Síndrome de los dedos púrpura en un varón de 90 años / Purple toes syndrome in a 90-year old male

No disponible

Pneumonia after heart transplantation: a multi-institutional study. Spanish Transplantation Infection Study Group.

A multiinstitutional study of 307 heart transplant recipients was carried out to determine the clinical, radiographic, and prognostic characteristics, the incidence, and the etiology of pneumonias in the first year after transplantation. There were 21.1 cases of pneumonia per 100 heart transplantations. Seventy-five percent of the cases occurred in the first trimester. Eighty-two causal agents were identified, of which 60% were opportunistic, 25% were nosocomial, and 15% were community-acquired. The most frequent isolates were cytomegalovirus (20), Aspergillus species (13), and Pneumocystis carinii (11). Hemoptysis occurred more frequently in aspergillus pneumonias than in other pneumonias (54% vs. 6%, respectively; P < .05); aspergillus pneumonia was the only type of pneumonia during which cavitated nodules were noted on thoracic radiographs. The overall mortality rate was 30.8%; the independent factors of a poor prognosis were aspergillus infection (relative risk [RR], 7.4; 95% confidence interval [CI], 5.8-9.1) and bilateral pulmonary infiltrates (RR, 10; 95% CI, 8.5-11.4).

[Endocarditis caused by Staphylococcus lugdunensis. Hospital incidence]. / Endocarditis por Staphylococcus lugdunensis. Incidencia hospitalaria.

BACKGROUND: Staphylococcus lugdenensis is a coagulase negative staphylococcus (CNS) associated with a wide spectrum of infections among which infectious endocarditis may be found and in which it is an aggressive pathogen. METHODS: Since 1993 a systematic search for S. lugdenensis in all the staphylococci isolated in blood cultures and the possibility of endocarditis en all of these was determined. A review of all the cases of endocarditis in the literature was performed. RESULTS: Three cases of endocarditis by S. lugdenensis on the native valve were detected from January 1993 to June 1997. None of the patients presented previous heart disease or risk factors. In all the cases, at least three blood cultures were positive for S. lugdenensis and vegetations were observed by echocardiogram. Despite correct antibiotic treatment, disappearance of fever, negativization of control blood cultures and in the third case, valve replacement, two patients presented heart failure and all died. On review of the literature 31 cases of endocarditis were found with valve replacement and mortality being 55%. It should be indicated that 85% of the patients who survived required surgery. CONCLUSIONS: Endocarditis by S. lugdenensis is a severe infection frequently requiring valve replacement and is associated with a high mortality. Therefore, adequate early identification of the microorganism is necessary distinguishing it from the remaining CNS.

[Infected atrial myxoma simulating infective endocarditis]. / Mixoma auricular infectado que simula endocarditis infecciosa.

BACKGROUND: We present a case of infected atrial myxoma simulating bacterial endocarditis. MATERIAL AND METHODS: A 75 year old male, without any antecedents of interest, with fever an evolution a month, and a cardiac murmur. Blood cultures were practiced by BACTEC N.R. 730 system. The diagnosis was performed by the bidimensional and transesophageal echo, and confirmed with the resection from surgery. The method of bibliographical review used, has been the data base of comprehensive Medline, cvc since 1987 up June 1992 and the Oncodise's Concerlit archive from the year 1985 up to june 1992 the date base of the IME (Indice Médico Español) was also review up to April 1992. RESULTS: The blood cultures were positive, 7/7 Streptococcus viridans and 3/7 a Staphylococcus epidermidis resistant to meticiline, we them with the same antibiogram. Echocardiography and angiography show a lef atrial mass, surgical resection of the mass, confirmed the hystological diagnostic of the myxoma and signs of infection. CONCLUSIONS: This is the first case in our country, with shows the rarity of it. We analyze the differential diagnosis with the non infected myxoma and the bacterial endocarditis. We think that there should be an early surgical treatment, together with antibiotic therapy, due to the high incidence of embolism in theses patients.

[Bilateral adrenal hemorrhage secondary to heparin treatment: a case report]. / Hemorragia suprarrenal bilateral, secundaria a tratamiento con heparina: descripción de un caso.

Bilateral suprarenal haemorrhage (BSH) has not been often described as a cause of chronic suprarenal insufficiency. The diagnosis before death is difficult and it was rare until the CAT scan became a routine diagnostic tool. Of 25 cases reported since 1981, 23 were diagnosed by CAT scan. We report a case of a patient that developed bilateral suprarenal haemorrhage (BSH) during heparin therapy for pulmonary embolism. The early clinical picture resembled a septic shock, and the diagnosis of Addison disease was made later. We reviewed the medical literature and we emphasized the clinical problems in which we should suspect the diagnosis of BSH, where early therapy with steroids may be critical to save the patient's life.

[Infection in systemic lupus erythematosus]. / Infección en el lupus eritematoso sistémico.

The possible infections of 43 hospitalized patients with systemic lupus erythematosus (SLE) has been assessed. Out of the 43 patients 17 had some type of infection (41%). The diagnosis was proven by positive cultures in 84% of the cases. Urinary infections due to E. coli were the infections most commonly found. Four infections due to staphylococcus, 2 to S. typhi and 2 to invasive Aspergillosis were also found. Tuberculosis was observed only in 2 patients. In twelve out of the 17 patients with infections, SLE was active and 10 of the latter had renal failure. In addition to the 18 urinary infections diagnosed, sepsis was encountered in 5 patients and pneumonias in 4. Only two infected patients died (those with invasive aspergillosis). Thus, infections are frequent in patients with SLE and precise diagnosis often requires positive culture test.