Interventions to decrease short-term peripheral venous catheter-related bloodstream infections: impact on incidence and mortality.

BACKGROUND: Short-term peripheral venous catheters are a significant source of healthcare-acquired bloodstream infections and a preventable cause of death. AIM: To assess the effectiveness of interventions applied to reduce the incidence and mortality associated with short-term peripheral venous catheter-related bloodstream infections (PVCR-BSIs). METHODS: The intervention included continuous PVCR-BSI surveillance, implementation of preventive measures related to catheter insertion and maintenance in accordance with evidence-based recommendations and the hospital's own data, front-line staff educational campaigns, and assessment of adherence to hospital guidelines by ward rounds. A Poisson regression model was used to estimate the trend of rate per year. FINDINGS: From January 2003 to December 2016, 227 episodes of PVCR-BSI were identified among hospitalized patients at a university hospital. The mean age of patients was 67 years (standard deviation 14 years), 69% were male and the median Charlson score was 3 (interquartile range 2-5). Staphylococcus aureus caused 115 (50.7%) episodes. Thirty-day mortality was 13.2%. After implementation of the intervention, the incidence of PVCR-BSIs decreased significantly from 30 episodes in 2003 (1.17 episodes/10,000 patient-days) to eight episodes in 2016 (0.36/10,000 patient-days). The number of episodes caused by S. aureus decreased from 18 episodes in 2003 (0.70/10,000 patient-days) to three episodes in 2016 (0.14/10,000 patient-day), and mortality decreased from seven cases in 2003 (0.27/10,000 patient-days) to zero cases in 2016 (0.00/10,000 patient-days). CONCLUSIONS: Surveillance, implementation of a multi-modal strategy and periodical assessment of healthcare workers' adherence to hospital guidelines led to a sustained reduction in PVCR-BSIs. This reduction had a major impact on S. aureus BSI rates and associated mortality.

Evolución en el diagnóstico y tratamiento del carcinoma oculto de mama con metástasis ganglionar (T0 pN1): ratificación de la propuesta terapéutica / No disponible

Objetivo: Valorar la evolución en el diagnóstico y tratamientodel carcinoma oculto de mama que se presenta comometástasis ganglionar.Pacientes y método: Trece mujeres diagnosticadas y tratadaspor haber presentado metástasis ganglionar de un carcinomade mama, sin localizar el foco primario.Resultados: Las 10 pacientes a las que se pudo aplicar cirugíaconservadora y radioterapia, evolucionaron favorablemente.Las tres que sólo recibieron hormonoterapia presentaronmastitis carcinomatosa a los pocos años.Conclusiones: Aunque la mamografía sigue siendo la exploraciónprincipal, la RNM y el PET ayudan a localizar algunoscarcinomas ocultos. Se confirma que el tratamiento consistenteen una linfadenectomía y radioterapia de la mama, esel de elección en la mayoría de los casos, frente a la cirugía radicalclásica(AU)

Objective: To evaluate the evolution in the diagnosis andtreatment of the occult breast carcinomas presented asmetastatic lymph node.Patients and methods: Thirteen women diagnosed andtreated of lymph node metastasis of breast cancer without primaryfocus localization.Results: Ten patients were treated with conservativesurgery and radiotherapy of the breast, presenting afavourable evolution. The 3 women that were treated onlywith hormonotherapy, had carcinomatous mastitis after fewyears.Conclusions: Mammography is still the gold standard testto study breast cancer. RNM and PET can help to localize occultbreast cancer. Lymphadenectomy and radiotherapy of thebreast is a good treatment in most cases, opposite to the classicalradical mastectomy(AU)

Successful desensitization protocol for hypersensitivity reactions caused by oxaliplatin.

