Utilidad de la resonancia magnética con espectroscopia para el diagnóstico no invasivo del tuberculoma cerebral / No disponible

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Manejo de la hepatitis crónica por virus C asociada a sarcoidosis: evolución y tratamiento / No disponible

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Derrame pleural tipo trasudado como expresión de afectación pleural por amiloidosis / Transudate type pleural effusion as expression of pleural involvement due to amyloidosis

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[Spinal epidural abscess without spondylodiscitis. Description of four cases]. / Absceso epidural espinal sin espondilodiscitis. Descripción de cuatro casos.

We performed a retrospective study about patients diagnosed of spinal epidural abscess without concurrent spondylodiscitis, collected in the last five years in our hospital. We describe four patients, all of them males, with ages ranged from 59 to 67 years old. All patients presented fever, elevated phase reactants and spinal pain, with cord compression in three of them. Two patients had risk factors: diabetes mellitus and non-Hodgkin lymphoma. S. aureus was isolated in three patients, and S. agalactiae in the other one. The posterior epidural space was the most frequently affected, with variable location along the spinal cord. Three patients required surgical operation, and the other one was treated only with antibiotics. All patients demonstrated a complete clinical, analytical and radiological resolution.

Absceso epidural espinal sin espondilodiscitis. Descripción de cuatro casos / Spinal epidural abscess without spondylodiscitis. Description of four cases

Realizamos un estudio retrospectivo de los casos diagnosticados de absceso epidural espinal sin espondilodiscitis asociada recogidos a lo largo de cinco años en nuestro hospital. Describimos cuatro casos que afectan a varones con una edad comprendida entre 59 y 67 años. Todos presentaron fiebre, reactantes de fase elevados y dolor raquídeo, apreciándose en tres de ellos datos de compresión medular. Dos pacientes tenían enfermedades de base: diabetes mellitus y linfoma no Hodgkin. En 3 pacientes se aisló S. aureus y S. agalactiae en el otro. La localización del absceso fue variable, siendo el espacio epidural posterior el más frecuentemente afectado. Un paciente se trató sólo con antibióticos, siendo sometidos los tres restantes también a intervención quirúrgica. Se evidenció en todos ellos una completa resolución clínica, analítica y radiológica

We performed a retrospective study about patients diagnosed of spinal epidural abscess without concurrent spondylodiscitis, collected in the last five years in our hospital.We describe four patients, all of them males, with ages ranged from 59 to 67 years old. All patients presented fever, elevated phase reactants and spinal pain, with cord compresion in three of them. Two patients had risk factors: diabetes mellitus and non-Hodgkin lymphoma. S. aureus was isolated in three patients, and S. agalactiae in the other one. The posterior epidural space was the most frequently affected, with variable location along the spinal cord. Three patients required surgical operation, and the other one was treated only with antibiotics. All patients demonstrated a complete clinical, analytical and radiological resolution

[Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome. Contribution of two new cases]. / Síndrome "overlap" hepatitis autoinmune-cirrosis biliar primaria. Aportación de dos nuevos casos.

The autoimmune hepatitis (AIH)-primary biliary cirrhosis (PBC) overlap syndrome is characterized for clinical, biochemical, immunological, and histological features overlapping those of AIH and PBC, whose pathogenesis and more appropriate treatment are unknown at present. We describe two new patients of this entity, which made debut with cholestasic acute hepatitis accompanied of hypergammaglobulinemia. In the first patient was demonstrated the presence of AMA, ASMA, and anti-LKM1 autoantibodies; and ANA in the second one. The histological findings showed changes suggestive of AIH and PBC. After the start of immunosuppressive treatment, associated to ursodeoxycholic acid in one patient, a successful outcome was observed.

Síndrome “overlap” hepatitis autoinmune-cirrosis biliar primaria. Aportación de dos nuevos casos / Primary biliary cirrhosis-autoimmune hepatitis over lap syndrome. Contribution of two new cases

El síndrome “overlap” hepatitis autoinmune (HAI)-cirrosis biliar primaria (CBP) se caracteriza por un solapamiento de hallazgos clínicos, analíticos, inmunológicos e histológicos tanto de HAI como de CBP, cuya patogenia y tratamiento más adecuado se desconoce en la actualidad. Describimos dos nuevos casos de esta entidad, que debutaron con un brote de hepatitis aguda colestásica acompañado de hipergammaglobulinemia. En el primer caso se demostró la presencia de los anticuerpos AMA, ASMA y anti-LKM1; y en el segundo de los ANA. Los hallazgos histológicos mostraron alteraciones sugestivas de HAI y de CBP. Tras la instauración de tratamiento inmunosupresor, asociado a ácido ursodesoxicólico en un caso, se observó una buena evolución clínica

The autoimmune hepatitis (AIH)-primary biliary cirrhosis (PBC) overlap syndrome is characterized for clinical, biochemical, immunological, and histological features overlapping those of AIH and PBC, whose pathogenesis and more appropriate treatment are unknown at present. We describe two new patients of this entity, which made debut with cholestasic acute hepatitis accompanied of hypergammaglobulinemia. In the first patient was demonstrated the presence of AMA, ASMA, and anti-LKM1 autoantibodies; and ANA in the second one. The histological findings showed changes suggestive of AIH and PBC. After the start of immunosuppressive treatment, associated to ursodeoxycholic acid in one patient, a successfull outcome was observed

[Enterococcus faecalis bacteremia]. / Bacteriemia por Enterococcus faecalis.

