Circulation of a novel human respiratory syncytial virus Group B genotype during the 2014-2015 season in Catalonia (Spain).

Human respiratory syncytial virus (HRSV) is one of the most common viral aetiological agents in the youngest population. In the present study a novel HRSV-B BA genotype is first described based on the phylogenetic analysis of the coding hypervariable region 2 sequences of G protein from strains detected during the 2014-2015 season. Among all strains detected in the last season, 44% belonged to this new genotype. Therefore, it highlights the importance of a continuous HRSV surveillance to monitor the emergence and spread of new genotypes or variants with genetic changes that may affect antigenic and tropism features.

Differentiating between malignant and idiopathic pleural effusions: the value of diagnostic procedures.

BACKGROUND: Which diagnostic procedures should be used to differentiate between idiopathic and malignant pleural effusions, is not well established. AIM: To identify which parameters allow differentiation between idiopathic and malignant pleural effusions. DESIGN: Case-note review. METHODS: Over a 12-year period, we treated 1014 consecutive pleural effusion patients, of whom 346 were diagnosed as having an idiopathic or malignant aetiology. We analysed medical history, chest X-ray, pleural fluid analysis (biochemical, microbiological and cytological), chest CT scan and additional examinations that were used according to clinical findings, and compared them with the eventual diagnosis and outcome. RESULTS: Eighty-three patients with idiopathic effusions and 263 with malignant effusions were included. Idiopathic pleural effusion resolved in 47 patients, improved in 20 and persisted in 16. Biochemical pleural fluid analysis did not predict these outcomes. A history of neoplasm, chest X-ray and CT features, as well as additional examinations according to clinical findings, established a diagnosis or suspicion of malignancy in 256 (97.7%) of the 263 patients who received a diagnosis of malignant effusion. Diagnostic thoracoscopy was helpful in seven patients in whom malignant disease was strongly suspected, despite the absence of other pathological findings. DISCUSSION: Non-invasive complementary examinations generally allowed accurate differentiation between malignant and idiopathic effusions. Patients with idiopathic pleural effusions generally had favourable outcomes.

Study of microvessel density and the expression of the angiogenic factors VEGF, bFGF and the receptors Flt-1 and FLK-1 in benign, premalignant and malignant prostate tissues.

PURPOSE: Vascular endothelial growth factor (VEGF) is an angiogenic factor that stimulates endothelial cell growth and enhances vascular permeability. VEGF exerts its action by binding to the specific cell surface receptors, fms-like tyrosine kinase 1 (Flt-1) and fetal liver kinase 1 (FLK/KDR). In tumor angiogenesis, Vascular endothelial growth factor stimulates endothelial cells to produce Basic fibroblastic growth factor (bFGF), which further enhances angiogenic activity. Very little information on the expression of VEGF, bFGF, and the receptors Flt-1 and FLK/KDR is available. Herein, we evaluate the expression of these angiogenic factors and receptors in normal prostate, high grade prostate intraepithelial neoplasia (HGPIN) and prostatic cancer (CaP). MATERIALS AND METHODS: 58 selected surgical specimens exhibiting areas of normal prostate, HGPIN, and CaP were evaluated for microvessel density, and for VEGF, bFGF, Flt-1 and FLK/KDR protein expression by immunohistochemistry. Results were correlated with pathological data. RESULTS: There was a statistically significant increase in the microvessel density and in the expression of the angiogenic factors VEGF, bFGF and the receptors FLK/KDR and Flt-1, in the premalignant and malignant tissues in comparison with normal prostatic glands. Microvessel density also correlated with higher Gleason grade, pathological stage and the expression of the receptors FLK/KDR and Flt-1. CONCLUSIONS: The "initiation switch" of angiogenesis was observed to be an early event consistent with the recruitment of new vasculature into high grade PIN lesions and it increased in the progression of prostatic cancer.

Metalloproteinases and tissue inhibitors of metalloproteinases in exudative pleural effusions.

