Síndrome de fatiga crónica: estudio de una serie consecutiva de 824 casos evaluados en dos unidades especializadas / Chronic fatigue syndrome: study of a consecutive series of 824 cases assessed in two specialized units

Fundamento y objetivo. El síndrome de fatiga crónica (SFC) condiciona una importante limitación funcional. En nuestro medio se disponen de escasos estudios sobre las características del SFC, por lo que se inició el estudio de una serie consecutiva de casos diagnosticados en dos unidades especializadas. Pacientes y método. Se han incluido todos los pacientes con SFC atendidos desde enero de 2008 hasta junio de 2010. Se analizaron datos sociodemográficos y laborales, tiempo desde el inicio, factores desencadenantes y forma de inicio, criterios diagnósticos de Fukuda y canadienses, los fenómenos comórbidos y el tratamiento. Resultados. Se incluyeron 824 pacientes, 748 (91%) mujeres, con una edad media de 48±9 años. La edad media de inicio de los síntomas fue de 35±11 años, el tiempo transcurrido hasta el diagnóstico fue de 108±88 meses. En 481 pacientes (58%) se identificó un factor desencadenante y en 517 (63%) el inicio fue gradual. En 515 (62,5%) pacientes la enfermedad estaba inactiva. Entre los criterios diagnósticos de Fukuda destacó la fatiga postejercicio físico, el sueño no reparador y las alteraciones en la concentración y memoria inmediata. Los bloques sintomáticos de los criterios canadienses mostraron la uniformidad de los síntomas. Los fenómenos comórbidos acompañantes fueron: ansiedad 691 (84%), síndrome seco 678 (82%) y fibromialgia 450 (55%). Realizaban tratamiento farmacológico 520 (63%) pacientes. Conclusiones. El SFC afecta preferentemente a mujeres jóvenes, condiciona importante ausentismo laboral. Entre los criterios diagnósticos destacó la intolerancia al ejercicio físico, la disfunción neurocognitiva y el sueño no reparador. En la valoración del paciente, es muy importante la aplicación de los criterios canadienses y estudiar la comorbilidad(AU)

Background and objective. The chronic fatigue syndrome (CFS) is a disabling disorder. Few studies are available in our area on the prevalence and characteristics of CFS. Therefore, we carried out a study of a consecutive series of 824 cases diagnosed in two specialized units. Patients and methods. We evaluated all of the CFS patients seen from January 2008 to June 2010. We analyzed social and demographic data, employment status, time of clinical evolution, trigger factors and onset, Fukuda and Canadian criteria, associated comorbidities and treatment. Results. A total of 824 patients were included, 748 (91%) woman, mean age 48±9 years. Average age of onset of symptoms was 35±11 years, time to diagnosis 108±88 month. A precipitating factor was identified in 481 (58%) patients, the onset was gradual in 517 (63%) and 515 (62.5%) were not employed. The most outstanding diagnostic criteria of Fukuda were prolonged generalized fatigue after exercise, sleep disturbance and impairments in concentration and short-term memory. The different groups of symptoms defined by the Canadian consensus showed that CFS is a homogeneous entity. Accompanying comorbidity phenomena were anxiety 691 (83%), sicca syndrome 678 (82%), fibromyalgia 450 (55%). A total of 63% of patients (520) received pharmacological treatment. Conclusions. CFS is an illness that preferentially affects young women and results in employment absenteeism. The most relevant clinical features were prolonged generalized fatigue after exercise, neurocognitive impairment and sleep disturbance. In the evaluation of the patient, it is very important to apply the Canadian criteria and to assess comorbidity(AU)

[Chronic fatigue syndrome: study of a consecutive series of 824 cases assessed in two specialized units]. / Síndrome de fatiga crónica: estudio de una serie consecutiva de 824 casos evaluados en dos unidades especializadas.

