Yeasts from sub-Antarctic region: biodiversity, enzymatic activities and their potential as oleaginous microorganisms.

Various microbial groups are well known to produce a range of extracellular enzymes and other secondary metabolites. However, the occurrence and importance of investment in such activities have received relatively limited attention in studies of Antarctic soil microbiota. Sixty-one yeasts strains were isolated from King George Island, Antarctica which were characterized physiologically and identified at the molecular level using the D1/D2 region of rDNA. Fifty-eight yeasts (belonging to the genera Cryptococcus, Leucosporidiella, Rhodotorula, Guehomyces, Candida, Metschnikowia and Debaryomyces) were screened for extracellular amylolytic, proteolytic, esterasic, pectinolytic, inulolytic xylanolytic and cellulolytic activities at low and moderate temperatures. Esterase activity was the most common enzymatic activity expressed by the yeast isolates regardless the assay temperature and inulinase was the second most common enzymatic activity. No cellulolytic activity was detected. One yeast identified as Guehomyces pullulans (8E) showed significant activity across six of seven enzymes types tested. Twenty-eight yeast isolates were classified as oleaginous, being the isolate 8E the strain that accumulated the highest levels of saponifiable lipids (42 %).

Determinación de humedad en harina precocida de maíz blanco utilizando un horno de microondas doméstico / Determination of moisture in flour precooked white corn using a domestic microwave oven

El contenido de humedad es un parámetro de principal interés entre los índices que regulan la calidad de granos, cereales y sus derivados. Los métodos oficiales para determinar la humedad (AOAC 32.1.03, ISO 6540:1980, NTC 2227:86 y COVENIN 2135:96) tienen la desventaja de consumir mucho tiempo en la determinación porque  requieren la desecación de la muestra en estufa. En este trabajo se compara el método propuesto de secado de la muestra de maíz blanco en un horno doméstico de microondas contra el método rápido convencional de termobalanza infrarrojo y los métodos de referencia oficiales AOAC (32.1.03) y COVENIN (2135:96). Se determinaron las condiciones de análisis: tamaño de muestra, tipo de recipiente, distribución de la muestra, condiciones de operación usando un microondas doméstico de 700 W de potencia, así como el secado en uno o varios pasos. Entre el método propuesto y el método de referencia no se encontraron diferencias estadísticamente significativas a p<0,05; el tiempo de secado se redujo de varias horas a pocos minutos: 4 min con 90% de potencia. Como se puede  concluir que es factible la determinación de humedad por volatilización en una matriz de harina precocida de maíz blanco usando un horno de microondas doméstico.

The moisture content is a primary parameter between indices governing the quality of grains, cereals and cereal products. The official methods for determining moisture (AOAC 32.1.03, ISO 6540: 1980, NTC 2227: 86 COVENIN 2135: 96) have the disadvantage of to be time consuming that require drying oven method. The aim in this paper was compare the proposed method of drying sample of white corn with domestic microwave oven against conventional rapid method of infrared thermobalance and official reference methods AOAC 32.1.03 method and COVENIN 2135:96. Sample size, vessel kind, sample container distribution,   operations conditions using domestic 700 W microwave and also analysis employed to one or more drying steps were determined. Between the proposed and the reference method not statistically significant differences were found at P <0.05; drying time was reduced from several hours to a few minutes: 4 min at 90% power. It can be concluded that the determination of moisture by volatilization in a matrix of precooked white corn flour using a domestic microwave oven is feasible.

Regional differences in species composition and toxigenic potential among Fusarium head blight isolates from Uruguay indicate a risk of nivalenol contamination in new wheat production areas.

