Subject(s)
Aneurysm, False/complications , Gastrointestinal Hemorrhage/etiology , Aneurysm, False/diagnostic imaging , Aneurysm, False/drug therapy , Angiography , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/diagnostic imaging , Hemostatics/therapeutic use , Humans , Male , Melena/diagnosis , Melena/diagnostic imaging , Melena/etiology , Middle Aged , Thrombin/therapeutic use , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Con el objetivo de identificar a los pacientes diagnosticados en nuestro hospital de endocarditis infecciosa por enterococo se ha realizado un estudio retrospectivo durante un período de 12 años (1994-2005), analizando sus características clínicas y microbiológicas, así como el tratamiento y la evolución de la enfermedad. Se encontraron 12 casos de endocarditis por enterococo, lo que representó el 6% del total de endocarditis y el 7% de las bacteriemias por enterococo. Se trataba de 8 hombres y 4 mujeres, con edades comprendidas entre los 37 y los 94 años. El microorganismo causante fue E. faecalis en 10 casos y E. faecium en 2 casos. Dos de los E. faecalis eran resistentes a aminoglucósidos. La válvula afectada con mayor frecuencia fue la aórtica, con 9 casos, seguida de la mitral, con 2 y de la tricúspide, 1 caso. En 10 pacientes la endocarditis se instaló sobre una válvula nativa y sólo en 2 casos sobre válvula protésica. Únicamente 5 pacientes tenían antecedentes de enfermedad valvular cardiaca. El tratamiento antimicrobiano más utilizado fue la combinación de ampicilina y gentamicina, que se empleó en 8 pacientes. Cuatro casos fueron tratados con monoterapia; 2 de ellos con ampicilina y 2 con vancomicina. Siete pacientes se complicaron con insuficiencia cardíaca, cinco de los cuales precisaron tratamiento quirúrgico de sustitución valvular aórtica. Los 4 enfermos tratados con monoterapia presentaron complicaciones graves, que provocaron la muerte de 2 pacientes
We have performed a retrospective study of patients diagnosed with infective endocarditis due to Enterococcus in our hospital for a period of 12 years (1994-2005). We review clinical and microbiological aspects, therapy, and outcome. We found 12 cases that were 6 % of total endocarditis, and 7% of enterococcal bacteremia. Eight cases were male, and 4 were female, aged between 37 and 94 years. The causative organism of endocarditis was E. faecalis in 10 patients and E. faecium in 2. Two E. faecalis were resistant to aminoglycosides. Aortic valve was the most frequently affected with 9 cases, followed by mitral valve (2 cases), and tricuspid valve (1 case). In 10 cases endocarditis affected a native valve,and only in 2 cases a prosthetic valve. Only 5 patients had underlying valve disease. The most frequently used antimicrobial therapy was the combination of ampicillin plus gentamicin (8 patients). Four cases were treated with monotherapy, 2 with ampicillin, and 2 with vancomycin. Seven patients suffered heart failure, and five of them required surgical therapy with aortic valve replacement. All the patients treated with monotherapy had severe complications, that led to death in 2 of them
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Endocarditis, Bacterial/etiology , Enterococcus/pathogenicity , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Enterococcus , Retrospective Studies , Drug Resistance, Microbial , Combined Modality Therapy , Ampicillin/therapeutic use , Gentamicins/therapeutic useABSTRACT
We have performed a retrospective study of patients diagnosed with infective endocarditis due to Enterococcus in our hospital for a period of 12 years (1994-2005). We review clinical and microbiological aspects, therapy, and outcome. We found 12 cases that were 6 % of total endocarditis, and 7% of enterococcal bacteremia. Eight cases were male, and 4 were female, aged between 37 and 94 years. The causative organism of endocarditis was E. faecalis in 10 patients and E. faecium in 2. Two E. faecalis were resistant to aminoglycosides. Aortic valve was the most frequently affected with 9 cases, followed by mitral valve (2 cases), and tricuspid valve (1 case). In 10 cases endocarditis affected a native valve, and only in 2 cases a prosthetic valve. Only 5 patients had underlying valve disease. The most frequently used antimicrobial therapy was the combination of ampicillin plus gentamicin (8 patients). Four cases were treated with monotherapy, 2 with ampicillin, and 2 with vancomycin. Seven patients suffered heart failure, and five of them required surgical therapy with aortic valve replacement. All the patients treated with monotherapy had severe complications, that led to death in 2 of them.
Subject(s)
Endocarditis, Bacterial/diagnosis , Enterococcus , Gram-Positive Bacterial Infections/diagnosis , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax.
