[Diagnostic performance of echocardiography in the follow-up of patients with toxic oil syndrome]. / Rendimiento diagnóstico de la indicación de ecocardiografía en el seguimiento de los pacientes con "sindrome de aceite tóxico".

INTRODUCTION AND OBJECTIVES: Toxic oil syndrome is an epidemic, multisystemic disease that appeared in Spain in 1981, and was caused by the consumption of rapeseed oil denatured with 2% aniline. The disease is similar to eosinophilia-myalgia syndrome. One of the cardiovascular disorders caused by this syndrome is pulmonary hypertension. We conducted a study to assess the validity of our indications for echocardiography in the follow-up of cardiovascular disorders in patients with this disease. PATIENTS AND METHOD: These patients are followed at our center with a standardized protocol for annual check-ups. From December 1997 through July 2002, a total of 1993 patients were examined. In this period we performed a total of 487 echocardiographic studies in 424 patients. The clinical records were reviewed to assess the indications for echocardiography according to the most recent guidelines for the clinical application of echocardiography of the American College of Cardiology and American Heart Association, and the indications were grouped into several categories. The diagnosis was recorded from the cardiologist's reports at the hospital where echocardiography was done. We calculated the sensitivity, specificity and positive likelihood ratio. RESULTS: 67% of the echocardiographic examinations were indicated to investigate possible pulmonary hypertension. About one-tenth of the studies (476 studies, 9.9%) led to a diagnosis of pulmonary hypertension. Sensitivity was highest (83%) for suspected pulmonary hypertension. Specificity was very high for most of the other indications. CONCLUSIONS: This study does not allow us to draw general conclusions about the cardiovascular disorders associated with toxic oil syndrome. However, echocardiography appears to be a good follow-up technique to diagnose complications such as pulmonary hypertension in these patients.

Rendimiento diagnóstico de la indicación de ecocardiografía en el seguimiento de los pacientes con "síndrome del aceite tóxico" / Diagnostic performance of doppler-echocardiography in the follow-up of patients with toxic oil syndrome

Introducción y objetivos. El "síndrome del aceite tóxico" es una enfermedad multisistémica, aparecida en España en 1981, debida al consumo de aceite de colza desnaturalizado con un 2 por ciento de anilina. Tiene similitudes con enfermedades como el síndrome eosinofilia-mialgia. La hipertensión pulmonar es una de las alteraciones cardiovasculares secundarias a este síndrome. Nuestro objetivo era conocer la validez de nuestras indicaciones de ecocardiografía para el seguimiento de las afecciones cardiovasculares en esta enfermedad. Pacientes y método. Nuestro centro realiza el seguimiento de estos enfermos con visitas anuales protocolizadas. Entre diciembre de 1997 y julio de 2002 se examinó a 1.993 pacientes. En este período se realizaron 487 ecocardiogramas a 424 pacientes. Las indicaciones se recogieron de las historias clínicas y se utilizaron las últimas guías de práctica clínica (American College of Cardiology/American Heart Association) para agruparlas en varias categorías. Los diagnósticos se obtenían del informe de cardiología del hospital donde se realizaron dichas pruebas. Se calcularon la sensibilidad, la especificidad y la razón de probabilidades diagnósticas. Resultados. El 67 por ciento de los ecocardiogramas fue solicitado por sospecha de hipertensión pulmonar, que fue diagnosticada en el 9,9 por ciento de las pruebas realizadas (n = 476). La sensibilidad más alta (83 por ciento) fue la referida a sospecha de hipertensión pulmonar. La especificidad fue muy alta para la mayor parte de las indicaciones. Conclusiones. Aunque este estudio no permite extraer conclusiones generales sobre las enfermedades cardiovasculares asociadas al síndrome tóxico, la ecocardiografía aparece como una técnica adecuada para el seguimiento de estos pacientes y para la detección de complicaciones como la hipertensión pulmonar (AU)

Carpal tunnel syndrome. A new feature in the natural history of TOS?

OBJECTIVE: To ascertain whether carpal tunnel syndrome (CTS) in patients affected with toxic oil syndrome (TOS) is associated with conditions and diseases considered risk factors for CTS in the general population and/or with certain clinical manifestations of TOS. METHODS: We conducted a case-control study to compare 89 TOS patients residing in Madrid diagnosed with CTS from 1981 through July 2001 (cases) against 638 TOS patients not affected with CTS (controls). Risk factors for CTS and clinical manifestations of TOS were analyzed. RESULTS: Multivariate logistic regression analysis yielded the following odds ratios (95% confidence interval): 3.32 (1.47-7.50) for TOS-related neuropathy; 2.85 (1.14-7.13) for TOS-related thromboembolic events; 2.63 (1.36-5.06) for female gender; 0.43 (0.24-0.80) for TOS-related scleroderma; 0.26 (0.12 0.59) for smoking; and, in women, 2.53 (1.06-5.70) for fibrositis and 1.84 (1.04-3.20) for miscarriages. CONCLUSION: Our study findings support the hypothesis that CTS in TOS patients is more linked to certain clinical manifestations of TOS, mainly neuropathy, than to conditions and diseases considered risk factors for CTS in the general population.

Mycobacterium simiae Infection in an Immunocompromised Patient without Acquired Immunodeficiency Syndrome.

We report a case of lung infection due to Mycobacterium simiae in an immunocompromised patient without acquired immunodeficiency syndrome. The patient had multiple pulmonary nodules similar to those seen in cases of lung disease caused by Mycobacterium avium in elderly women. Appropriate therapy for M. simiae disease should be determined because, in some cases, the risk of adverse effects can outweigh the potential benefits of treatment.