Members of the Fusarium graminearum species complex (FGSC) are the primary cause of Fusarium head blight (FHB) of wheat, and frequently contaminate grain with trichothecene mycotoxins that pose a serious threat to food safety and animal health. The species identity and trichothecene toxin potential of 151 FGSC isolates collected from wheat in Uruguay were determined via multilocus genotyping. Although F. graminearum with the 15ADON trichothecene type accounted for 86% of the isolates examined, five different FGSC species and all three trichothecene types were identified in this collection. This is the first report of Fusarium asiaticum, Fusarium brasilicum, Fusarium cortaderiae, and Fusarium austroamericanum from Uruguay. In addition, we observed significant (P<0.001) regional differences in the composition of FGSC species and trichothecene types within Uruguay. Isolates of F. graminearum with the 15ADON type were the most prevalent in western provinces (95%), while F. asiaticum (43%) and the NIV type (61%) predominated in the new wheat production zone in Cerro Largo along Uruguay's eastern border with Brazil. F. graminearum isolates (15ADON type) were significantly (P<0.005) more aggressive on wheat than were isolates from the other species examined (NIV or 3ADON types). However, F. graminearum isolates (15ADON type) were significantly (P<0.05) more sensitive to tebuconazole than isolates from other species (NIV type). These results document substantial heterogeneity among the pathogens responsible for FHB in Uruguay. In addition, the regional predominance of the NIV trichothecene type is of significant concern to food safety and indicates that additional monitoring of nivalenol levels in grain may be required.

Eficacia de los programas de cribado de hepatocarcinoma: ¿mejoran las opciones terapéuticas de estos pacientes? / Are hepatocellular carcinoma surveillance programs effective at improving the therapeutic options?

Objetivo: determinar si la utilización en nuestro medio delprograma de cribado de HCC establecido –alfa-fetoproteína (AFP)y ecografia semestral– en pacientes con hepatopatía crónica permitedetectar pacientes en estadios precoces de la enfermedad.Material y métodos: Diseño experimental: estudio retrospectivo.Criterios diagnósticos de HCC: 2 o más técnicas de imagencon lesión hipervascular mayor de 2 cm o 1 técnica de imagencon lesión hipervascular mayor de 2 cm asociado a AFPmayor de 400 ng/ml. Pacientes: 85 pacientes diagnosticados deHCC en el Hospital Donostia entre los años 2003 y 2005. Datosanalizados: información demográfica (sexo, edad), factores deriesgo (alcohol, virus de hepatitis, hemocromatosis, otras enfermedadesasociadas), e información clínica (etiología de la hepatopatía,estadio de Child-Pugh, determinación de AFP, hallazgos radiológicos,criterios de resecabilidad, tratamiento recibido,evolución). Se divide la muestra en dos grupos según hubieran seguidoo no un programa de cribado.Resultados: el 70% de los pacientes del grupo de cribado sediagnostican en estadio precoz frente al 26,7% del grupo de nocribado (p < 0,05). Trece pacientes no pueden recibir tratamientocurativo a pesar del diagnóstico en fase precoz (9 en el grupo decribado y 4 en el de no cribado). La sensibilidad global del cribadoen nuestra serie es del 95%.Conclusiones: en nuestro medio, el programa de cribado dehepatocarcinoma es eficaz en términos de aplicación de tratamientoscurativos(AU9

Aim: to evaluate whether the current surveillance programs(ultrasonography and alpha-fetoprotein testing every six months)are successful in detecting patients in the early stages.Material and methods: the health records of all patientsdiagnosed with hepatocellular carcinoma in Donostia Hospitalbetween 2003 and 2005 were reviewed retrospectively. Eightyfivepatients (11 women and 74 men) were included in the studyand demographic data, risk factors and clinical data were obtained.Patients were split into two groups according to whether ornot they had been included in a surveillance program.Results: seventy per cent of patients of the surveillance groupis diagnosed in early stage opposite to 26.7% of patients in nosurveillance group (p < 0.05). Thirteen patients cannot receivecurative treatment in spite of the diagnosis in early stage (9 in thesurveillance group and 4 in the no surveillance group. The globalsensibility of the surveillance program in our series is 95%.Conclusions: current hepatocellular carcinoma surveillanceprograms, which comprise six-monthly ultrasonography and alpha-fetoprotein tests, are highly sensitive and effective. These programsresult in the detection of hepatocellular carcinoma in itsearly-stages, when potentially curative treatment may be offered(AU)

Are hepatocellular carcinoma surveillance programs effective at improving the therapeutic options.

