Troponin I and risk stratification of patients with acute nonmassive pulmonary embolism.

The assessment of risk and appropriate treatment of patients with acute pulmonary embolism (PE) remains a challenge. The prognostic performance of cardiac troponin I (cTnI) in predicting 30-day all-cause mortality was prospectively assessed in consecutive haemodynamically stable patients with PE. The present study included 318 haemodynamically stable patients with PE. During the 30-day study period, 23 (7%) patients died. cTnI was elevated (>or=0.1 ng x mL(-1)) in 102 (32%) patients. An age >65 yrs, systolic blood pressure <120 mmHg and severity of illness assessed using the PE severity index (PESI) were significantly associated with an increased risk for mortality, but no significant association was found between elevation of cTnI and 30-day mortality in a logistic regression analysis. When only fatal PE was considered, multivariate analysis showed that severity of illness using the PESI and an elevated cTnI (odds ratio 3.7, 95% confidence interval (CI) 1.1-12.8) were associated with a significant increase in the risk for death. The negative predictive value (95% CI) of a negative cTnI for mortality was 93 (90-97)%. In conclusion, in haemodynamically stable patients with acute pulmonary embolism, cardiac troponin I was not an independent predictor of 30-day all-cause mortality, although it did predict fatal pulmonary embolism.

Phosphine-functionalized NHC Ni(ii) and Ni(0) complexes: synthesis, characterization and catalytic properties.

Two families of nickel complexes bearing chelating diphenylphosphine-functionalized NHC ligands [NiII(ArNHCPPh2)(allyl)]Cl 1a (Ar = Mes); 1b, (Ar = 2,6-iPr2-C6H3) and [Ni0(ArNHCPPh2)(alkene)] 2a (Ar = 2,6-iPr2-C6H3, alkene = styrene); 2b (Ar = 2,6-iPr2-C6H3, alkene = diethyl fumarate) have been prepared and fully characterized. VT-NMR experiments in solution reveal that the allyl derivatives 1a-b are stereochemically nonrigid. The solid-state structure of the Ni0 derivative 2b is also reported. These complexes display interesting catalytic properties in various cross-coupling reactions. The precatalyst [Ni0(ArNHCPPh2)(styrene)] 2a was found to be the most active system. The bulkiness of the N-substituent on the imidazole ring and the low oxidation state of the metal center in 2a accounted for its enhanced catalytic performance. This system catalyzed effectively the coupling of (hetero)aryl chlorides with a range of nucleophiles including Grignard reagents, boronic acids, secondary amines and indoles.

Routine use of pleural fluid cultures. Are they indicated? Limited yield, minimal impact on treatment decisions.

In pleural infection, it has been recommended that Gram stain and cultures should be obtained on a routine basis. However, this recommendation has not been tested prospectively. We evaluated the yield of microbiological studies in 259 patients with parapneumonic pleural effusion. Microbiological studies were positive on the pleural fluid of 50 patients (19.3%). In 48 of the 50 patients with positive microbiological results (96%), the need for pleural drainage was correctly predicted by pleural fluid parameters. There were no differences in hospital stay (9.5+/-2.5 days versus 9.9+/-3.2 days, P=0.68) or in mortality (2 deaths in each group, P=0.58) between the group of patients in which antibiotic treatment was changed according to microbiological results and the group of patients in which it is not. In conclusion, this study demonstrates that, at least in our institution, routine microbial investigation of pleural fluid adds very little to the standard management of parapneumonic effusions.

Endobronchial hamartoma resected by rigid bronchoscope.

Endobronchial hamartomas are not very common and they are usually symptomatic because of bronchial obstruction. The diagnosis is made by fiberoptic bronchoscopy of thoracotomy and there are several possibilities of treatment but until now the most common has been surgical resection. We report the case of a man with an endobronchial hamartoma who was diagnosed by fiberoptic bronchoscopy and successfully treated by rigid bronchoscopy.

[Inappropriate antidiuretic hormone secretion syndrome associated with a pleuropulmonary infection]. / Síndrome de secreción de hormona antidiurética asociado a infección pleuropulmonar.

A case of pleuropulmonary infection without a demonstrable causal agent associated to inappropriate secretion of antidiuretic hormone is reported. Although antidiuretic hormone levels were not measured, unequivocal indirect proof of elevated levels was present as evidenced by characteristic serum and urinary electrolyte abnormalities, other possible causes having been carefully ruled out. The hyposmolar clinical picture was refractory to conservative measures, and it was corrected only when a loculated empyema was surgically drained by way of thoracotomy. The literature on inappropriate secretion of antidiuretic hormone related to pleuropulmonary pathology is briefly reviewed. Particular emphasis is made on the pleural encapsulation in the present case as the factor responsible for perpetuation of pulmonary infection and origin of the hormonal disturbance.

[Hepatitis B markers at 3 open centers for mentally retarded]. / Marcadores de la hepatitis B en tres centros abiertos para disminuidos psíquicos.

