Anti-Pseudomonas aeruginosa antibody detection in patients with bronchiectasis without cystic fibrosis.

BACKGROUND: Pseudomonas aeruginosa is a frequent cause of infection in patients with bronchiectasis. Differentiation between non-infected patients and those with different degrees of P aeruginosa infection could influence the management and prognosis of these patients. The diagnostic usefulness of serum IgG antibodies against P aeruginosa outer membrane proteins was determined in patients with bronchiectasis without cystic fibrosis. METHODS: Fifty six patients were classified according to sputum culture into three groups: group A (n=18) with no P aeruginosa in any sample; group B (n=18) with P aeruginosa alternating with other microorganisms; and group C (n=20) with P aeruginosa in all sputum samples. Each patient had at least three sputum cultures in the 6 months prior to serum collection. Detection of antibodies was performed by Western blot and their presence against 20 protein bands (10-121 kd) was assessed. RESULTS: Antibodies to more than four bands in total or to five individual bands (36, 26, 22, 20 or 18 kd) differentiated group B from group A, while antibodies to a total of more than eight bands or to 10 individual bands (104, 69, 63, 56, 50, 44, 30, 25, 22, 13 kd) differentiated group C from group B. When discordant results between the total number of bands and the frequency of P aeruginosa isolation were obtained, the follow up of patients suggested that the former, in most cases, predicted chronic P aeruginosa colonisation. CONCLUSION: In patients with bronchiectasis the degree of P aeruginosa infection can be determined by the number and type of outer membrane protein bands indicating which serum antibodies are present.

El control de la oxigenoterapia domiciliaria en un hospital comarcal / Monitoring domiciliary oxygen therapy from a regional hospital

OBJETIVOS: Valorar la correcta oxigenoterapia domiciliaria (OD), averiguar la tasa de prevalencia de OD y evaluar los mismos parámetros después de la actuación de una unidad de control (UCO). PACIENTES Y MÉTODO: Estudio transversal y prospectivo de todos los pacientes con OD antes y después de la instauración de la UCO. Se practicó espirometría, se analizaron la indicación y el cumplimiento de la OD y se realizó una pulsioximetría de control para adecuar el flujo de oxígeno. RESULTADOS: Un total de 76 pacientes recibían OD (63/100.000 habitantes). De los 60 pacientes con EPOC, el 50 por ciento tenía una indicación idónea; el 65 por ciento cumplían más de 15 h de oxigenoterapia y la hipoxemia no se había corregido en el 26 por ciento. La UCO retiró el oxígeno a 28 pacientes (reducción del 37 por ciento) e inició OD a 27 nuevos pacientes, 11 de los cuales reciben oxígeno líquido. Actualmente, 46 pacientes reciben OD (38/100.000).CONCLUSIONES: a) El 54 por ciento de los pacientes con OD tienen una indicación idónea y un adecuado cumplimiento, y se ha verificado la corrección de la hipoxemia; b) la creación de una UCO mejora el control de la OD, y c) la prevalencia de OD en nuestras comarcas se ha reducido de 63 a 38/100.000 habitantes (AU)

[Microorganisms isolated in cases of pertussis-like syndrome]. / Microorganismos aislados en casos de síndrome pertusoide.

OBJECTIVE: To describe the etiologic study of the pertussis-like syndrome, not only as far as Bordetella genus is concerned but also regarding the causative role of other microorganisms for a 11-year period (1988-1998). METHODS: In all specimens from patients suffering from pertussis-like cough the presence of Bordetella spp., other bacteria, viruses, and mycoplasma was investigated. The analysed data included microbiological findings and epidemiologic issues (age, sex, hospital admission area, yearly distribution and seasonal period). RESULTS: A total of 1,063 specimens were investigated, most of them nasopharyngeal aspirates (910), corresponding to 905 patients; a positive culture was obtained form 56.9 of these patients. B. pertussis was isolated from 10.5% of patients. As for other bacteria, Haemophilus influenzae and Streptococcus pneumoniae were also isolated, in 16.9% and 15.8% of occasions, respectively. The respiratory syncitial virus was isolated from 10.7% of patients and other viruses in 9.4%. Among mycoplasma, Ureaplasma urealyticum predominated, with a recovery rate of 2.9%. The male/female ratio was 495/410; the ages of 67.2% of patients ranged from 0 to 6 months; a total of 689 (76.1%) required hospital admission. The recovery of B. pertussis and adenoviruses predominated during spring and summer months. In contrast, H. influenzae, S. pneumoniae and respiratory syncitial virus were recovered more frequently during winter months. CONCLUSIONS: Most patients with pertussis-like syndrome are children aged less than 6 months. The recovery percentages of B. pertussis and respiratory syncitial virus are identical and therefore we think that the investigation of their presence in this syndrome is fully warranted as well as the search for other microorganisms, since clinical symptoms are commonly non-specific among infants.

[Iatrogenic hyperthyroidism secondary to weight loss medication. Predictive factors for their precocious detention]. / Hipertiroidismo yatrógeno secundario a cápsulas adelgazantes. Factores predictivos para su detección precoz.