AIM: to evaluate whether the current surveillance programs (ultrasonography and alpha-fetoprotein testing every six months) are successful in detecting patients in the early stages. MATERIAL AND METHODS: the health records of all patients diagnosed with hepatocellular carcinoma in Donostia Hospital between 2003 and 2005 were reviewed retrospectively. Eighty-five patients (11 women and 74 men) were included in the study and demographic data, risk factors and clinical data were obtained. Patients were split into two groups according to whether or not they had been included in a surveillance program. RESULTS: seventy per cent of patients of the surveillance group is diagnosed in early stage opposite to 26.7% of patients in no surveillance group (p < 0.05). Thirteen patients cannot receive curative treatment in spite of the diagnosis in early stage (9 in the surveillance group and 4 in the no surveillance group. The global sensibility of the surveillance program in our series is 95%. CONCLUSIONS: current hepatocellular carcinoma surveillance programs, which comprise six-monthly ultrasonography and alpha-fetoprotein tests, are highly sensitive and effective. These programs result in the detection of hepatocellular carcinoma in its early-stages, when potentially curative treatment may be offered.

Pyogenic versus amoebic liver abscesses. A comparative clinical study in a series of 58 patients.

OBJECTIVE: To compare the clinical and epidemiological characteristics of patients with pyogenic liver abscess (PLA) and with amebic liver abscess (AHA) in order to determine the potential factors that may help improve diagnosis and treatment for this disease. MATERIAL AND METHOD: A retrospective study of clinical histories of 45 patients with PLA and 13 with ALA, diagnosed between 1985 and 2005 in Donostia Hospital in San Sebastián. RESULTS: Among the 45 patients with PLA (30 men and 15 women, with a mean age of 61 years and 11 months), more than a half were cholangitic (13 cases) or were of unknown origin (15 cases). In 10 patients, diabetes was considered to be a predisposing condition. Increased ESR (> 30), leukocytosis (> 12,000), fever and abdominal pain were observed in 95.5%, 86.7%, 82.8% and 68.9%, respectively. Twenty-five patients had single abscesses. Abscess and blood cultures were positive in 77.1% and 50% of cases, respectively (44.4% with polymicrobial infection). E. coli and S. milleri were the most commonly found germs. A percutaneous drainage was performed on 22 patients. Mean hospital stay was 27 days, and overall mortality, including that related to concomitant conditions, was 7 of 45 cases.Of the 13 cases of ALA (7 men and 6 women, with mean age of 42,9 years), 2 were locally acquired. Increased AF and GGTP (> 2N), fever, leukocytosis and ESR (> 30) were observed in 92.3, 77, 70 and 61.5% of cases, respectively. There were single abscesses in 10 patients and all except one were located in the right lobe. The serological test for E. histolytica (IFF > or = 1/256) was positive in 100% of cases. A percutaneous drainage was carried out on 6 patients. Mean hospital stay was 18 days and two patients died. CONCLUSIONS: In our series, the clinical parameters suggesting pyogenic origin were: age 50 or older, male gender, diabetes, moderately elevated bilirubin and transaminases. In amoebic cases the associated features were being aged 45 or younger, diarrhoea, and presence of a single abscess in the right lobe. Parasitism by E. histolytica must be considered in the differential diagnosis of liver abscesses, even with no epidemiological clinical history of travel and/or immigration.

Absceso hepático piógeno versus amebiano. Estudio clínico comparativo de una serie de 58 casos / Pyogenic versus amoebic liver abscesses. A comparative clinical study in a series of 58 patients

Objetivo: comparar las características clínicas y epidemiológicasde los pacientes con absceso hepático piógeno (AHP) y conabsceso hepático amebiano (AHA) para establecer posibles factoresque ayuden a mejorar el diagnóstico y tratamiento de la enfermedad.Material y método: se realiza un estudio retrospectivo de lashistorias clínicas de 45 pacientes con AHP y de 13 con AHA,diagnosticados entre 1985 y 2005 en el Hospital Donostia deSan Sebastián.Resultados: de los 45 casos de AHP (30 hombres y 15 mujerescon una edad media de 61 años y 11 meses), más de la mitadfueron de origen colangítico (13 casos) o criptogenético (15 casos).La diabetes como enfermedad predisponente se objetivó en10. La elevación de la VSG (> 30), leucocitosis (> 12.000), fiebrey dolor abdominal se observaron en el 95,5, 86,7, 82,8 y 68,9%de los casos respectivamente. Los abscesos fueron solitarios en25 casos. Los cultivos del absceso y los hemocultivos fueron positivosen el 77,1 y 50%, respectivamente (44,4% de los casos eranpolimicrobianos). E. coli y S. milleri fueron los gérmenes más habituales.Se hizo drenaje percutáneo en 22 pacientes. La mortalidadglobal, incluida la relacionada con la patología subyacente, fuede 7 casos y la estancia media hospitalaria de 27 días.De los 13 casos de AHA (7 hombres y 6 mujeres con una edadmedia de 42 años y 9 meses), 2 fueron autóctonos. La elevaciónde la FA y GGTP (> 2N), fiebre, leucocitosis y VSG (> 30) se observaronen el 92,3, 77, 70 y 61,5% de los casos respectivamente.Los abscesos fueron únicos en 10 casos y excepto uno, 12 selocalizaron en el lóbulo derecho. La serología a E. histolytica (IFI>= 1/256) fue positiva en el 100% de los casos. Se hizo drenajepercutáneo en 6 pacientes. La mortalidad fue de 2 casos y la estanciamedia hospitalaria de 18 días...(AU)

