, 4.3). Eighty-four percents were infected with human immunodeficiency virus. The location of IE was right-side in 26 (73%), left-side in 7 cases (18%) and right-left in one (2%). Staphylocococcus aureus was isolated in 31 cases (91%), it was meticillin-resistant in 4 cases (13%); Pseudomonas aeruginosa, and Streptococcus equisimilis was isolated in one case each. Fever was present in 33 patients (97%) and more than half were cough, pleuritic chest pain and expectoration. Twenty-five patients with right IE has chest X-ray abnormal, specially nodules-infiltrates pulmonary. Vegetations were not observe in 7 (21%) occasions by transthoracic echocardiography. In six of 8 patients with left-side IE present a cerebri embolisms. Two patients with left IE death (21%). The rate of successful therapy in the right-side IE treated during 2 or 4 weeks were 100%. CONCLUSIONS: The IE in IDU is a entity produced mainly by S. aureus, affect preferentially a right-side cavities and the prognosis is generally good.

[Fever of unknown origin in internal medicine. The experience of Spanish authors over 20 years]. / Fiebre de origen desconocido en medicina interna. Experiencia de autores españoles durante 20 años.

The diseases responsible of fever of unknown origin (FUO) have changed in the last years. With the object of study the etiologic spectrum and diagnostic attitude in the FUO in a national level in the last 25 years, we has revised 14 articles of FUO realized in Internal Medicine published from 1970 to 1995, without aids patients. We use MEDLINE and Indice Médico Español to search the publications about FUO. In 14 articles, 914 cases of FUO was evaluated, the infection was the principal cause (41.2%), followed by tumor (19.2%) and collagenoses/vasculitis (13.7%). In the infection group, the disease more frequent was the tuberculosis (134/377) (35.5%) follow by brucellosis (15.6%) y abscesses (11.6%). Half of malignancy group was due to lymphoma. Systemic lupus erythematous, polyarteritis nodosa and temporal arteritis were caused of FUO in 28.8%, 21.6% y 20% of collagenoses/vasculitis group. In the miscellaneous group emphasized granulomatous diseases (38.8%) (including sarcoidosis, idiopathic granulomatous hepatitis and chronic granulomatous disease). The improve of diagnostic procedures has conditioned a change of spectrum of the diseases, with a decrease of infectious causes (as brucellosis or salmonellosis) and increase or neoplasia and collagenoses/vasculitis (except lupus).

[Diffuse pulmonary hemorrhage syndrome at a regional hospital. Description and clinical course]. / Síndrome de hemorragia pulmonar difusa en un hospital regional. Descripción clínica y evolución.

The clinical characteristics and evolution of 15 patients with Diffuse Pulmonar Hemorrhage Syndrome are reviewed. According to etiology diseases are classified in three groups: 1) Basal Antimembrane Antibodies disease (66.6%), 2) Vasculitis-Granulomatosis (24.6%), and 3) Idiopathic (6.6%). Pulmonary Hemorrhage was the first manifestation of the primary disease in 80% of patients and was present in 100% of those patients with anemia and opacities in chest x-Ray and in 73% of those with renal insufficiency, nephritic sediment and respiratory insufficiency. To reach the etiological diagnosis, invasive techniques were needed in order to obtain samples for the pathology exam. Three patients died (20%) and 7 had a relapse (46.6%) during the first year. It is underlined the need of an empirical aggressive treatment with steroids and immune-suppress drugs before reaching the final etiological treatment.

[An etiopathogenic and diagnostic update of vasculitis]. / Actualización etiopatogénica y diagnóstica de las vasculitis.

In this study, we examine with attention the latest etiopathogenic findings of this protein-like group of diseases in which even today, exist unclear and controversial aspects. We analyze from an immunological point of view either the role of immunocomplexes and the role of cell-mediated immunity, standing out the direct antibodies-mediated injury, especially emphasizing antineutrophil antibodies. Next, we describe steps and attitudes to be taken when facing one of these diseases diagnosis, including not only suspect, confirmation and degree of spreading, but also setting behaviour guidelines that make feasible the search of associate diseases and discarding other kind of diseases with which may arise some confusion.