The aim of this study was to assess the expression of several metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in exudative pleural effusions, and their relationship with inflammatory and fibrinolytic mediators in parapneumonic effusions. The study included 51 parapneumonic effusions (30 empyema or complicated parapneumonic, 21 noncomplicated parapneumonic), 28 tuberculous, 30 malignant and 30 transudates. Inflammatory markers (tumour necrosis factor-alpha, interleukin-8, polymorphonuclear elastase), fibrinolytic system variables (tissue plasminogen activator (PA), urokinase PA (u-PA), plasminogen activation inhibitor (PAI)-1, PAI-2), and several MMPs (MMP-1, MMP-2, MMP-8, MMP-9) and TIMPs (TIMP-1, TIMP-2) were determined by ELISA in plasma and pleural fluid. Elevated MMP-2 and TIMP-1 concentrations were observed in all the pleural fluid samples studied. The group of empyema or complicated parapneumonic effusions showed higher MMP-1, MMP-8 and MMP-9 concentrations than the remaining exudates. There was no correlation between MMP and TIMP levels in plasma and pleural fluid in this group of effusions. In parapneumonic effusions, MMP-1, MMP-8 and MMP-9 showed a positive correlation with the inflammatory markers and with u-PA and PAI-1. Moreover, there was a relationship between MMP-8 concentration in pleural fluid and pleural thickening at the end of treatment. In conclusion, elevated metalloproteinase-1, -8 and -9 expression was found in parapneumonic pleural effusions. These metalloproteinases could be implicated in the local inflammatory response existing in this group of effusions.

Clinical significance of antinuclear antibodies in malignant diseases: association with rheumatic and connective tissue paraneoplastic syndromes.

Our objective was to determine the prevalence of antinuclear antibodies (ANAs) in patients with malignancies and to investigate if their presence might be related with development of musculoskeletal symptoms or paraneoplastic rheumatic syndromes. Antinuclear antibodies were determined by indirect immunofluorescence on Hep-2 cells in 274 neoplastic patients and in a control group of 140 age-adjusted healthy subjects. Antinuclear antibody specificities (anti-DNA and anti-ENA) were investigated in patients with rheumatological symptoms and positive ANA. Antinuclear antibodies were detected in 76 of 274 (27.7%) patients with malignancies and in nine of 140 (6.4%) healthy subjects. Twenty patients reported paraneoplastic rheumatic symptoms or syndromes. Two of them developed clinical symptoms mimicking rheumatoid arthritis (rheumatoid-like arthropathy), one systemic lupus erythematosus (lupus-like syndrome), one dermatomyositis and four cutaneous vasculitides. Musculoskeletal symptoms and paraneoplastic rheumatic symptoms and syndromes were both more frequently observed in patients with positive ANA. Antinuclear antibody specificities were found in only two cases. We can conclude that there is an increased incidence of antinuclear antibodies in malignant conditions. Musculoskeletal symptoms and rheumatic paraneoplastic symptoms and syndromes seem to be more frequent in patients with cancer-related positive ANAs. The failure to find ANA specificities (anti-ENA, anti-DNA) in patients with malignancies and positive ANAs in our study may simply reflect molecular differences between the autoantigens involved in cancer and those characteristically involved in the systemic autoimmune diseases.

Mortality and prognostic factors in Spanish patients with systemic sclerosis.

OBJECTIVE: To determine survival and mortality in a cohort of Spanish patients with scleroderma (systemic sclerosis, SSc) and to analyse whether survival is influenced by demographic, clinical or immunological variables or the extent of skin involvement. METHODS: The study included 79 patients diagnosed with SSc and taking part in a study to determine the extent of sclerosis, visceral involvement and immunological alterations. We studied the number of observed and expected deaths (the expected number being based on age- and sex-specific rates in the background population) and derived standardized mortality ratios with their 95% confidence intervals (CI). Cumulative survival after onset of the first symptom was estimated according to the Kaplan-Meier method. The Cox method was used to identify the prognostic factors. RESULTS: The mortality rate was 0.0249 deaths per person-year. Survival at 15 yr was 0.62 (95% CI 0.410-0.778). The standardized mortality ratio was 429.4% (95% CI 222-750). On crude analysis, lung involvement [forced vital capacity (FVC) <70%, pulmonary hypertension], SSc renal crisis, an active capillaroscopic pattern, pericardial effusion and age over 60 yr at diagnosis were associated with shorter survival. On multivariate analysis, only age at diagnosis over 60 yr, FVC <70% and SSc renal crisis were independent prognostic factors. CONCLUSIONS: The mortality rate associated with SSc showed a four-fold increase compared with the background population. Lung involvement and sclerodermal renal crisis were found to be independently associated with reduced survival.