BACKGROUND AND OBJECTIVE: The chronic fatigue syndrome (CFS) is a disabling disorder. Few studies are available in our area on the prevalence and characteristics of CFS. Therefore, we carried out a study of a consecutive series of 824 cases diagnosed in two specialized units. PATIENTS AND METHODS: We evaluated all of the CFS patients seen from January 2008 to June 2010. We analyzed social and demographic data, employment status, time of clinical evolution, trigger factors and onset, Fukuda and Canadian criteria, associated comorbidities and treatment. RESULTS: A total of 824 patients were included, 748 (91%) woman, mean age 48±9 years. Average age of onset of symptoms was 35±11 years, time to diagnosis 108±88 month. A precipitating factor was identified in 481 (58%) patients, the onset was gradual in 517 (63%) and 515 (62.5%) were not employed. The most outstanding diagnostic criteria of Fukuda were prolonged generalized fatigue after exercise, sleep disturbance and impairments in concentration and short-term memory. The different groups of symptoms defined by the Canadian consensus showed that CFS is a homogeneous entity. Accompanying comorbidity phenomena were anxiety 691 (83%), sicca syndrome 678 (82%), fibromyalgia 450 (55%). A total of 63% of patients (520) received pharmacological treatment. CONCLUSIONS: CFS is an illness that preferentially affects young women and results in employment absenteeism. The most relevant clinical features were prolonged generalized fatigue after exercise, neurocognitive impairment and sleep disturbance. In the evaluation of the patient, it is very important to apply the Canadian criteria and to assess comorbidity.

Nicotinamida adenina dinucleótido (NADH) en pacientes con síndrome de fatiga crónica / Nicotinamide adenine dinucleotide (NADH) in patients with chronic fatigue syndrome

AntecedentesLa nicotinamida adenina dinucleótido (NADH) podría estar deplecionada en el síndrome de fatiga crónica. El objetivo del estudio fue evaluar la eficacia de la suplementación con NADH en estos pacientes.Material y métodosSe realizó un ensayo clínico, doble ciego, controlado con placebo de 3 meses de duración. Los pacientes fueron randomizados a NADH oral 20mg o placebo durante los 2 primeros meses. Se evaluó la intensidad de la fatiga, estado funcional, estado de ánimo, impacto funcional de la fatiga, calidad de vida, calidad del sueño, capacidad al ejercicio y reserva funcional, así como la opinión del investigador y pacientes sobre la eficacia de la intervención, antes y a los 30, 60 y 90 días del inicio del tratamiento. En la visita basal y a los 60 días (último día de tratamiento doble ciego) se realizó una prueba de esfuerzo.ResultadosSe incluyeron 86 enfermos de los cuales 77 concluyeron el estudio (edad media, 47 años; 72 mujeres). No se hallaron diferencias significativas en la mayoría de las variables estudiadas al finalizar el estudio. La administración de NADH se asoció a una disminución de estado de ansiedad de −1,0 puntos (p<0,05) y de −0,2 puntos (p=NS) en el grupo asignado a placebo. La frecuencia cardiaca máxima tras la prueba de esfuerzo disminuyó una media de −8,1l/min (p<0,05) en el grupo NADH y ascendió +1,7l/min en el grupo placebo (p=0,73). No se hallaron diferencias en la percepción de eficacia con NADH y placebo, por parte del investigador y pacientes.ConclusionesLa administración de NADH oral se asoció a una disminución de la ansiedad y de la frecuencia cardiaca máxima, tras una prueba de esfuerzo, en los pacientes con síndrome de fatiga crónica. Por el contrario, este tratamiento no modificó otras variables clínicas y el estado funcional global(AU)

BackgroundNicotinamide adenine dinucleotide (NADH) may be depleted in chronic fatigue syndrome (SFC). The purpose of the study was to evaluate the efficacy of supplementation with NADH in these patients.ResultsA total of 86 patients, 77 of whom completed the study (mean age, 47 years, 72 women) were enrolled. No significant differences were found in most of the variable studied at the end of the study. Administration of NADH was associated to a decrease in anxiety condition of −1.0 points (p<0.05) and of −0.2 points (p=NS) in the placebo assigned group. Maximum heart rate after the stress test decreased a mean of −8.1l/min (p<0.05) in the NADH group and increased by +1.7l/min in the placebo group (p=0.73). No differences were found in the perception of efficacy with NADH and placebo, by the investigator and patients.ConclusionsAdministration of oral NADH was associated to a decrease in anxiety and maximum heart rate, after a stress test in patients with CFS. On the contrary, this treatment did not modify other clinical variables and the global functional performance(AU)

Differentiating between malignant and idiopathic pleural effusions: the value of diagnostic procedures.

