Abscesos hepáticos: análisis retrospectivo de 68 casos / Liver abscess: retrospective review of 68 cases

Objetivos: Conocer las características clínicas y de las pruebas complementarias de pacientes con abscesos hepáticos (AH) y establecer factores pronósticos. Pacientes y métodos: Análisis retrospectivo de pacientes diagnosticados de AH en el Hospital Severo Ochoa, entre 1989 y 2005. Resultados: Se recogieron 68 pacientes: 39 hombres y 29 mujeres; incidencia: 26 casos/100.000 ingresos hospitalarios; edad (Me): 63 años. El origen fue: biliar (37%), portal (16%), por diseminación hematógena (7%), por inoculación directa (4%), desconocido (35%). La ecografía fue diagnóstica en 43% de casos y la tomografía computarizada en 57%. Los AH fueron mayores a 3 cm de diámetro en 62% de casos y en 28% fueron AH múltiples. Fueron positivos 71% de cultivos de pus y 52% de hemocultivos. Se aisló el germen causal en 73,5% de AH. Se realizó antibioterapia en 100% de pacientes, drenaje percutáneo en 56% y cirugía en 25%. Evolución: 13% de complicaciones, 9% de recidivas y 19% de mortalidad. Conclusiones: Cuadro clínico mal definido del AH. Factores asociados a complicaciones: enfermedad neurológica o tumoral abdominal, previas y AH múltiples. Factores asociados a mortalidad: índice de comorbilidad de Charlson corregido por la edad > 5, índice de Quick < 60% y aparición de complicaciones. Es necesario individualizar la indicación de drenaje en cada paciente

Objetive: To assess clinical and laboratory features of patients with liver abscesses (LA), and determine prognostic features. Methods: We performed a retrospective analysis of medical records of patients receiving a diagnosis of LA in the Hospital Severo Ochoa, between 1989-2005. Results: We were able to find 68 patients: 39 males and 29 females; the incidence amounts 26 cases/100,000 hospital admissions; mean age 63 years. A biliary source accounted for 37%, 16% were of portal origin, 7% were ascribed to hematogenous dissemination, 4% direct inoculation during a procedure and no cause could be found in 35%. Liver ultrasonography allowed diagnosis in 43% of cases, and CT scan un 57%. Sixty-two percent of LA were larger than 3 cm in diameter; 28% of cases had multiple abscesses. Cultures of abscess fluid were positive in 71%,and blood cultures in 52%. Globally, we were able to isolate the causal microorganism in 73.5% of cases. Hundred percent of patients received antimicrobials, 56% had percutaneous drainage performed and 25% were surgically managed. There were complications in 13%, 9% suffered recurrences and we found a 19% mortality rate. Conclusions: LA has an ill-defined clinical picture. A history of neurological disease or abdominal tumor, and multiple LA are associated with an increased complication rate. Following factors correlated with increased mortality: Age-adjusted Charlson’s morbidity index >=5; Quick index < 60% and development of complications. Drainage indication has to be individualized

[Liver abscess: retrospective review of 68 cases]. / Abscesos hepáticos: análisis retrospectivo de 68 casos.

OBJECTIVE: To assess clinical and laboratory features of patients with liver abscesses (LA), and determine prognostic features. METHODS: We performed a retrospective analysis of medical records of patients receiving a diagnosis of LA in the Hospital Severo Ochoa, between 1989-2005. RESULTS: We were able to find 68 patients: 39 males and 29 females; the incidence amounts 26 cases/100,000 hospital admissions; mean age 63 years. A biliary source accounted for 37%, 16% were of portal origin, 7% were ascribed to hematogenous dissemination, 4% direct inoculation during a procedure and no cause could be found in 35%. Liver ultrasonography allowed diagnosis in 43% of cases, and CT scan un 57%. Sixty-two percent of LA were larger than 3 cm in diameter; 28% of cases had multiple abscesses. Cultures of abscess fluid were positive in 71%, and blood cultures in 52%. Globally, we were able to isolate the causal microorganism in 73.5% of cases. Hundred percent of patients received antimicrobials, 56% had percutaneous drainage performed and 25% were surgically managed. There were complications in 13%, 9% suffered recurrences and we found a 19% mortality rate. CONCLUSIONS: LA has an ill-defined clinical picture. A history of neurological disease or abdominal tumor, and multiple LA are associated with an increased complication rate. Following factors correlated with increased mortality: Age-adjusted Charlson's morbidity index > or =5; Quick index < 60% and development of complications. Drainage indication has to be individualized.

[Fever in patients of a Service of Internal Medicine: prospective study in 204 cases]. / Fiebre en pacientes hospitalizados en un Servicio de Medicina Interna: análisis prospectivo de 204 casos.

