Estudio de concordancia en el grado de fibrosis hepáticaestimada mediante los índices bioquímicos APRI y FORNS, y la elastografía de transición (Fibroscan®) en pacientes coinfectados por VIH-VHC / Grade of consistency existing in the grade of hepatic fibrosis calculated with the APRI and FORNS biochemistry indexes and transient elastography (Fibroscan®) in patients coinfected with HIV-HCV

Introducción. Existen métodos diagnósticos no invasivos de fibrosis hepática que se basan en determinaciones bioquímicas (como APRI o Forns) o en elastografía de transición. Este estudio se propone comparar la concordancia entre ellos en pacientes coinfectados por los virus de inmunodeficiencia humana y el de la hepatitis C. Pacientes y métodos. Se realizó elastografía, APRI y Forns a 331 pacientes para valorar la concordancia entre grados avanzados y bajos de fibrosis. Se estimaron los grados de concordancia existentes entre ellos mediante el coeficiente kappa. Resultados. Los pacientes que presentaron grados intermedios de fibrosis estimados por APRI y Forns (51 y 54% respectivamente) no fueron incluidos en el estudio. La concordancia de la elastografía en el grado avanzado frente al índice APRI fue del 65% y del 76% frente al Forns. Cuando la elastografía obtuvo estimaciones de grado bajo de fibrosis la concordancia con APRI fue del 89 y del 82,2% con Forns. La concordancia global fue del 85,5%, y con al menos un índice bioquímico del 72,1%. Conclusión. En los pacientes coinfectados por VIH y VHC la utilización de los índices bioquímicos APRI y Forns para estimar el grado de fibrosis hepática no logra clasificar adecuadamente a al menos la mitad de los pacientes. Sin embargo, en los pacientes clasificados como con fibrosis alta ó baja, la concordancia entre las estimaciones obtenidas mediante la elastografía y las derrivadas de los índices de APRI y de Forns es moderada-alta(AU)

Introduction. There are non-invasive diagnostic methods of liver fibrosis that are based on biochemical measurements (such as APRI or Forns) or on transient elastography. This study aims to compare the consistency between them in patients coinfected by the human immunodeficiency virus and the hepatitis C virus. Patients and methods. An elastography, APRI and Forns were performed for 331 patients to evaluate the consistency between the advanced and low grades of fibrosis. The grades of consistency existing between them were calculated with the kappa coefficient. Results. The grades of fibrosis calculated by APRI and by Forns provided intermediate results (51.1% and 54.7%, respectively), and these patients were not enrolled in the study. The consistency of the elastography in the advanced grade versus the APRI index was 65% and 75% for the Forns index. Results. When the elastography obtained low grade calculations of fibrosis, the consistency with APRI was 80% and 82.2% with Forns Global consistency was 85.5% and with at least one biochemistry index of 72.1%. Conclusion. In the HIV and HCV coinfected patients, the use of the APRI and Forns biochemistry indexes to calculate grade of liver fibrosis does not successfully classify at least half of the patients. However, in the patients classified as having high or low fibrosis, the consistency between the calculations obtained by elastography and those derived from the APRI and Forns indexes is moderate to high(AU)

Late infection of an embolized renal graft presented as buttock cellulitis.

Graft intolerance syndrome (GIS) is a common complication developed in failed kidney allografts left in situ when the patients returned to hemodialysis. GIS usually develops within the first 6 months after immunosuppression has been withdrawn. When medical treatment has failed, transplantectomy is the conventional therapy. Nevertheless, in recent years, transvascular ethanol embolization has been reported as an effective, safe, and less invasive technique than transplantectomy for the management of patients with GIS. Although infrequent, the most severe complication is infection of the graft or surrounding tissues, which usually appears in the first weeks after the procedure. We present the first case of late infection of an embolized renal graft, more than 2 years after embolization.

Individualized management of bacteraemia in patients with a permanent endocardial pacemaker.