[Repercussion of age on management of neoplastic patients in an Internal Medicine Service]. / Relación de la edad con el manejo de los pacientes diagnosticados de neoplasia en un Servicio de Medicina Interna.

AIM: To determine whether age is a factor affecting the management of patients diagnosed with neoplastic disease in an internal medicine service. PATIENTS AND METHODS: Prospective study of 388 patients diagnosed with cancer in the internal medicine service of a large public health teaching hospital. We evaluated clinical characteristics, diagnostic procedures, types and stage of neoplasm, referral after hospital discharge and treatment. A comparative study based on age was performed between patients 65 years older and patients under this age. RESULTS: The 388 cancer patients accounted for 12% of hospital admissions in our service. Among the total, 62% were > or = 65 years old. Constitutional syndrome, the most frequently associated symptom and the main reason for the consultation, was more common in the > or = 65-year-old group. Lung cancer was predominant in men and hematologic neoplasms in women. Patients > or = 65 were referred more frequently to internal medicine physicians, general practitioners and home palliative assistance services (p < 0.05) and they received only palliative treatment in a greater percentage of cases (50% vs. 37%, p = 0.001). CONCLUSIONS: The incidence of neoplasms in our service was high (12%), with a considerable percentage of patients in advanced phases of the disease (83%). Age was not related to diagnostic methods nor was it determinant in the staging, but it did have repercussions on treatment; patients > or = 65 received palliative treatment alone more often than younger patients.

Relación de la edad con el manejo de los pacientes diagnosticados de neoplasia en un Servicio de Medicina Interna / Repercussion of age on management of neoplastic patients in an Internal Medicine Service

Objetivo: Valorar la relación de la edad con el manejo de los pacientes diagnosticados de neoplasia en un servicio de Medicina Interna. Pacientes y métodos: Estudio prospectivo de 388 pacientes diagnosticados de cáncer en un Servicio de Medicina Interna. Se evalúan las características clínicas, procedimientos diagnósticos, tipos de neoplasia y estadiaje, derivación al alta y tratamiento. Se realiza un estudio comparativo basado en la edad, pacientes de 65 años o mayores frente a los más jóvenes. Resultados: Los 388 pacientes diagnosticados de cáncer supusieron un 12% de los ingresos en nuestro servicio. El 62% tenían 65 años. El síndrome constitucional fue la sintomatología más frecuente asociada y el principal motivo de consulta, siendo más relevante en los 65 años. El cáncer de pulmón fue el más frecuente en los hombres y las neoplasias hematológicas en las mujeres. Los enfermos 65 años fueron controlados con más frecuencia por Medicina Interna, médico de cabecera y Servicio de Asistencia Paliativa a Domicilio (P<0,05) y recibieron tratamiento únicamente paliativo en un mayor porcentaje de casos (50% vs 37%, p=0,001). Conclusiones: La incidencia de neoplasias en nuestro servicio fue alta (12%), con un alto porcentaje de pacientes en fases avanzadas de la enfermedad (83%). La edad no se relacionó con el manejo diagnóstico ni demostró ser determinante en el estadiaje, pero sí en el tratamiento, puesto que los pacientes 65 años recibieron con mayor frecuencia tratamiento paliativo (AU)

Aim: To determine whether age is a factor affecting the management of patiens diagnosed with neoplastic disease in an internal medicine service. Patients and methods: Prospective study of 388 patients diagnosed with cancer in the internal medicine service of a large public health teaching hospital. We evaluated clinical characteristics, diagnostic procedures, types and stage of neoplasm, referral after hospital discharge and treatment. A comparative study based on age was performed between patients 65 years older and patients under this age. Results: The 388 cancer patiens accounted for 12% of hospital admissions in our service. Among the total, 62% were >= 65 years old. Constitutional syndrome, the most frequently associated symptom and the main reason for the consultation, was more common in the >= 65-year-old group. Lung cancer was predominant in men and hematologic neoplasms in women. Patients >= 65 were referred more frequently to internal medicine physicians, general practitioners and home palliative assistance services (p<0.05) and they received only palliative treatment in a greater percentage of cases (50% vs. 37%, p=0.001). Conclusions: The incidence of neoplasms in our service was high (12%), with a considerable percentage of patients in advanced phases of the disease (83%). Age was not related to diagnostic methods nor was it determinant in the staging, but it did have repercussions on treatment; patients >=65 received palliative treatment alone more often than younger patients (AU)

Effects of oleic-rich and omega-3-rich diets on serum lipid pattern and lipid oxidation in mildly hypercholesterolemic patients.