OBJECTIVES: Fever in hospitalized patients (FHP) is a difficult problem. We study clinical characteristics and predictive parameters of infection, sepsis and outcome. PATIENTS AND METHODS: Prospective study of 204 patients with fever > 38 degrees C admitted in an Internal Medicine ward. In each patient clinical evaluation, complete blood count (CBC) urinalysis (UA), C-reactive protein (CRP), chest X- ray (CXR), blood and urine cultures were performed. RESULTS: 115 patients suffered infection (75.9% nosocomial, 7.4% sepsis), 35 had a non-infectious etiology and 54 an unknown cause. CBC and CRP did not distinguish infection, bacteremia or sepsis. In UA, positive nitrites, leukocytes and bacteriuria were predictive of infection. 18.6% of the patients were diagnosed by CXR. 18% of urine cultures and 13% of blood cultures were positive. 71.6% received antibiotics (deemed unnecessary in 18%). Microbiological results modified 25% of initial treatments. Average hospital stay was 17 days; 16.7% died. Chronic lung disease, fever duration, dysphagia and urinary tract alterations predict infection. Obesity, diabetes mellitus, liver failure, immunocompromised host, central vascular access, fever duration and nosocomial infection predict bacteremia. Sepsis is more prevalent in males, with malignancy and vascular or nosocomial infection. Chronic liver disease, nosocomial infection, severe lung infection and sepsis increase mortality. CONCLUSIONS: Clinical diagnosis of FHP is inaccurate. Infection is it s most frequent cause; UA, CXR, and blood and urine cultures are useful. FHP increases mortality and hospital stay. We have established predictable models of infection, bacteremia, sepsis and mortality. However, its sensibility and specificity are low.

Fiebre en pacientes hospitalizados en un Servicio de Medicina Interna: análisis prospectivo de 204 casos / Fever in patients of a service of internal medicine prospective study in 204 cases

Objetivos: La fiebre en pacientes hospitalizados (FI) es un problema complejo. Se pretenden establecer las características de estos pacientes y parámetros predictívos de infección, sepsis y evolución. Pacientes y métodos: Estudio prospectivo de 204 pacientes con temperatura > 38 ºC ingresados en Medicina Interna. En cada paciente se realizó evaluación clínica, hemograma, sistemático de orina (SO), proteína C reactiva (PCR), radiografía de tórax (RXT), hemocultivos y urocultivo. Resultados: Tuvieron infección 115 pacientes (nosocomial:75.9%, sepsis: 7.4%), causa no infecciosa 35 y no filiada 54. Hemograma y PCR no discriminaron infección, bacteriemia ni sepsis. En SO, la positividad de “nitritos + leucocituria + bacteriuria”, tiene valor predictívo para urocultivo positivo. La RXT diagnosticó 18,6% de pacientes. Fueron positivos 18% de urocultivos y 13% de hemocultivos. Se administraron antibióticos a 71,6% de pacientes (innecesarios en 18%). Los resultados microbiológicos modificaron 25% de tratamientos iniciales. Evolución: estancia: 17 días, mortalidad: 16,7%. Existieron variables asociadas a infección (enfermedad pulmonar crónica, duración de la fiebre, alteraciones en la deglución y en vías urinarias), bacteriemia (diabetes, obesidad, hepatopatía crónica, inmunodepresión, vía vascular central, duración de la fiebre e infección nosocomial), sepsis (varón, neoplasia, infecciones vascular y nosocomial) y mortalidad (hepatopatía crónica descompensada, infección nosocomial, infección respiratoria de vías bajas y sepsis). Conclusiones: El diagnóstico de sospecha de FI tiene baja fiabilidad. La causa más frecuente es la infección. Tienen utilidad diagnóstica: SO, RXT, hemocultivos y urocultivo. Nuestros modelos predictívos de infección, bacteriemia, sepsis y mortalidad, tuvieron baja sensibilidad y especificidad

Objectives: Fever in hospitalized patients (FHP) is a difficult problem. We study clinical characteristics and predictive parameters of infection, sepsis and outcome. Patients and methods: Prospective study of 204 patients with fever > 38 ºC admitted in an Internal Medicine ward. In each patient clinical evaluation, complete blood count (CBC) urinalysis (UA), C-reactive protein (CRP), chest X- ray (CXR), blood and urine cultures were performed. Results: 115 patients suffered infection (75.9% nosocomial, 7.4% sepsis), 35 had a non-infectious etiology and 54 an unknown cause. CBC and CRP did not distinguish infection, bacteremia or sepsis. In UA, positive nitrites, leukocytes and bacteriuria were predictive of infection. 18.6% of the patients were diagnosed by CXR. 18% of urine cultures and 13% of blood cultures were positive. 71.6% received antibiotics (deemed unnecessary in 18%). Microbiological results modified 25% of initial treatments. Average hospital stay was 17 days; 16.7% died. Chronic lung disease, fever duration, dysphagia and urinary tract alterations predict infection. Obesity, diabetes mellitus, liver failure, immunocompromised host, central vascular access, fever duration and nosocomial infection predict bacteremia. Sepsis is more prevalent in males, with malignancy and vascular or nosocomial infection. Chronic liver disease, nosocomial infection, severe lung infection and sepsis increase mortality. Conclusions: Clinical diagnosis of FHP is inaccurate. Infection is it’s most frequent cause; UA, CXR, and blood and urine cultures are useful. FHP increases mortality and hospital stay. We have established predictibles models of infection, bacteremia, sepsis and mortality. However, its sensibility and specificity are low

Síndrome constitucional, fiebre y dolor en flanco izquierdo en mujer de 41 años / 41-year-old female with constitutional syndrome, fever, and pain in left flank

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[Tumor-associated significant pericardiac effusions: analysis of 18 cases]. / Derrames pericárdicos significativos asociados a tumores: análisis de 18 casos.

