La Tomografía axial computarizada en la vigilancia de la patología laboral respiratoria / What does axial computed tomography provide in the surveillance system of respiratory labour disease?

Objetivo: Establecer el interés de la tomografía axial computarizada (TAC) en el sistema de vigilancia de la patología laboral respiratoria. Métodos: Estudio epidemiológico de tipo transversal sobre una población diana de 1.200 trabajadores sospechosos de estar expuestos en su medio laboral a agentes implicados en el desarrollo de enfermedades respiratorias. A partir de los datos obtenidos en un reconocimiento médico específico, que incluye espirometría y TAC, se analizan (mediante pruebas estadísticas de homogeneidad de muestras) diversas variables, posiblemente relacionadas con la aparición de imágenes respiratorias anómalas en esta última, se comparan grupos sectoriales de actividad y se examina la concordancia entre ambos métodos de diagnóstico. Resultados: Casi la mitad de los trabajadores mostraron en la TAC torácica imágenes respiratorias anómalas. La TAC respiratoria anormal fue más frecuente entre ex fumadores, entre los que presentaron un patrón espirométrico anormal, fundamentalmente mixto, y entre los que mostraron alguna anomalía fuera del aparato respiratorio. Fue menos frecuente entre no fumadores y entre los que tenían un patrón espirométrico normal. Los trabajadores sin lesiones respiratorias en la TAC eran más jóvenes. La aparición de imágenes anómalas en la TAC respiratoria no diferenció al sector siderometalúrgico del resto, aunque sus trabajadores presentaban mayor proporción de anomalías pleurales. Conclusiones: La utilización de la TAC torácica podría ayudar a optimizar el manejo de los trabajadores tras un programa de vigilancia de enfermedades respiratorias en el medio laboral(AU)

Objective: To establish the interest of the axial computed tomography use (ACT) in the screening of respiratory labour disease.Methods: Transversal type epidemiologic research on a 1,200 workers target population suspected to be exposed to agents implicated in respiratory disease development in their labour environment. Starting from the values obtained in a specific medical evaluation, which includes spirometry and ACT, diverse variables are analyzed (by statistics tests for homogeneity samples) implicated in the appearance of anomalous respiratory images in this last, activity sectorial groups are compared and validity and security reciprocal from both methods are considered.Results: Nearly half of workers showed anomalous respiratory images in thoracic ACT. Abnormal respiratory ACT was more frequent among ex-smokers, among who showed an abnormal spirometric patron, fundamentally mixed, and among who showed in the ACT some anomaly out of the respiratory system. It was less frequent among no smokers and among who had a normal spirometric patron. Workers whitout respiratory lesions in ACT were younger. The appearance of anomalous images in respiratory ACT didn’t stands out the sidermetallurgic sector from the rest, although their workers showed bigger proportion of pleural anomalies.Conclusions: ACT thoracic use might help to optimize the managing of the workers after a surveillance respiratory diseases program in labour environment (AU)

Misión del internista en el hospital moderno / Internist mision at the modern hospital

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[Non-tropical pyomyositis: review of a case]. / Piomiositis no tropical: revisión a propósito de un caso.

The pyomyositis is still being a rare disease in our environment. A review of this illness is made as a result of a new case, which shows some peculiarities that differ it from others published previously: the patient showed a basic medullary carcynoma of thyroid with cerebral metastasis and the responsible germ was a Streptococcus pneumoniae. The immunodepressor factors which are presented at most patients who suffer a pyomyositis, the clinic picture so suggestive and the image methods we dispose nowadays, should serve to suspect its diagnostic in an earlier way, proceeding to its bacteriological confirmation before illness evolves to stages as advanced as in the shown case.

[Domiciliary intravenous antibiotic therapy]. / Antibioterapia intravenosa domiciliaria.

BACKGROUND: To assess the efficiency and safety of intravenous antibiotic therapy (IAT) when performed through the traditional simple infusion system by gravity in the home setting. PATIENTS AND METHODS: The clinical records of patients undergoing intravenous antibiotic therapy through the traditional gravitational infusion system in the home care unit over a five year period were reviewed retrospectively. RESULTS: 120 patients were treated (44 F/76 M), with a mean age of 48 years (44-52). 67% of the total had chronic diseases. Infections were most commonly found in bones and joints (38%), followed by the skin and soft tissues. A wide variety of antibiotics was used, 61% as monotherapy. 76% of them were given intermittently. 161 intravenous catheters were used, 53% of which were central catheters with peripheral insertion, 27% inserted centrally and 20% peripheral catheters. The overall incidence of phlebitis was 18% without associated bacteremia. 91% of our patients evolved well, 6% had to become in-patients, none of them due to problems with the infusion system or by their own petition. The intravenous treatment lasted a mean of 17 days at home and 25 days at both home and hospital, which represents a decrease of 2,040 hospital stays. CONCLUSIONS: The traditional gravitational system of infusion is an effective and safe method for intravenous antibiotic administration at home. For these therapies to be successful, suitable patients must be selected and continuous attention is required. This treatment at home satisfies the patient and permits hospital stays to be reduced, thus improving the use of hospital resources.

[Acute eosinophilic pneumonia: presentation of a case and review of the literature]. / Neumonía eosinófila aguda: presentación de un caso y revisión de la literatura.

Pulmonary eosinophilias are characterized by the appearance of lung infiltrates by eosinophils and the presence, commonly, of peripheral blood eosinophilia. Among idiopathic pulmonary eosinophilias, with no evidence of any cause or underlying disease, chronic eosinophilic pneumonia is the most characteristic. Recently, there has been described a few cases of eosinophilic pneumonia with many similarities to chronic eosinophilic pneumonia but with a shorter clinical course, a very good response to corticoid therapy, and without tendency to relapse. This process has been named acute eosinophilic pneumonia. We present a case of this entity and review the literature, emphasizing on the potential severity of this disease, which often conduce to progressive respiratory failure, and its excellent prognosis after appropriate treatment.

[Treatment of gram negative bacilli bacteremia with intramuscular ceftriaxone in home care]. / Tratamiento de bacteriemias por bacilos gramnegativos con ceftriaxona intramuscular en hospitalización domiciliaria.

BACKGROUND: Bacteremias by gram negative bacilli (BGNB) are serious diseases which normally require hospital admission. In accordance with the pharmacokinetic characteristics of ceftriaxone, the possibility of treating such processes with home care (HC) and the existence of advantages for both the patient and the hospital were evaluated. METHODS: Twenty patients were prospectively studied. Upon obtaining clinical stability in the hospital the possibility of following home care (HC) treatment was evaluated. Ceftriaxone was administrated at intramuscular doses of 1g/24 h. The clinical and bacteriologic response, patient satisfaction and treatment time were estimated. RESULTS: The origin of the bacteremia was varied as was the type of gram negative bacilli responsible. All the patients evolved favorably with no relevant secondary effects. The mean length of treatment was 12.75 days per patient. The antibiotic was mainly administered at home (83%), permitting a mean reduction of 10.5 hospital stays per patient. The social and psychologic advantages for the patients were evident. CONCLUSIONS: This study confirms the possibility of treating stable phase gram negative bacilli bacteremias at home efficiently with the supervision of home care teams leading to a substantial reduction in hospital expenses and patient satisfaction.