With the aim of investigating the prevalence of hepatitis B virus infection, we studied 161 mentally retarded patients with an age range of 1 to 56, in three open institutions from the Safor Area (Valencia). Some positive serum markers of HBV infection were found in 15 patients (9.3%). The mentally retarded older than 17, presented a prevalence of HBV markers (20.6%), in contrast to those under this age (1.1%) and against the control group (5.1%) (p < 0.001). HBsAg positive markers were found in three cases, representing 4.4% among the older than 17's, against 0.4% of the general population (p < 0.05). There was some positive correlation with personal history of hepatitis (p < 0.01) and severely handicapped patients (p < 0.05) an there was no association with sex, duration of stay and Down's Syndrome. Our results indicate that seropositive B prevalence is similar to the general population in the mentally retarded younger than 17 years old and higher from this age on, which confirms the need for active prophylaxis in the youngest of this collective. Reviewing the Spanish studies we observe a lower prevalence of HBsAg(carriers) and HBV markers in open institutions than in closed institutions.

Etiology and frequency of gas exchange abnormalities in cirrhosis.

OBJECTIVE: gas exchange abnormalities are frequent in cirrhosis. These abnormalities can be considered an indication or contraindication for liver transplantation. The aim of this study was to investigate the etiology and frequency of these alterations. METHOD: seventy-eight patients with cirrhosis and 20 healthy subjects were selected randomly. Arterial basal blood gases, diffusing capacity of carbon monoxide (DLco), pulmonary function test (PFT) and contrast transthoracic echocardiography (CTTE) with 0. 9% saline were done. RESULTS: patients showed lower DLco (79 +/- 23. 2 vs 96 +/- 20; p < 0.01), lower PaCO2 levels (32.2 +/- 4.5 vs 37.5 +/- 4; p < 0.001) and higher alveolar-arterial oxygen difference (AaPaO2) (22.5 +/- 11.4 vs 12 +/- 7.4; p < 0.001) than controls, but the difference between groups in mean PaO2 levels was not significant. Twenty-three patients (29.5%) had pulmonary vasodilatation (PV) and 28 (36%) altered PFT. Hypocapnia was the most frequently observed alteration in gas exchange (73.4%). Hypoxemia and decreased DLco were more frequent in the presence of altered PFT than in the presence of PV. Both PFT abnormalities and PV were associated with increased AaPaO2. Child stage was higher in patients with PV (7.9 +/- 2.3 vs 9.2 +/- 2; p = 0.01) than in those without PV. CONCLUSIONS: gas exchange abnormalities are frequent in cirrhosis. The most frequent alteration is hypocapnia, which is associated with PV. The main cause of severe hypoxemia in these patients is PFT abnormality. Pulmonary vasodilatation is more frequent and more severe in patients with advanced hepatocellular dysfunction.

[The liver and AIDS]. / Hígado y SIDA.

Hepatic disorders in AIDS are very common, although the injuries observed are usually non-specific. This is the reason why the real usefulness of hepatic biopsy in this patients is being currently discussed. In this work, such aspect and the hepatic injuries observed in patients with AIDS are discussed. Current indications for hepatic biopsy are summarized, as well as its later manipulation in order to obtain maximum profitability of it.

[Acute hepatic failure and Hodgkin's disease]. / Insuficiencia hepática aguda y enfermedad de Hodgkin.

We present the clinical outcome and imaging micro and macroscopic of a patient who died of e liver acute failure. Hodgkin disease with massive infiltration was found at necropsy. We offer a review of the liver complaint in this particular disease.

[Hepatosplenic sarcoidosis. Apropos of a case]. / Sarcoidosis hepatoesplénica. A propósito de una observación.

We present a case of hepatosplenic sarcoidosis without associated pulmonary affection. We have also revised the literature in this respect with special emphasis on the etiopathogenic aspects. The evolution and treatment followed during the period two liver biopsies were performed. The good response to treatment with steroids, clinically and histopathologically, are commented on.

Eosinophil-selective mediators in human strongyloidiasis.

Strongyloides stercoralis infection is characterized by the production of IgE and eosinophils in peripheral blood. Experimental studies have demonstrated that eosinophils play an important role in protection against Strongyloides stercoralis, but the mechanisms regulating eosinophils are not known. In this study we have focused on analysing the molecules that selectively regulate eosinophil migration, namely eotaxin and interleukin-5 (IL-5), using an enzyme-linked immunosorbent assay in patients with strongyloidiasis. Serum expression of eotaxin and IL-5 were significantly increased in patients compared with the control group. This rise suggests that selective mediators of the eosinophil can have a role in immunity against S. stercoralis in human infection.

A case of secondary pulmonary hypertension due to microscopic pulmonary tumor cell embolism from gallbladder carcinoma.

We describe a case of subacute cor pulmonale caused by tumor embolism from a gallbladder carcinoma in a 63-year-old woman. The patient was admitted to hospital with increasing dyspnea. Physical examination and echocardiography showed signs of pulmonary hypertension. She died of circulatory failure. At autopsy microscopic studies revealed tumor embolism in the pulmonary vessels and subsequent lesions causing the lethal pulmonary hypertension. This is the first case report of pulmonary hypertension caused by embolism from a gallbladder carcinoma in the literature worldwide.