Association of idiopathic retroperitoneal fibrosis, rapidly progressive glomerulonephritis and antiproteinase 3 antineutrophil cytoplasmic antibodies (anti PR3-ANCA).

We report a case of idiopathic retroperitoneal fibrosis and rapidly progressive glomerulonephritis with serum antiproteinase 3 antineutrophil cytoplasmic antibodies (anti-PR3-ANCA), without clinical or histological signs of Wegener's granulomatosis, in a 46-year-old man. Our case and previously reported cases showing the same association support the hypothesis that the association is not fortuitous, but reflects a common immunological mechanism.

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

Con el objetivo de identificar a los pacientes diagnosticados en nuestro hospital de endocarditis infecciosa por enterococo se ha realizado un estudio retrospectivo durante un período de 12 años (1994-2005), analizando sus características clínicas y microbiológicas, así como el tratamiento y la evolución de la enfermedad. Se encontraron 12 casos de endocarditis por enterococo, lo que representó el 6% del total de endocarditis y el 7% de las bacteriemias por enterococo. Se trataba de 8 hombres y 4 mujeres, con edades comprendidas entre los 37 y los 94 años. El microorganismo causante fue E. faecalis en 10 casos y E. faecium en 2 casos. Dos de los E. faecalis eran resistentes a aminoglucósidos. La válvula afectada con mayor frecuencia fue la aórtica, con 9 casos, seguida de la mitral, con 2 y de la tricúspide, 1 caso. En 10 pacientes la endocarditis se instaló sobre una válvula nativa y sólo en 2 casos sobre válvula protésica. Únicamente 5 pacientes tenían antecedentes de enfermedad valvular cardiaca. El tratamiento antimicrobiano más utilizado fue la combinación de ampicilina y gentamicina, que se empleó en 8 pacientes. Cuatro casos fueron tratados con monoterapia; 2 de ellos con ampicilina y 2 con vancomicina. Siete pacientes se complicaron con insuficiencia cardíaca, cinco de los cuales precisaron tratamiento quirúrgico de sustitución valvular aórtica. Los 4 enfermos tratados con monoterapia presentaron complicaciones graves, que provocaron la muerte de 2 pacientes

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

[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.

[Bilateral chylothorax in a case of metastatic adenocarcinoma of unknown primary]. / Quilotórax bilateral en un caso de adenocarcinoma metastásico de primario desconocido.

We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax.

Quilotórax bilateral en un caso de adenocarcinoma metastásico de primario desconocido / Bilateral chylothorax in a case of metastatic adenocarcinoma of unknown primary

Presentamos el caso de una paciente diagnosticada de quilotórax bilateral y de linfangitis carcinomatosa pulmonar, que evolucionó de forma desfavorable conduciendo al fallecimiento por insuficiencia respiratoria, en el contexto de un adenocarcinoma metastásico de primario desconocido tras el estudio necrópsico. A partir de este caso, revisamos la etiología, el diagnóstico y las opciones disponibles en el tratamiento de los quilotórax

We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax

Hepatitis autoinmune asociada a enfermedad de Crohn y anticuerpos anticitoplasma de los neutrófilos con patrón citoplásmico / Autoimmune hepatitis associated with Crohn’s disease and cytoplasmic antineutrophilic

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[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.

Pronóstico de las bacteriemias adquiridas en la comunidad ingresadas en un Servicio de Medicina Interna / Outcome of community-acquired bacteremia admitted to an internal medicine department

