[Adult spontaneous cerebrospinal fluid otorrhea. Report of two cases and review of the literature]. / Otolicuorrea espontánea en el adulto. Presentación de dos casos y revisión de la literatura.

INTRODUCTION: Spontaneous cerebrospinal fluid otorrhea is a relatively rare entity and can be easily missed in adults. Every adult older than 50 years with a negative history of otologic disease who has recurrent serous otitis media should be evaluated for this pathology. Meningitis is the most serious complication, so there is no doubt that the condition needs immediate attention and correction. OBJECTIVE: We present two patients who were diagnosed with spontaneous CSF otorrhea and make a review of what is reported about this topic. CONCLUSION: Surgical repair is mandatory to seal these nontraumatic CSF leaks. There are two main surgical approaches, the middle fossa craniotomy and the transmastoid approach. A multilayered closure technique in which autologous and artificial materials are combined is considered to result in the highest rate of success.

Otolicuorrea espontánea en el adulto. Presentación de dos casos y revisión de laliteratura / Adult spontaneous cerebrospinal fluid otorrhea. Report of two cases and review of the literature

Introducción. Las fístulas espontáneas de LCR noson una entidad frecuente y pueden ser infradiagnosticadasen el adulto. Para algunos autores, debesospecharse esta patología en cualquier paciente mayorde 50 años con episodios de otitis serosas recurrentesy ausencia de antecedentes otológicos. La meningitis essu complicación más grave, por lo que es prioritario undiagnóstico precoz y certero.Objetivo. Presentar dos casos clínicos atendidos ennuestro servicio y revisar la literatura científica existenteal respecto.Conclusión El tratamiento de estas fístulas atraumáticases eminentemente quirúrgico, pudiendo emplear lacraneotomía de fosa media o la vía transmastoidea. Enel sellado debe emplearse una técnica multicapa, combinandomateriales autólogos y artificiales para conseguirmejores resultados (AU)

Introduction. Spontaneous cerebrospinal fluid otorrheais a relatively rare entity and can be easily missedin adults. Every adult older than 50 years with a negativehistory of otologic disease who has recurrent serousotitis media should be evaluated for this pathology.Meningitis is the most serious complication, so there isno doubt that the condition needs immediate attentionand correction.Objective. We present two patients who were diagnosedwith spontaneous CSF otorrhea and make areview of what is reported about this topic (..) (AU)

Incidence of anaemia and impact on sustained virological response in HIV/HCV-coinfected patients treated with pegylated interferon plus ribavirin.

Ribavirin (RBV) exposure is important for maximizing the response to chronic hepatitis C virus (HCV) therapy. However, RBV-associated haemolytic anaemia may force dose reductions or even treatment discontinuation. The use of zidovudine might further increases the risk of anaemia in HCV/HIV-coinfected patients. The predictors of anaemia were examined in PRESCO, a large trial conducted in HIV/HCV-coinfected patients treated with pegylated interferon alpha-2a 180 mug/week plus RBV 1000-1200 mg/day. Measurements included maximal decrease in haemoglobin (Hb) throughout treatment, drops in Hb to <10 (moderate) or to <8.5 g/dL (severe), and premature RBV discontinuation because of anaemia. Finally, the impact of anaemia on sustained virological response (SVR) was assessed. Moderate or severe anaemia occurred, respectively, in 51 (13%) and 13 (3.3%) of 389 patients included in the study. Lower baseline Hb [RR: 0.14 (95% CI 0.07-0.27); P < 0.0001] and greater Hb drops during the first 4 weeks of therapy [RR: 4.74 (95% CI 2.95-7.60); P < 0.0001] were independent predictors of moderate anaemia at any time point in the multivariate analysis. Mean drops in Hb from baseline to week 4 were significantly greater in patients receiving zidovudine compared with other drugs (-3.09 vs-2.3 g/dL; P < 0.001). Lower baseline Hb [RR: 0.33 (95% CI 0.11-0.95); P = 0.04] and maximal Hb drops during treatment [RR: 2.48 (95% CI 1.33-4.59); P = 0.004] predicted treatment discontinuation because of anaemia. However, maximal Hb drops, development of moderate-severe anaemia and RBV dose reductions were comparable among patients who achieved SVR and those who did not. Lower baseline Hb predicts maximal drops in Hb and development of anaemia in HIV/HCV-coinfected patients treated with pegylated interferon plus RBV. The use of zidovudine is associated with greater Hb declines at week 4. However, severe anaemia is relatively infrequent and seems not to have much impact on SVR. Given the availability of alternative antiretroviral drugs, it is advised to avoid zidovudine while receiving anti-HCV treatment.