Subject(s)
Adenocarcinoma/diagnosis , Adenocarcinoma/secondary , Chylothorax/etiology , Neoplasms, Unknown Primary/diagnosis , Autopsy , Fatal Outcome , Female , Humans , Lymphangitis , Middle AgedABSTRACT
Presentamos el caso de una paciente diagnosticada de quilotórax bilateral y de linfangitis carcinomatosa pulmonar, que evolucionó de forma desfavorable conduciendo al fallecimiento por insuficiencia respiratoria, en el contexto de un adenocarcinoma metastásico de primario desconocido tras el estudio necrópsico. A partir de este caso, revisamos la etiología, el diagnóstico y las opciones disponibles en el tratamiento de los quilotórax
We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax
Subject(s)
Female , Aged , Humans , Chylothorax/diagnosis , Chylothorax/therapy , Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Lymphangitis/complications , Lymphangitis/diagnosis , Pleural Effusion/diagnosis , Pleural Effusion/therapy , Thoracotomy/methods , Thoracoscopy/methods , Tomography, Emission-Computed/methods , Tomography, Emission-Computed/trendsABSTRACT
No disponible
Subject(s)
Humans , Hepatitis, Autoimmune/complications , Crohn Disease/complications , Crohn Disease/diagnosis , Antibodies, Antineutrophil CytoplasmicABSTRACT
OBJECTIVE: To analyze mortality and associated factors in community-acquired bacteremia admitted to an Internal Medicine Department. PATIENT AND METHODS: Prospective study of bacteremia admitted in 1 year (May 1999-April 2000). We have collected demographic data, previous comorbid conditions, functional status, source of infection, complications, vital signs, laboratory values, APACHE II and SOFA scores, blood cultures, therapy and 28-day mortality. In bivariate analysis, we have used Chi-square, Student-t test and Mann-Whitney U as needed. Significant variables have been introduced in a stepwise backward logistic regression model with mortality as the dependent variable. RESULTS: We have observed 115 episodes of bacteremia in 114 patients. The source of bacteremia was urinary tract in 57.4% episodes and the most common isolate was Escherichia coli (54.4%). 28-day mortality was 15.3%. Factors independently associated with mortality were septic shock (OR 10.4), non-urinary source of bacteremia (OR 9.3), APACHE II score higher than 20 (OR 5.5), and previous dependent functional status (OR 4.8). CONCLUSIONS: Mortality risk factors were septic shock, non-urinary source of bacteremia, APACHE II score and dependent functional status.
Subject(s)
Bacteremia/mortality , APACHE , Aged , Aged, 80 and over , Community-Acquired Infections/mortality , Female , Hospitalization , Humans , Internal Medicine , Logistic Models , Male , Middle Aged , Prognosis , SpainABSTRACT
Objetivo: Estudiar la mortalidad y los factores asociados a la misma en las bacteriemias adquiridas en la comunidad que ingresan en el servicio de Medicina Interna de un hospital terciario. Pacientes y métodos: Estudio prospectivo de las bacteriemias ingresadas durante 1 año (mayo 1999-abril 2000). Se han recogido datos demográficos, patología previa, situación funcional, foco infeccioso, complicaciones, constantes vitales, valores de laboratorio, puntuaciones del APACHE II y SOFA, resultados de los hemocultivos, tratamiento y supervivencia a los 28 días. En primer lugar se ha realizado un análisis bivariante con la prueba de la Chi-cuadrado, la t de Student y la prueba no paramétrica de Mann-Whitney, según correspondiera. Las variables significativas se han introducido en un modelo de regresión logística múltiple de exclusión escalonada paso a paso, utilizando la mortalidad como variable dependiente. Resultados: Se han observado 115 casos de bacteriemia en 114 pacientes. El foco urinario supuso el 57,4% de los casos y el microorganismo aislado con mayor frecuencia fue Escherichia coli (54,4% de los aislamientos). La mortalidad a los 28 días fue del 15,3%. Los factores asociados de forma independiente a la misma fueron el shock séptico (OR 10,4), el foco de bacteriemia diferente del urinario (OR 9,3), la puntuación en el APACHE II mayor o igual a 20 (OR 5,5) y la existencia de un estado funcional dependiente previo al episodio (OR 4,8). Conclusiones: Los factores de riesgo de mortalidad fueron el shock séptico, el foco no urinario, la puntuación del APACHE II y el estado funcional previo
Objective: To analyze mortality and associated factors in community-acquired bacteremia admitted to an Internal Medicine Department. Patient and methods: Prospective study of bacteremia admitted in 1 year (May 1999-April 2000). We have collected demographic data, previous comorbid conditions, functional status, source of infection, complications, vital signs, laboratory values, APACHE II and SOFA scores, blood cultures, therapy and 28-day mortality. In bivariate analysis, we have used Chi-square, Student-t test and Mann-Whitney U as needed. Significant variables have been introduced in a stepwise backward logistic regression model with mortality as the dependent variable. Results: We have observed 115 episodes of bacteremia in 114 patients. The source of bacteremia was urinary tract in 57.4% episodes and the most common isolate was Escherichia coli (54.4%). 28-day mortality was 15.3%. Factors independently associated with mortality were septic shock (OR 10.4), non-urinary source of bacteremia (OR 9.3), APACHE II score higher than 20 (OR 5,5), and previous dependent functional status (OR 4.8). Conclusions: Mortality risk factors were septic shock, non-urinary source of bacteremia, APACHE II score and dependent functional status
Subject(s)
Male , Female , Aged , Aged, 80 and over , Humans , Bacteremia/mortality , APACHE , Community-Acquired Infections/mortality , Hospitalization , Internal Medicine , Logistic Models , SpainABSTRACT
No disponible
Subject(s)
Middle Aged , Adult , Male , Female , Humans , Leptospirosis , Lymphoma, AIDS-Related , HIV Infections , Pericardium , Cardiac Tamponade , Lymphoma, Non-Hodgkin , Immunocompetence , Heart NeoplasmsABSTRACT
La temperatura corporal se mantiene en unos márgenes muy estrechos, regulada por una serie de mecanismos complejos coordinados en el hipotálamo anterior. Las alteraciones de la termorregulación engloban una serie de entidades en cuya sintomatología destaca la alteración de la temperatura corporal, sin que existan trastornos de los mecanismos de termorregulación. En la hipotermia accidental existe un descenso de la temperatura del organismo por debajo de los 35°C, generalmente asociada a la exposición a temperaturas ambientales bajas. En la hipertermia se produce un aumento de la temperatura, bien por aumento de la producción de calor o bien por una alteración en la eliminación del mismo. Los síndromes de mayor trascendencia clínica son los trastornos por exposición al calor, hipertermia maligna, síndrome neuroléptico maligno y síndrome serotoninérgico. Se revisan la fisiopatología, manifestaciones clínicas y tratamiento de estas entidades, que deben diagnosticarse y tratarse en los servicios de urgencias (AU)