OBJECTIVE: To report the successful desensitization of a patient with a hypersensitivity reaction to oxaliplatin. CASE SUMMARY: A 57-year-old woman with metastatic colon cancer was receiving oxaliplatin, fluorouracil and leucovorin every 2 weeks and showed a partial response to therapy. During the fourth cycle, an anaphylactic reaction with palpitations and rash occurred. The patient was hypotensive with mild pulmonary wheezing. Since oxaliplatin was the probable cause of the hypersensitivity reaction, therapy with this drug was discontinued. Therapy in the patient was continued using cetuximab and irinotecan but this resulted in progression of the cancer. In view of the initial satisfactory response to the oxaliplatin-based regimen, it was decided to attempt desensitization to oxaliplatin using a protocol adapted from carboplatin regimens. The desensitization procedure was successful and the patient subsequently tolerated an additional three cycles using this regimen without further symptoms of hypersensitivity. DISCUSSION: In cases with moderate-to-severe reactions to oxaliplatin, reexposure is not usually considered. However, a need to use first-line therapy when there is recurrence of the cancer has encouraged the development of rapid desensitization procedures which allow patients to be treated with medications to which they have previously shown hypersensitivity reactions. A combination of premedication using intravenous dexamethasone and a desensitization regimen was designed which was used successfully to increase concentrations and flow rates of oxaliplatin. CONCLUSIONS: Hypersensitivity reactions to oxaliplatin are not rare and physicians need to be aware of these. When substitution of another antineoplastic drug is not feasible, oxaliplatin desensitization should be considered even when hypersensitivity reactions to oxaliplatin are severe.

Possible macular exanthema associated with linezolid therapy.

OBJECTIVE: To report a case of macular exanthema associated with linezolid therapy. CASE SUMMARY: A 54-year-old white man diagnosed as having laryngeal epidermoid carcinoma attended our emergency department because of fatigue, fever, neck pain and a fistulized fixed mass in the right side of the neck with purulent exudation. Treatment with amoxicillin/clavulanic acid 875 mg/125 mg p.o. every 8 hours as empirical therapy was started. Cultures of the exudates from the fistula confirmed the presence of methicillin-resistant Staphylococcus aureus (MRSA). Amoxicillin/clavulanic acid was discontinued and therapy was started with linezolid 600 mg p.o. every 12 hours but 5 days after commencing linezolid the patient came to our emergency room because of generalized erythematous macular eruptions. A diagnosis of severe and generalized macular exanthema induced by linezolid was made. Administration of linezolid was suspended and there was an improvement in the skin lesions and general state of health. The patient was discharged without further symptoms. DISCUSSION: In this case, there was a close temporal correlation between drug exposure and the onset of symptoms. When linezolid was discontinued, the skin lesions resolved quickly and the general condition of the patient improved. Furthermore, linezolid was the only drug added before the cutaneous lesions appeared. It is possible that the adverse reaction was associated with administration of amoxicillin/clavulanic acid. However, the patient had been treated with this antibiotic previously without appearance of any cutaneous reaction. An objective causality assessment revealed that an adverse effect was possible. CONCLUSION: Based on our observations, we conclude that linezolid was the most likely cause of the adverse reaction. Clinicians should be aware of this infrequent but severe reaction.

Angiosarcoma primario de bazo con metástasis hepáticas: presentación de un caso y revisión de la bibliografía / Primary angiosarcoma of the spleen with liver metastases. Case reprot and literature review

Los angiosarcomas esplénicos son tumores poco frecuentes que a menudo se presentan con metástasis hepáticas. Acostumbran a ser múltiples y con mal pronóstico; se dispone de marcadores inmunohistoquímicos que nos pueden facilitar el diagnóstico preoperatorio, ya que las imágenes radiológicas y ecográficas son bastante inespecíficas. El tratamiento aconsejado es la esplenectomía, y no se ha demostrado un beneficio claro con quimioterapia y radioterapia (AU)

Angiosarcomas of the spleen are infrequent tumors that often present with liver metastases. These tumors are usually multiple and have a poor prognosis. Immunohistochemical markers can aid preoperative diagnosis since radiological and ultrasonographic images are fairly nonspecific. The recommended treatment is splenectomy. The benefits of chemotherapy and radiotherapy have not been clearly demonstrated (AU)

[Primary angiosarcoma of the spleen with liver metastases. Case report and literature review]. / Angiosarcoma primario de bazo con metástasis hepáticas: presentación de un caso y revisión de la bibliografía.