OBJECTIVE: Analysis of Enterococcus faecalis bacteremia epidemiological, clinical, microbiological and prognostic characteristics. METHODS: Retrospective analysis of clinical records of patients with E. faecalis bacteremia throughout 7 years (January 1995-December 2001). RESULTS: 95 episodes of bacteremia were documented, 83.2% with nosocomial origin, 85.3% associated to previous invasive procedures and 9.5% in neonates. 57.9% patients suffered an underlying disease and 41.1% had received previously broad-spectrum antibiotics without activity against enterococcus. 32.6% bacteremia episodes was considered primary and, in the rest, the most frequent associated sources of infection were cardiovascular, intra-abdominal, urogenital, and lung. The resistance study showed a single case of resistance to ampicillin and none to glucopeptides. Global mortality was 23.9%, although only in 9.9% was directly attributable to bacteremia. Inadecuate treatment and mechanical ventilation were factors of poor prognosis in the multivariate analysis. CONCLUSIONS: E. faecalis bacteremia is in our environment essentially a hospital-acquired infection in patients with severe underlying diseases, subject to invasive procedures, and previously treated with wide spectrum antibiotherapy. Ampicillin continues to be the treatment of choice. Inappropriateness of the initial empirical antibiotic treatment and mechanical ventilation are factors of poor prognosis.

Endocarditis por Kingella kingae / Endocarditis for Kingella kingae

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Neurosyphilis in HIV-infected patients.

To determine the prevalence and the clinical and serological findings of neurosyphilis in HIV-infected patients, Treponema pallidum hemagglutination (TPHA) tests, CD4+ lymphocyte counts and determination of rapid plasma reagin (RPR) titers were performed in 972 HIV-infected patients over a period of 3.5 years. Patients were scored according to the Centers for Disease Control's classification for HIV infection. Reactive serum syphilis tests and positive cerebrospinal fluid (CSF)-Venereal Disease Research Laboratory (VDRL) tests, with or without clinical symptoms, were used as the criteria for diagnosis of neurosyphilis. The TPHA test was positive in 31 patients, representing 3.1% of all HIV-infected patients included in the study. Of these, 13 were intravenous drug addicts, 14 were homosexuals and 4 were heterosexuals. Diagnosis of syphilis was concurrent with HIV infection in 19 patients, prior to HIV infection in 6 patients and after HIV infection in 6 patients. CSF examinations were performed in 28 of the 31 (90.3%) patients with serologically evident syphilis. Four patients had positive CSF-VDRL tests with pleocytosis (23.5% of untreated syphilis patients in whom CSF was examined), three of whom reported mild headache, which was considered a doubtful manifestation of neurosyphilis. Patients with syphilis diagnosed and treated prior to diagnosis of HIV infection did not have evidence of neurosyphilis. Seven patients had pleocytosis with a negative CSF-VDRL test, without any clinical manifestations of neurosyphilis. There was no significant difference in the mean CD4+ lymphocyte count between patients with and without neurosyphilis (p = 0.5). RPR titers in neurosyphilis patients were greater than those in patients previously treated for syphilis and in those with pleocytosis only (p = 0.046 and 0.036, respectively). All neurosyphilis patients had an RPR titer > 1:8. After therapy, neurosyphilis patients had negative CSF-VDRL tests with a lower level of pleocytosis. The prevalence of neurosyphilis was 0.4% in HIV-infected patients and 23.5% in HIV-infected patients with untreated syphilis. This high prevalence of neurosyphilis warrants CSF examination in HIV-infected patients with syphilis, regardless of the stage of syphilis.

[Cryofibrinogenemia: apropos of a case]. / Criofibrinogenemia: a propósito de un caso.

We describe the case of a 70-years-old woman with ischemic-hemorrhagic lesions in the cutaneous surface of both feet and analytical data of disseminated intravascular coagulation, in which the studies conducted were negative except for the presence of cryofibrinogen in plasma. We also review the clinical manifestations and the diseases associated to cryofibrinogenemia previously described in the literature.

[Infection by Salmonella typhi in the southern area of Ponteverde]. / Infección por Salmonella typhi en el área sur de Pontevedra.

A retrospective study of patients infected by Salmonella typhi (ST) was conducted in the southern area of Pontevedra during a 17-month period in order to assess the clinical and evolutive characteristics and the pattern of antibiotic susceptibility of the infection. ST was isolated from samples of 30 patients: 25 hemocultures, 7 coprocultores, 1 urine and 1 aortic aneurysm. Nineteen cases had consumed non-sanitary controlled water, 95% from rural areas. The clinical characteristics were similar to the ones traditionally described. Seven patients (23%) developed complications and their presence was associated to a poorer prognosis. We did not observe any resistance to the commonly used antibiotics. In summary, the infection by ST is still a health problem in our environment, probably associated to insufficient measures in the enloration of water for human consumption.