[Pyomyositis: retrospective review in a third-level hospital in the north of Spain]. / Piomiositis: una revisión retrospectiva en un hospital terciario del norte de España.

OBJECTIVE: To describe the clinical, radiological and microbiological features of a series of patients diagnosed with pyomyositis in a tertiary care university-affiliated center over a 12-year period. PATIENTS AND METHODS: The medical records of all patients diagnosed with pyomyositis between January 1992 and December 2003 were reviewed. The charts were retrieved from the hospital database. Data were extracted according to a standardized protocol and included clinical, radiological, laboratory and microbiological parameters. RESULTS: A total of 54 patients (mean age, 50 years, 61% men) had pyomyositis. The most frequent predisposing factors were diabetes mellitus (22%) and traumatic injury (20%), followed by neoplasms (9%). Primary pyomyositis was diagnosed in 25 patients (55%), and a contiguous source of infection was detected in the remainder, with skin infection being the most frequent (40%). The most common presentation was isolated inflammatory signs with or without other symptoms (94%). Isolated fever was documented in only one patient. Ultrasonography was the most common diagnostic procedure performed (32%), followed by CT scanning (18%). Forty-five patients underwent a drainage procedure combined with antibiotic therapy. Pyomyositis was monomicrobial in 20 cases, and polymicrobial in 12. The most frequent pathogen was Staphylococcus aureus followed by coagulase-negative staphylococci (6 cases). Sepsis developed in 4 patients, and recurrence was observed in 8 (15%). Mortality was 10% (5 patients). CONCLUSIONS: Pyomyositis is a relatively uncommon infection in temperate climates, and is often considered late in the diagnostic workup. Physicians should bear this disease in mind to avoid diagnostic delays and initiate prompt therapy, in order to improve the prognosis of these patients.

Piomiositis: una revisión retrospectiva en un hospital terciario del norte de España / Pyomyositis: Retrospective review in a third-level hospital in the north of Spain

Objetivo. Describir las características epidemiológicas y microbiológicas de los pacientes diagnosticados de piomiositis en un hospital universitario de tercer nivel durante 12 años. Pacientes y métodos. Revisión retrospectiva de las historias clínicas de los pacientes con piomiositis entre enero de 1992 y diciembre de 2003. Resultados. Se identificaron 54 pacientes. La media de edad fue de 50 años. El 61% de los casos eran varones. Los factores predisponentes más frecuentes fueron la diabetes (22%) y el traumatismo previo (20%), seguidos de las neoplasias (9%). La piomiositis primaria se diagnosticó en 25 pacientes (55%). En los demás se encontró un foco contiguo, el más frecuente de los cuales era la piel (40%). Los signos inflamatorios aislados o asociados a fiebre o leucocitosis fueron la forma habitual de presentación (94%). En cambio, la fiebre aislada se documentó sólo en un paciente. La ecografía fue el método diagnóstico más utilizado (32%) seguido de la tomografía computarizada (18%). Un total de 45 pacientes recibieron tratamiento combinado con antibióticos y drenaje. La piomiositis fue monomicrobiana en 20 casos y polimicrobiana en 12. El microorganismo aislado con más frecuencia fue Staphylococcus aureus, seguido de los estafilococos coagulasa negativos (6 casos). Un total de 4 pacientes presentaron sepsis y la piomiositis recurrió en ocho (15%). La tasa de mortalidad fue del 10% (5 pacientes). Conclusiones. La piomiositis es una entidad poco frecuente en climas templados y, por tanto, probablemente, infradiagnosticada. Un mayor conocimiento de esta enfermedad puede evitar un retraso en el diagnóstico y favorecer un tratamiento precoz que mejore el pronóstico de estos pacientes (AU)

Objective. To describe the clinical, radiological and microbiological features of a series of patients diagnosed with pyomyositis in a tertiary care university-affiliated center over a 12-year period. Patients and methods. The medical records of all patients diagnosed with pyomyositis between January 1992 and December 2003 were reviewed. The charts were retrieved from the hospital database. Data were extracted according to a standardized protocol and included clinical, radiological, laboratory and microbiological parameters. Results. A total of 54 patients (mean age, 50 years, 61% men) had pyomyositis. The most frequent predisposing factors were diabetes mellitus (22%) and traumatic injury (20%), followed by neoplasms (9%). Primary pyomyositis was diagnosed in 25 patients (55%), and a contiguous source of infection was detected in the remainder, with skin infection being the most frequent (40%). The most common presentation was isolated inflammatory signs with or without other symptoms (94%). Isolated fever was documented in only one patient. Ultrasonography was the most common diagnostic procedure performed (32%), followed by CT scanning (18%). Forty-five patients underwent a drainage procedure combined with antibiotic therapy. Pyomyositis was monomicrobial in 20 cases, and polymicrobial in 12. The most frequent pathogen was Staphylococcus aureus followed by coagulase-negative staphylococci (6 cases). Sepsis developed in 4 patients, and recurrence was observed in 8 (15%). Mortality was 10% (5 patients). Conclusions. Pyomyositis is a relatively uncommon infection in temperate climates, and is often considered late in the diagnostic workup. Physicians should bear this disease in mind to avoid diagnostic delays and initiate prompt therapy, in order to improve the prognosis of these patients (AU)

[Electrolyte disorders following colonic cleansing for imaging studies]. / Alteraciones electrolíticas inducidas por la preparación para los estudios de imagen del colon.