Objective: to compare the clinical and epidemiological characteristicsof patients with pyogenic liver abscess (PLA) and withamebic liver abscess (AHA) in order to determine the potentialfactors that may help improve diagnosis and treatment for this disease.Material and method: a retrospective study of clinical historiesof 45 patients with PLA and 13 with ALA, diagnosed between1985 and 2005 in Donostia Hospital in San Sebastián.Results: among the 45 patients with PLA (30 men and 15women, with a mean age of 61 years and 11 months), more thana half were cholangitic (13 cases) or were of unknown origin (15cases). In 10 patients, diabetes was considered to be a predisposingcondition. Increased ESR (> 30), leukocytosis (> 12,000),fever and abdominal pain were observed in 95.5%, 86.7%,82.8% and 68.9%, respectively. Twenty-five patients had singleabscesses. Abscess and blood cultures were positive in 77.1% and50% of cases, respectively (44.4% with polymicrobial infection).E. coli and S. milleri were the most commonly found germs. Apercutaneous drainage was performed on 22 patients. Mean hospitalstay was 27 days, and overall mortality, including that relatedto concomitant conditions, was 7 of 45 cases.Of the 13 cases of ALA (7 men and 6 women, with mean ageof 42,9 years), 2 were locally acquired. Increased AF and GGTP(> 2N), fever, leukocytosis and ESR (> 30) were observed in 92.3,77, 70 and 61.5% of cases, respectively. There were single abscessesin 10 patients and all except one were located in the rightlobe. The serological test for E. histolytica (IFF >= 1/256) waspositive in 100% of cases. A percutaneous drainage was carriedout on 6 patients. Mean hospital stay was 18 days and two patientsdied.Conclusions: In our series, the clinical parameters suggestingpyogenic origin were: age 50 or older, male gender, diabetes,moderately elevated bilirubin and transaminases...(AU)

[Pneumonia above 80 years, admitted to the hospital]. / Neumonía en el anciano mayor de 80 años con ingreso hospitalario.

OBJECTIVE: To analyze and compare differences in patients older than 80 years with Community acquired Pneumonia admitted in Internal Medicine or Pneumology of a General Hospital from the Emergency Room. MATERIAL AND METHODS: Retrospective study of all the 277 patients above 80 years admitted into the Hospital in 2005 with the main diagnosis of Pneumonia. RESULTS: 84% community-acquired, 16% from Institutions. Mean age: 85.8 y (48% men, 52% women). 19% FINE-3, 49% FINE-4, 32% FINE-5. Known etiology: 25% (Pneumococcal 19%, H. Influenzae and other Gram (-) 6%. 75% treated by Internists, 22% treated by Pneumologists. Standard Guidelines followed up by 30,5% a variant 60% (Equal by Internists or Pneumologists). Time door-1st antibiotic dose 6.6 hours. Global Mortality 16.7%. Women died at 87.4 y, men at 84.5 y (p = 0.035). Mortality FINE 3-4-5: 4.5, 12.4, 30% respectively. Mortality treated before 4 hours: 34.6%, after 4 hours: 11.5% (p = 0.01). Many more FINE 5 cases in Int. Medicine than Pneumology. Mortality by Internists 22%. Mortality by Pneumologists 3% (p = 0.001). Mortality similar following strict guidelines or variant. CONCLUSIONS: a) Internist receive patients sicker than Pneumologists; b) Important mortality in these very old patients of 16.7%, and progressive according the FINE severity index, in spite of correct therapy; c) Rapid initiation of Antibiotics did not decreased mortality; d) Mortality did not change following strict or variant Guidelines; and e) There are areas of quality improvement in our Hospitals.

