RESUMO
OBJECTIVE: Epidemiological description, retrospective in its classification, evolution and therapeutics of total prosthesis knee and hip infected among the arthoplasties made between 1st of January 1994 and 31st of December 2003 in our hospital. RESULTS: The global infection rate was 2.4% (confidence interval of 95% [CI 95%], 1.6%-3.2%) over 40 cases in 1,666 joint implants. The average age +/- standard deviation (SD) was 69.5 years old +/- 5.1 years, mainly in women (67.5%). The most common location was the knee, 31 cases (77.5%). In 90.0% of the patients the aetiology was identified: 64,0% were gram-positive cocci (plasmacoagulase-negative staphylococci, and Staphylococcus aureus); 14.0% were gram-negative bacilli and mixed flora (11.0%). Acute infections were found in most of the cases (45,0%). The joint replacement had a healing rate of 66.7% in the first replacement and of 83.3% in the second replacement. CONCLUSIONS: The gram-positive cocci are the main microorganisms in these infections. More extensive studies about multiple aspects are necessary to evaluate the effectiveness of the different surgical techniques, the new antibiotics and the combined antibiotic therapies.
Assuntos
Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Artroplastia de Substituição/métodos , Feminino , Humanos , Masculino , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Artérias/patologia , Aterosclerose/complicações , Isquemia Encefálica/etiologia , Acidente Vascular Cerebral/etiologia , Adulto , Aterosclerose/patologia , Isquemia Encefálica/patologia , Circulação Cerebrovascular , Feminino , Humanos , Imageamento por Ressonância Magnética , Acidente Vascular Cerebral/patologiaAssuntos
Doenças Cerebelares/etiologia , Encefalite/etiologia , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/complicações , Doença Aguda , Adulto , Doenças Cerebelares/microbiologia , Disartria/etiologia , Encefalite/microbiologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Cefaleia/etiologia , HumanosRESUMO
BACKGROUND: Currently growing medical and social significance of nosocomial infection by multiresistant pathogens (NIMP) prompted us to establish its incidence, nosology, presenting forms in admission areas, and mortality in a secondary hospital, Lleida (Spain). METHOD: For that purpose, we analyzed the first year experience of a unit for the control of nosocomial infection (NI) created in our hospital. From January to December 2000, 79 patients with a NIMP admitted to the University Hospital Arnau de Vilanova entered in this prospective, descriptive study. RESULTS: The overall annual incidence of NIMP was 4.0 per 103 patients admitted. Acinetobacter baumannii showed the highest individual rate of incidence, particularly, at the Intensive Care Unit (15.4 per 103 patients admitted; p < 0.001). By nosologies, infection prevailed over colonization (69.6% vs 30.4%; p < 0.001). Mean hospital stay length increased in colonized patients (38.9 days). Finally, overall mortality was high (29.1%); again, A. baumannii was the agent most frequently detected in death cases (66.6%; p < 0.001). CONCLUSIONS: Surveillance and control measures are required for the prevention of NIMP. Incidence studies how this, can be useful to create a database to establish the distribution and occurrence of NI, including the detection of multiresistant pathogen outbreaks.
Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/tratamento farmacológico , Feminino , Hospitais , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de TempoAssuntos
Artrite Infecciosa/diagnóstico , Adulto , Antibacterianos , Antirreumáticos/uso terapêutico , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/tratamento farmacológico , Diagnóstico Diferencial , Quimioterapia Combinada/uso terapêutico , Febre/etiologia , Humanos , Articulação do Joelho/patologia , Masculino , Líquido Sinovial/química , Líquido Sinovial/microbiologiaRESUMO
OBJECTIVE: The aim of biochemical pleural fluid testing is to reach an etiological diagnosis of the pleural effusion. We assessed the utility of considering cuttoff points for the wide range of analytes used to investigate pleural fluid. PATIENTS AND METHODS: Among 1,040 patients with pleural effusion, we sought the etiologies of those fluids which showed any of the following characteristics: red blood cell count = 10 x 109/L, leukocytes = 10 x 109/L, percentage of neutrophils or lymphocytes >50%, protein = 50 g/L, glucose = 60 mg/dL, pH = 7.2, lactate dehydrogenase = 1,000 U/L, adenosine deaminase = 40 U/L, amylase = 100 U/L or cholesterol = 60 mg/dL. RESULTS: Some of the more prominent findings were: a) a sixth of transudates were blood-tinged or contained predominantly neutrophils; b) a groosly bloody fluid suggests malignant disease, trauma, or pulmonary embolization; c) nearly 90% of fluids containing = 10 x 10(9) leukocytes/L were parapneumonics; d) 73% of tuberculous pleural fluids had protein > or = 50 g/L, e) tuberculosis and parapneumonics explained more than 90% of fluids with high adenosine deaminase content; f) one third of amylase-rich pleural effusions were malignant; g) a low pleural glucose or pH levels indicate that patient probably has a parapneumonic, tuberculous or malignant etiology; y h) the diagnostic yield of pleural fluid cytology in malignant effusions was 57%, a percentage which raised to 94% in those with low glucose fluid level. CONCLUSIONS: Cuttof values of biochemical pleural fluid tests may greatly support particular causes of pleural effusions.