Fifty-five episodes of bacteraemia arising in patients with a permanent endocardial pacemaker (PEP), from May 1987 to March 2006, were reviewed to determine whether clinical and microbiological data might assist in individual clinical management. Episodes of PEP-related bacteraemia were divided into early-onset bacteraemia, occurring within 6 months after device implantation or manipulation, and late-onset bacteraemia, occurring thereafter. Episodes with a source different from the PEP were classified as out-of-system bacteraemia. The PEP was the source of infection in 27 (49%) patients. Among patients with early-onset PEP-related bacteraemia (n = 16), Staphylococcus aureus was isolated in 87.5% (14/16) of cases; 81% of them (13/16) had local signs of infection at the PEP pocket and 25% (4/16) died. Conversely, patients with late-onset PEP-related bacteraemia (n = 11) had a protracted clinical course; local signs of infection were infrequently observed (18%); a coagulase-negative staphylococcus was isolated in 91% of cases, and no death-related infection was registered. In patients with out-of-system bacteraemia (n = 28), the device became colonized and required explantation in 56% (5/9) of patients with S. aureus infection; the remaining 19 patients with out-of system bacteraemia caused by a microorganism other than S. aureus were successfully managed with medical treatment. Early-onset and late-onset PEP-related bacteraemia differ regarding the microorganism involved, the clinical presentation, and the prognosis. When the pacing system is involved, a complete explantation of the device is necessary to cure the infection. However, most episodes of bacteraemia arising outside the PEP, mainly those not caused by S. aureus, can be conservatively managed.

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

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La clave estaba en la historia clínica / No disponible

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Artropatía de Charcot y úlceras neuropáticas plantares causadas por neuropatía autosómica sensorial hereditaria / No disponible

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[Complications related with cocaine abuse that required hospital admission]. / Complicaciones relacionadas con el consumo de cocaína que precisaron ingreso hospitalario.

INTRODUCTION: Although cocaine abuse is an increasingly important medical problem, many manifestations of its toxicity are not well understood. The aim of this study is to review the most serious clinical manifestations related to cocaine abuse. PATIENTS AND METHOD: We reviewed the medical records of all patients over 16 years of age admitted to the hospital from January 1994 to December 2005 where cocaine abuse was recorded in their clinical history. RESULTS: A total of 170 patients, with 188 episodes and 268 pathologic manifestations related to cocaine abuse were included. Thirty two out of the 170 patients (18.8%) were females. Mean age was 33 +/- 11 years, with no significant difference between males and females. A total of 88.8% were smokers, 70% had alcohol abuse and 67.3% had other illegal drug abuses. The more frequent reason for their hospitalization was: pulmonary infection (29.6%), bronchial hyperreactivity (14%), acute psychotic attack related to drugs (12%), ischemic heart disease (10%), infectious endocarditis (7.8%), cerebrovascular disease (8.6%), seizures (6.2%) and severe abdominal complications (2.3%). Eight patients died (6.25%). The association with cocaine was only suspected in 46% of the toxic manifestations. CONCLUSIONS: Several clinical manifestations are associated to cocaine abuse and its consumption causes potentially fatal complications. The integral treatment of these patients could be improved if these complications are kept in mind.

Complicaciones relacionadas con el consumo de cocaína que precisaron ingreso hospitalario / Complications related with cocaine abuse that required hospital admission

Introducción. Aunque la cocaína supone un problema sanitario de importancia creciente, muchos síntomas de su toxicidad no son bien conocidos. El objetivo de este estudio es dar una visión global de las manifestaciones clínicas más graves relacionadas con la cocaína. Pacientes y método. Se revisaron los historiales clínicos de todos los pacientes mayores de 16 años de edad ingresados en nuestro hospital desde el 1 de enero de 1994 hasta el 31 de diciembre de 2005, entre cuyos códigos diagnósticos al alta figuraba el consumo de cocaína. Resultados. Se incluyeron 170 pacientes que sumaron un total de 188 episodios y 268 manifestaciones patológicas relacionadas con la cocaína. De los 170 pacientes, 32 (18,8%) eran mujeres. La edad media fue de 33 ± 11 años y no difirió significativamente entre hombres y mujeres. El 88,8% era fumador, el 70% ingería alcohol en exceso y el 67,3% consumía otras drogas ilegales. El motivo de ingreso más frecuente fue: infección pulmonar (29,6%), hiperreactividad bronquial grave (14%), trastorno psicótico agudo (12%), cardiopatía isquémica (10%), enfermedad cerebrovascular (8,6%), endocarditis bacteriana (7,8%), convulsiones (6,2%) y complicaciones abdominales graves (2,3%). Ocho pacientes fallecieron (6,25%). La asociación con la cocaína sólo se sospechó en un 46% de las manifestaciones clínicas. Conclusiones. El espectro de manifestaciones clínicas asociadas al consumo de cocaína es amplio y causa complicaciones potencialmente fatales. Mejorar su conocimiento por parte de los clínicos puede facilitar el tratamiento integral de estos enfermos (AU)