AIMS: To evaluate which dietary fat elicits the best response in terms of plasma lipids, lipoproteins, and oxidative processes. METHODS: After a 4-week run-in period, 14 mildly hypercholesterolemic subjects were fed two balanced diets for 6-week periods. During the first intervention period, patients received a monounsaturated fatty acid (MUFA)-enriched diet (olive oil diet). During the second period this diet was supplemented by n-3 polyunsaturated fatty acids (PUFAs) (n-3 diet). RESULTS: After the olive oil diet, a significant decrease in total serum cholesterol (-8.54%, P<0.01), and in apolipoprotein B (Apo B) (-10.0%, P<0.01) was observed. With the addition of n-3 fatty acids no further significant changes in serum lipid concentrations were found. However, the n-3 diet was followed by an increase in lipoperoxides in isolated native low-density lipoprotein (LDL) (67.23%, P<0.01). CONCLUSIONS: A beneficial effect on the serum lipid pattern was observed with the olive oil-enriched diet. The lack of further beneficial modifications on blood lipids and lipoproteins and the increase in the oxidative susceptibility of LDL observed after the addition of n-3 PUFA to the olive oil diet does not favor the use of this diet in hypercholesterolemic patients if it is not associated with a high intake of antioxidants.

Pleural-fluid myeloperoxidase in complicated and noncomplicated parapneumonic pleural effusions.

The diagnostic accuracy of myeloperoxidase (MPO) in pleural fluid, for differentiating between complicated and noncomplicated parapneumonic pleural effusions (PPE) evaluated prospectively. Seventy patients aged >18 yrs with PPE (36 complicated and 34 noncomplicated) were studied after admission to a tertiary referral teaching hospital. MPO concentration was measured in plasma and pleural fluid using a double-antibody competitive radioimmunoassay. The concentrations of MPO in complicated and noncomplicated PPE were compared using a Mann-Whitney U-test and multiple logistic regression models were used to predict the odds that an effusion was complicated. MPO pleural-fluid concentrations were significantly higher in complicated than in noncomplicated PPE. After excluding purulent effusions, pleural-fluid MPO was the marker that best differentiated between the two types of PPE: the area under the receiver operating characteristic curve was 0.912, the sensitivity was 87.5% and the specificity was 85.1% at a cut-point limit of 3.000 microg x L(-1). The authors concluded that the concentration of pleural-fluid myeloperoxidase helps to differentiate between nonpurulent complicated and noncomplicated parapneumonic pleural effusions.

SPET miocárdico de perfusión y ventriculografía isotópica en la miocardiopatía hipertrófica obstructiva y no obstructiva / Myocardial perfusion spect and isotopic ventriculography in obstructive and non-obstructive hypertrophic myocardiopathy

Objetivos: Valorar el papel del SPET miocárdico de perfusión y de la ventriculografía isotópica en la miocardiopatía hipertrófica (MH).Material y Métodos: A una serie consecutiva de 101 pacientes (54 ñ 15 años de edad, 50 mujeres, 55 obstructivos), diagnosticados por ecocardiograma-Doppler de MH, se les practicó un SPET miocárdico de perfusión con 99mTctetrofosmina y una ventriculografía isotópica. El seguimiento medio desde el momento del diagnóstico fue de 9,9 ñ 6,7 años (entre 1 y 28 años). Resultados: El 36 por ciento de los pacientes presentaron defectos de perfusión (15 defectos fijos y 21 defectos reversibles). En las MH no obstructivas se observó un mayor número de pacientes con defectos fijos (p = 0,01) y en los pacientes con defectos fijos se observó una mayor incidencia de ondas Q patológicas en el ECG (p = 0,01), mayores volúmenes ventriculares (p < 0,05), menor fracción de eyección (p = 0,001) y un tiempo a la velocidad máxima de llenado ventricular superior (p < 0,05). Cuatro pacientes fallecieron, 15 presentaron síncope, en 18 se indicó la implantación de marcapasos y en 6 miectomía. La fracción de eyección fue más alta en los pacientes que presentaron síncope (p = 0,034) mientras que ninguna variable isotópica fue predictora de mortalidad ni de indicación de marcapasos o miectomía. Conclusiones: Ni la tomogammagrafía miocárdica de perfusión ni la ventriculografía isotópica aportan información pronóstica en la MH, aunque en los pacientes con síncope se observan valores de fracción de eyección más elevados. Los pacientes con defectos fijos presentan mayor proporción de ondas Q patológicas en el ECG, mayores volúmenes ventriculares y fracción de eyección más baja en la ventriculografía isotópica, lo cual indica una evolución hacia la forma dilatada de la MH (AU)

[Myocardial perfusion SPECT and isotopic ventriculography in obstructive and non-obstructive hypertrophic myocardiopathy]. / SPET miocárdico de perfusión y ventriculografía isotópica en la miocardiopatía hipertrófica obstructiva y no obstructiva.

