Assessment of craniofacial hyperhidrosis and flushing by sphenopalatine blockade - a randomized trial.

BACKGROUND: Craniofacial hyperhidrosis (CFH) and flushing express nervous system autonomic dysfunction. Available reference treatments lack good compliance. The study objective was to investigate variations of CFH/flushing after two methods of sphenopalatine ganglion (SPG) blockade. METHODOLOGY: CFH patients (n=25) were randomized in a ratio of 1:3 in two groups; 1) endoscopic application of topical lidocaine over SPG (TL; n=7); 2) endoscopic injection of lidocaine in the SPG (IL; n=18). CFH, flushing, rhinorrhoea, nasal obstruction, and smell detection were scored by Visual Analogue Scale (VAS). Nasal endoscopy, acoustic rhinometry, mucociliary transport test, smell/taste test, Schirmer test, Short Form-12, Chronic Skin Diseases Questionnaire, and Skin Satisfaction Questionnaire were also performed at visit 0, 1, 3 and 6 months. RESULTS: At baseline, groups reported similar CFH VAS (TL: 89.3 plus or minus 17.5mm; IL: 85.7 plus or minus 22.1mm) or flushing VAS (TL: 52.7 plus or minus 30mm; IL: 59 plus or minus 33.8mm). After 6 months, the least squares mean of CFH VAS in IL was -38.1 (-47.3 to -28.9) compared to TL 1.9 (-12.2 to 15.9). However, flushing VAS did not improve. Any rhinological measure nor quality of life test showed significant changes. One patient presented controlled epistaxis intraoperatively during IL. CONCLUSIONS: This preliminary study shows the sphenopalatine blockade injection as a safe procedure. Patients with CFH or flushing had significant improvement after lidocaine injection which lasted 6 months. Due to the small sample and the lack of objective measures more studies are needed.

[Prognostic factors of functional recovery from a stroke at one year]. / Factores pronosticos de recuperacion funcional del ictus al año.

INTRODUCTION: Recovery of the ability to walk and independence is fundamental for any patient who suffers a stroke, and it can be influenced by a number of factors. AIM: To determine what variables are more important to achieve a good functional recovery at one year after the stroke. PATIENTS AND METHODS: An observational, longitudinal prospective study was conducted with 231 patients diagnosed with a stroke in the year 2013. An analysis was performed of the clinical characteristics, socio-demographic data, neurological situation at the time of hospitalisation -National Institute of Health Stroke Scale (NIHSS)-, functional situation (Rankin Scale and Barthel Index) and ability to walk, both on hospitalisation and on discharge from rehabilitation and at one year. RESULTS: The mean age was 74.26 ± 13.1 years, and 55.4% were males. The mean length of stay in hospital was 16.24 days. 68.9% followed rehabilitation therapy, with an average of 95.5 sessions. Good functional capacity was recovered by 51.7% at one year (Rankin < 2 and Barthel > 85), and 63.5% regained the ability to walk independently. The factors that had the most significant influence on functional and gait recovery at one year were: lower age, NIHSS score < 10 in the first week, the type of stroke (small vessel), the absence of atrial fibrillation and better previous functional situation. CONCLUSION: At one year of having suffered a stroke, most of the patients recover the capacity for independent gait and to a lesser extent independence in activities of daily living.

