Hemorragia digestiva alta por ingestión de un comprimido en blíster / Gastric hemorrhage after ingestion of a blister-wrapped tablet

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Infección del líquido pleural y ascítico por Listeria monocytogenes: caso clínico / Pleural and ascitic fluid infection by Listeria monocytogenes: report of one case

Ascitic and pleural fluids infection by Listeria monocytogenes is uncommon. The association of spontaneous bacterial peritonitis and empyema caused by this microorganism has been seldom reported. A 61 year-old male with an alcoholic cirrhosis and an upper right ¡obectomy for a lung cáncer, consulted because of an exacerbation of dyspnea, abdominal pain and fever. Listeria monocytogenes was isolated from ascitic and pleural fluids and from blood cultures. He was successfully treated with ampicillin and a chest tube for drainage.

Fournier's gangrene following botulinum toxin injection.

Fournier's gangrene is a form of necrotizing fasciitis of the perineal region that frequently affects immunocompromised patients. In most cases the point of entry of the infecting microorganisms goes undetected. A case of necrotizing fasciitis was diagnosed in a 77-year-old male with diabetes mellitus following an injection of botulinum toxin in the anal sphincter to treat an anal fissure.

[Pleural and ascitic fluid infection by Listeria monocytogenes. Report of one case]. / Infección del líquido pleural y ascítico por Listeria monocytogenes. Caso clínico.

Ascitic and pleural fluids infection by Listeria monocytogenes is uncommon. The association of spontaneous bacterial peritonitis and empyema caused by this microorganism has been seldom reported. A 61-year-old male with an alcoholic cirrhosis and an upper right lobectomy for a lung cancer, consulted because of an exacerbation of dyspnea, abdominal pain and fever. Listeria-monocytogenes was isolated from ascitic and pleural fluids and from blood cultures. He was successfully treated with ampicillin and a chest tube for drainage.

[Neurological involvement in Wegener's granulomatosis: report of one case]. / Manifestaciones neurológicas de la granulomatosis de Wegener: Caso clínico.

Wegener's granulomatosis is a systemic necrotizing vasculitis that affects medium size and small vessels. Neurological involvement occurs in 22% to 54% of patients, mainly in the form of mononeuritis multiplex. Central nervous system involvement is reported in only 2% to 8% of the cases. We report a 42-year-old male who presented with headache, diplopia, third and sixth cranial nerve palsies and left eye amaurosis associated to mass located in the Meckel cavum and diffuse meningeal involvement. A biopsy of the mass disclosed a chronic granulomatous necrotizing inflammation with Langhans giant cells. A chest CAT scan showed three cavitated lung nodules and ANCA antibodies were positive in a titer of 1:80. Treatment with steroid and cyclophosphamide was started and cranial nerve palsies resolved and the number and size of lung nodules decreased. The patient was lost from follow up.

Manifestaciones neurológicas de la granulomatosis de Wegener: Caso clínico / Neurological involvement in Wegener's granulomatosis: Report of one case

Wegener's granulomatosis is a systemic necrotizing vasculitis that affects medium size and small vessels. Neurological involvement occurs in 22 percent to 54 percent of patients, mainly in the form of mononeuritis multiplex. Central nervous system involvement is reported in only 2 percent to 8 percent of the cases. We report a 42-year-old male who presented with headache, diplopia, third and sixth cranial nerve palsies and íeft eye amaurosis associated to mass located in the íeft Meckel cavum and diffuse meningeal involvement. A biopsy of the mass disclosed a chronic granulomatous necrotizing inflammation with Langhans giant cells. A chest CAT scan showed three cavitated lung nodules and ANCA antibodies were positive in a titer of 1:80. Treatment with steroid and cyclophosphamide was started and cranial nerve palsies resolved and the number and size of lung nodules decreased. The patient was lost from follow up.

[Infective endocarditis in an internal medicine ward]. / Estudio retrospectivo de la endocarditis infecciosa en diferentes grupos de riesgo.

BACKGROUND: Due to the increasing number of intravenous drug users, subjects with immune deficiencies or with prosthetic valves, infective endocarditis (IE) continues to be prevalent and to have a high mortality. AIM: To review all cases of infective endocarditis diagnosed in an Internal Medicine Service. MATERIAL AND METHODS: Retrospective review of medical records of all patients with infective endocarditis, hospitalized in an Internal Medicine ward, between 1989 and 2003. Dukes criteria were used to define definitive, possible and less probable cases of IE. RESULTS: Eighty seven patients with definite IE were identified (66 males, age range 19-84 years), with a mean incidence of 5.3 per 1000 hospitalizations. IE in intravenous drugs users was usually caused by Staphylococcus aureus and presented high risk of embolism (RR: 3,21). Subjects aged over 70 years had a relative risk of mortality of 5.5. Hospital acquired IE was associated with advanced age and IV catheters appeared as the only predisposing factor. Patients with prosthetic valves were also older, their main complication was abscess formation and their mortality was higher. CONCLUSIONS: A closer approach to differential conditions of patients, according to age, intravenous drug use or the presence of prosthetic valves, is necessary.