OBJECTIVE: To evaluate the role of myocardial perfusion SPET and radionuclide ventriculography in patients with hypertrophic cardiomyopathy (HC). METHODS: Exercise myocardial perfusion SPET with 99mTc-tetrofosmin and radionuclide ventriculography were performed in a consecutive series of 101 patients (54 15 years, 50 women, 55 with dynamic obstruction) diagnosed of HC by echo. Follow-up from the diagnosis was 9,9 6,7 years (1 to 28 years). RESULTS: Thirty six percent of patients had perfusion defects (non reversible in 15 and reversible in 21). In non obstructive HC higher number of patients with non reversible defects (p = 0.01 was obseved and in patients with no reversible defects higher incidence of pathologic Q waves in ECG (p = 0.01), Higher ventricular volumes (p < 0.05), lower ejection fraction (p = 0,0001) and longer time to peak emptying velocity (p < 0.05). There were 4 cardiac deaths, 15 syncopes, 18 pacemakers and 6 myectomy. Ejection fraction was higher in patients with syncope (p = 0,034) and there was no isotopic variable predictive of mortality, pacemaker or myectomy. CONCLUSIONS: Neither SPET nor radionuclide ventriculography have a prognostic role in patients with HC, but patients with syncope have higher values of ejection fraction. Patients with non reversible defects have higher rate of pathologic Q waves in ECG, higher ventricular volumes and lower ejection fraction. This is indicative of evolution to dilated form of HC.

Churg-Strauss syndrome: outcome and long-term follow-up of 32 patients.

OBJECTIVES: To study the clinical spectrum and evolution of Churg-Strauss syndrome in order to assess the clinicopathological features of the disease, the response to treatment and the long-term outcome. METHODS: Thirty-two patients with proven allergic and granulomatous angiitis (Churg-Strauss syndrome) and followed up at a single institution were evaluated. They were recruited between 1977 and 1999 from internal medicine departments. Data were obtained retrospectively from medical files in 15 cases and prospectively, using a standardized form, for the remaining patients. RESULTS: All patients had asthma and hypereosinophilia. The lungs, skin and peripheral nervous system were the organs most frequently involved. Antineutrophil cytoplasmic antibodies with antimyeloperoxidase specificity (MPO-ANCA) were detected in 77.8% of tested patients but they were not useful for monitoring disease activity. Extravascular granulomas were rarely seen in tissue biopsies. Forty per cent of the patients were treated with steroids alone. Immunosuppressive agents were added to the treatment when severe neurological, cardiac or gastrointestinal involvement was present. The outcome and long-term survival were good. Clinical relapse was rare after the first year of therapy. Dysaesthesiae of the distal limbs, neurophatic pain and cardiac failure were the most frequent sequelae. CONCLUSIONS: Churg-Strauss syndrome is a rare disorder characterized by hypereosinophilia and systemic vasculitis occurring in patients with asthma and allergic rhinitis. Vasculitis commonly affects the lungs, skin and peripheral nervous system. Outcome and long-term survival is usually good with steroids alone or in combination with immunosuppressive agents. The syndrome has a low mortality rate compared with other systemic vasculitides.

Pleural fluid myeloperoxidase as a marker of infectious pleural effusions.