TITLE: Factores pronosticos de recuperacion funcional del ictus al año.Introduccion. La recuperacion de la marcha y de la independencia es fundamental para cualquier paciente que sufre un ictus, y existen numerosos factores que pueden influir en ella. Objetivo. Conocer que variables son mas importantes para conseguir una buena recuperacion funcional al año del ictus. Pacientes y metodos. Estudio prospectivo, longitudinal, observacional, realizado en 231 pacientes diagnosticados de ictus en el año 2013. Se analizaron datos sociodemograficos, caracteristicas clinicas, situacion neurologica en el momento del ingreso ­National Institute of Health Stroke Scale (NIHSS)­, situacion funcional (escala de Rankin e indice de Barthel) y capacidad de marcha, tanto en el momento del ingreso como en el momento del alta de rehabilitacion y al año. Resultados. La edad media fue de 74,26 ± 13,1 años, y un 55,4% eran hombres. La estancia media hospitalaria fue de 16,24 dias. El 68,9% realizo rehabilitacion, 95,5 sesiones como media. El 51,7% recupero al año una buena capacidad funcional (Rankin < 2 y Barthel > 85), y el 63,5%, la marcha independiente. Los factores que influyeron de forma mas significativa en la recuperacion funcional y de la marcha al año fueron: la menor edad, la NIHSS < 10 en la primera semana, el tipo de ictus (de pequeño vaso), la ausencia de fibrilacion auricular y la mejor situacion funcional previa. Conclusion. La mayoria de los pacientes al año de haber sufrido un ictus recupera la capacidad de marcha independiente y, en menor medida, la independencia en las actividades de la vida diaria.

[Currarino syndrome]. / Sindrome de Currarino.

The Currarino syndrome is a form of caudal regression syndrome characterized by the classic triad of presacral mass, sacral bone defect and anorectal malformation in which an autosomal dominant inheritance has been described. In case of clinical suspicion it is necessary to search for the classic alterations and to detect other possible associated malformations in order to avoid complications. The management is multidisciplinary and depends on the type of alterations that the patient has. We report a 17-month-old female baby that initially passed unnoticed and was detected during a rectoplasty for reconstruction of a rectal stenosis. The baby presented complications derived from ignorance of the existence of a presacral mass. Early diagnose and adequate treatment is very important.

Reparación quirúrgica por vía anterior de la rotura distal del tendón del bíceps braquial / Anterior surgical repair of distal ruptures of the brachial biceps tendon

Objetivos. La rotura distal del tendón del bíceps braquial es una lesión poco frecuente. El objetivo de nuestro estudio es evaluar los resultados de las roturas distales de dicho tendón, intervenido quirúrgicamente por vía anterior entre noviembre de 1998 y diciembre de 2003. Material y método. Estudio retrospectivo con 12 pacientes y 13 lesiones, con un seguimiento medio de 37 meses (12-60). La edad media fue de 37,6 años, y todos los pacientes eran del sexo masculino. Todas las lesiones se localizaron en el brazo dominante, excepto un caso de rotura bilateral. Todos fueron intervenidos a través de un abordaje anterior. Diez lesiones (76,9%) se suturaron con arpones, dos (15,4%) con túneles óseos y una (7,7%) se suturó con un anclaje con endobutton. Todos los pacientes, excepto uno, fueron inmovilizados con una férula de escayola braquioantebraquial posterior durante las dos primeras semanas postoperatorias. En cinco pacientes se continuó con esta inmovilización y en seis se sustituyó por una ortesis articulada. Resultados. Se evaluaron los parámetros de: movilidad, fuerza, dolor y satisfacción personal. Todos los pacientes presentaron una movilidad completa. Once pacientes (91,6%) recuperaron la fuerza totalmente. Como complicaciones se encontró una paresia transitoria del nervio radial. La satisfacción personal fue excelente en once pacientes (91,6%) y buena en un paciente (8,4%). No existió ninguna nueva re-ruptura. Conclusiones. Los resultados clínicos y funcionales han sido en la mayoría de los pacientes excelentes, por lo que se recomienda la sutura con arpones por vía anterior (AU)

