[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

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

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[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.

[Chronic obstructive lung disease in the general population. An epidemiologic study performed in Guipúzcoa]. / Enfermedad pulmonar obstructiva crónica en la población general. Estudio epidemiológico realizado en Guipúzcoa.

To perform a cross-sectional descriptive study of chronic obstructive pulmonary disease in the general population. We studied 600 men aged between 40 and 60 from a random sample (69.9% of the total, 76.6% eligible subjects). Each subject answered a questionnaire, underwent spirometric testing and measurement of CO in expired air. Smokers accounted for 50.8% of the sample, although only 24.8% of the population had CO levels in expired air greater than 10 ppm. The prevalence of chronic bronchitis was 9.2%. Forty subjects (6.8%), only 25% of whom had previously undergone spirometry, met the criteria for air flow limitation. Air flow limitation was associated with chronic bronchitis and smoking, which were also mutually associated. Our data underline the need to combat smoking, given its relation with chronic bronchitis and airflow limitation, as well as to perform spirometry more routinely, mainly in smokers or patients with symptoms of chronic bronchitis.

[Angiocentric immunoproliferative lesions: the terminology and the clinical picture]. / Lesiones angiocéntricas inmunoproliferativas: terminología y cuadros clínicos.

Two diagnosed clinical cases of T-cell angiocentric lymphoma are presented, different in their clinical aspects, evolution and treatment. Both represent different spectrums within the entity of angiocentric immunoproliferative lesions. The medical literature is reviewed and emphasis is placed on the different illness which include a wide range from less to more highly malignant within the same entity.

[Smoking among maritime workers in the province of Guipúzcoa. An epidemiological study]. / El hábito del tabaco en los trabajadores de la mar de la provincia de Guipúzcoa. Estudio epidemiológico.

Smoking is the principal environmental cause of human disease and seafarers are often heavy smokers as a consequence of difficult working conditions. The object of this study was to determine the prevalence of smoking among seafarers and possible associated factors. Cross-sectional descriptive study. Interviewers administered questionnaires to 834 seafarers between 40 and 60 years of age who were registered members of the marine health and social services authority of Guipúzcoa, whether they were active (working) or passive (unemployed or retired). Expiratory concentrations of CO were also measured. Smokers accounted for 47.5%. Average consumption was 33.9 packs/year (p/y); CO in expired air was 26.1 ppm. Ex-smokers accounted for 23.7% (28.2 p/y; 6.0 ppm). The percentage of smokers was higher among fishermen of the high seas than among coastal fishermen (59.5% versus 38.0%; p < 0.001); consumption of cigarettes of both smokers and ex-smokers (35.9-27.2 p/y; p < 0.001) and mean CO concentration in expired air (18.8-12.4 ppm; p < 0.001) were also found to be higher in this group. Those who had consumed more cigarettes over the course of a lifetime were active seafarers (41.1-30.5 p/y; p < 0.001), but among them were also more ex-smokers (30.8-22.2%; p = 0.04) and fewer current smokers (35.6-50.0%; p = 0.002). Fishing the high seas was the only variable associated with cigarette consumption; being unemployed or retired was the only factor associated with quitting.(ABSTRACT TRUNCATED AT 250 WORDS)

[Respiratory disorders among fishermen]. / Alteraciones respiratorias de los trabajadores de la mar.

BACKGROUND: Information concerning to the habits and diseases of sea fishermen is scarce. The respiratory disorders and the risk groups in fishermen from the province of Guipúzcoa, Spain were evaluated in this study. METHODS: A descriptive transversal study (questionnaire and spirometry) and retrospective review of the data on laboral disability and mortality were carried out. RESULTS: The prevalences of chronic bronchitis, asthma and smokers were found to be 18.3%, 9.8% and 47.5% respectively; with a history of pneumonia being 8.9%, tuberculosis 7.3%, pleural disease 5.5%, rib fracture 10.6%, and obstructive disorder 8.9%. Smoking, followed by the presence of previous infectious, were the factors most associated to the presence of respiratory disease. The most prevalent smoking habit observed among the high sea fishermen did not completely explain the greater prevalence of chronic bronchitis found among these subjects. The number of years working at sea was not related to any disorder. Tumors represented the first cause of mortality (34.9%) with those of the trachea, bronchials and lung heading the list (13.3%). Laboral disability due to respiratory causes occupied the third place in the global population (13.0%) and the first place in high sea fishermen (22.2%). In relation with coastal fishermen, the high sea fishermen presented a lower Tiffeneau index and a greater prevalence of smoking, chronic bronchitis, history of tuberculosis and laboral disability, number of medical consultations and admissions due to respiratory problems. CONCLUSIONS: Sea fishermen present a high prevalence of respiratory disease. Differences were observed between high sea and coastal fishermen with the former demonstrating a lower Tiffeneau index and a greater frequency of smoking, chronic bronchitis, tuberculosis history and laboral disabilities, number of medical consultations and admissions for respiratory causes.