Estudio retrospectivo de la endocarditis infecciosa en diferentes grupos de riesgo / Infective endocarditis in an internal medicine ward

Background: Due to the increasing number of intravenous drug users, subjects with immune deficiencies or with prosthetic valves, infective endocarditis (IE) continues to be prevalent and to have a high mortality. Aim: To review all cases of infective endocarditis diagnosed in an Internal Medicine Service. Material and methods: Retrospective review of medical records of all patients with infective endocarditis, hospitalized in an Internal Medicine ward, between 1989 and 2003. Dukes criteria were used to define definitive, possible and less probable cases of IE. Results: Eighty seven patients with definite IE were identified (66 males, age range 19-84 years), with a mean incidence of 5.3 per 1000 hospitalizations. IE in intravenous drugs users was usually caused by Staphylococcus aureus and presented high risk of embolism (RR: 3,21). Subjects aged over 70 years had a relative risk of mortality of 5.5. Hospital acquired IE was associated with advanced age and IV catheters appeared as the only predisposing factor. Patients with prosthetic valves were also older, their main complication was abscess formation and their mortality was higher. Conclusions: A closer approach to differential conditions of patients, according to age, intravenous drug use or the presence of prosthetic valves, is necessary

Serum levels of cytokeratin-18 (tissue polypeptide-specific antigen) in liver diseases.

OBJECTIVE: The tissue polypeptide-specific antigen (TPS, cytokeratin-18, a normal constituent of the hepatocyte cytoskeleton) is a standard tumour marker. This study aimed to evaluate serum TPS levels in patients with liver disease. METHODS: Serum TPS was measured with a commercial immunoassay in 884 individuals (753 outpatients from a liver disease clinic, 131 patients admitted to the hospital with acute liver disease). RESULTS: Abnormally high (> 80 U/l) TPS levels were found in 57.7% (95% CI 54.0-61.3%) of outpatients with liver disease. Elevated TPS levels were observed for all liver diseases, including fatty liver, alcoholic disease, chronic viral hepatitis, autoimmune hepatitis, cholestasis, transplantation, and hepatocarcinoma. TPS levels correlated with liver markers, particularly serum AST. In addition, TPS levels correlated with Knodell's score in patients with chronic hepatitis. TPS was increased in one-third of patients with normal liver enzyme values. Serum TPS levels decreased after specific therapy in patients with hepatitis C and autoimmune hepatitis. Abnormally high TPS levels were found in the vast majority of patients admitted to the hospital, with markedly high (> 800 U/l) values being observed in 47.5% (95% CI 36.1-55.7%) of patients with alcoholic liver disease and in 80.8% (95% CI 60.0-92.7%) of patients with acute hepatitis. CONCLUSIONS: Serum TPS (cytokeratin-18) is elevated in patients with non-malignant liver diseases, particularly in those with prominent cytolysis. Further studies are needed to evaluate the use of TPS as a marker of liver disease.

Fiebre recurrente y bacteriemia por Staphylococcus aureus / Relapsing fever and Staphylococcus aureus bacteriemia

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Fiebre Reumatica: incidencia y cumplimiento de la profilaxis secundaria / Rhumatic fever: incidence and accomplishment of secundary prophylaxis

Se estudió la incidencia de fiebre reumática aguda de 1986 a 1996 entre los residentes habituales en la provincia de Pinar del Rio con edades entre 5 y 25 años.Todos los pacientes con probable padecimiento de la enfermedad fueron ingresados en los hospitales durante el período.Se aplicaron los criterios de Jones modificados para verificar el diagnóstico.Las tasas de incidencia disminuyeron en la medida que transcurrió el tiempo.En 1986 fue de 18,6x100 000habitantes(2,1 para un primer ataque y 6,4 para las recurrencias) y en 1996 fue de 2,5 x 100 000 habitantes(2,1 para un primer ataque y 0,4 para las recrrencias).Existió mejoria en el cumplimiento de la profilaxis secundaria,aunque todavia hay paciente que la cumple de forma irregular planteándose que hay que seguir haciendo énfasis en este aspecto(AU)