ABSTRACT
The objective was to evaluate the utility of the Pneumonia Severity Index (PSI) developed by Fine et al. as a tool to streamline diagnostic and therapeutic effort. Site of care of patients was recommended in accordance with the PSI class: classes I and II underwent treatment at home and classes III, IV, and V were hospitalized. Class I comprised 37 patients; class II had 30, class III had 20, class IV had 31, and class V had 10 patients. 80 patients were admitted into the hospital, 3 of whom required admittance to the intensive care unit, and 48 were managed as outpatients from the emergency room. Overall mortality was 4 patients (3.1%). Of these, 3 belonged to class IV and 1 to class V. The aetiological diagnosis was obtained in 53.9% of the cases (69/128). If classes I to III are analysed together, the percentage of aetiological diagnoses was 47% (41/87), increasing to 68% (28/41) for patients in classes IV and V. In our experience Fine's PSI classification, with rationalization and adaptation to the particularities of each centre, is an effective tool for deciding on hospitalization for selecting the most suitable battery of diagnostic tests based on cost-benefit criteria. However, it is inadequate for young patients with hypoxia or pleural effusion. Therefore, although hospitalization of patients with pneumonia should be mainly based on clinical criteria, Fine's PSI classification could help physicians in making more rational decisions in this respect.
Subject(s)
Community-Acquired Infections/diagnosis , Hospitalization , Pneumonia, Bacterial/diagnosis , Pneumonia, Pneumococcal/diagnosis , Severity of Illness Index , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Female , Humans , Male , Middle Aged , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/microbiology , Pneumonia, Pneumococcal/drug therapy , Pneumonia, Pneumococcal/microbiologyABSTRACT
Paciente varón de 75 años con antecedentes de mieloma múltiple que acudió por una fractura patológica a través de la diáfisis femoral distal derecha. Dicha fractura fue fijada con clavos de Enders. Dos meses y medio más tarde el paciente reingresó por aumento de tamaño rápidamente progresivo del muslo derecho.Se realizó ecografía, TC y RM que reveló infiltración de la musculatura anterior del muslo derecho con extensión craneal hacia el músculo iliopsoas y al espacio retroperitoneal, por encima de la vena renal homolateral.Una biopsia guiada ecográficamente de las partes blandas del muslo mostró infiltración mielomatosa difusa por células plasmablásticas (AU)