Objetivo: Estudiar la mortalidad y los factores asociados a la misma en las bacteriemias adquiridas en la comunidad que ingresan en el servicio de Medicina Interna de un hospital terciario. Pacientes y métodos: Estudio prospectivo de las bacteriemias ingresadas durante 1 año (mayo 1999-abril 2000). Se han recogido datos demográficos, patología previa, situación funcional, foco infeccioso, complicaciones, constantes vitales, valores de laboratorio, puntuaciones del APACHE II y SOFA, resultados de los hemocultivos, tratamiento y supervivencia a los 28 días. En primer lugar se ha realizado un análisis bivariante con la prueba de la Chi-cuadrado, la t de Student y la prueba no paramétrica de Mann-Whitney, según correspondiera. Las variables significativas se han introducido en un modelo de regresión logística múltiple de exclusión escalonada paso a paso, utilizando la mortalidad como variable dependiente. Resultados: Se han observado 115 casos de bacteriemia en 114 pacientes. El foco urinario supuso el 57,4% de los casos y el microorganismo aislado con mayor frecuencia fue Escherichia coli (54,4% de los aislamientos). La mortalidad a los 28 días fue del 15,3%. Los factores asociados de forma independiente a la misma fueron el shock séptico (OR 10,4), el foco de bacteriemia diferente del urinario (OR 9,3), la puntuación en el APACHE II mayor o igual a 20 (OR 5,5) y la existencia de un estado funcional dependiente previo al episodio (OR 4,8). Conclusiones: Los factores de riesgo de mortalidad fueron el shock séptico, el foco no urinario, la puntuación del APACHE II y el estado funcional previo

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

[Sclerosing mesenteritis. Report of two cases with different clinical presentation]. / Mesenteritis esclerosante. A propósito de dos casos con diferente forma de presentación clínica.

Sclerosing mesenteritis is a rare disease of the mesenterium of unknown cause and chronic evolution. Two presentations have been reported: mesenteric panniculitis and retractile mesenteritis; inflammation of mesenteric fat predominates in one of them, while fibrotic thickening and shortening of the mesenterium is characteristic of the other. We report two cases of sclerosing mesenteritis which presented in very different ways. One patient suffered an episode of intestinal obstruction, and the second one was admitted for evaluation of fever of unknown origin (FUO). While intestinal obstruction is a relatively common complication of sclerosing mesenteritis, its presentation as a FUO is exceptional.

Mesenteritis esclerosante. A propósito de dos casos con diferente forma de presentación clínica / Sclerosing mesenteritis. Report of two cases with different clinical presentation

La mesenteritis esclerosante es una rara enfermedad del mesenterio, de causa desconocida y de evolución crónica, que tiene dos formas de presentación: paniculitis mesentérica y mesenteritis retráctil; en la primera predomina la inflamación de la grasa mesentérica y en la segunda el engrosamiento fibrótico con acortamiento del mesenterio. Presentamos dos casos de mesenteritis esclerosante cuya forma de presentación clínica fue muy diferente. Uno de los pacientes debutó con un cuadro de suboclusión intestinal y el segundo caso ingresó para estudio de una fiebre de origen desconocido (FOD). Mientras que la obstrucción intestinal es una complicación relativamente frecuente, la presentación de esta enfermedad como FOD es excepcional (AU)

[Intra-abdominal abscess as presentation of colonic cancer]. / Abscesos intraabdominales como forma de presentación de cáncer de colon.

Splenic abscess and retroperitoneal abscess are uncommon, although severe diseases, with a high mortality rate that has been attributed to delayed diagnosis, due to the unspecificity of clinical symptoms. We report two patients with a splenic and a retroperitoneal abscess, respectively, in both cases as an onset of colon cancer. The two patients complained of abdominal pain and fever as onset symptoms. Abdominal ultrasonography was normal in the case of retroperitoneal abscess and abnormal in the case of splenic abscess. CT Scan was diagnostic in both cases. In the patient with splenic abscess. CT Scan established a further diagnostic suspect of colon cancer, which was confirmed by colonoscopy. In the patient with retroperitoneal abscess, diagnosis of colon carcinoma was made during the surgical act. In spite of an adequate, combined medical and surgical therapy, both patients died within a short time after surgery.

Abscesos intraabdominales como formade presentación de cáncer de colon / Intraabdominal abcess as presentation of colon cancer

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[Pleural effusion due to Listeria monocytogenes. A case report and review of the literature]. / Derrame pleural por Listeria monocytogenes. Presentación de un caso y revisión de la literatura.