Neumonía en el anciano mayor de 80 años con ingreso hospitalario / Pneumonia above 80 years, admitted to the hospital

Objetivo: analizar y comparar diferencias en pacientes mayores de 80 años con Neumonía Adquirida en la Comunidad (NAC) como diagnóstico de alta en pacientes ingresados desde Urgencias a servicios de Medicina Interna (MEDIN) y Neumología (NEUMO) de un Hospital General. Material y métodos: análisis retrospectivo de todos los 277 pacientes mayores de 80 años con ingreso hospitalario por NAC en el 2005. Resultados: 84% Comunitarios. 16% de Instituciones. Edad media: 85,8 años (52% mujeres). Severidad: 19% FINE-3. 49% FINE-4. 32%FINE-5. Etiología conocida 25% (Neumocócica 19%, H. Influenzae y otros Gram (-) 6%). 75% trata MEDIN, 22% NEUMO. Guías Clínicas de tratamiento estrictas 30’5%, una variante 60% (Igual en MEDIN que en NEUMO). Tiempo puerta-1ª dosis antibiótico fue de 6,6 horas. Mortalidad:16,7%. Edad fallecidos mujeres: 87,4 a. mayor que hombres: 84,5a. (p = 0,035). Mortalidad FINE-3-4-5: 4,5, 12,4, 30% respectivamente. Mortalidad tratados antes de 4 horas: 34,6%, después de 4 horas: 11,5% (p = 0,01). Mucho más FINE-5 en MEDIN que en NEUMO. Mortalidad MEDIN: 22%, Mortalidad NEUMO: 3% (p = 0,001). Mortalidad igual siguiendo la Guía Clínica o variante. Conclusiones: a) MEDIN recibe pacientes más graves que NEUMO; b) mortalidad importante (16,7%) y progresiva en la escala FINE, a pesar de tratamiento correcto; c) la rápida administración de antibióticos no redujo la mortalidad; d) la mortalidad no varía aún con variantes de las Guías Clínicas; y c) hay areas de mejora en nuestros Servicios

Objetive: To analize and compare differences in patients older than 80 years with Community acquired Pneumonia admitted in Internal Medicine or Pneumology of a General Hospital from the Emergency Room. Material and methods: Retrospective study of all the 277 patients above 80 years admitted into the Hospital in 2005 with the main diagnosis of Pneumonia. Results: 84% community-acquired, 16% from Institutions. Mean age: 85.8 y (48% men, 52% women). 19% FINE-3, 49% FINE-4, 32% FINE-5. Known etiology: 25% (Pneumococcal 19%, H. Influenzae and other Gram (-) 6%. 75% treated by Internists, 22% treated by Pneumologists. Standard Guidelines followed up by 30,5% a variant 60% (Equal by Internists or Pneumologists). Time door-1st antibiotic dose 6.6 hours. Global Mortality 16.7%. Women died at 87.4 y, men at 84.5 y (p = 0.035). Mortality FINE 3-4-5: 4.5, 12.4, 30% respectively. Mortality treated before 4 hours: 34.6%, after 4 hours: 11.5% (p = 0.01). Many more FINE 5 cases in Int. Medicine than Pneumology. Mortality by Internists 22%. Mortality by Pneumologists 3% (p = 0.001). Mortality similar following strict guidelines or variant. Conclusions: a) Internist receive patients sicker than Pneumologists ; b) Important mortality in these very old patients of 16.7%, and progressive according the FINE severiy index, in spite of correct therapy; c) Rapid initiation of Antibiotics did not decreased mortality; d) Mortality did not change following strict or variant Guidelines; and e) There are areas of quality improvement in our Hospitals

[Comparison of the results obtained through manual and automatic phonetogram]. / Comparación entre los resultados del fonetograma manual y el fonetograma automático.