Purpose. Distal ruptures of the brachial biceps tendon are an infrequent injury. The purpose of this paper is to assess the outcome of distal ruptures of the tendon addressed surgically through an anterior approach between November 1998 and December 2003. Materials and methods. Retrospective study of 12 patients and 13 injuries with a mean follow-up of 37 months (range: 12-60). Mean age was 37.6 years and all patients were male. All injuries were located in the dominant arm, except for one case in which the rupture was bilateral. All were operated with an anterior approach. In ten injuries (76.9%) harpoon sutures were used, in two (15.4%) bone tunnels and in one instance (7.7%) an endobutton anchor. All patients but one were immobilized with a brachioantebrachial plaster splint during the first two weeks post-op. In five patients, this immobilization was continued, whereas in four it was replaced by an articulated brace. Results. Range of movement, strength, pain and personal satisfaction were the parameters assessed. All patients had full mobility. Eleven patients (91.6%) recovered their full strength. As far as complications are concerned, we had a transient radial nerve palsy. Personal satisfaction was excellent in eleven patients (91.6%) and good in one (8.4%). There was no re-rupture. Conclusions. Our clinical and functional results are excellent, for which reason we recommend harpoon suturing with an anterior approach (AU)

Tumor fibroso solitario del adulto en la cadera / Adult solitary fibrous tumor of the hip

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Embryonic cardiac morphometry in Carnegie stages 15-23, from the Complutense University of Madrid Institute of Embryology Human Embryo Collection.

AIMS: We performed a morphometric study of cardiac development on human embryos to complement the scarce data on human embryonic cardiac morphometry and to attempt to establish, from these, algorithms describing cardiac growth during the second month of gestation. METHODS: Thirty human embryos from Carnegie stages 15-23 were included in the study. Shrinkage and compression effects from fixation and inclusion in paraffin were considered in our calculations. RESULTS: Growth of the cardiac (whole heart) volume and volume of ventricular myocardium through the Carnegie stages were analysed by ANOVA. Linear correlation was used to describe the relationship between the ventricular myocardium and cardiac volumes. Comparisons of models were carried out through the R2 statistic. The relationship volume of ventricular myocardium versus cardiac volume is expressed by the equation: cardiac volume = 0.6266 + 2.4778 volume of ventricular myocardium. The relationship cardiac volume versus crown-rump length is expressed by the equation: cardiac volume = 1.3 e(0.126 CR length), where e is the base of natural logarithms. CONCLUSION: At a clinical level, these results can contribute towards the establishment of a normogram for cardiac development, useful for the design of strategies for early diagnosis of congenital heart disease. They can also help in the study of embryogenesis, for example in the discussion of ventricular trabeculation.

Skin to calcaneus distance in the neonate.

BACKGROUND: Current recommendations for obtaining blood from neonates advise avoidance of the midline area of the heel and are based on postmortem studies. OBJECTIVE: Because of the potential pain and tissue damage from repeated heel pricking in the same area, to investigate using ultrasonography whether the distance from skin to calcaneus is less at the midline than at the borders. METHODS: One hundred consecutive healthy preterm and 105 consecutive healthy term neonates were studied 48-72 hours after delivery. The skin to perichondrium distance (SPD) was measured on two occasions by ultrasound at the external, midline, and internal areas of the heel. FINDINGS: Mean SPD was 0.2 mm less at the midline than at the other sites. The proportion of measurements <3 mm at any of the three sites was the same. Depth was <3 mm in less than 3% of the term and approximately 20% of the preterm infants. The SPD correlated only with gestational age. Of children <33 weeks gestational age, 38% had an SPD <3 mm compared with 8% of older preterm infants. The proportions of preterm infants of > or = 33 weeks gestation and term infants with an SPD <3 mm were similar (8% v 3%). INTERPRETATION: With the use of automated lancets of 2.2 mm length or less, the whole heel plantar surface is safe for obtaining blood in term and preterm infants of > or = 33 weeks gestation. This means that soft tissue damage and pain from repeated pricking in the same area can be reduced.

