[The association of pleural empyema and perinephritic infection: apropos 4 cases]. / Asociación de empiema pleural e infección perinefrítica: a propósito de cuatro casos.

Empyema of renal origin is very rare (3% in our series). We discuss 4 cases of empyemas associated to perirenal infection. Two of them were diabetic and all of them have renal lithiasis. They made their debut through pleural effusions, isolating Escherichia coli in all of them. Treatment was antibiotics and drainage in both foci, three of them evolved to healing and one of them died being the abdominal foci without drainage. This association must be suspected when no clear etiology of the empyema is present in patients with history of renal lithiasis and diabetes.

[Diffuse pulmonary hemorrhage: review of nine cases]. / Hemorragia pulmonar difusa: revisión de nueve casos.

Nine cases of diffuse pulmonary hemorrhage (DPH) diagnosed in our hospital during the past eight years are reviewed. We assess the clinical, diagnostic, etiologic and evolutive characteristics of all these cases and, thus, of such entity in our environment. The nine patients had anemia, hemoptysis and transient pulmonary infiltrations. Renal affectation was observed in seven patients. Based on clinical and laboratory data, supplementary explorations and immunological and histological studies, the following etiologic diagnosis were established: idiopathic extracapillary glomerulonephritis (three cases), idiopathic pulmonary hemosiderosis (two cases), Wegener's granulomatosis (one case), unclassifiable systemic necrosant vasculitis or overlapping syndrome (two cases). In one patient, it was not possible to establish the etiology. Global mortality was 44.4% (four patients); two of them died during the course of the initial massive hemoptysis (not controlled, as in the other patients, with steroids) and two other patients died due to late complications. In this series, none of the patients developed a disease associated to antibodies against the basal membrane. The application of a severe diagnostic systematic has been a key factor for the management of these patients.

[Atraumatic rupture of the spleen. A proposal of new attitudes. Apropos a case in brucellosis]. / Rotura atraumática de bazo. Propuesta de nuevas actitudes. A propósito de un caso en brucelosis.

A case of spontaneous spleen rupture during acute brucellosis, followed by clinical and ultrasound examinations until the natural resolution of the subcapsular hematoma, is presented. The causes of this complication are reviewed and a new classification is proposed, creating 3 groups of nontraumatic ruptures: spontaneous, with basal splenic disease and associated to other pathology. We highlight the several states of spleen ruptures--some with spontaneous resolution--and the utility of the radiological techniques to carry out a follow-up on them, which can in some cases help avoid surgical intervention.