RESUMEN
Bladder perforation, a significant urological emergency, presents a diagnostic challenge due to its diverse etiologies and varying clinical manifestations. This paper discusses a rare case of bladder perforation in an 87-year-old woman with a history of hypertension and previous stomach and uterine cancer. The patient was admitted with a urinary tract infection and subsequently experienced mild abdominal discomfort and reduced urinary output, prompting further investigation. Imaging studies revealed bladder wall thickening and ureterohydronephrosis, raising suspicion of a bladder tumor. Intriguingly, a catheter-related bladder perforation was identified through MRI. This case emphasizes the importance of considering bladder perforation as a potential complication, especially in elderly patients with indwelling catheters. Clinicians must maintain a high index of suspicion and employ appropriate diagnostic modalities to ensure timely recognition and suitable management of this rare condition.
RESUMEN
Fever of unknown origin remains a diagnostic challenge. Aortitis, defined as inflammation of the aorta, has multiple infectious and non-infectious causes. We report the case of an elderly woman with vertigo and bilateral hearing loss, presenting with fever of unknown origin. Blood tests were remarkable for leucocytosis with neutrophilia, elevation of C-reactive protein and the erythrocyte sedimentation rate, and positive antinuclear antibodies and rheumatoid factor, and an unremarkable search for multiple infectious causes of fever. During admission the patient developed a bilateral red eye. Abdominal and chest computed tomography was performed and demonstrated signs of aortitis. Due to the coexistence of aortitis, ocular inflammation, vertigo and bilateral hearing loss in a patient with persistent fever and elevation of inflammatory parameters, a presumptive diagnosis of Cogan's syndrome was made, with improvement after initiation of steroid therapy. LEARNING POINTS: Fever of unknown origin is a diagnostic challenge with an extensive list of possible causes.The coexistence of fever, aortitis, ocular and vestibulo-cochlear symptoms should raise the suspicion of Cogan's syndrome.Steroid therapy is the first-line treatment for Cogan's syndrome.
RESUMEN
INTRODUCTION: The Appropriateness Evaluation Protocol (AEP) is an instrument to study the appropriate use of hospital beds based in objective criteria that classify a hospital admission as appropriate or inappropriate. OBJECT: Evaluate the appropriateness of hospital admissions and stays of the patients of our Internal Medicine Department using the concurrent version of AEP. METHOD: Transversal study where was evaluated the clinical record of the patients admitted to our Department of Internal Medicine on March 13th of 2003, excluding all these who were admitted the day of the study. We analyzed demographic and clinic parameters and the appropriateness of hospital admission and stay using the AEP. RESULTS: 22 patients fulfilled the inclusion criteria, 54.5% of male gender with a average age of 70.7 years. All the admissions were considered appropriate. The most common criteria was the need of intravenous therapy (100%), followed by the sudden lost of corporal mobility (12.3%). 27.3% of stays were considered inappropriate on the day of the study. The most common criteria of appropriateness was the need of intravenous therapy (93.7%). The most usual reason of inappropriate stay was the existence of planned discharge, but without the order written down in the clinical file (66.7%). CONCLUSIONS: The AEP allows an efficient evaluation of the appropriateness of the hospital admissions and stays in a Health Unit, being used for a better utilization of resources. In our department all admissions were justified and about a quarter of stays were considered inappropriate using the AEP.