Traumatismo medular neonatal y neuroimagen / Neonatal spinal cord injury and neuroimaging

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Factores de riesgo asociados a pacientes tuberculosos con microscopía del esputo positiva / Risk factors associated to tuberculosis patients with positive sputum microscopy

Objetivo: El factor determinante para la producción de casos de tuberculosis por transmisión exógena es la existencia de pacientes con baciloscopias positivas. El objetivo de este estudio fue determinar los factores de riesgo asociados a pacientes con microscopía positiva en secreciones respiratorias. Métodos: Se estudiaron los casos incidentes de tuberculosis del período 1992-1998 en la provincia de Lleida. Las variables del estudio fueron: edad, sexo, infección por el VIH, uso de drogas por vía parenteral (UDVP), consumo de alcohol, existencia de cavernas y resultado de la microcopia del esputo. Se calculó la tasa de incidencia por 100.000 personas-año. La asociación de la variable dependiente -caso de tuberculosis con baciloscopia positiva- con el resto de variables independientes se determinó con la odds ratio (ORc, cruda, y ORa, ajustada mediante regresión logística no condicional) con su intervalo de confianza (IC) del 95 por ciento. Resultados: Se detectaron 905 casos nuevos de tuberculosis. La tasa de incidencia del período 1992-1998 decreció desde 38,8 a 30,8. El 44,9 por ciento de los casos (n = 406) presentó una baciloscopia positiva. El riesgo de ser bacilífero se asoció positivamente con la presencia de cavernas en la radiografía de tórax (ORa = 6,8; IC del 95 por ciento, 4,8-9,5), el género masculino (ORa = 1,8; IC del 95 por ciento, 1,3-2,6) y el consumo de alcohol (ORa = 1,6; IC del 95 por ciento, 1,1-2,3) y fue inferior en los menores de 15 años (ORa = 0,2; IC del 95 por ciento, 0,1-0,5) y coinfectados por el VIH (ORa = 0,5; IC del 95 por ciento, 0,3-0,9). Conclusiones: La infección por el VIH implica un reducido impacto en la endemia tuberculosa. El estudio de contactos y la implantación de tratamientos directamente observados se deben considerar no sólo para los coinfectados por el VIH y UDVP, sino para adultos varones, con consumo excesivo de alcohol, especialmente si presentan lesiones cavernosas (AU)

Nonsevere community-acquired pneumonia: correlation between cause and severity or comorbidity.

BACKGROUND: Community-acquired pneumonia frequently constitutes a nonsevere infection manageable at home. However, for these low-risk episodes, the epidemiological features have not been carefully analyzed. OBJECTIVES: To determine the cause of nonsevere community-acquired pneumonia and to investigate if a correlation exists between cause and severity or comorbidity. METHODS: During a 3-year period, all patients with nonsevere community-acquired pneumonia, according to the Pneumonia Patient Outcome Research Team prognostic classification (patients in groups 1-3), were included in the study. Causes were investigated through the following procedures: cultures of blood, sputum, and pleural fluid; serologic tests; and polymerase chain reaction methods to detect Streptococcus pneumoniae DNA in whole blood or Mycoplasma pneumoniae and Chlamydia pneumoniae DNA in throat swab specimens. RESULTS: Of 317 initially included patients, 247 were eligible for the study. A microbial diagnosis was obtained in 162 patients (66%), and the main pathogens detected were S pneumoniae (69 patients [28%]), M pneumoniae (40 patients [16%]), and C pneumoniae (28 patients [11%]). For the 58 patients in prognostic group 1, M pneumoniae was the most prevalent cause, and atypical microorganisms constituted 40 (69%) of the isolated agents. In contrast, for patients in prognostic groups 2 and 3, S pneumoniae was the leading agent, and a significant reduction of M pneumoniae cases and a greater presence of other more uncommon pathogens were observed. The existence of comorbid conditions was not a determining factor for particular causes. CONCLUSIONS: Among low-risk patients with community-acquired pneumonia, there was a certain correlation between severity and cause. In contrast, the existence of a comorbidity did not have a predictive causative value.