Introduction. Although cocaine abuse is an increasingly important medical problem, many manifestations of its toxicity are not well understood. The aim of this study is to review the most serious clinical manifestations related to cocaine abuse. Patients and method. We reviewed the medical records of all patients over 16 years of age admitted to the hospital from January 1994 to December 2005 where cocaine abuse was recorded in their clinical history. Results. A total of 170 patients, with 188 episodes and 268 pathologic manifestations related to cocaine abuse were included. Thirty two out of the 170 patients (18.8%) were females. Mean age was 33 ± 11 years, with no significant difference between males and females. A total of 88.8% were smokers, 70% had alcohol abuse and 67.3% had other illegal drug abuses. The more frequent reason for their hospitalization was: pulmonary infection (29.6%), bronchial hyperreactivity (14%), acute psychotic attack related to drugs (12%), ischemic heart disease (10%), infectious endocarditis (7.8%), cerebrovascular disease (8.6%), seizures (6.2%) and severe abdominal complications (2.3%). Eight patients died (6.25%). The association with cocaine was only suspected in 46% of the toxic manifestations. Conclusions. Several clinical manifestations are associated to cocaine abuse and its consumption causes potentially fatal complications. The integral treatment of these patients could be improved if these complications are kept in mind (AU)

Manejo exitoso conservador de prótesis osteoarticular infectada por vía hematógena tardía por Streptococcus pneumoniae / Successful management to protect osteoarticular prosthesis due to Streptococcus pneumoniae infection by means of late hematogenous pathway

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Pielonefritis y embarazo. Experiencia durante un año en un hospital general / Pyelonephritis and pregnancy. Our experience in a general hospital

Objetivos: La incidencia de la pielonefritis durante el embarazo alcanza hasta un 2%. Para prevenirla recomendamos realizar análisis de orina en el primer trimestre con el objeto de detectar bacteriuria asintomática, debiéndose tratar aquellos casos con urocultivo positivo. Métodos: Se recogen de forma retrospectiva todos los casos diagnosticados de pielonefritis aguda en embarazadas ingresadas en nuestro Centro a lo largo del año 2004 y se tabulan los datos demográficos, métodos diagnósticos, tratamientos, evolución, nuevos episodios y repercusiones sobre la fecha del parto y del recién nacido. Resultados: Estudiamos todos los casos de pielonefritis en embarazadas ocurridas en nuestro centro durante un año (4.700 partos). Objetivamos que el despistaje de bacteriuria se hacía, de manera incorrecta con sedimento urinario (piuria). La incidencia fue de 0,21%, atribuyendo dicha cifra tan baja a que, posiblemente, alguna enferma con pielonefritisno ingresó en nuestro centro. Las evoluciones fueron favorables, siendo el único germen aislado E. coli. Las pielonefritis del primer trimestre recidivaron. Conclusiones: En todos los embarazos se debe realizar urocultivo en el primer trimestre debiendo, después del tratamiento adecuado, repetir el urocultivo, sobre todo si la bacteriuria ocurre en el primer trimestre de embarazo (AU)

Objective: The incidence of pyelonephritis during pregnancy reaches 2%. We recommend obtaining a urinalysis during the first trimester in order to detect asymptomatic bacteriuria and treat those cases with positive urine culture. Methods: We retrospectively reviewed all cases diagnosed as acute pyelonephritis in pregnant women admitted to our hospital during 2004 and analyzed demographic data, diagnostic methods, treatments, outcome, new episodes and the impact on the date of birth and the newborns. Results: We studied all the cases of pyelonephritis in pregnant women diagnosed in our hospital for one year (4,700 childbirths). We found that screening of bacteriuria was done incorrectly based on the presence of pyuria in the sediment of urine specimen. The incidence was 0.21 %, and such a low rate might be related to the possibility that some patients were not admitted in our hospital. Prognosis was excellent being E. coli the only agent isolated in all cases. Pyelonephritis that occurred during the first trimester relapsed. Conclusions: A urine culture must be obtained during the first trimester of pregnancy and should be repeated after completion of adequate therapy of an infection, particularly if bacteriuria is detected in the first trimester (AU)

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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