Metastatic infiltration is most frequent than primary pericardiac tumors. Most frequent tumors are adenocarcinoma and lymphomas. A retrospective analysis of 18 oncological patients with significant pericardiac effusion (SPE) is carried out. The conclusions of the study are: SPE can be the first manifestation of a neoplasm; frequently, pericardiac tamponade (PT) has a neoplastic origin; thorax is the most frequent localization of the primary tumor; pericardiac fluid (PF) cytology analysis has low diagnostic yield; most useful diagnostic tests are thoracocentesis, thorax computerized tomography (CT) and bronchoscopy; SPE in a neoplasm suggest poor short-term prognosis; poor prognosis variables in this series were primary tumor unfavorable histology, advanced tumor disease and (probably) presentation as PT.

[Analysis of 73 cases of significant pericardiac effusion]. / Análisis de 73 casos de derrame pericárdico significativo.

Seventy-three patients with significant pericardiac effusion (SPE) are analyzed retrospectively. The results concerning etiology, clinical findings, evolution, echocardiography findings and pericardiac effusion (PE) findings are summarized. Conclusions drawn are: 1) the pericardiac effusion (PE) is a difficult diagnosis without the assistance of the echocardiogram; 2) the echocardiogram signs of hemodynamic alterations have prognostic value; 3) the most frequent causes of SPE are: tumors, idiopathic acute pericarditis, and iatrogenesis; 4) in an important percentage of DPS patients the cause is not identified; 5) the clinical presentation as pericardiac tamponade (PT) is most frequent in the tumors; 6) the analysis of the PE has a low yield, which means that diagnostic pericardicentesis is not justified in all patients with SPE; 7) the pericardiac biopsy hasa low diagnostic yield; 8) the predictive mortality factors are: presentation as PT and tumor etiology, and 9) because of the dynamic character of the SPE, it is important to carry out a progress follow-up of it.

Linfadenitis histiocítica necrotizante de Kikuchi / Kikuchi's histiocytic necrotizing lymphadenitis

La linfadenitis histiocítica necrotizante (LHN) o enfermedad de Kikuchi-Fujimoto es una entidad anatomoclínica poco frecuente; afecta preferentemente a mujeres jóvenes e individuos de razas orientales y se caracteriza por fiebre, adenopatías preferentemente cervicales, afectación sistémica y, ocasionalmente, extraganglionar.Se presentan dos casos de LHN en mujeres jóvenes con afectación cutánea y en uno de los casos con meningitis linfocitaria.Se discuten los aspectos etiológicos, la relación de la LHN con las enfermedades colágeno-vasculares (fundamentalmente el lupus eritematoso sistémico [LES]), los problemas del diagnóstico anatomopatológico y las posibilidades terapéuticas (AU)

[Kikuchi's histiocytic necrotizing lymphadenitis]. / Linfadenitis histiocítica necrotizante de Kikuchi.

Necrotizing histiocytic lymphadenitis (NHL) or Kikuchi-Fujimoto disease is an infrequent seen clinicopathologic entity that affects most frequently young women and individuals of eastern races, and that is characterized by fever and adenopathies (basically cervical) and systemic disease even though occasional patients present extranodal disease. We present two young women with NHL and cutaneous affectation, and with lymphocytic meningitis in one of the patients. We discuss the etiology of NHL, the relation of NHL with collagen-vascular diseases (basically systemic erythematous lupus) the problem of the pathologic diagnosis, and the therapeutic possibilities in these patients.

Aracnoiditis y lesión intramedular. Complicaciones de la meningitis tuberculosa en dos pacientes con infección por el virus de la inmunodeficiencia humana / Arachnoiditis and intraspinal lesion

Escanear (AU)

Enfermedad de Still del adulto e hipofisitis linfocitaria

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[Arachnoiditis and intraspinal lesion. Complications of tuberculous meningitis in 2 patients with human immunodeficiency virus infection]. / Aracnoiditis y lesión intramedular. Complicaciones de la meningitis tuberculosa en dos pacientes con infección por el virus de la inmunodeficiencia humana.

Radiculomyelitis (arachnoiditis) (RMA) is a severe complication of tuberculous meningitis (TM). Two patients with HIV infection and TM are here reported. These patients developed RMA. In Spain only four cases of RMA have previously been reported (only one of them was HIV-positive). Clinical manifestations (subacute paraplegia, radicular pain, sensitive level and neurogenic bladder) are reported. Cerebrospinal fluid had inflammatory features, wit predominance of mononuclear cells and remarkable increase in protein content. Magnetic resonance imaging (MRI) is the most suitable diagnostic method. The therapeutic possibilities of this complication are discussed.

Hipocalcemia sintomática en un adenocarcinoma de próstata con metástasis osteoblásticas / Symptomatic hypocalcemia in an adenocarcinoma of the prostate with osteoblastic metastases

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