Role of immunosuppression in the evolution of Legionnaires' disease.

The clinical course of legionella pneumonia in immunosuppressed patients is uncertain. This study was undertaken to determine the clinical evolution of legionellosis on the basis of the immune state and to establish the variables associated with death directly related to legionellosis. The study included 78 patients: 28 with chronic disease who had received immunosuppressive treatment (group 1), 24 with chronic disease without immunosuppressive treatment (group 2), and 26 controls. Inclusion criteria were the occurrence of nosocomially acquired pneumonia, Legionella pneumophila infection, and erythromycin therapy that was initiated within 72 hours following diagnosis. Respiratory and extrarespiratory complications were observed more frequently in groups 1 and 2. Bilateral radiological involvement was most frequent in group 1, and recurrence of legionella pneumonia was observed exclusively in group 1. None of these variables achieved statistical significance. The global mortality of the series was 11.5% (17.9%, 12.5%, and 3.8% in groups 1, 2, and 3, respectively). Variables statistically related to mortality were acute renal failure, shock, and need for mechanical ventilation. Although many of the variables analyzed lacked statistical significance, a trend was seen between complications and basal immunosuppression, as previously suggested.

Comparison of radioimmunoassay and enzyme immunoassay kits for detection of Legionella pneumophila serogroup 1 antigen in both concentrated and nonconcentrated urine samples.

We evaluated a commercial enzyme immunoassay (EIA) kit for detection of Legionella pneumophila serogroup 1 soluble antigen by comparing it to radioimmunoassay (RIA), using both concentrated and nonconcentrated urine samples. The sensitivity of EIA was 67.4% in nonconcentrated urine samples and 82.6% in concentrated urine samples. The sensitivity of RIA was 60.9% and 84.8% in nonconcentrated and concentrated urine samples, respectively. Our study indicates that the sensitivity and specificity of EIA are comparable to those of RIA, and that concentrating the antigen by selective ultrafiltration increases sensitivity for both EIA and RIA, with no significant decrease in specificity.

Detection of Legionella pneumophila serogroup 1 antigen in nonconcentrated urine and urine concentrated by selective ultrafiltration.

We evaluated a commercially available radioimmunoassay technique for detecting the soluble antigen of Legionella pneumophila serogroup 1 using concentrated and nonconcentrated urine. Concentration was achieved by selective ultrafiltration. The sensitivity of the technique was 60.9% for nonconcentrated urine and 80.4% for concentrated samples, with 100% specificity in both cases.

Pulmonary diffuse amyloidosis and ankylosing spondylitis. A rare association.

We report herein the association of primary pulmonary amyloidosis and ankylosing spondylitis. To our knowledge, this rare association has never been reported. This case reemphasizes that not all pulmonary complications that appear in the course of ankylosing spondylitis are related to the seronegative spondyloarthropathy. Primary pulmonary amyloidosis should be considered in patients with interstitial pulmonary disease.

[Syncope as presentation form of pulmonary thromboembolism. Study of 15 cases]. / Síncope como forma de presentación de un tromboembolismo pulmonar. Estudio de 15 casos.

BACKGROUND: To evaluate the prevalence of syncope as a form of presentation of pulmonary thromboembolism (PTE) in the emergency department of a general hospital. METHODS: All the cases of PTE having gone to the emergency department between May 1983 and July 1989 were collected. A radiography of the thorax, arterial gasometry, an electrocardiogram and a pulmonary perfusion scintigraphy were performed in each patient. Ventilation scintigraphy and/or pulmonary DIVAS were also carried out when necessary. RESULTS: Of a total of 63 patients, 15 (24%) had a syncope as a primary manifestation. No significant differences were observed in regards to predisposing factors between the syncope group (S) and the non-syncope group (NS) with there being a predominance of women in the S group (p less than 0.05). Furthermore, the S group had a greater prevalence of tachycardia, hypotension, electrocardiographic changes, pleural effusion and perfusion defect greater than 50% in the pulmonary scintigraphy. CONCLUSIONS: PTE should be discarded in any patient with a clinical picture of syncope with hypotension and tachycardia, especially if female. When PTE is presented as a syncope it is generally a massive embolism.

[Oat cell carcinoma of the esophagus]. / Oat cell esofágico.

Extrapulmonary locations of undifferentiated small cell carcinoma of the "oat cell" type are uncommon. In spite of its rarity, the appearance of this type of tumor has been described in various organs of the economy. Of these, the esophagus is the most common location, constituting 0.05 to 7.6% of esophageal carcinomas. Of uncertain histopathologic origin, these tumors are characterized by their extreme aggressiveness, which carries a poor short term prognosis. Surgery, radiotherapy and chemotherapy, separately or in combination, have produced discouraging results in the treatment of primitive esophageal "oat cell" carcinoma. In this paper are presented four cases of esophageal "oat cell" carcinoma treated in the Hospital de la Santa Cruz y San Pablo in 1979-1988, out of a total of 260 carcinomas in the same location. The clinical evolution and pathological findings of this type of tumor are commented. The literature on this unusual histological type of carcinoma is reviewed.