BACKGROUND: Which diagnostic procedures should be used to differentiate between idiopathic and malignant pleural effusions, is not well established. AIM: To identify which parameters allow differentiation between idiopathic and malignant pleural effusions. DESIGN: Case-note review. METHODS: Over a 12-year period, we treated 1014 consecutive pleural effusion patients, of whom 346 were diagnosed as having an idiopathic or malignant aetiology. We analysed medical history, chest X-ray, pleural fluid analysis (biochemical, microbiological and cytological), chest CT scan and additional examinations that were used according to clinical findings, and compared them with the eventual diagnosis and outcome. RESULTS: Eighty-three patients with idiopathic effusions and 263 with malignant effusions were included. Idiopathic pleural effusion resolved in 47 patients, improved in 20 and persisted in 16. Biochemical pleural fluid analysis did not predict these outcomes. A history of neoplasm, chest X-ray and CT features, as well as additional examinations according to clinical findings, established a diagnosis or suspicion of malignancy in 256 (97.7%) of the 263 patients who received a diagnosis of malignant effusion. Diagnostic thoracoscopy was helpful in seven patients in whom malignant disease was strongly suspected, despite the absence of other pathological findings. DISCUSSION: Non-invasive complementary examinations generally allowed accurate differentiation between malignant and idiopathic effusions. Patients with idiopathic pleural effusions generally had favourable outcomes.

Factors influencing length of hospital stay in patients with bacterial pleural effusion.

BACKGROUND: Factors influencing length of hospital stay have been poorly analyzed in parapneumonic pleural effusions (PPE). OBJECTIVES: The aim of this work is to identify the variables that determine increased hospital stay in patients with infectious pleural effusion (PE). PATIENTS AND METHODS: We analyzed 112 patients with PE: empyema, complicated parapneumonic and non-complicated parapneumonic. Epidemiologic, biochemical, therapeutic and radiological variables were analyzed. Correlations with hospital stay were studied using the Student's t test, analysis of variance, Mann-Whitney U-test and linear regression model. RESULTS: Among the 112 patients studied, there were 32 empyema, 50 complicated and 30 non-complicated parapneumonic cases. The median of length stay for all patients was 17 days. Longer hospitalization was required in patients with empyemic PE (p = 0.015), patients with underlying diseases (p = 0.003), those needing pleural drainage (p = 0.005) or decortication (p = 0.043) and those presenting unfavorable radiological outcome after treatment (p = 0.02). Biochemical parameters associated with longer hospital stay were elevated pleural fluid polymorphonuclear elastase (p = 0.001, r = 0.307) and lactate dehydrogenase (p = 0.001, r = 0.312). After linear regression analysis, only underlying disease, pleural drainage and pleural fluid polymorphonuclear elastase values remained in the model, explaining 23.1% of the variability of days of hospitalization. CONCLUSIONS: The patients with PPE and empyema who required longer hospitalization were those with purulent fluid, underlying disease, surgical drainage and/or decortication, with unfavorable radiological outcome and higher pleural fluid levels of lactate dehydrogenase and polymorphonuclear elastase.

[Prevalence of atopy in chronic fatigue syndrome]. / Prevalencia de atopia en el síndrome de fatiga crónica.

BACKGROUND: Several hypotheses have been postulated to explain the etiopathogenesis of chronic fatigue syndrome (CFS). Among these, immunologic dysfunction has been proposed. Up to 30 % of these patients have a history of allergic disease. The aim of this study was to investigate whether allergic sensitization is higher in patients with CFS than in the general population. METHODS: Twenty-five patients with CFS and 20 controls were evaluated. A clinical history for allergy was taken and immediate hypersensitivity tests were performed. RESULTS: Twelve patients (48 %) and eight controls (40 %) had a family history of atopy. Personal histories of atopy were as follows: rhinoconjunctivitis: 12 patients (48 %), seven controls (35 %); asthma: five patients (20 %), two controls (10 %); food allergy: three patients (12 %); atopic dermatitis: two patients; contact dermatitis: two patients. No statistically significant differences were found between the groups in any of the variables (p > 0.05). In the CSF group, 3.4 % (15/441) of the inhalant prick tests were positive, and in the control group 3.8 % (16/420) were positive. None of the tests for hypersensitivity to food or latex were positive. CONCLUSIONS: In our study atopy was not more prevalent in patients with CFS than in healthy controls, although the CSF group tended to report more respiratory symptoms and drug allergies.

