[Evaluation of the utility and efficacy of a day hospital in a gastroenterology department]. / Valoración de la utilidad y eficacia de un hospital de día en un servicio de patología digestiva.

Because public health funds are limited, full advantage should be taken of the resources available. Consequently, hospital stay should be reduced with no loss of health care quality. In our Gastroenterology Department, investigations or treatment requiring a short hospital stay are carried out in a day hospital. Between March 1998 and March 2000, 2,169 patients were treated: 1,862 outpatients and 307 patients referred from another hospital. A total of 95.2% of the outpatients were discharged. Hospital stay was prolonged in 4.8% (91/1,862): 13 due to incomplete investigations, 29 because of worsening of their underlying disease before the procedure and 49 due to complications. The overall complication rate was 2.8% (62/2,169). Six complications developed after discharge; of these two appeared within 24 hours. After the opening of the day hospital, the mean hospital stay in the Gastroenterology Department was reduced from 9.05 days to 6.07 days (p = 0.001). In conclusion, the use of a day hospital in a gastroenterology department is useful, effective, safe and profitable.

Aparición paradójicade tuberculoma y formaciónde absceso cerebelosoen un paciente con el virusde la inmunodeficiencia humanatratado con triple terapiaantirretrovírica / Parodoxical appearance of tuberculoma and formation of a cerebellar abscess in a patient with human immunodeficiency virus treated with triple antiretroviral therapy

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[Disseminated encephalic cryptococcosis as a form of presentation of idiopathic T-CD4 lymphocytopenia]. / Criptococosis encefálica diseminada como forma de presentación de una linfocitopenia T-CD4 idiopática.

INTRODUCTION: The term idiopathic T-CD4 lymphocytopenia is used to describe a new syndrome, defined as reduced T-CD4 lymphocytes in persons with no evidence of HIV infection or other causes which would explain the immunosuppression (secondary to neoplasties, immunosuppressive treatment, hereditary immunodeficiencies, infections, etc.). The reduced number of T-CD4 lymphocytes leads to deterioration in cellular immunity and therefore this leads to a predisposition to develop tumors and opportunist infections in patients with such defects. CLINICAL CASE: We describe a case of depletion of T-CD4 lymphocytes, associated with disseminated encephalic cryptococcosis (multiple cortical, capsulo-ganglionar, thalamic and cerebellar cryptococcomas) in a patient with no evidence of HIV infection. The case we present fulfilled diagnostic criteria for idiopathic T-CD4 lymphocytopenia, a clinical condition seldom described in this country. We discuss the pathogenic mechanisms of cryptococcosis, the different varieties of Cryptococcus neoformans and their different roles as the cause of opportunist infections in humans. CONCLUSIONS: In view of the neurotrophism of this fungus, the neurological signs and symptoms should make one suspect the presence of Cryptococcus neoformans infection in non-HIV carriers with cellular immunity defects such as those present in idiopathic T-CD4 lymphocytopenia.

[Cerebral abscesses. The clinical and evolutionary aspects of 17 cases treated surgically]. / Abscesos cerebrales. Aspectos clínicos y evolutivos de 17 casos intervenidos quirúrgicamente.

Seventeen cases of cerebral abscesses undergoing surgery were reviewed, underlying the characteristics of predisposing factors, infectious sources, microbiological and radiological studies, as well as clinical and evolutive aspects. The average age of the patients was 34 years, with a higher incidence in the second (35%) and sixth (22%) decades. The young patients (< 40 years) showed a greater frequency of adjacent infectious sources (83%) and the older patients (> 40 years), distant infectious sources (75%). The average time gap between the onset of symptoms and the diagnosis was 7 +/- 13 days. CAT showed in all the patients typical hypodense images with a peripheral ring; three patients had multiple abscesses and the remainder, single abscesses. In 12 patients (70.5%), microbiological cultures were positive, 3 (25%) for aerobe germs, 7 (50.3%) for anaerobe germs, 1 (8.33%) for multiple germs and 1 (8.33%) for fungi. Eleven patients underwent surgical drainage, four of which required latter exeresis. Six other patients underwent exeresis as the only surgical treatment. One patient died and the remainder showed a positive evolution. The hospital length of stay was 42.3 +/- 52.3 days. The most frequent sequela was the epilepsia present in 23.5% of the patients. Our findings are similar to the results of recent works, although in our series, there is a higher frequency of anaerobe germs. No differences were observed between the surgical techniques used nor between the past and current antibiotherapy patterns.

Reoperation after lumbar disc surgery: results in 130 cases.

Out of a series of 1850 cases operated upon for lumbar disc herniation 130 underwent re-operation because of persistent or recurrent symptoms. Re-operation was successful in 62%. The prognosis of re-operation was not related to special clinical symptoms and signs but only to the operative findings. Herniations at other levels and recurrences of lumbar disc herniations had the best results (excellent in 98% respectively 54%), but scar formations alone came out much less satisfactory (only 38% excellent results). Computed tomography (CT) findings were less reliable in distinguishing between disc prolapse and fibrosis than magnet resonance imaging (MR). Therefore MR is the diagnostic method of choice in these conditions, and scar formations alone should be considered a contra-indication for re-operation.

[Respiratory insufficiency in acute pancreatitis]. / Insuficiencia respiratoria en la pancreatitis aguda.

BACKGROUND: Acute respiratory failure (ARF) is one of the systemic complications of acute pancreatitis (AP). The severity of AP may be objectified by the Ranson index and the radiologic alterations showed by abdominal computerized tomography (CT). The aim of the present was to study the relation between both problems. METHODS: Two hundred ninety-five cases of AP attended between November 1983 and August 1987 were revised. Ranson criteria were used to qualify the 295 AP and the abdominal CT in 85 cases. ARF was defined as PaO2 less than 60 mmHg breathing air at room temperature. The severity of ARF was classified by the respiratory index (RI: PaO2/FIO2) with ARF being considered as severe when less than 200. In 100 cases of AP the thoracic radiologic alterations were objectified and evaluated in order to know their relation with ARF. RESULTS: ARF was the most frequent complication (28%) of AP, being severe in 8%. Pleural effusion was the radiologic alteration most frequently observed (23 patients). In 28% there was no correlation between the radiology and the presence of ARF. The correction of ARF was achieved in 85% of the patients with a mask of O2 less than 40%. Mean ARF was 227. A correlation was found between ARF and the severity of the episode of AP and the changes observed in the abdominal CT. CONCLUSIONS: Acute respiratory failure is the most frequent complication of acute pancreatitis and correlates with the severity of the episode of the latter; classification of the episode of acute respiratory failure by respiratory index is of use.

[Cerebral cysticercosis. 10 cases]. / Cysticercose cérébrale. Dix cas.

Ten patients with cerebral cysticercosis seen between 1983 and 1986 were treated with praziquantel and in some cases by a ventriculoperitoneal shunt and/or surgical excision of cysts. Clinical and biological data were of no prognostic value. CT only was useful in orientating therapy and establishing the prognosis. A favorable course was obtained in 7 parenchymatous and meningeal forms, the fatal cases being of the mixed type. Praziquantel was inactive against intraventricular cysts.