OBJECTIVE: To establish the differential clinical characteristics between the Iatrogenic hyperthyroidism for not conventional medication for obesity treatment (weight losers) and the endogenous by Graves Basedow disease. PATIENT AND METHODS: Observational and analytical study, populational based, in the one which prospectively were compared cases with Iatrogenic hyperthyroidism (secondary to weight losers) with those with endogenous hyperthyroidism (Graves Basedow disease) as controls. Consisted of the variable clinical record of 100 correlative patients that consulted in specialized attention of endocrinology for Iatrogenic hyperthyroidism secondary to weight losers and for Graves Basedow disease. RESULTS: The differences observed between Iatrogenic hyperthyroidism (secondary to weight losers) (n = 43) as compared to endogenous hyperthyroidism (Graves Basedow disease) (n = 57) were: smaller age (31.8 +/- 10 as compared to 37.8 +/- 12.6 years), greater body mass index (27.6 +/- 7.2 as compared to 23.4 +/- 3.1), smaller goiter frequency (16.3% as compared to 84.2%) as well as absence of signs of ophthalmopathy (0% as compared to 57.9%). Both groups had low levels of TSH, and the difference rests in the values of free T4, low in the first group and increased in the endogenous hyperthyroidism. The odds ratio were: IMC > 27: 3.92 (0.91-16.72), age < 33 years: 5.58 (1.42-21.99), absence of goiter: 23.29 (6.39-84.85). The precedent of weight losers use was not selective of the first group, being detected in a 12.3% of cases of endogenous hyperthyroidism, though in periods of time remoter in relationship to the beginning of the clinic. CONCLUSIONS: In the differential diagnosis of a case of hyperthyroidism, it can be suspected Iatrogenic hyperthyroidism (secondary to weight losers) for medication for the obesity in patients of the feminine sex with overweight, without previous or familiar history of thyroid disease, and in those which in the physical exploration is not verified goiter neither ophthalmopathy.

[Cardiac tamponade as a clinical symptom of systemic lupus erythematosus]. / Taponamiento cardíaco como presentación clínica de lupus eritematoso sistémico.

Pericarditis is the most frequent cardiac manifestation of systemic lupus erythematosus (SLE), but pericardial effusion causing tamponade rarely occurs, and it is even less frequent for the pericardial tamponade to be the presenting feature of SLE. We report a case of pericardial tamponade due to SLE with severe hemodynamic involvement as the clinical presentation of the disease. We comment on its clinical course and its rarity in the medical literature.

[Diarrhea, rectorrhagia and colonic ulceration following the ingestion of NSAIDs]. / Diarrea, rectorragia y ulceración colónica tras la ingesta de AINES.

The lower digestive tract, in contrast to the gastroduodenal tract, is infrequently affected by non-steroidal antiinflammatory drugs (NSAID), and rarely referred to in medical literature. We report the case of a 40-year-old man who presented with bloody diarrhea following treatment with NSAID. The fiber gastroscopy was normal. The fiber colonoscopy showed elongated aphthous ulcers with fibrin in the sigmoid colon. Others studies were normal. After withdrawal of NSAID, the patient returned to normal, as did the fiber colonoscopy. The treatment with NSAID has been linked with ulcerative lesions in the lower digestive tract, perforation, bloody lesions, perforation of diverticuli, reactivation of quiescent colitis and stenosis. In spite of this, doubts persist about the frequency of presentation, high risk doses and its pathophysiological mechanism, which probably involves blocking the cyclooxigenase system and the formation of the leukotrienes and free oxygen radicals. Taking into consideration the above factors, more care should be taken in investigating colonic involvement in patients who present with gastrointestinal bleeding following treatment with NSAID.

[A prospective study of thyroid nodules]. / Estudio prospectivo de los nódulos tiroideos.

OBJECTIVE: To evaluate a procedure for studying thyroid nodules (TN) by means of echography and puncture aspiration with a fine needle (PAFN) in order to select those patients best suited for surgery. DESIGN: Prospective and descriptive. SITE. The counties of Terra Alta, Baix Ebre and Montsià with TN referred for investigation to out-patient clinics of Internal Medicine at Tortosa hospital. PARTICIPANTS: 71 patients with TN were studied. MEASUREMENT AND MAIN RESULTS: Application of the procedure between 1990 and 1992. 94.4% of the TN were benign and 5.6% malignant. PAFN sensitivity was 50% and its specificity, 88%. 25% of the total number of patients underwent a surgical intervention. 22% of those patients operated on had a carcinoma. The concordance between the cytology of the surgical and non-surgical TN and their histology was 0.54 (Kappa Index). CONCLUSIONS: Applying the procedure allowed patients with malignant or suspect nodules to be selected for surgical intervention, leading to a considerable reduction in surgical morbidity and expenditure.

[Tracheobronchial amyloidosis: a report of a new case]. / Amiloidosis traqueobronquial: aportación de un nuevo caso.

Tracheobronchial amyloidosis is the most frequent manifestation of pulmonary amyloidosis. We present the case of a patient who initially presented pneumonia with atelectasis in the upper right lobe (URL) and in whom the presence of nodular bodies in all the bronchial tree was detected with bronchoscopy, with almost complete obstruction of the URL bronchus, identified as amyloid AL. Therapy with laser photoresection was effective, with almost complete resolution of the obstruction.

[Biphasic viral hepatitis "A" associated with autoimmune phenomena]. / Hepatitis vírica "A" bifásica asociada a fenómenos autoinmunes.

Acute hepatitis A virus infection (HAV) is a benign, self limited disease with infrequent extrahepatic features unlike the hepatitis B or the nonA-nonB virus infection. We describe the case of a 37 year old white woman with HAV who had a relapse with a second elevation of the alanine aminotransferase level together with joint pain, skin lesions, angioneurotic edema, and autoantibodies (ANA, anti smooth muscle, antiparietal gastric cells). The liver biopsy showed piecemeal and early bridging necrosis. She had a rapid reversal of her clinical, biochemical and histological abnormalities. As far as we known, this is the first reported case of autoantibodies or angioneurotic edema associated with HAV. We comment on the pathogenesis of this rare association.