Prevalencia de atopia en el síndrome de fatiga crónica / Prevalence of atopy in chronic fatigue syndrome

Antecedentes: La etiología del síndrome de fatiga crónica (SFC) es desconocida habiéndose postulado varias hipótesis entre ellas la inmunológica. Se han descrito hasta en un 30 % de estos pacientes antecedentes de enfermedades alérgicas. El objetivo del estudio fue evaluar si la sensibilización alérgica es mayor en pacientes con SFC respecto a la población general. Pacientes y métodos: 25 pacientes diagnosticados de SFC y 20 voluntarios control fueron evaluados mediante una historia clínica y pruebas de hipersensibilidad inmediata. Resultados: Del total de pacientes evaluados 12 (48%) referían antecedentes familiares de atopia y en 8 de los controles (40%). Referían antecedentes personales de rinoconjuntivitis 7 controles (35%) y 12 pacientes (48%), asma 2 controles (10%) y 5 pacientes (20%), alergia alimentaria 3 pacientes (12%), dermatitis atópica 2 pacientes (8%) y dermatitis de contacto también 2 pacientes (8%). En ninguna de las variables se han observado diferencias estadísticamente significativas (p > 0,05). En las pruebas de hipersensibilidad inmediata a neumoalergenos se observaron 15/441 reacciones positivas (3,4%) en el grupo SFC y 16/420 (3,8%) en el grupo control. En las pruebas de hipersensibilidad a alimentos y látex no se observaron reacciones positivas. Conclusiones: La prevalencia de atopia en los pacientes con síndrome de fatiga crónica no es mayor que en la población general aunque se observa una mayor tendencia a referir síntomas respiratorios y reacciones adversas medicamentosas en el grupo con SFC

Background: Several hypotheses have been postulated to explain the etiopathogenesis of chronic fatigue syndrome (CFS). Among these, immunologic dysfunction has been proposed. Up to 30 % of these patients have a history of allergic disease. The aim of this study was to investigate whether allergic sensitization is higher in patients with CFS than in the general population. Methods: Twenty-five patients with CFS and 20 controls were evaluated. A clinical history for allergy was taken and immediate hypersensitivity tests were performed. Results: Twelve patients (48%) and eight controls (40%) had a family history of atopy. Personal histories of atopy were as follows: rhinoconjunctivitis: 12 patients (48%), seven controls (35%); asthma: five patients (20%), two controls (10%); food allergy: three patients (12%); atopic dermatitis: two patients; contact dermatitis: two patients. No statistically significant differences were found between the groups in any of the variables (p > 0.05). In the CSF group, 3.4% (15/441) of the inhalant prick tests were positive, and in the control group 3.8% (16/420) were positive. None of the tests for hypersensitivity to food or latex were positive. Conclusions: In our study atopy was not more prevalent in patients with CFS than in healthy controls, although the CSF group tended to report more respiratory symptoms and drug allergies

[A prospective study on patients with heart failure admitted to the internal medicine department]. / Estudio prospectivo de los enfermos ingresados por insuficiencia cardíaca en una sala de hospitalización de medicina interna.

CONTEXT: Heart failure (HF) is one of the most important causes of morbidity and mortality and represents one of the most frequent causes of rehospitalization. PATIENTS AND METHOD: Prospective study on patients admitted because of HF. A data collection questionnaire was completed: cardiology history, HF etiology, reason for admission, previous treatment, treatment during and after the admission, hospital stay and complementary explorations carried out. A biweekly telephone monitoring was carried out after the discharge. RESULTS: 62 patients admitted because of HF with an average age of 73 +/- 11 years. The etiology of the HF was: unknown (54%), hypertensive (21.5%), valvular (15.4%), ischemic (7.3%), alcohol (1.6%). All patients received diuretic treatment, 25% angiotensin-converting enzyme inhibitors (ACEI) and 6% oral anticoagulants. 51.6% showed atrial fibrillation. Echocardiogram was carried out in 10% of the patients. The average hospital stay was 6.2 +/- 3.2 days, and it was significantly higher when an echocardiogram was carried out (5.7 +/- 0.4 versus 7.55 +/- 0.9 days; p < 0.001). 6-month incidence of rehospitalization and mortality was 26% and 20% respectively. CONCLUSIONS: HF implied one fourth of admissions in a population of elderly patients with multiple conditions. The etiology of the HF was not established in more than half of the patients. A suboptimal utilization of the available treatments is demonstrated. HF is associated to a high incidence of rehospitalization and mortality.

