'Catching the spike and tracking the flow': Holter-temperature monitoring in patients admitted in a general internal medicine ward.

OBJECTIVE: To study if a 24-h continuous monitoring of temperature reveals information not accessible through conventional care. This included omitted fever peaks and circadian and complexity characteristics that may correlate with specific aetiologies. DESIGN: Ours was a prospective, observational study. A total of 62 patients, admitted to a general internal medicine ward, in whom a temperature > 38 °C had been observed the day before inclusion underwent a 24-h long continuous monitoring of both central and peripheral temperatures. The time series were recorded in a file, while they otherwise followed conventional care. Time series were analysed for standard statistics, chronobiological analysis (amplitude, mesor, acrophase, intra-daily variability) and complexity analysis (Approximate Entropy of both central and peripheral temperature, cross-ApEn). A month after discharge, the clinical reports were reviewed and a definitive diagnosis of the febrile syndrome was established. RESULTS: A total of 62 patients were initially included. In six cases, no time series could be obtained because of technical problems, leaving 56 patients accessible for analysis. In 10 cases, no definitive diagnosis was established. Continuous monitoring detected a mean of 0.7 (CI = 0.27-1.33) peaks of fever (central temperature > 38.0 °C) unobserved by conventional care per patient. A proportion of 16% (CI = 6-26) of patients considered afebrile by conventional care had at least one fever peak detected by continuous monitoring. Circadian rhythm persisted or was exacerbated in febrile patients. Circadian amplitude was increased in patients with tuberculosis. Complexity analysis did not differ among different diagnostic groups, although in subgroup analysis, viral infections had a higher complexity than other infectious diseases. CONCLUSIONS: Temperature Holter monitoring reveals fever peaks that pass otherwise unobserved. Furthermore, chronobiological and complexity analysis of the temperature profile may provide quick and easy 'hidden information', not available to conventional care.

[Bronchiolitis obliterans organizing pneumonia. Review of six cases]. / Bronquiolitis obliterante con neumonía organizativa. Revisión de seis casos.

BACKGROUND: Bronchiolitis obliterans with organizing pneumonia (BOOP) is recently described clinicopathological entity, with only a few series of patients reported. Terminology is unclear, which together with its rarity lead to a poor understanding of the entity. OBJECTIVE: To review the clinical, radiological, and laboratory features and the response to therapy in cases of BOOP in our environment. MATERIALS AND METHODS: A total of 463 lung biopsies were obtained at Móstoles Hospital, Madrid, from 1992 to 1994. In six cases the anatomo-pathological diagnosis was BOOP. Clinical histories of these patients were reviewed. RESULTS: Six patients were diagnosed with BOOP. From these six patients, four (66%) were female, with a mean age of 59 years (45-74 years). Three patients (50%) were smokers. BOOP was idiopathic in four cases (66%) and secondary to rheumatoid arthritis in one (17%) and Legionella pneumonia in another patient (17%). Patients presented with cough and dyspnea (100%), chest pain and constitutional syndrome (66%) and fever (34%) of one to eight weeks evolution. Laboratory data included: increased ESR (100%), abnormal levels of liver enzymes (83%), hypoxemia (83%) and abnormal spirometry (50%). Radiological studies demonstrated alveolar infiltrates in 83%, predominantly in lower lobes, which were of a migratory nature in 33%. CT, performed in five patients, demonstrated alveolar infiltrates in all patients, which were bilateral and peripheric in two. Transbronchial biopsy was diagnostic in five cases, and in one patient thoracotomy had to be performed. One patient died (17%); the remaining patients (83%) improved with steroids, although 34% relapsed. Mean follow-up time was eleven months (5-24 months). CONCLUSIONS: BOOP observed in our environment is a rare entity, usually of an idiopathic nature, which presents with characteristic clinical course and laboratory findings. Transbronchial biopsy is diagnostic in many patients. The clinical course is good with steroids in most patients, although relapses are common.