[Enterococcal infective endocarditis: description of 12 cases]. / Endocarditis infecciosa por enterococo: descripción de 12 casos.

We have performed a retrospective study of patients diagnosed with infective endocarditis due to Enterococcus in our hospital for a period of 12 years (1994-2005). We review clinical and microbiological aspects, therapy, and outcome. We found 12 cases that were 6 % of total endocarditis, and 7% of enterococcal bacteremia. Eight cases were male, and 4 were female, aged between 37 and 94 years. The causative organism of endocarditis was E. faecalis in 10 patients and E. faecium in 2. Two E. faecalis were resistant to aminoglycosides. Aortic valve was the most frequently affected with 9 cases, followed by mitral valve (2 cases), and tricuspid valve (1 case). In 10 cases endocarditis affected a native valve, and only in 2 cases a prosthetic valve. Only 5 patients had underlying valve disease. The most frequently used antimicrobial therapy was the combination of ampicillin plus gentamicin (8 patients). Four cases were treated with monotherapy, 2 with ampicillin, and 2 with vancomycin. Seven patients suffered heart failure, and five of them required surgical therapy with aortic valve replacement. All the patients treated with monotherapy had severe complications, that led to death in 2 of them.

[Outcome of community-acquired bacteremia admitted to an Internal Medicine Department]. / Pronóstico de las bacteriemias adquiridas en la comunidad ingresadas en un Servicio de Medicina Interna.

OBJECTIVE: To analyze mortality and associated factors in community-acquired bacteremia admitted to an Internal Medicine Department. PATIENT AND METHODS: Prospective study of bacteremia admitted in 1 year (May 1999-April 2000). We have collected demographic data, previous comorbid conditions, functional status, source of infection, complications, vital signs, laboratory values, APACHE II and SOFA scores, blood cultures, therapy and 28-day mortality. In bivariate analysis, we have used Chi-square, Student-t test and Mann-Whitney U as needed. Significant variables have been introduced in a stepwise backward logistic regression model with mortality as the dependent variable. RESULTS: We have observed 115 episodes of bacteremia in 114 patients. The source of bacteremia was urinary tract in 57.4% episodes and the most common isolate was Escherichia coli (54.4%). 28-day mortality was 15.3%. Factors independently associated with mortality were septic shock (OR 10.4), non-urinary source of bacteremia (OR 9.3), APACHE II score higher than 20 (OR 5.5), and previous dependent functional status (OR 4.8). CONCLUSIONS: Mortality risk factors were septic shock, non-urinary source of bacteremia, APACHE II score and dependent functional status.

[Complications in the hemiplegic patient in the first year after the stroke]. / Complicaciones en el paciente hemipléjico durante el primer año tras el ictus.

INTRODUCTION: After a cerebrovascular accident (CVA) a hemiplegic patient is at risk from numerous complications after leaving hospital. OBJECTIVE: To analyze the frequency of occurrence of the commonest complications characteristic of the hemiplegic syndrome, during the first year after the stroke. PATIENTS AND METHODS: We evaluated 73 hemiplegic patients admitted to the rehabilitation department for treatment after a stroke. At each medical consultation, on admission and three, six and twelve months after the CVA, the complications 'belonging' to the hemiplegic syndrome were evaluated. These included contractures, painful shoulder, sympathetic-reflex dystrophy, fractures and thalamic pain. RESULTS: During the first year of the illness 81% of the patients had some type of complication. A painful shoulder was the commonest complication, seen in 40% of the patients, followed by contractures (23%). Sympathetic-reflex dystrophy of the paretic arm occurred in 11 patients (15%). CONCLUSION: The commonest complication in patients during the first year after their stroke are painful shoulder and contractures.

[Value of the MSH classification in the hemiplegic stroke patient]. / Valor de la clasificación MSH en el paciente hemipléjico tras un ictus.

INTRODUCTION: The functional prognosis of patients should be known when planning their rehabilitation treatment. OBJECTIVE: To find the prognostic value of the MSH classification for hemiplegic patients, which is based on the clinical deficits seen after the stroke, and to distinguish between the M group (motor deficit), MS group (motor and sensory deficits) and the MSH group (motor, sensory and homonymous deficits). PATIENTS AND METHODS: A prospective analytical study was made of the hemiplegic patients admitted consecutively to the Rehabilitation Department after strokes. The initial examination was made 17 days (CI: 15-19) after the stroke. Satisfactory functional results were considered to be obtaining a Barthel index of > 90 together with the ability to walk unaided on level ground six months after the stroke. RESULTS: Of the 55 patients finally included in the study, 23 were in group M (41.8%) 21 in group MS (38.1%) and 11 patients in group MSH (20.1%). Walking ability and function in the different cohorts showed a statistically significant difference. Whilst 96% of the patients with pure hemiparesia (group M) attained a satisfactory degree of independence in walking, only 54% of the patients with three associated deficits (MSH) achieved this. Even more difference was found with acquired functional independence, since whilst 82% of group M attained a good degree of autonomy in carrying out everyday activities, only 18% of the MSH group achieved this. The remaining patients (MS group) had intermediate results. CONCLUSION: The MSH classification is, soon after having a stroke, a useful means of determining the functional prognosis of hemiplegic patients.