Estudio prospectivo de los enfermos ingresados por insuficiencia cardíaca en una sala de hospitalización de Medicina Interna / A prospective study on patients with heart failure admitted to the Internal Medicine Department

Fundamento. La insuficiencia cardíaca (IC) es una de las mayores causas de morbimortalidad y representa una de las causas más frecuentes de reingreso hospitalario. Pacientes y método. Estudio prospectivo de los enfermos ingresados por IC. Se cumplimentó un cuestionario de recogida de datos: historia cardiológica, etiología de la IC, motivo de ingreso, tratamiento recibido antes, durante y después del ingreso, estancia hospitalaria y exploraciones complementarias practicadas. Tras el alta se realizó un seguimiento telefónico quincenal. Resultados. Sesenta y dos enfermos ingresaron por IC con una edad media de 73ñ11 años. La etiología de la IC fue: desconocida (54 por ciento), hipertensiva (21,5 por ciento), valvular (15,4 por ciento), isquémica (7,3 por ciento) y alcohol (1,6 por ciento). Todos los enfermos recibían tratamiento diurético, un 25 por ciento con inhibidores de la enzima de conversión de angiotensina (IECA) y un 6 por ciento con anticoagulantes orales. El 51,6 por ciento presentaba fibrilación auricular. Se realizó ecocardiograma al 10 por ciento de los enfermos. La estancia media fue de 6,2ñ3,2 días, significativamente superior cuando se realizó ecocardiograma (5,7ñ0,4 frente a 7,55ñ0,9 días; p<0,001). La incidencia de reingreso y de mortalidad a los 6 meses fue del 26 por ciento y 20 por ciento, respectivamente. Conclusiones. La IC supuso la cuarta parte de los ingresos en una población de elevada edad y pluripatología asociada. La etiología de la IC no estaba establecida en más de la mitad de los pacientes. Se constata una utilización subóptima de los tratamientos disponibles. La IC presenta una elevada incidencia de reingreso y de mortalidad (AU)

[Repercussion of age on management of neoplastic patients in an Internal Medicine Service]. / Relación de la edad con el manejo de los pacientes diagnosticados de neoplasia en un Servicio de Medicina Interna.

AIM: To determine whether age is a factor affecting the management of patients diagnosed with neoplastic disease in an internal medicine service. PATIENTS AND METHODS: Prospective study of 388 patients diagnosed with cancer in the internal medicine service of a large public health teaching hospital. We evaluated clinical characteristics, diagnostic procedures, types and stage of neoplasm, referral after hospital discharge and treatment. A comparative study based on age was performed between patients 65 years older and patients under this age. RESULTS: The 388 cancer patients accounted for 12% of hospital admissions in our service. Among the total, 62% were > or = 65 years old. Constitutional syndrome, the most frequently associated symptom and the main reason for the consultation, was more common in the > or = 65-year-old group. Lung cancer was predominant in men and hematologic neoplasms in women. Patients > or = 65 were referred more frequently to internal medicine physicians, general practitioners and home palliative assistance services (p < 0.05) and they received only palliative treatment in a greater percentage of cases (50% vs. 37%, p = 0.001). CONCLUSIONS: The incidence of neoplasms in our service was high (12%), with a considerable percentage of patients in advanced phases of the disease (83%). Age was not related to diagnostic methods nor was it determinant in the staging, but it did have repercussions on treatment; patients > or = 65 received palliative treatment alone more often than younger patients.

Relación de la edad con el manejo de los pacientes diagnosticados de neoplasia en un Servicio de Medicina Interna / Repercussion of age on management of neoplastic patients in an Internal Medicine Service

Objetivo: Valorar la relación de la edad con el manejo de los pacientes diagnosticados de neoplasia en un servicio de Medicina Interna. Pacientes y métodos: Estudio prospectivo de 388 pacientes diagnosticados de cáncer en un Servicio de Medicina Interna. Se evalúan las características clínicas, procedimientos diagnósticos, tipos de neoplasia y estadiaje, derivación al alta y tratamiento. Se realiza un estudio comparativo basado en la edad, pacientes de 65 años o mayores frente a los más jóvenes. Resultados: Los 388 pacientes diagnosticados de cáncer supusieron un 12% de los ingresos en nuestro servicio. El 62% tenían 65 años. El síndrome constitucional fue la sintomatología más frecuente asociada y el principal motivo de consulta, siendo más relevante en los 65 años. El cáncer de pulmón fue el más frecuente en los hombres y las neoplasias hematológicas en las mujeres. Los enfermos 65 años fueron controlados con más frecuencia por Medicina Interna, médico de cabecera y Servicio de Asistencia Paliativa a Domicilio (P<0,05) y recibieron tratamiento únicamente paliativo en un mayor porcentaje de casos (50% vs 37%, p=0,001). Conclusiones: La incidencia de neoplasias en nuestro servicio fue alta (12%), con un alto porcentaje de pacientes en fases avanzadas de la enfermedad (83%). La edad no se relacionó con el manejo diagnóstico ni demostró ser determinante en el estadiaje, pero sí en el tratamiento, puesto que los pacientes 65 años recibieron con mayor frecuencia tratamiento paliativo (AU)