[Kikuchi-Fujimoto disease: review of four cases]. / Enfermedad de Kikuchi-Fujimoto: estudio de cuatro casos.

Kikuchi-Fujimoto disease is an uncommon form of lymphadenitis, firstly described in Japan. Etiology is unknown. It affects mainly young women. It commonly manifests as a painful cervical lymphadenitis usually associated with fever and leukopenia. Clinical course users to be benign, leading spontaneously to a complete recovery. Histological findings include necrotizing changes with cariorrhesis, partial loss of ganglionar architecture and foci of histiocytic infiltrates in the cortical and/or paracortical zones of the lymph nodes. A common finding is the absence of neutrophil granulocytes in the inflammatory infiltrates, in contrast to other necrotizing lymphadenitis. We report four cases of Kikuchi-Fujimoto disease, recently identified in our hospital.

Enfermedad de Kikuchi-Fujimoto: estudio de cuatro casos / Kikuchi-Fujimoto disease: review of four cases

La enfermedad de Kikuchi Fujimoto es una forma inusual de linfadenitis observada inicialmente en Japón. La etiología es desconocida y afecta preferentemente a mujeres jóvenes en forma de linfadenitis cervical dolorosa asociado con frecuencia fiebre y leucopenia. Se trata de una enfermedad benigna y de resolución espontánea. La lesión histológica se caracteriza por fenómenos necróticos con cariorrexis, pérdida parcial de la estructura ganglionar y focos de histiocitos en la zona cortical y/o paracortical. Un hallazgo característico es la ausencia de granulocitos neutrófilos, lo que la diferencia de otras linfadenitis necrotizantes. Recogemos cuatro casos de enfermedad de Kikuchi-Fujimoto atendidos en nuestro centro en un año. Tres pacientes eran adultos y el otro una niña en edad pediátrica. La mitad referían fiebre y los cuatro tuvieron adenopatías. La evolución fue buena en todos. Pensamos que la enfermedad de Kikuchi-Fujimoto es probablemente más frecuente en nuestro país que lo recogido en la literatura

Kikuchi Fujimoto disease is an uncommon form of lymphadenitis, firstly described in Japan. Etiology is unknown. It affects mainly young women. It commonly manifests as a painful cervical lymphadenitis usually associated with fever and leukopenia. Clinical course users to be benign, leading spontaneously to a complet recovery. Histological findings include necrotizing changes with cariorrhesis, partial loss of ganglionar architecture and foci of histiocytic infiltrates in the cortical and/or paracortical zones of the lymph nodes. A common findings is the absence of neutrophil granulocytes in the inflammatory infiltrates, in contrast to other necrotizing lymphadenitis. We report four cases of Kikuchi Fujimoto disease, recently identified in our hospital

Case Reports. Infection due to Scedosporium apiospermum in renal transplant recipients: a report of two cases and literature review of central nervous system and cutaneous infections by Pseudallescheria boydii/Sc. apiospermum.

Two cases of infections due to Scedosporium apiospermum in renal transplant recipients, one localized in the central nervous system, the other in the skin, are presented, and a literature review of 21 cases of central nervous system and cutaneous infections due to Pseudallescheria boydii/Sc. apiospermum is given.

A randomized, double-blind, double-dummy, multicenter trial of voriconazole and fluconazole in the treatment of esophageal candidiasis in immunocompromised patients.

The efficacy, safety, and tolerability of voriconazole and fluconazole were compared in 391 immunocompromised patients with mycology- and biopsy-proven esophageal candidiasis. Primary efficacy analysis (256 patients) of esophageal treatment as assessed by esophagoscopy revealed success rates of 98.3% with voriconazole and 95.1% with fluconazole. The 95% confidence interval for the difference in success rates ranged from -1.0% to 7.5%. The overall safety and tolerability of both antifungals were acceptable. Fewer patients discontinued voriconazole treatment because of insufficient clinical response (4 patients [2.0%] vs. 5 patients [2.6%]). More patients discontinued voriconazole than fluconazole treatment because of laboratory test abnormalities (7 patients [3.5%] vs. 2 patients [1.0%]) or treatment-related adverse events (5 patients [2.5%] vs. 1 patient [0.5%]). The most frequent adverse events (23%) with voriconazole were mild, transient visual disturbances. Voriconazole (200 mg, b.i.d.) was shown to be at least as effective as fluconazole in the treatment of biopsy-proven esophageal candidiasis in immunocompromised patients.

