Candida isolation in patients hospitalized on a surgical ward: significance and mortality-related factors.

BACKGROUND: Infections caused by Candida are an emerging pathology on surgical wards. The aim of the present study was to evaluate the incidence, characteristics, and predictive factors of mortality in patients colonized and/or infected by Candida spp. in this setting. METHODS: A consecutive series of 105 patients hospitalized on a general surgery ward between 2000 and 2004 were included, and 118 positive cultures for Candida were identified. The variables age, sex, previous medical history, current disease, anemia, ICU stay, type and localization of the microorganism, need for parenteral nutrition, and transfusions were recorded. The primary outcome was in-hospital mortality. A univariate analysis was performed to determine which of these variables were associated with mortality. With a logistic regression model, independent prognostic factors of mortality were determined. RESULTS: The prevalence of patients colonized and/or infected by Candida on our surgical ward was 0.98% (CI 95%: 0.79-1.17), and the incidence was 49 cases per 1,000 patient-years. Of the 105 patients in this series, 56 were men (53%) and 49 women (47%); the mean age was 63.8 years (SD +/- 15.7). Twelve patients (11.4%) had candidemia. Crude mortality was 23% (24 patients), whereas the mortality attributable to candidemia was 25% (3/12 cases). Anemia (p = 0.001); transfusions (p = 0.003), and an ICU stay (p = 0.002) were associated with mortality. Candidemia was associated with neoplasms (p = 0.02) and the infection caused by Candida parapsilosis (p = 0.04). The only independent factor related to mortality was the anemia (p = 0.028; Odds Ratio: 6.43; 95% CI: 1.23-33.73). CONCLUSIONS: Colonization and/or infection by Candida spp. in non-ICU hospitalized surgical patients implies a relative high mortality. Anemia is an independent factor for mortality.

[Splenic artery aneurysm. Review of two surgically operated cases]. / Aneurisma de la arteria esplénica. Revisión de dos casos intervenidos quirúrgicamente.

Among arterial aneurysms, splenic artery aneurysms are very uncommon in the current practice. The etiologic factors are in relation with: angiodysplasia, portal hypertension, pregnancy and atherosclerosis. The great majority are asymptomatic. Symptomatic cases are in relation with rupture in the peritoneum or in organs or structures of the vicinity. We present two cases of splenic artery aneurysm in a 57 year old man and in a 59 year old woman. In both cases the diagnosis was made by plain abdominal x-ray, abdominal scanner and abdominal aortography. Both cases were surgically treated by transverse laparotomy and total aneurysm resection. The pathology dictamen of the two cases was consistent with atherosclerosis. After 120 and 38 months of follow-up both patients are doing well and without evidence of splenic artery aneurysm. A review of this entity is exposed, with special reference in the etiology, symptomatology, diagnosis and treatment.

[Combined treatment of embolization followed by surgical resection in carotid paraganglioma]. / Tratamiento combinado de embolización seguido de resección quirúrgica en un paraganglioma carotídeo.

Carotid body tumors represent a relatively uncommon finding in vascular surgery. We present the case of a 62 years old man with a right carotid paraganglioma diagnosed by cervical ultrasound scanner, magnetic resonance imaging and carotid arteriography. We decided to treat the patient in two times. In a first approach the tumor was percutaneously embolized, later on in a second time the paraganglioma was surgically resected. The patient is doing well without echographic evidence of tumor 3 years after the operation. This modality of treatment, embolization followed by surgical excision is a useful and valuable alternative.

Aneurisma de la arteria esplénica. Revisión de dos casos intervenidos quirúrgicamente / Splenic artery aneurysm. Review of two surgically operated cases

Entre los aneurismas arteriales, los localizados en la arteria esplénica son de infrecuente aparición en la práctica clínica. La etiología puede ser debida y está en relación con: fibrodisplasia, hipertensión portal, embarazo y arteriosclerosis. La mayor parte son asintomáticos, otras veces la clínica es por la rotura y perforación del aneurisma en peritoneo libre o en un órgano o estructura vecina. Presentamos dos casos de aneurisma silente en la arteria esplénica en dos pacientes, un varón y una hembra de 57 y 59 años respectivamente. En ambos se hizo el diagnóstico por radiología de abdomen, TAC abdominal y arteriografía. Los dos se intervinieron quirúrgicamente por laparotomía transversa, practicándose resección completa del aneurisma. En los dos casos el diagnóstico anatomopatológico fue arteriosclerosis. Los pacientes están bien y sin evidencia de aneurisma visceral a los 120 y 38 meses respectivamente de la operación. Se comentan los aspectos clínicos, diagnósticos y el tratamiento de esta entidad

Among arterial aneurysms, splenic artery aneurysms are very uncommon in the current practice. The etiologic factors are in relation with: angiodisplasia, portal hypertension, pregnancy and atherosclerosis. The great majority are asymptomatic. Symptomatic cases are in relation with rupture in the peritoneum or in organs or structures of the vecinity. We present two cases of splenic artery aneurysm in a 57 year old man and in a 59 year old woman. In both cases the diagnosis was made by plain abdominal x-ray, abdominal scanner and abdominal aortography. Both cases were surgically treated by transverse laparotomy and total aneurysm resection. The pathology dictamen of the two cases was consistent with atherosclerosis. After 120 and 38 months of follow-up both patients are doing well and without evidence of splenic artery aneurysm. A review of this entity is exposed, with special reference in the etiology, symptomatology, diagnosis and treatment

Tratamiento combinado de embolización seguido de resección quirúrgica en un paraganglioma carotídeo / Combined treatment of embolization followed by surgical resection in carotid paraganglioma

Los paragangliomas carotídeos son un diagnóstico poco frecuente en patología vascular. Presentamos el caso de un paciente varón de 62 años con un paraganglioma carotídeo derecho diagnosticado por ecografía, TAC, RMN y arteriografía cervical que fue tratado en dos tiempos. En una primera fase se efecúó embolización percutánea del tumor evidenciándose arteriograficamente la disminución en su irrigación arterial. En una segunda fase se procedió a la resección quirúrgica. El resultado ha sido excelente estando el paciente asintomático y si evidencia de tumor al tumor al estudio ecográfico cervical a los 3 años. En casos seleccionados, ésta aproximación terapéutica nos parece de utilidad e interés en el tratamiento de este tipo de lesiones

Carotid body tumors represent a relatively uncommon finding in vascular surgery. We present the case of a 62 years old man with a right carotid paraganglioma diagnosed by cervical ultrasound scanner, magnetic resonance imaging and carotid arteriography. We decided to treat the patient in two times. In a first approach the tumor was percutaneously embolized, later on in a second time the paraganglioma was surgically resected. The patient is doing well without echographic evidence of tumor 3 years after the operation. This modality of treatment, embolization followed by surgical excision is a useful and valuable alternative