Aim: To determine whether age is a factor affecting the management of patiens diagnosed with neoplastic disease in an internal medicine service. Patients and methods: Prospective study of 388 patients diagnosed with cancer in the internal medicine service of a large public health teaching hospital. We evaluated clinical characteristics, diagnostic procedures, types and stage of neoplasm, referral after hospital discharge and treatment. A comparative study based on age was performed between patients 65 years older and patients under this age. Results: The 388 cancer patiens accounted for 12% of hospital admissions in our service. Among the total, 62% were >= 65 years old. Constitutional syndrome, the most frequently associated symptom and the main reason for the consultation, was more common in the >= 65-year-old group. Lung cancer was predominant in men and hematologic neoplasms in women. Patients >= 65 were referred more frequently to internal medicine physicians, general practitioners and home palliative assistance services (p<0.05) and they received only palliative treatment in a greater percentage of cases (50% vs. 37%, p=0.001). Conclusions: The incidence of neoplasms in our service was high (12%), with a considerable percentage of patients in advanced phases of the disease (83%). Age was not related to diagnostic methods nor was it determinant in the staging, but it did have repercussions on treatment; patients >=65 received palliative treatment alone more often than younger patients (AU)

[Spontaneous peritonitis induced by Campylobacter spp in patients with liver cirrhosis. Report of 2 cases and review of the literature]. / Peritonitis espontánea por Campylobacter spp en pacientes con cirrosis hepática. Presentación de dos casos y revisión de la literatura.

Campylobacter spp is not usual as the aetiology agent for spontaneous bacterial peritonitis. We report two cases of spontaneous peritonitis due to Campylobacter jejuni diagnosed in our hospital and review the literature trough MEDLINE data base. We found 13 cases of spontaneous peritonitis in which Campylobacter sp was isolated from ascitic fluid. The main characteristics of these cases were: the existence of an evolved alcoholic cirrhosis, a high positivity of blood cultures as well as a high relapse index and letality.

[Bronchiolitis obliterans organizing pneumonia associated with Legionella pneumophila]. / Bronquiolitis obliterante con neumonía organizativa asociada a Legionella pneumophila.

Bronchitis obliterans organizing pneumonia (BOOP) is an unusual pulmonary condition. The clinical features and the radiologic findings are useful for the diagnosis of BOOP. However it is necessary to confirm its presence by an open or transbronchial pulmonary biopsy specimen. BOOP is usually idiopathic, although it may also occur in association with connective tissue disease, some haematologic disorders and in response to viral infections. The association of Legionella pneumophila infection with BOOP is very rare.

Bronquiolitis obliterante con neumonía organizativa asociada a Legionella pneumophila / Bronchiolitis obliterans organizing pneumonia associated to Legionella pneumophila

La bronquiolitis obliterante con neumonía organizativa (BONO) es una entidad infrecuente. La sintomatología clínica y las exploraciones de imagen sugieren el diagnóstico, pero es necesaria la confirmación anatomopatológica. Aunque la mayoría de los casos son idiopáticos se ha asociado a diversos procesos, fundamentalmente enfermedades del colágeno, hematológicas e infecciosas. La BONO secundaria a una infección por Legionella pneumophila es excepcional (AU)

Bronchilitis obliterans organizing pneumonia (BOOP) is an unusual pulmonary condition. The clinical features and the radiologic findings are useful for the diagnosis of BOOP. However it is necessary to confirm its presence by an open or transbronchial pulmonary biopsy specimen. BOOP is usually idiopathic, although it may also occur in association with connective tissue disease, some haemathologic disorders and in response to viral infections. The association of Legionella pneumophila infection with BOOP is very rare (AU)

Pleural-fluid myeloperoxidase in complicated and noncomplicated parapneumonic pleural effusions.