Background: The aim of this study was to establish the diagnostic accuracy of neutrophil markers (elastase, lysozyme, myeloperoxidase) found in pleural fluid in differentiating between infectious and non-infectious pleural effusions (PE). Methods: We studied 184 patients over 18 years of age with PE, classified as either infectious (34 complicated parapneumonic, 32 non-complicated parapneumonic, 45 tuberculous) or non-infectious (31 neoplasms and 42 undiagnosed exudates). Polymorphonuclear elastase (PMN-E) was determined using an immunoactivation method and lysozyme using a turbidimetric method. Myeloperoxidase (MPO) was measured by double antibody competitive radioimmunoassay. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy. Results: Pleural fluid MPO was the biochemical marker that best differentiated between infectious and non-infectious PE. The ROC area under the curve (AUC) for myeloperoxidase was 0.86. MPO values over 550 &mgr;g/l diagnosed infectious PE with a specificity of 90.4% and a sensitivity of 77.4%. After excluding purulent parapneumonic PE, the sensitivity of a pleural MPO value >/=550 &mgr;g/l was 72.6%. Conclusions: Pleural fluid MPO was the marker that best differentiated between infectious and non-infectious PE.

[Protein-calorie malnutrition and lymphocytopenia as predictors of hospital infection in the elderly]. / Malnutrición caloricoproteica y linfocitopenia como predictores de infección hospitalaria en ancianos.

BACKGROUND: Clinical and epidemiological studies have established that malnutritionis a risk factor for infection in patients being submitted to surgery. To date no study has been carried out to establish the association between the nutritional condition and the incidence of hospital-acquired infections in patients in the medical area. We study the incidence of hospital-acquired infections in the elderly in an attempt to determine the rate of this infection and its association with protein-calorie malnutrition. Another aim of this study has been to determine the predictive value of the parameters used to evaluate the patient's state of nutrition and immunity. PATIENTS AND METHOD: We included 240 patients over 64 years old, 118 males and 122 females, admitted to the medical area of a general hospital. The nutritional and immunity condition of the patients was evaluated through determinations of weight, height, body mass index, hypoalbuminemia and total lymphocyte count. The psichophisical degree of dependence was evaluated through of Norton scale. The details on the hospital infections came from a clinical and microbiological follow-up of patients, in accordance with the criteria of the Centers for Disease Control of Atlanta. RESULTS: The frequency of protein-calorie malnutrition was 12.5% and the accumulated incidence of hospital-acquired infections was 19.6%. Functional incapacity of the elderly prior to hospitalization (odds ratio,4.70; 95% CI: 1.1-19.0) as well as the presence of certain extrinsicrisk factors (odds ratio, 2.35; 95% CI: 1.1-5.1) were, in addition to hypoalbuminemia (odds ratio, 3.60; 95% CI: 1.3-10.2) and lymphocytopenia(odds ratio, 2.67; 95% CI: 1.3-5.7), the independent variables that showed the most significant association with the incidence of hospital-acquired infections. CONCLUSIONS: The nutritional parameters associated with the immune system determinedgreater risk of hospital-acquired infections among elderly patients admitted to the medical area of a hospital. The initial evaluation of elderly patients hospitalitzed in accordance whit the psychophysical degree of dependence based on the Norton scale is useful to evaluate those patients who were at greater risk for hospital infections.

Prognostic assessment of uncomplicated first myocardial infarction by exercise echocardiography and Tc-99m tetrofosmin gated SPECT.

BACKGROUND: We evaluate the prognostic value of stress echo and gated single photon emission computed tomography (SPECT) after a first uncomplicated acute myocardial infarction. METHODS AND RESULTS: We used predischarge maximal subjective exercise echocardiography and gated SPECT with technetium 99m tetrofosmin to prospectively study 103 patients younger than 70 years with a first acute myocardial infarction. During a 12-month follow-up period, 2 patients died, 9 had heart failure, and 29 had ischemic complications (4 reinfarction and 25 angina). Predictive variables for heart failure in multivariate analysis were ejection fraction evaluated by echocardiography (odds ratio [OR] 8.5, P =.016) or by gated SPECT (OR 10.7, P =.009). Predictive variables for ischemic complications in multivariate analysis were less than 5 metabolic equivalents (METS) in exercise test (OR 5.2, P =.007) and greater than 15% ischemic extent in the polar map (OR 3.6, P =.04) of SPECT. CONCLUSIONS: Exercise echocardiography and Tc-99m tetrofosmin gated SPECT were predictive for heart failure, but exercise SPECT was the only test with predictive power for ischemic complications.

Interhospital observer agreement in interpretation of exercise myocardial Tc-99m tetrofosmin SPECT studies.