Pacemaker endocarditis: report of 2 cases.

Two cases of endocarditis due to placement of a pacemaker are reported. In both cases administration of intravenous antibiotic and removal of the entire pacing system was successful.

[Laryngeal tuberculosis: study of 11 cases]. / Tuberculosis laríngea: estudio de 11 casos.

We report 11 patients with laryngeal tuberculosis seen in our hospital, January 1990 to July 2000. Eight were men and all cases presented with dysphonia and/or disphagia. In 8 pulmonary tuberculosis was associated. Mycobacterium tuberculosis was isolated from the sputum in 7 patients. Granulomatous laryngitis was demonstrated in the eight patients with laryngeal biopsy. The evolution with medical treatment was favourable in all patients.

Tuberculosis Laríngea: estudio de 11 casos / Laryngeal Tuberculosis: review or eleven cases

Describimos 11 enfermos con tuberculosis laríngea observados en nuestro hospital desde enero de 1990 a julio de 2000. Ocho eran varones de edad superior a los 30 años y diez fumadores importantes. El diagnóstico se realizó en una media de 43 días desde que comenzaron con las manifestaciones clínicas. Todos referían disfonía y/o disfagia y en 8 se diagnosticó tuberculosis pulmonar asociada. En 7enfermos se aisló Mycobacterium tuberculosis en esputo. En los 8 casos que se realizó biopsia laríngea, se demostró la presencia de granulomas. Con tratamiento médico antituberculoso, la evolución fue satisfactoria en todos los casos, no habiéndose observado en ninguno clínica residual (AU)

We report 11 patients with laryngeal tuberculosis seen in our hospital, January 1990 to July 2000. Eight were men and all cases presented with dysphonia and/or disphagia. In 8 pulmonary tuberculosis was associated. Mycobacterium tuberculosis was isolated from the sputum in 7 patients. Granulomatous laryngitis was demonstrated in the eight patients with laryngeal biopsy. The evolution with medical treatment was favourable in all patients (AU)

Tularemia adquirida por picadura de garrapata en Castilla-León

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[Infection after orthotopic liver transplantation: analysis of the first 120 consecutive cases]. / Infección después del trasplante hepático ortotópico: análisis de los 120 primeros casos consecutivos.

OBJECTIVE: To report the infectious complications and presentation time of the first 120 consecutive liver transplants performed at our institution. METHODS: Prospective study of infectious complications among 120 consecutive adult patients who received orthotopic liver transplantation at Hospital de Cruces, from February 1996 to November 1998. Two patients received a renal transplant concomitantly. The same surveillance protocols were used for all patients and the criteria used to define infections were those reported by other authors. RESULTS: The group consisted of 120 patients, 95 males and 25 females. The age ranged from 20 and 66 years (mean: 54 +/- 9 years). The indications for transplantation included alcoholic cirrhosis (47%), HCV cirrhosis (20%), hepatocellular carcinoma (17.5%), fulminant hepatitis (6%), primary biliary cirrhosis (2.5%) and miscellaneous conditions (7%). Three patients required retransplantation. Acute rejection was histologically diagnosed in 38 patients (31%). None of the patients had corticosteroid-resistant rejection. Fifty-one patients (42.5%) developed 76 episodes of severe infection, which included: 48 episodes of bacterial infection among 33 patients (27.5%), tuberculosis in 7 patients (6%), 9 episodes of fungal infection among 8 patients (7%) and cytomegalovirus (CMV) infection among 8.5% of patients. No patient developed Pneumocystis carinii pneumonia. Fifteen (12.5%) patients died: six (12.5%) with active infection, and in four of them the infection was considered the cause of death. CONCLUSIONS: Infection rates due to bacteria and fungi were similar to those reported in the literature. A high rate of tuberculosis was found, which possible correlated with the high incidence of this disease in the general population. The low incidence of CMV infection was probably due to the preemptive therapy with gancyclovir. Trimethoprim-sulfamethoxazol prophylaxis against Pneumocystis carinii was highly effective.

Primary actinomycosis of the urinary bladder.