Congenital epulis: prenatal diagnosis by ultrasound.

We present a case of congenital epulis, diagnosed prenatally with US. Congenital epulis is a benign gingival tumour whose differential diagnosis includes other oral-facial masses such as haemangioma, granular cell myoblastoma and cystic hygroma. This tumour can cause obstruction of the airway or feeding problems in the newborn child. Surgical excision is the treatment of choice.

[Hepatitis C virus genotypes. Study of 302 patients coinfected by the human immunodeficiency virus]. / Genotipos del virus de la hepatitis C. Estudio de 302 pacientes coinfectados por el virus de la inmunodeficiencia humana.

BACKGROUND: To study the distribution of different HCV genotypes in HIV-infected patients. PATIENTS AND METHOD: This study was carried out in 302 HIV/HCV-coinfected patients who were followed-up at the HIV/AIDS Unit of the Arnau de Vilanova University Hospital of Lleida (Spain). HCV genotypes were determined by Inno-Lipa HCV II technique (Innogenetics, Belgium). RESULTS: 143 patients (51.43%) had a genotype-1, followed by genotype-3 (81 patients; 29.13%), genotype-4 (53 patients; 19.06%), and genotype-2 (one patient; 0.35%). It was not possible to know the genotype in 24 patients (NT). CONCLUSIONS: In our health care area, HCV genotype-1 was the commonest among HIV/HCV-coinfected patients. However, a given HIV-infected patient with HCV antibodies has practically the same probability of having a genotype-1 as a genotype non-1.

[Risk factors associated to tuberculosis patients with positive sputum microscopy]. / Factores de riesgo asociados a pacientes tuberculosos con microscopía del esputo positiva.

OBJECTIVE: The main factor responsible for producing new cases of tuberculosis by exogen transmission is the existence of Mycobacterium tuberculosis in the sputum of tuberculosis patients. The objective of this study was to determine the risk factors associated to positive smear tuberculosis cases in Lleida (Spain). METHODS: We studied new cases of tuberculosis over the period 1992-1998. The variables considered were: age, gender, coinfection with HIV, injection drug use (IDU), consumption of alcohol, existence of caverns in thorax X-ray, and laboratory results of direct smear examination. We calculated the incidence rates for 100,000 persons-year. The association between the dependent variable case of tuberculosis with positive Mycobacterium tuberculosis smear and the remaining independent variables were assessed obtaining odds ratios (OR) and 95% confidence intervals (CI) (crude cOR and adjusted aOR by non conditional logistic regression). RESULTS: We detected 905 new cases of tuberculosis. The rates in the period 1992-1998 decreased from 38.8 to 30.8. 44.9% of cases (n = 406) presented a positive direct smear. There was a positive association between the risk of being a positive smear patient and having caverns in thorax x-ray (aOR = 6.8; 95% CI, 4.8-95), being male (aOR = 1.8; 95% CI, 1.3-2.6) and consuming alcohol (aOR = 1.6; 95% CI,1.1-2.3) and this risk was significant lower in those under 15 years old (aOR = 0.2; 95% CI, 0.1-0.5), and coinfection with HIV (aOR = 0.5; 95% CI, 0.3-0.9). CONCLUSIONS: HIV infection implies a reduced impact in endemecity of tuberculosis. Study of contacts and the implementation of directly observed treatment must be considered not only for coinfected HIV cases and IDU but also for adult males, especially those who consume alcohol, particularly when they have caverns.

Community-acquired pneumonia: development of a bedside predictive model and scoring system to identify the aetiology.

