[Streptococcal toxic shock syndrome: ten years' experience at a tertiary hospital]. / Síndrome del shock tóxico estreptocócico: experiencia de los últimos 10 años en un hospital terciario.

INTRODUCTION: In the last two decades there has been a reported increase in the incidence of streptococcal toxic shock syndrome (STSS). The objective of this study was to determine the clinical and epidemiological characteristics of this infection. METHODS: Retrospective study of all cases of STSS diagnosed at a single tertiary hospital over the last ten years. RESULTS: We report 13 cases of STSS (8 men, mean age 62 years). The mean annual incidence was 0.19 episodes/100,000 population from 1994 to 1998 and 0.53 episodes/100,000 population from 1999 to 2003 (p = 0.059). All patients had at least one underlying disease and there were no intravenous drug users. The most common portals of entry were the skin and soft tissues (85%) and all but one patient had a positive blood culture. Two cases were nosocomial and five patients required surgery (amputation and/or debridement). There was a high mortality rate (85%) and a rapid course from onset to death; nine patients died within four days after establishing the diagnosis. CONCLUSION: The incidence of SSTS has increased over the last five years at our hospital. Elderly patients with underlying medical conditions were more susceptible to acquiring this infection. Early mortality was very high.

Síndrome del shock tóxico estreptocócico: experiencia de los últimos 10 años en un hospital terciario / Streptococcal toxic shock syndrome: ten years, experience at a tertiary hospital

Introducción. En las dos últimas décadas, diferentes estudios han señalado un aumento de la incidencia del síndrome del shock tóxico estreptocócico (SSTE). El objetivo de este estudio ha sido determinar las características clinicoepidemiológicas del SSTE en nuestro medio. Métodos. Estudio retrospectivo de los casos de SSTE diagnosticados en los últimos 10 años en un hospital terciario. Resultados. Se diagnosticaron 13 casos de SSTE (edad media: 62 años, 8 varones). La tasa de incidencia media anual entre 1994 y 1998 fue de 0,19 casos/100.000 habitantes, y entre 1999 y 2003, de 0,53 casos/100.000 habitantes (p 5 0,059). Todos los pacientes presentaron alguna enfermedad subyacente, pero ninguno fue adicto a drogas por vía parenteral. El foco de origen más frecuente se localizó en la piel y los tejidos blandos (85%). Hubo bacteriemia en 12 casos y la infección fue nosocomial en 2 casos; se realizó cirugía mayor (amputación y/o desbridamiento) en 5 casos. La mortalidad fue muy elevada (85%), y la mayoría (82%) fallecieron en los primeros 4 días tras el diagnóstico. Conclusión. La incidencia del SSTE aumentó en los últimos 5 años. Afectó sobre todo a pacientes de edad avanzada con importante comorbilidad y la mortalidad precoz fue muy elevada (AU)

Introduction. In the last two decades there has been a reported increase in the incidence of streptococcal toxic shock syndrome (STSS). The objective of this study was to determine the clinical and epidemiological characteristics of this infection. Methods. Retrospective study of all cases of STSS diagnosed at a single tertiary hospital over the last ten years. Results. We report 13 cases of STSS (8 men, mean age 62 years). The mean annual incidence was 0.19 episodes/100,000 population from 1994 to 1998 and 0.53 episodes/100,000 population from 1999 to 2003 (p 5 0.059). All patients had at least one underlying disease and there were no intravenous drug users. The most common portals of entry were the skin and soft tissues (85%) and all but one patient had a positive blood culture. Two cases were nosocomial and five patients required surgery (amputation and/or debridement). There was a high mortality rate (85%) and a rapid course from onset to death; nine patients died within four days after establishing the diagnosis. Conclusion. The incidence of SSTS has increased over the last five years at our hospital. Elderly patients with underlying medical conditions were more susceptible to acquiring this infection. Early mortality was very high (AU)

[Primary melanoma of the rectum: an infrequent neoplasia with an atypical presentation]. / Melanoma primario de recto: una neoplasia infrecuente con una forma de presentación atípica.

Primary anorectal melanoma is a rare malignancy with an extremely aggressive biological behaviour. The main clinical presentations are local symptoms such as rectal bleeding, anal mass or pain, or a change in bowel habits. The tumour is frequently mistaken for benign conditions as haemorrhoids or rectal polyps. Many treatments can be used: surgery, chemotherapy, radiotherapy, immunotherapy and even bio-therapy. Despite this, the disease has a very poor prognosis and 10% of patients survive 5 years.

Melanoma primario de recto: una neoplasia infrecuente con una forma de presentación atípica / Primary melanoma of the rectum: an infrequent neoplasia with an atypical presentation

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Primary anorectal melanoma is a rare malignancy with an extremely aggressive biological behaviour. The main clinical presentations are local symptoms such as rectal bleeding, anal mass or pain, or a change in bowel habits. The tumour is frequently mistaken for benign conditions as haemorrhoids or rectal polyps. Many treatments can be used: surgery, chemotherapy, radiotherapy, immunotherapy and even biotherapy. Despite this, the disease has a very poor prognosis and 5 years