Angiosarcomas of the spleen are infrequent tumors that often present with liver metastases. These tumors are usually multiple and have a poor prognosis. Immunohistochemical markers can aid preoperative diagnosis since radiological and ultrasonographic images are fairly nonspecific. The recommended treatment is splenectomy. The benefits of chemotherapy and radiotherapy have not been clearly demonstrated.

Parálisis del aparato extensor de la rodilla* Análisis y resultados sobre una serie de 120 plastias de cuadríceps / Paralysis of the extensor mechanism of the knee. Analysis and results of a series of 120 quadricepsplasties

No disponible

Fibromatosis de mama. lesión benigna con agresividad local. A propósito de un caso / Mammary fibromatosis. Benign lesion with local agressivity. A case report

Se presenta el caso de una mujer de 57 años de edad, sin antecedentes de cáncer familiar y con antecedente traumático hace 4 años, que consulta por presentar una tumoración palpable en CSI de mama derecha de 4 cm de diámetro. La mamografía mostró un nódulo polilobulado de márgenes parcialmente mal definidos de características mamográficas de malignidad. Se realizó exéresis quirúrgica con el diagnóstico histológico definitivo de fibromatosis mamaria. A pesar de la tumorectomía, la lesión recidivó, realizándose una mastectomía simple a los 36 meses del diagnóstico inicial.Se comentan los hallazgos histológicos y las características de la lesión, y se plantea la importancia de una actitud quirúrgica agresiva para evitar la recidiva. (AU)

Cervical cystic lymph node metastasis as first manifestation of occult papillary thyroid carcinoma: report of seven cases.

BACKGROUND: Cervical cystic lymph node metastases as first and sole manifestation of occult papillary thyroid carcinoma are observed exceptionally rarely. In the seven patients here reported, a cystic, ovoid mass in the lateral aspect of the neck was the initial symptom of the papillary microcarcinoma. METHODS: There were six men and one woman, aged between 17 and 54 years (mean 31.7 years), who complained of round, movable, painless masses in the lateral aspect of the neck. Two patients were first seen with two cervical tumors. Tumors had been present from a few days to 12 months (mean 5.1 months). The cystic nature of tumors was demonstrated by echographic studies. In all cases, thyroid tumors were not palpable on physical examination and no abnormalities of the thyroid gland were shown by other diagnostic procedures. RESULTS: The diagnosis was made preoperatively by fineneedle aspiration cytology of the nodes in five of the seven cases. All patients underwent thyroidectomy with conservative neck dissection followed by radioactive iodine therapy. After a follow-up period from 1 to 7 years, all patients are alive with no apparent signs of recurrence or metastasis. CONCLUSIONS: In a young patient with solitary lateral cervical cyst, the diagnosis of lymph node metastasis from occult papillary thyroid carcinoma should be considered. Any lateral mass requires tissue diagnosis, and fine-needle aspiration is usually adequate for clarification of the histology. Ipsilateral modified neck dissection and total thyroidectomy followed by radioactive iodine therapy offers a favorable prognosis.

Consumption of alcohol, coffee, and tobacco, and gastric cancer in Spain.

A case-control study on gastric cancer was carried out between 1987 and 1989 in four regions of Spain. Three hundred and fifty-four cases of histologically confirmed adenocarcinoma were included (235 men and 119 women). For each case, a control was selected, matched by sex, age, and area of residence, from the same hospital as the case. No association was observed with smoking, nor with the consumption of coffee or tea. The usual consumption of alcohol was associated with gastric cancer in men (odds ratio = 1.54, 95 percent confidence interval = 1.03-2.31), but there was no dose-response relationship. No association was observed in women. All estimations were carried out taking into account the effect of the dietary factors associated with gastric cancer. In accordance with previous evidence, the association observed between gastric cancer and alcohol appears not to be causal.