[Lung abscess and thoracic empyema: retrospective analysis in an internal medicine department]. / Abcesso pulmonar e empiema torácico: análise retrospectiva num serviço de medicina interna.

INTRODUCTION: Lung abscess is a collection of necrotic and suppurated tissue located at the pulmonary parenchyma. Empyema is defined as the presence of pus in the pleural space. OBJECTIVES: To study the clinical and microbiological characteristics, treatment and prognosis of patients with lung abscess and/or empyema admitted to an Internal Medicine ward. METHODS: A retrospective analysis of medical records was performed, including all patients admitted to an Internal Medicine ward for lung abscess or empyema, between 2000 and 2008. RESULTS: Thirty patients were included (22 males/ eight females), accounting for 0.18% of all patients admitted in this ward in the same period. Three patients had pulmonary abscess, 18 empyema, and nine both diseases. The average age was 68.5 years (31 to 90). The most frequent complaints were dyspnoea (90%), fever (73.3%), cough (66.7%), weight loss (60%) and chest pain (53.3%). The most frequent associated disorders were stroke associated disability (46.7%), heart failure (43.3%) and arterial hypertension (33.3%). Thoracentesis was performed in all patients with empyema. In one patient with lung abscess an anaerobic microorganism was identified. In patients with empyema, cultures were positive in 61.1% of cases, with a slight predominance of methicillin-resistant Staphylococcus aureus (27.3%) and Prevotella intermedia (18.2%). In patients with both abscess and empyema, cultures of the abscess were positive in 44.4% and of the pleural fluid in 33.3%, with no predominant microorganism. Empiric antimicrobial therapy was started in all patients and later adapted to the antibiotic sensitivity test results. Surgery was performed in three patients. Seven patients (23.3%) died during admission. The average age of the patients who died was 81.3 years and of those who survived was 64.5 years. CONCLUSION: Lung abscess and empyema are infrequent diseases in an Internal Medicine ward, affect mostly males and have unspecific clinical manifestations. The chest X-ray, computed tomography (CT) and thoracentesis were the main diagnostic tests. Most cultures were negative. Medical treatment was the most frequent choice, with surgery being used in 10% of cases. Older age and multiple associated conditions were associated with a worse prognosis.

[Negative paraquaturia does not exclude paraquat fatal poisoning]. / Paraquatúria negativa não exclui intoxicação fatal por paraquat.

The authors present a case report of fatal paraquat poisoning demonstrating persistently negative urine paraquat test. A brief review is also made, concerning the importance of blood test for paraquat, the false negative results in urine test and the need for new effective therapeutic approaches that can change the tragic course of most of these poisoning cases.

Ehlers-Danlos syndrome type IV in association with a (c.970G>A) mutation in the COL3A1 gene.

The Ehlers-Danlos syndrome type IV (EDS-IV) is a hereditary, autosomal dominant disease that causes a defect in the procollagen III synthesis, which results in a structural modification in this protein. An awareness of the disease is of vital importance for the optimal outcome, since the affected individuals have a high risk of vascular, intestinal and uterine rupture. It's a disease with great clinical variability and the diagnosis is confirmed by detection of a mutation in the gene encoding collagen type III. The authors present a case report of a patient who appeared at the emergency ward with acute abdomen and hypovolemic shock after spontaneous aortic rupture. The diagnosis was confirmed after genetic study that identified a mutation in the (c.970G>A) in the COL3A1 gene, only reported once in the literature in a family with internal carotid dissections in some of its members. It's the first time that this mutation is reported in association with the EDS-IV. The authors also make a brief review of the clinical, genetic and molecular characteristics of this syndrome.

[Lithokelyphopedion]. / Litoquelifopédio.

Lithopedions are extremely rare conditions. Less than 300 cases were described worldwide. We report a case occurring in a woman of 77 years of age, admitted with dehydration, urinary tract infection and infected limb pressure ulcers. She had been recently admitted in a Surgery ward for incarcerated umbilical hernia. At the time the abdominal examination revealed a mass with about 10 cm in diameter, with petrous consistency, adherent to the deep plans around the umbilical regium and the hypogastrium. This finding was interpreted as a probable left renal tumor. The abdominal X-ray revealed voluminous calcified mass and the CT-scan showed to be a lithokelyphopedion with about fifty years, of a full term pregnancy.