[Vertebral osteomyelitis: description of a series of 103 cases and identification of predictive variables of the etiological group]. / Osteomielitis vertebral: descripción de una serie de 103 casos e identificación de variables predictivas del grupo etiológico.

BACKGROUND: Vertebral osteomyelitis (VO) is an infrequent disease that requires early antibiotic treatment to prevent serious disabling sequels. The aim of our study was to identify clinical variables capable to guide the initial treatment. PATIENTS AND METHODS: Our retrospective study involved 103 patients seen during a 13 years period, mostly (94%) diagnosed by magnetic resonance imaging. Patients were classified as having brucellar (50 patients), pyogenic (29 patients), tuberculous (20 patients), and other (4 patients) spondylitis. Clinical and laboratory variables entered into a multivariate analysis to identify those independently associated with each etiologic subgroup. RESULTS: Brucellar spondylitis was associated with epidemiological exposure (LR+: 14,9; LR-: 0,02), and with a blood neutrofil percentage < or = 65% (LR+: 6,6; LR-: 0,12). The presence of an underlying chronic disease (LR+: 29,5; LR-: 0,01), an erythrocyte sedimentation rate > or = 60 mm/h (LR+: 11,3; LR-: 0,07), and the absence of constitutional symptoms (LR+: 5,2; LR-: 0,18), were independent predictors of a pyogenic spondylitis. Finally, previous exposure or tuberculous disease (LR+: 11,2; LR-: 0,06), and a delay of > or = 8 weeks in first consulting (LR+: 10,6; LR-: 0,07) were associated with tuberculous spondylitis. CONCLUSION: The combination of a few clinical and laboratory variables facilitates the differential diagnosis between pyogenic, brucellar and tuberculous vertebral osteomyelitis, allowing the choice of the initial antibiotic treatment.

[Cuttoff values of biochemical tests on pleural fluid: their usefulness in differential diagnosis of 1,040 patients with pleural effusion]. / Puntos de corte de los parámetros bioquímicos del líquido pleural: su utilidad en el diagnóstico diferencial de 1.040 pacientes con derrame pleural.

OBJECTIVE: The aim of biochemical pleural fluid testing is to reach an etiological diagnosis of the pleural effusion. We assessed the utility of considering cuttoff points for the wide range of analytes used to investigate pleural fluid. PATIENTS AND METHODS: Among 1,040 patients with pleural effusion, we sought the etiologies of those fluids which showed any of the following characteristics: red blood cell count = 10 x 109/L, leukocytes = 10 x 109/L, percentage of neutrophils or lymphocytes >50%, protein = 50 g/L, glucose = 60 mg/dL, pH = 7.2, lactate dehydrogenase = 1,000 U/L, adenosine deaminase = 40 U/L, amylase = 100 U/L or cholesterol = 60 mg/dL. RESULTS: Some of the more prominent findings were: a) a sixth of transudates were blood-tinged or contained predominantly neutrophils; b) a groosly bloody fluid suggests malignant disease, trauma, or pulmonary embolization; c) nearly 90% of fluids containing = 10 x 10(9) leukocytes/L were parapneumonics; d) 73% of tuberculous pleural fluids had protein > or = 50 g/L, e) tuberculosis and parapneumonics explained more than 90% of fluids with high adenosine deaminase content; f) one third of amylase-rich pleural effusions were malignant; g) a low pleural glucose or pH levels indicate that patient probably has a parapneumonic, tuberculous or malignant etiology; y h) the diagnostic yield of pleural fluid cytology in malignant effusions was 57%, a percentage which raised to 94% in those with low glucose fluid level. CONCLUSIONS: Cuttof values of biochemical pleural fluid tests may greatly support particular causes of pleural effusions.

[Epidemiology of acute cerebrovascular disease in Lleida from 1996 to 1997. Predictive factors of mortality at short and medium term]. / Epidemiología de la enfermedad cerebrovascular aguda en la provincia de Lleida durante el período 1996-1997. Factores predictivos de mortalidad a corto y medio plazo.

INTRODUCTION: Given the great clinical relevance of the cerebrovascular disease, the incidence, nosology, vascular risk factors and factors predicting short and medium-term survival after stroke were evaluated in Lleida (Spain). PATIENTS AND METHODS: Five hundred forty-five consecutive patients with an acute stroke admitted to the Hospital Universitario Arnau de Vilanova during the period 1996-1997 were evaluated. A descriptive epidemiological study and a multivariate logistic regression analysis of predictive factors of mortality at 1-month and 1-year after the stroke were made. The latter provided a clinical scoring system for predicting survival. RESULTS: The incidence rate of stroke was 138.3/100,000 inhabitants. Significant risk factors were hypertension and peripheral vasculopathy. There were 80.1% of ischemic and 19.9% of hemorrhagic strokes (p < 0.001). A Glasgow scale < or = 7, hemianopsia and hemorraghic stroke were significant predictors of 1-month mortality, whereas age > or = 70 years, diabetes, atrial fibrillation and limb weakness decreased survival at 1 year. CONCLUSIONS: The incidence rate of stroke in Lleida is low respect to other studies in Spain. Simple clinical measures may help to establish a prognosis at short and medium-term.