BACKGROUND AND OBJECTIVE: An adequate bowel cleansing is needed prior to radiologic and endoscopic procedures. However, it may have a number of adverse effects, including abnormalities of calcium-phosphorus homeostasis. PATIENTS AND METHOD: This was an observational prospective study in a hospital practice setting. We included consecutive inpatients (n = 47) subjected to a barium enema or colon endoscopy. Prior cleansing was done as indicated by the attending physician by using a low-salt oral poliethylenglicol (PEG) solution, oral sodium phosphate or a phosphate-containing enema. RESULTS: PEG solution frequently caused mild increases in serum sodium, and decreases in serum potassium. Oral phosphate caused a significant increase in serum phosphorus and parathormone concentrations, whereas it decreased serum calcium. Mild hyperphosphatemia was found in 57% of cases, and hypocalcemia in 36%. Phosphate enema also increased serum phosphate, causing mild hyperphosphatemia (33% cases). Although in the whole subgroup of enema-treated patients there were no significant changes in serum calcium, mild hypocalcemia was found in 27% cases. CONCLUSIONS: Bowel cleansing procedures, particularly those using oral phosphate salts, frequently induce hyperphosphatemia and other abnormalities in serum electrolytes. Although usually transitory and without overt clinical consequences, clinicians should be aware of this potential risk, especially in elderly patients and those with impaired renal function.

Alteraciones electrolíticas inducidas por la preparación para los estudios de imagen del colon / Electrolyte disorders following colonic cleansing for imaging studies

Fundamento y objetivo: La limpieza intestinal es imprescindible para que los estudios de imagen del colon sean eficaces. Sin embargo, no está exenta de riesgos. En particular, recientemente se ha llamado la atención sobre la posibilidad de que ocasione alteraciones del metabolismo fosfocálcico. Este estudio se ha diseñado para evaluar sistemáticamente estas alteraciones en pacientes hospitalizados. Pacientes y método: Se ha realizado un estudio observacional prospectivo en un entorno de práctica hospitalaria habitual. Se incluyó en él a los pacientes hospitalizados consecutivos que iban a ser sometidos a un estudio endoscópico o radiológico del colon (n = 47). La preparación previa se llevó a cabo, según el criterio del médico a cargo del paciente, con uno de los 3 preparados siguientes: solución de polietilenglicol (PEG) con baja concentración de sales, fosfato sódico por vía oral (Fosfosoda®) o fosfato sódico en enemas. Resultados: La solución de PEG indujo frecuentemente hipernatremia e hipopotasemia ligeras, sin alterar la homeostasia fosfocálcica. El fosfato sódico oral provocó además un aumento significativo de la fosfatemias y un descenso de la calcemia, con un incremento compensador de la hormona paratiroidea. El 57% de los pacientes presentó valores de fósforo por encima del intervalo de referencia, mientras el 36% presentó calcemias inferiores al límite normal. El fosfato sódico en enemas no provocó cambios en las concentraciones de sodio y potasio, pero también aumentó significativamente la fosfatemia y la hormona paratiroidea. En un 33% de los casos provocó hiperfosfatemia. Aunque los cambios globales de la calcemia no fueron estadísticamente significativos, en un 27% de los pacientes que recibió enemas la concentración de calcio se redujo por debajo del límite inferior de la normalidad. Conclusiones: Las preparaciones de limpieza intestinal, en particular las basadas en el fosfato oral, se asocian frecuentemente a alteraciones electrolíticas. Aunque en general son autolimitadas y sin repercusión clínica, estas complicaciones deben tenerse en cuenta en pacientes de riesgo, como los ancianos y los que presentan insuficiencia renal

Background and objective: An adequate bowel cleansing is needed prior to radiologic and endoscopic procedures. However, it may have a number of adverse effects, including abnormalities of calcium-phosphorus homeostasis. Patients and method: This was an observational prospective study in a hospital practice setting. We included consecutive inpatients (n = 47) subjected to a barium enema or colon endoscopy. Prior cleansing was done as indicated by the attending physician by using a low-salt oral poliethylenglicol (PEG) solution, oral sodium phosphate or a phosphate-containing enema. Results: PEG solution frequently caused mild increases in serum sodium, and decreases in serum potassium. Oral phosphate caused a significant increase in serum phosphorus and parathormone concentrations, whereas it decreased serum calcium. Mild hyperphosphatemia was found in 57% of cases, and hypocalcemia in 36%. Phosphate enema also increased serum phosphate, causing mild hyperphosphatemia (33% cases). Although in the whole subgroup of enema-treated patients there were no significant changes in serum calcium, mild hypocalcemia was found in 27% cases. Conclusions: Bowel cleansing procedures, particularly those using oral phosphate salts, frequently induce hyperphosphatemia and other abnormalities in serum electrolytes. Although usually transitory and without overt clinical consequences, clinicians should be aware of this potential risk, especially in elderly patients and those with impaired renal function

Adenocarcinoma pulmonar con ginecomastia dependiente de aromatasa / Aromatase-dependent gynecomastia in a patient with adenocarcinoma of the lung

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Henoch-Schönlein purpura after intravesical administration of bacillus Calmette-Guérin.

The administration of intravesical bacille Calmette-Guérin (BCG) in early stages of bladder cancer is usually a safe therapy. Side-effects of BCG immunotherapy can be of both local and systemic nature. We report the first case of Henoch-Schönlein purpura following intravesical administration of BCG.