Although initial presentation has been commonly used to select empirical therapy in patients with community-acquired pneumonia (CAP), few studies have provided a quantitative estimation of its value. The objective of this study was to analyse whether a combination of basic clinical and laboratory information performed at bedside can accurately predict the aetiology of pneumonia. A prospective study was developed among patients admitted to the Emergency Department University Hospital Arnau de Vilanova, Lleida, Spain, with CAP. Informed consent was obtained from patients in the study. At entry, basic clinical (age, comorbidity, symptoms and physical findings) and laboratory (white blood cell count) information commonly used by clinicians in the management of respiratory infections, was recorded. According to microbiological results, patients were assigned to the following categories: bacterial (Streptococcus pneumoniae and other pyogenic bacteria), virus-like (Mycoplasma pneumoniae, Chlamydia spp and virus) and unknown pneumonia. A scoring system to identify the aetiology was derived from the odds ratio (OR) assigned to independent variables, adjusted by a logistic regression model. The accuracy of the prediction rule was tested by using receiver operating characteristic curves. One hundred and three consecutive patients were classified as having virus-like (48), bacterial (37) and unknown (18) pneumonia, respectively. Independent predictors related to bacterial pneumonia were an acute onset of symptoms (OR 31; 95% CI, 6-150), age greater than 65 or comorbidity (OR 6.9; 95% CI, 2-23), and leukocytosis or leukopenia (OR 2; 95% CI, 0.6-7). The sensitivity and specificity of the scoring system to identify patients with bacterial pneumonia were 89% and 94%, respectively. The prediction rule developed from these three variables classified the aetiology of pneumonia with a ROC curve area of 0.84. Proper use of basic clinical and laboratory information is useful to identify the aetiology of CAP. The prediction rule may help clinicians to choose initial antibiotic therapy.

Diagnosis of pneumococcal pneumonia by polymerase chain reaction (PCR) in whole blood: a prospective clinical study.

BACKGROUND: Streptococcus pneumoniae is the leading cause of community acquired pneumonia; however, only a small proportion of cases can be detected by conventional methods. The ability of the polymerase chain reaction (PCR) test performed on whole blood samples to identify patients with pneumococcal pneumonia was investigated. METHODS: One hundred and fourteen consecutive adult patients with community acquired pneumonia were evaluated by a wide battery of diagnostic tests in order to determine the aetiology. Blood samples from these patients and 50 controls were also tested by the nested PCR test to detect selected pneumolysin gene fragments of S pneumoniae. RESULTS: The patients were divided into four groups: (1) 40 patients with pneumococcal pneumonia in 22 of whom (55%) the PCR was positive (eight of 11 with bacteraemia and 14 of 29 without); (2) 30 with pneumonia due to other pathogens in all of whom the PCR was negative; (3) 44 with pneumonia of unknown aetiology in 14 of whom (32%) PCR was positive, and (4) 50 controls in whom the PCR test was positive in two (4%). Thus, the sensitivity of the test was 55% and the specificity 100% (81% if positive PCR tests among undiagnosed patients are considered as false positive results). CONCLUSION: PCR applied to whole blood samples appears to be a sensitive and very specific diagnostic test for identifying patients with pneumococcal pneumonia with a potential application in clinical practice.

Is Streptococcus pneumoniae the leading cause of pneumonia of unknown etiology? A microbiologic study of lung aspirates in consecutive patients with community-acquired pneumonia.

PURPOSE: Although a wide variety of recognized pathogens can cause community-acquired pneumonia, in many patients the etiology remains unknown after routine diagnostic workup. The aim of this study was to identify the causal agent in these patients by obtaining lung aspirates with transthoracic needle aspiration. SUBJECTS AND METHODS: During a 15-month period, all consecutive patients with community-acquired pneumonia who were eligible for transthoracic needle aspiration were enrolled in the study. In addition to conventional microbial methods (culture of blood and sputum, serologic studies), we performed cultures and genetic and antigen tests for common respiratory pathogens in lung aspirates. RESULTS: The study group consisted of 109 patients. Conventional microbial studies identified an etiology in 54 patients (50%), including Mycoplasma pneumoniae in 19 patients, Chlamydia pneumoniae in 9 patients, and Streptococcus pneumoniae in 9 patients. Among the remaining 55 patients, study of the lung aspiration provided evidence of the causal agent in 36 (65%). In 4 additional patients with a single microbial diagnosis by conventional methods, the lung sample provided evidence of an additional microorganism. The new pathogens detected by lung aspiration were S. pneumoniae in 18 patients, Haemophilus influenzae in 6 patients, Pneumocystis carinii in 4 patients, and C. pneumoniae in 3 patients; other organisms were identified in 4 patients. CONCLUSIONS: In our study, S. pneumoniae was the leading cause of community-acquired pneumonia, accounting for 25% of all cases, including about one-third of the cases the cause of which could not be ascertained with routine diagnostic methods.