The infection caused by Listeria monocytogenes is a relatively common condition in immunosuppressed patients. The most frequent presentation in adults are sepsis and meningitis. Pleural fluid infection due to this pathogen is a rare finding in the literature. Most cases are found in immunosuppressed patients, particularly in those with haematologic malignancies. We report one case of pleural fluid infection due to Listeria monocytogenes in a patient with hepatic cirrhosis (the third case in the literature). We also review the seventeen cases previously reported and describe the clinical manifestations, its immunosuppression states relationship, the treatment of choice and the mortality.

Derrame pleural por Listeria monocytogenes. Presentación de un caso y revisión de la literatura / Pleural fluid infection caused by listeria monocytogenes: case report and literature review

La infección por Listeria monocytogenes es relativamente frecuente en pacientes inmunodeprimidos, la sepsis y la afectación neuromeníngea son las formas de presentación más habituales. La infección de la cavidad pleural por este germen es una entidad escasamente descrita en la literatura, en la mayoría de los casos se presenta en pacientes inmunodeprimidos, sobre todo con enfermedades hematológicas malignas. Presentamos un caso de infección pleural por Listeria monocytogenes en un paciente con cirrosis hepática (tercer caso descrito) y revisamos diecisiete casos previos analizando las formas de presentación, su relación con estados de inmunodepresión, tratamiento de elección y mortalidad (AU)

[Type I Gaucher's disease. Report of 2 affected families]. / Enfermedad de Gaucher tipo I. Descripción de dos familias afectadas.

Gaucher's disease (GD) is the most common lisosomic deposit disorders which is caused by an inherited deficit of the glucocerebrosidase enzyme. The most common for in the adult is type I and the clinical manifestations include liver and spleen enlargement, thrombocytopenia, and skeletal changes. Four patients with GD type I are here reported. They belonged to two different families and these underwent enzyme and genetic investigations. Eight healthy carriers were identified and the genetic counsel was given. The most relevant clinical manifestations included liver and spleen enlargement (3/4), thrombocytopenia (3/4), skeletal changes (2/4) and pulmonary involvement (1/4). Diagnosis was achieved by the demonstration of a decrease in the leukocyte enzymatic activity in the four patients. The mutation observed most frequently (66%) was N370S. The patient with pulmonary involvement has been under substitutive enzyme therapy for 9 months by means of alglucerase infusions (placental derivative of glucocerebrosidase), and an improvement in pulmonary function testing has been observed.

Interferon alpha for the treatment of chronic hepatitis C in patients infected with human immunodeficiency virus. Hepatitis-HIV Spanish Study Group.

Liver disease secondary to hepatitis C virus (HCV) infection is a rising cause of morbidity and mortality among individuals who have been infected parenterally with human immunodeficiency virus (HIV) such as injection drug users, hemophiliacs, and transfused patients. We analyzed both the efficacy of interferon (IFN) alpha therapy in these patients and the predictors of response to this agent. A total of 119 patients with chronic hepatitis C (90 of whom were infected with HIV and 29 of whom were not) were included in a multicenter, prospective, open, nonrandomized observational study. IFN-alpha was given subcutaneously in a dosage of 5 million units three times a week during a 3-month period; those patients who responded received a dose of 3 million units given subcutaneously three times a week for an additional 9 months. One hundred seven patients completed the study; the level of aminotransferases returned to normal and sera became negative (complete response) for HCV RNA in 26 (32.5%) of 80 HIV-infected patients and 10 (37.0%) of 27 non-HIV-infected patients (P = .666) after completion of the treatment. Two variables were independently associated with a response in HIV-infected patients: a CD4+ T lymphocyte count of > 500 x 10(6)/L and a baseline HCV viremia level of < 10(7) copies/mL. In the 12 months following treatment, relapses occurred in 30.8% of the HIV-infected patients and 12.5% of non-HIV-infected patients (P = .403).