Assuntos
Derrame Pleural/diagnóstico , Biomarcadores/análise , Diagnóstico Diferencial , Testes Diagnósticos de Rotina/métodos , Exsudatos e Transudatos/citologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/classificação , Valores de Referência , Estudos Retrospectivos , Sensibilidade e EspecificidadeAssuntos
Síndrome da Imunodeficiência Adquirida/complicações , HIV-1 , Neoplasias Pulmonares/patologia , Linfoma Relacionado a AIDS/patologia , Síndrome da Imunodeficiência Adquirida/patologia , Síndrome da Imunodeficiência Adquirida/terapia , Evolução Fatal , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/terapia , Linfoma Relacionado a AIDS/diagnóstico por imagem , Linfoma Relacionado a AIDS/terapia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Tosse/etiologia , Febre/etiologia , Arterite de Células Gigantes/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/uso terapêutico , Biópsia , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Células Gigantes/patologia , Humanos , Prednisona/uso terapêutico , Artérias Temporais/patologiaRESUMO
There are many different diseases that can be associated with pleural effusions. When a pleural effusion is discovered, two questions need to be answered: 1) is the effusion a transudate or is it an exudate?, and 2) if the effusion is an exudate, what is the disease responsible for its production?. Answers to these questions can be obtained in more than two-thirds of patients testing the pleural fluid by diagnostic thoracentesis. The remainder may require watchful waiting until resolution or further diagnostic procedures, either non-invasive (radiologic imaging) or invasive (bronchoscopy, pleural biopsy, thoracoscopy).
Assuntos
Derrame Pleural/terapia , Diagnóstico Diferencial , Exsudatos e Transudatos , Humanos , Doenças Pleurais/diagnóstico , Derrame Pleural/diagnóstico , Derrame Pleural/etiologiaAssuntos
Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/etiologia , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Idoso , Feminino , Humanos , Doenças do Mediastino/complicações , Isquemia Miocárdica/complicações , Tomografia Computadorizada de Emissão , Tomografia Computadorizada por Raios XRESUMO
The malignant pleural mesothelioma is a rare neoplastic consequence observed in people with previous exposition to asbestos essentially. The malignant mesothelioma like a term, not only reports to primary malignant extended tumors that are derived of pleural mesothelioma but also, pericardial and peritoneal (about 20%). The exposition of asbestos stands for a sequential cellular reaction with oncogenic potential and with a typical majority clinical presentation. We described the case a patient complaint of malignant pleural mesothelioma with unusual radiology presentation with the result that unilateral calcified pleural plaques with pleural thickening and pleural effusion absence. Definitive diagnostic was achieved by thoracotomy.
Assuntos
Mesotelioma/diagnóstico por imagem , Neoplasias Pleurais/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pleura/diagnóstico por imagem , Doenças Pleurais/diagnóstico por imagem , Radiografia Abdominal , Radiografia Torácica , Tomografia Computadorizada por Raios XAssuntos
Timoma/diagnóstico , Neoplasias do Timo/diagnóstico , Feminino , Hepatomegalia/complicações , Humanos , Pessoa de Meia-Idade , Radiografia Torácica , Recidiva , Infecções Respiratórias/complicações , Esplenomegalia/complicações , Timoma/complicações , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Given the great clinical relevance of the cerebrovascular disease, the incidence, nosology, vascular risk factors and factors predicting short and medium-term survival after stroke were evaluated in Lleida (Spain). PATIENTS AND METHODS: Five hundred forty-five consecutive patients with an acute stroke admitted to the Hospital Universitario Arnau de Vilanova during the period 1996-1997 were evaluated. A descriptive epidemiological study and a multivariate logistic regression analysis of predictive factors of mortality at 1-month and 1-year after the stroke were made. The latter provided a clinical scoring system for predicting survival. RESULTS: The incidence rate of stroke was 138.3/100,000 inhabitants. Significant risk factors were hypertension and peripheral vasculopathy. There were 80.1% of ischemic and 19.9% of hemorrhagic strokes (p < 0.001). A Glasgow scale < or = 7, hemianopsia and hemorraghic stroke were significant predictors of 1-month mortality, whereas age > or = 70 years, diabetes, atrial fibrillation and limb weakness decreased survival at 1 year. CONCLUSIONS: The incidence rate of stroke in Lleida is low respect to other studies in Spain. Simple clinical measures may help to establish a prognosis at short and medium-term.