BACKGROUND: We sought to determine the degree of interhospital agreement in the interpretation of exercise myocardial technetium-99m tetrofosmin single photon emission computed tomography (SPECT). METHODS AND RESULTS: Five experienced hospital laboratories were asked to submit 2 sets of myocardial Tc-99m tetrofosmin SPECT images obtained in 150 patients undergoing coronary angiography: group A used a uniform color scale for all hospitals, and group B used the individual color scale in place at each hospital (uniform color scale, nonuniform color scale, and black-and-white scale). Thus a total of 300 images were interpreted by each center without knowledge of any other patient data. Angiographically significant coronary artery disease (< or =50% diameter stenosis) was present in 90 patients (60%). By a majority decision (3 or more centers), the sensitivity was found to be similar for groups A and B (82% and 84%, respectively), but the specificity was significantly higher for group A (87% vs 73%; P =.021). Four or all 5 of the centers agreed on abnormal or normal results of SPECT images in 87% of patients in group A (kappa 0.626) and in 78% of patients in group B (kappa 0.528). The kappa value of 0.617 was obtained for the uniform color scale, 0.467 for the uniform black-and-white scale, and 0.444 for the nonuniform color scale. Agreement on the left anterior descending artery territory (81% for group A and 78% for group B) was similar to that of the right coronary artery territory (79% for A and 75% for B) and to that of the left circumflex artery territory (91% for A and 85% for B). Agreement was similar in patients with 1-, 2-, and 3-vessel coronary artery disease (91%, 88%, and 86% for group A and 81%, 82%, and 82% for group B, respectively). CONCLUSIONS: In the interpretation of myocardial Tc-99m tetrofosmin SPECT images, good interinstitutional observer agreement was found, mainly when the uniform display method was adopted.

[Value of Doppler-echocardiography in the prognosis and follow up of hypertrophic myocardiopathy]. / Valor del ecocardiograma-Doppler en el pronóstico y en el seguimiento de la miocardiopatía hipertrófica.

INTRODUCTION AND OBJECTIVES: The aim of this study was to assess the value of Doppler-echocardiogram for the prognosis and follow up of a hospital-based series of adult patients with hypertrophic cardiomyopathy (HC). METHODS: One-hundred nineteen consecutive patients with HC (52 +/- 12 years, 60 women) were studied over a follow up period of 9.7 +/- 6.7 years. Echocardiographic evolution was analyzed in 104 patients (67 with dynamic obstruction) who had, at least, two echocardiograms performed within an interval of 3.7 +/- 3 years (1 to 7 years). RESULTS: Seven patients died during follow up and 31 patients developed severe complications (7 deaths, 15 syncopes, 4 class IV angina, 3 class IV dyspnea and 2 acute myocardial infarctions). The presence of mitral insufficiency (p = 0.001) and dynamic gradient > 50 mmHg (p = 0.02) were predictive of mortality and a left atrial index > 25 mm/m2 was predictive (p = 0.028) of severe complications. Fifteen percent of the patients without dynamic obstruction in the first Doppler-echo showed a gradient > 25 mmHg in the last echo. A greater number of patients with mitral insufficiency (80% vs 66%; p = 0.01) and an increase in its severity (p = 0.038) was observed during follow up. CONCLUSIONS: Mitral insufficiency, a dynamic gradient > 50 mmHg and a left atrial index > 25 mm/m2 are variables of a bad prognosis in adult patients with HC. An evolution to obstructive HC was observed in 15% of non obstructive HC, and a tendency to increased severity of mitral insufficiency was observed during follow up.

[Residual pleural thickening in tuberculous pleuritis. Associated factors]]. / Engrosamiento pleural residual en la pleuritis tuberculosa. Factores asociados.

BACKGROUND: To study the factors related to the development of residual pleural thickening in pleural tuberculosis. PATIENTS AND METHODS: We studied 39 patients with tuberculous pleural effusion. A chest X-ray was taken of each patient at the end of treatment. The patients' medical histories, pleural fluid findings and diagnostic chest films were evaluated. Residual pleural thickening was defined as thickening that was visibly greater than 2 mm in the lower side portion of the chest film. RESULTS: Residual pleural thickening developed in 26% of patients and was found mainly in men (RR = 3.86). In no patients with Löwenstein-Jensen cultures positive for Mycobacterium tuberculosis did pleural complications develop. CONCLUSION: Residual pleural thickening is a common complication of tuberculous pleural effusion. Residual pleural thickening in tuberculous pleurisy occurs more often in men and older patients, and in cases in which pleural liquid culture is negative for M. tuberculosis.