[Peritoneal pseudomyxoma secondary to mucinous cystadenoma of the ovary]. / Pseudomixoma peritoneal secundario a cistoadenoma mucinoso de ovario.

We present a new case of pseudomyxoma peritonei secondary to a mucinous cystadenoma of the ovary, whose presenting symptoms were abdominal distension and bilateral hernias. This is an uncommon entity and diagnosis tends to be casual. Each day, ultrasonography and computed tomography are more useful in suspicion. Aggressive surgical debulking followed by intraperitoneal chemotherapy seem to be the better treatment, even though controversies persist.

[Protein-calorie malnutrition and degree of hepatic failure in chronic hepatopathy]. / Malnutrición calórico-protéica y grado de insuficiencia hepática en hepatopatías crónicas.

BACKGROUND: Malnutrition is often associated with chronic liver disease, particularly in alcoholics. Its objective assessment by means of methods which are useful and accessible to daily clinical practice is nowadays considered to be necessary for an adequate diagnosis and treatment of these problems, being also a necessary requirement in the selection of the candidates for a liver transplant. Besides, the still insufficiently known relation between nutritional status and the degree of liver dysfunction is of great interest, which has given rise to the present study. PATIENTS AND METHODS: The level of malnutrition and of hepatic function of 48 patients suffering from chronic liver disease hospitalized in Internal Medicine is evaluated, by means of the Ratio of Protein-Caloric Malnutrition proposed by Pomar et al and the Ratio obtained from Clinical and Laboratory data proposed by Orrego et al, respectively. RESULTS: All the patients showed different levels of malnutrition, 27% of the cases being severe, 69% moderate and the remaining 4% mild. The serum albumin and the response to cutaneous antigens were the most frequently altered tests, while the brachial muscular extent was the less altered parameter. A lineal correlation between the degree of malnutrition and that of liver dysfunction (r = 0.3998, p < 0.01) is also made evident. CONCLUSIONS: Malnutrition is often associated with chronic liver disease, is of mixed characteristics (marasmus and Kwashiorkor disease), and seems to aggravate with the progression of the liver dysfunction.

[Immunoregulating phenomena in patients with alcoholic cirrhosis]. / Estudio de los fenómenos inmunorregulatorios en pacientes con cirrosis alcohólica.

Several immunologic changes, both humoral and cellular, have been described in patients with post-alcoholic cirrhosis. One of these changes was a polyclonal hypergammaglobulinemia which can be produced by a failure in the immunoregulation dynamics. The number of leukocytes, as well as lymphocytic population and subpopulation, did not prove significant differences between healthy people and patients. The seric immunoglobulin showed an increase of IgG in cirrhotics. The synthesis of immunoglobulins "in vitro" showed increased productions in cirrhotics; this being spontaneous in IgA and induced by pokeweed in the case of IgG and IgA.

[Somatostatin and ventricular function in liver cirrhosis]. / Somatostatina y función ventricular en cirrosis hepática.

Left ventricular function is studied in cirrhotic patients and in patients with alcoholic hepatitis by means of isotopic ventriculography (Tc99m) both in basal conditions and after the i.v. injection of a somatostatin bolus (250 mcg). The results obtained are compared to those of conventional hemodynamics. Basal ventricular function is normal in both groups and somatostatin induces a significant decrease (p less than 0.001) in heart rate (74 + 12 vs 67 + 11 bpm), ejection fraction (60 + 6 vs 57 + 65) and maximal ejection rate (-3.3 + 0.4 vs -2.0 + 0.3) in patients and normal controls respectively. The hormone induces a significant increase (p less than 0.01) in telediastolic pressure of the left ventricle (8.1 + 4 vs 21 + 7 mmHg) with no change in systemic resistance. The results suggest that somatostatin has a negative inotropic effect on the heart as well as causing bradycardia.

Cutaneous vasculitis in a patient with acute brucellosis.

A patient suffering from brucellosis developed maculonodular and purpuric lesions. The skin biopsy showed granulomatous vasculitis with no deposition of immunoglobulins and complement on the vessels.