INTRODUCTION: The phonetogram (F) is the graphic representation of a person phonatory potential. The F carried out with a sonometer and a frequency analyser is what is called "manual phonetogram" (MPh), and the one obtained by means of a computer is called the "automatic phonetogram" (APh). MATERIAL AND METHODS: We have carried out in 12 lyrical singers a standard MPh and an APh with the program Dr. Speech Science 3.0. RESULTS: It was showed a significant difference with a p < 0.0005 in 14 of the 15 measures compared, and a p < 0.05 for the other one, being in general the results of the automatic test different from those of the manual in excess, with a correlation between the results obtained through both methods. CONCLUSIONS: The APh obtained with the program Dr. Speech Science 3.0 is a faster and easier way to obtain the phonetogram than the one used to obtain the MPh, showing however big differences in excess compared with the ones of the MPh in all the usual phonetometric parameters.

Comparación entre los resultados del fonetograma manual y el fonetograma automático / Comparison of the results obtained through manual and automatic phonetogram

Introducción: El fonetograma (F) es la representación gráfica del potencial fonatorio de un individuo. El F obtenido empleando un sonómetro y un analizador de frecuencias se denomina “fonetograma manual” (FM), y el obtenido mediante programas informáticos se denomina “fonetograma automático” (FA). Material y métodos: Se ha realizado en 12 cantantes líricos un FM standard y un FA con el programa Dr. Speech Science 3.0, midiendo la correlación entre ambos sistemas. Resultados: Se objetivó una diferencia entre los dos sistemas para 14 de las 15 medidas fonetométricas con una p<0,0005, y con una p<0,05 para la restante, siendo los resultados numéricos del FA habitualmente mayores que los del FM, mostrando una correlación entre los resultados de ambos métodos. Conclusiones: El FA obtenido con el programa Dr. Speech Science 3.0 es un sistema más rápido y sencillo que el empleado para el FM, mostrando sin embargo diferencias por exceso respecto al FM en todos los parámetros fonetométricos habituales

INTRODUCTION: The phonetogram (F) is the graphic representation of a person phonatory potential. The F carried out with a sonometer and a frequency analyser is what is called "manual phonetogram" (MPh), and the one obtained by means of a computer is called the "automatic phonetogram" (APh). MATERIAL AND METHODS: We have carried out in 12 lyrical singers a standard MPh and an APh with the program Dr. Speech Science 3.0. RESULTS: It was showed a significant difference with a p < 0.0005 in 14 of the 15 measures compared, and a p < 0.05 for the other one, being in general the results of the automatic test different from those of the manual in excess, with a correlation between the results obtained through both methods. CONCLUSIONS: The APh obtained with the program Dr. Speech Science 3.0 is a faster and easier way to obtain the phonetogram than the one used to obtain the MPh, showing however big differences in excess compared with the ones of the MPh in all the usual phonetometric parameters

Histiocitosis de células de Langerhans en vulva y hueso / Langerhans cell histiocytosis of the vulva and bone

No disponible

Regression of infancy hemangiomas with recombinant IFN-alpha 2b.

Interferon-alpha (IFN-alpha) has antitumor and antiangiogenic effects. The purpose of this work was to evaluate its efficacy and safety in the treatment of infancy hemangioma and to monitor the appearance of anti-IFN antibodies in these patients. Thirty-nine children (29 girls) aged 1.5-158 months, with 19 younger than 1 year and 9 older than 5, were treated with 3 x 10(6) IU/m(2) IFN-alpha 2b, subcutaneously (s.c.) daily. Inclusion criteria were life-threatening or life-limiting hemangioma and parents' informed consent. Regression was considered if tumor size diminished by 50% or more. Of the 38 patients who completed 6 months of treatment, 27 (71.1%) had regression and 11 (28.9%) had stable disease. No patient experienced progression. Regression was more frequent (100%) among patients between 1 and 5 years old, but it was particularly important (68%) among those under 1 year old, when spontaneous regression is rare. The main side effects were the IFN-related flulike syndrome (79%), increase in serum alanine aminotransferase (ALT) (28%), anorexia (19%), and mild inflammation at the injection site (19%). There was no effect on psychomotor or physical development. On the contrary, 1 patient with neurologic symptoms improved remarkably, including seizure disappearance. Eight patients developed anti-IFN-alpha 2 neutralizing antibodies, and 7 of them responded to IFN treatment. IFN-alpha 2b is a safe and efficacious treatment of infancy hemangioma. Further work should look for other treatment schedules and ways of administration and carefully monitor anti-IFN neutralizing antibodies, which does not seem to interfere with response.