Actinomycosis is caused by bacilli of the Actinomyces sp. They are Gram-positive, anaerobic or microaerophilic non-spore-forming bacilli. Actinomyces israelii is the most common aetiological agent. A case is reported of primary actinomycosis in the urinary bladder successfully treated with ceftriaxone.

Infección después del trasplante hepático ortotópico: análisis de los 120 primeros casos consecutivos / Infection after orthotopic liver transplantation: analysis of the first 120 consecutive cases

Objetivo. Describir las complicaciones infecciosas y tiempo de presentación en los 120 primeros trasplantes hepáticos consecutivos realizados en nuestro centro. Métodos. Estudio prospectivo de las complicaciones infecciosas que presentaron 120 pacientes adultos consecutivos que recibieron trasplante hepático ortotópico en el Hospital de Cruces entre febrero de 1996 y noviembre de 1998. Dos pacientes recibieron simultáneamente trasplante renal. En todos los pacientes se realizaron los mismos controles de vigilancia y los criterios para definir las infecciones fueron los descritos por otros autores. Resultados. Del grupo total, 95 eran varones y 25 mujeres. La edad osciló entre 20 y 66 años (media: 54 ñ 9 años). Las indicaciones de trasplante fueron: cirrosis alcohólica (47 por ciento), cirrosis por virus de la hepatitis C (VHC) (20 por ciento), carcinoma hepatocelular (17,5 por ciento), hepatitis fulminante (6 por ciento), cirrosis biliar primaria (2,5 por ciento) y otras indicaciones (7 por ciento).Tres pacientes precisaron retrasplante. Se diagnosticó histológicamente rechazo agudo en 38 pacientes (31 por ciento). Ninguno presentó rechazo corticorresistente. Cincuenta y un pacientes (42,5 por ciento) desarrollaron 76 episodios de infección grave, que correspondían: infección bacteriana, 48 episodios en 33 pacientes (27,5 por ciento); tuberculosis, 7 pacientes (6 por ciento); infección fúngica, 9 episodios en 8 pacientes (7 por ciento), y enfermedad por citomegalovirus (CMV) el 8,5 por ciento de los pacientes. Ningún paciente desarrolló infección por Pneumocystis carinii. Fallecieron 15 (12,5 por ciento): seis (40 por ciento) con infección activa y en cuatro de ellos la infección se consideró causa mayor de la muerte. Conclusiones. La tasa de infecciones por bacterias y hongos es similar a la recogida en la literatura. Encontramos una tasa alta de tuberculosis, que se corresponde posiblemente con la alta incidencia de esta enfermedad en la población general. La baja incidencia de enfermedad por CMV la asociamos con el tratamiento anticipado con ganciclovir. La profilaxis con trimetropin-sulfametoxazol es altamente eficaz frente a Pneumocystis carinii (AU)

[Varicella pneumonia in the adult: study of 22 cases]. / Neumonía por varicela en el adulto: estudio de 22 casos.

BACKGROUND: Retrospective study of the varicella pneumonia in adults with clinical, therapeutic and evolutive features in 22 patients in the last 5 years. MATERIAL AND METHODS: The diagnosis was established by clinical and radiologic criteria in the course of varicella infection. The antecedents of pregnancy, smoking habit, previous contact with patients with varicella and underlying disease were evaluated. RESULTS: Twenty-two patients (14 males and 8 women: mean age 31 years. range: 22-40) were included in the study. None of them were immunocompromised, 16 (72.7%) have had previous contact with varicella patients. 19 (86.3%) were heavy smokers and none of the female patients was pregnant. All patients had fever and exanthem, cough had 20 (90.9%) dyspnea 16 (72.7%), chest pain 9 (40.9%) and hemoptysis 5 (22.7%). Only two patients showed pO2 < 60 mmHg. Chest X-ray revealed an interstitial pattern in 14 cases (63.3%), and micronodular in 8 (36.3%). All patients received treatment with intravenous acyclovir. Three patients (13.6%) were admitted to the Intensive Care Unit due to respiratory insufficiency, needing mechanical ventilation one of them (4.5%). Another three developed failure renal reversible associated with acyclovir. All patients had a favourable clinical course. CONCLUSIONS: We believe, that early, aggressive use of intravenous acyclovir in adult varicella pneumonia may be lifesaving, preventing progressive respiratory failure and reducing the high mortality rate of the disease. Therapy with corticosteroids should be considered in addition to antiviral therapy in patients with severe varicella pneumonia. While oral acyclovir chemoprophylaxis is probably beneficial in populations with chicken pox.