The diagnostic accuracy of myeloperoxidase (MPO) in pleural fluid, for differentiating between complicated and noncomplicated parapneumonic pleural effusions (PPE) evaluated prospectively. Seventy patients aged >18 yrs with PPE (36 complicated and 34 noncomplicated) were studied after admission to a tertiary referral teaching hospital. MPO concentration was measured in plasma and pleural fluid using a double-antibody competitive radioimmunoassay. The concentrations of MPO in complicated and noncomplicated PPE were compared using a Mann-Whitney U-test and multiple logistic regression models were used to predict the odds that an effusion was complicated. MPO pleural-fluid concentrations were significantly higher in complicated than in noncomplicated PPE. After excluding purulent effusions, pleural-fluid MPO was the marker that best differentiated between the two types of PPE: the area under the receiver operating characteristic curve was 0.912, the sensitivity was 87.5% and the specificity was 85.1% at a cut-point limit of 3.000 microg x L(-1). The authors concluded that the concentration of pleural-fluid myeloperoxidase helps to differentiate between nonpurulent complicated and noncomplicated parapneumonic pleural effusions.

Peritonitis espontánea por Campylobacter spp en pacientes con cirrosis hepática. Presentación de dos casos y revisión de la literatura / Peritonitis due to campylobacter spp in patients with hepatic cirrhosis. Presentation of two cases and review of the literature

Los microorganismos del género Campylobacter son infrecuentes como agente etiológico de la peritonitis bacteriana espontánea (PBE).Presentamos 2 casos de PBE por Campylobacter jejuni diagnosticados en nuestro hospital junto a una revisión de la literatura mediante el sistema MEDLINE. En total encontramos 13 casos de PBE en los que se aisló Campylobacter sp en el líquido ascítico. Las principales características de estos casos fueron: la existencia de una cirrosis hepática evolucionada de etiología enólica, una alta positividad de los hemocultivos así como un índice de recidiva y una letalidad elevada. (AU)

[Tumors diagnosed in 65 patients with type I neurofibromatosis]. / Tumoraciones diagnosticadas en 65 pacientes afectados de neurofibromatosis tipo I.

BACKGROUND: Type 1 neurofibromatosis patients develop malignant neoplasm more frequently than general population. PATIENTS AND METHOD: We have studied 65 patients with neurofibromatosis type 1 because we intend to know the kind of neoplasms that they have presented. RESULTS: 65 patients (48 men and 17 women) fulfilling type 1 neurofibromatosis criteria have been studied. Globally 67 tumors appeared, from which 47 (70%) were benign and 20 (30%) were malignant. Benign tumors included 25 neurofibromas, 11 central nervous system tumors and 11 extraneurological tumors. Malignant tumors accounted for 6 soft tissue sarcomas, 6 carcinomas, 3 malignant CNS tumors and 2 acute lymphoblastic leukemias. CONCLUSION: Presentation of neoplasms is frequent in type 1 neurofibromatosis and constitutes main death and morbility cause.

Sepsis por Streptococcus pyogenes en un paciente con linfoma anaplásico Ki-1 / Sepsis by Streptococcus pyogenes in a patient with anaplastic Ki-1 lymphoma

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Pleural fluid myeloperoxidase as a marker of infectious pleural effusions.

Background: The aim of this study was to establish the diagnostic accuracy of neutrophil markers (elastase, lysozyme, myeloperoxidase) found in pleural fluid in differentiating between infectious and non-infectious pleural effusions (PE). Methods: We studied 184 patients over 18 years of age with PE, classified as either infectious (34 complicated parapneumonic, 32 non-complicated parapneumonic, 45 tuberculous) or non-infectious (31 neoplasms and 42 undiagnosed exudates). Polymorphonuclear elastase (PMN-E) was determined using an immunoactivation method and lysozyme using a turbidimetric method. Myeloperoxidase (MPO) was measured by double antibody competitive radioimmunoassay. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy. Results: Pleural fluid MPO was the biochemical marker that best differentiated between infectious and non-infectious PE. The ROC area under the curve (AUC) for myeloperoxidase was 0.86. MPO values over 550 &mgr;g/l diagnosed infectious PE with a specificity of 90.4% and a sensitivity of 77.4%. After excluding purulent parapneumonic PE, the sensitivity of a pleural MPO value >/=550 &mgr;g/l was 72.6%. Conclusions: Pleural fluid MPO was the marker that best differentiated between infectious and non-infectious PE.