Congenital chondromyxoid fibroma of the ethmoid: case report.

This report describes a congenital case of chondromyxoid fibroma (CMF) arising from the ethmoid bone. We believe it to be the second case of congenital CMF that has been documented, and the third case of CMF arising in the ethmoid. We describe the radiographic features of this rare entity and indicate the necessity for careful correlation between radiographic and histological findings to distinguish CMF from chondrosarcoma.

Rapid detection of pneumococcal antigen in lung aspirates: comparison with culture and PCR technique.

Detection of pneumococcal antigen has been used to increase the rate of diagnosis of pneumococcal pneumonia. The present study was designed to determine the value of rapid detection of pneumococcal antigen in samples obtained by transthoracic needle aspiration (TNA) from patients with community-acquired pneumonia (CAP) in a comparative analysis with culture and polymerase chain reaction (PCR). Pneumococcal antigen was detected by latex agglutination. One hundred and ten consecutive patients diagnosed with CAP underwent TNA. Patients were grouped, according to PCR, culture and serological results, into pneumococcal pneumonia (n = 18), other known aetiology (n = 67) and unknown aetiology (n = 25). In patients with pneumococcal pneumonia, antigen was detected in 17 (94.4%) cases. Antigen was detected in one and nine patients with pneumonia of other known or unknown aetiologies, respectively, yielding a specificity of 89.1%. In conclusion, detection of pneumococcal antigen on samples obtained by TNA from patients with CAP provides a sensitive and specific diagnosis of Streptococcus pneumoniae infection. Furthermore, its rapid results would reduce the dependence on empirical treatments.

Detection of Mycoplasma pneumoniae by polymerase chain reaction in lung aspirates from patients with community-acquired pneumonia.

STUDY OBJECTIVE: This study was designed to evaluate the usefulness of polymerase chain reaction (PCR) to detect Mycoplasma pneumoniae DNA in samples obtained by transthoracic needle aspiration (TNA). DESIGN: Prospective study of cases. SETTING: A university hospital in Lleida, Spain. PATIENTS: A total of 101 unselected patients, admitted between January 1993 and March 1994 in the emergency department, with a clinical and radiologic picture of community-acquired pneumonia, and without contraindications for TNA application. INTERVENTIONS: Patients were studied with conventional diagnostic techniques for community-acquired pneumonia. In addition, a sample obtained by TNA was processed by the following methods: culture in standard media, culture in selective media for Legionella, detection of capsular antigens for Streptococcus pneumoniae and Haemophilus influenzae, and detection of M pneumoniae specific genome by PCR. RESULTS: Serologic data were not available in eight patients and were excluded from this analysis. M pneumoniae PCR amplification was possible in eight cases, well correlated with serologic responses indicating current infection. Samples from ten additional patients, negative by PCR, were found to be demonstrative of recent M pneumoniae infection by serologic study. Finally, in all the remaining 75 cases, including the 59 patients for whom a different microbial diagnosis was established, M pneumoniae PCR test gave negative results. CONCLUSION: This study indicates that PCR, applied to samples obtained by TNA, appears to be a moderately sensitive and highly specific method for rapid detection of M pneumoniae lung infection.