Pyogenic liver abscesses of bacterial origin. A study of 45 cases.

OBJECTIVE: to determine the clinical, microbiological, diagnostic and therapeutic characteristics of pyogenic liver abscesses of bacterial origin. METHODS: retrospective analysis of pyogenic liver abscesses diagnosed at the Aránzazu Hospital in San Sebastián (northern Spain) between 1989 and 1998. RESULTS: we studied 45 patients with pyogenic liver abscesses of bacterial origin (30 men, 15 women, mean age 61 years 11 months). The site of the liver abscess was biliary in 28.9% of the patients, portal in 11.1%, and unknown in 33.3%. Elevated erythrocyte sedimentation rate (95.5%), leukocytosis (86.7%) and fever (82.2%) were the most frequent clinical and laboratory findings. The abscesses were solitary in 55. 5% of the patients. Echography was diagnostic in 68.4% of patients, and computed tomography was diagnostic in 100%. Cultures of pus from the abscess and blood were positive in 77.1% and 50% respectively. Of the abscesses diagnosed as being of bacterial origin, 44.4% involved multiple organisms. Escherichia coli and Streptococcus milleri were the germs isolated most frequently. Percutaneous drainage was done in 22 patients (48.9%), with satisfactory results in 18. Overall mortality related with abscesses was 15.5%. CONCLUSIONS: the clinical presentation of pyogenic liver abscess did not vary during the study period. Computed tomography is fundamental for diagnosis and treatment. Percutaneous drainage associated with early antibiotic therapy is the treatment of choice.

Abcesos hepáticos piógenos de origen bacteriano. Estudio de una serie de 45 casos / Pyogenic liver abscesses of bacterial origin. A study of 45 cases

OBJETIVOS: conocer las características clínicas, microbiológicas, diagnósticas y terapéuticas de los abscesos hepáticos piógenos de origen bacteriano. PACIENTES Y MÉTODOS: análisis retrospectivo de los abscesos hepáticos piógenos diagnosticados entre 1989 y 1998 en el Hospital Aránzazu de San Sebastián. RESULTADOS: se estudiaron 45 casos de abscesos hepáticos piógenos de origen bacteriano (30 varones y 15 mujeres; edad media: 61 años y 11 meses). El absceso hepático fue de origen biliar en el 28,9 por ciento, portal en el 11,1 por ciento y desconocido en el 33,3 por ciento. La elevación de la VSG (95,5 por ciento), la leucocitosis (86,7 por ciento) y la fiebre (82,2 por ciento) fueron los datos clínicos y analíticos más frecuentes. Los abscesos fueron solitarios en el 55,5 por ciento. La ecografía fue diagnóstica en el 68,4 por ciento de los casos la TAC en el 100 por ciento. Los cultivos de pus del absceso y los hemocultivos fueron positivos en el 77,1 por ciento y 50 por ciento respectivamente. El 44,4 por ciento de los abscesos con diagnóstico bacteriológico fueron polimicrobianos. E coli y S milleri fueron los gérmenes más habitualmente aislados. Se hizo drenaje percutáneo en 22 pacientes (48,9 por ciento), 18 con resultado satisfactorio. La mortalidad global, relacionada con la patología asociada del enfermo fue del 15,5 por ciento. CONCLUSIONES: el absceso hepático piógeno no ha variado en su presentación clínica. La TAC es fundamental tanto para el diagnóstico como para el tratamiento. El drenaje percutáneo asociado a la antibioterapia temprana es el tratamiento de elección (AU)

[Nocardiosis in 2 immunocompetent patients]. / Nocardiosis en dos pacientes inmunocompetentes.

Two diagnosed clinical cases of nocardiosis in immunocompetent patients are presented, different in their clinical aspects, evolution and treatment. We report a 55 years-old man with disseminated nocardiosis and a 32 years-old man with splenectomy diagnosed of pulmonary nocardiosis. The medical literature is reviewed and emphasis is placed on the different illness and treatment of the nocardiosis.