RESUMEN
Objetivos: Conocer las características clínicas y de las pruebas complementarias de pacientes con abscesos hepáticos (AH) y establecer factores pronósticos. Pacientes y métodos: Análisis retrospectivo de pacientes diagnosticados de AH en el Hospital Severo Ochoa, entre 1989 y 2005. Resultados: Se recogieron 68 pacientes: 39 hombres y 29 mujeres; incidencia: 26 casos/100.000 ingresos hospitalarios; edad (Me): 63 años. El origen fue: biliar (37%), portal (16%), por diseminación hematógena (7%), por inoculación directa (4%), desconocido (35%). La ecografía fue diagnóstica en 43% de casos y la tomografía computarizada en 57%. Los AH fueron mayores a 3 cm de diámetro en 62% de casos y en 28% fueron AH múltiples. Fueron positivos 71% de cultivos de pus y 52% de hemocultivos. Se aisló el germen causal en 73,5% de AH. Se realizó antibioterapia en 100% de pacientes, drenaje percutáneo en 56% y cirugía en 25%. Evolución: 13% de complicaciones, 9% de recidivas y 19% de mortalidad. Conclusiones: Cuadro clínico mal definido del AH. Factores asociados a complicaciones: enfermedad neurológica o tumoral abdominal, previas y AH múltiples. Factores asociados a mortalidad: índice de comorbilidad de Charlson corregido por la edad > 5, índice de Quick < 60% y aparición de complicaciones. Es necesario individualizar la indicación de drenaje en cada paciente
Objetive: To assess clinical and laboratory features of patients with liver abscesses (LA), and determine prognostic features. Methods: We performed a retrospective analysis of medical records of patients receiving a diagnosis of LA in the Hospital Severo Ochoa, between 1989-2005. Results: We were able to find 68 patients: 39 males and 29 females; the incidence amounts 26 cases/100,000 hospital admissions; mean age 63 years. A biliary source accounted for 37%, 16% were of portal origin, 7% were ascribed to hematogenous dissemination, 4% direct inoculation during a procedure and no cause could be found in 35%. Liver ultrasonography allowed diagnosis in 43% of cases, and CT scan un 57%. Sixty-two percent of LA were larger than 3 cm in diameter; 28% of cases had multiple abscesses. Cultures of abscess fluid were positive in 71%,and blood cultures in 52%. Globally, we were able to isolate the causal microorganism in 73.5% of cases. Hundred percent of patients received antimicrobials, 56% had percutaneous drainage performed and 25% were surgically managed. There were complications in 13%, 9% suffered recurrences and we found a 19% mortality rate. Conclusions: LA has an ill-defined clinical picture. A history of neurological disease or abdominal tumor, and multiple LA are associated with an increased complication rate. Following factors correlated with increased mortality: Age-adjusted Charlsons morbidity index >=5; Quick index < 60% and development of complications. Drainage indication has to be individualized
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Absceso Hepático/diagnóstico , Absceso Hepático/fisiopatología , Absceso Hepático/cirugía , Comorbilidad , Ictericia/complicaciones , Anemia/complicaciones , Anemia/microbiología , Absceso Hepático , Absceso Hepático/complicaciones , Pronóstico , Tiempo de Protrombina/métodos , Tiempo de Protrombina/tendencias , Tomografía Computarizada de Emisión/métodos , Dolor Abdominal/complicaciones , Dolor Abdominal/etiologíaRESUMEN
OBJECTIVE: To assess clinical and laboratory features of patients with liver abscesses (LA), and determine prognostic features. METHODS: We performed a retrospective analysis of medical records of patients receiving a diagnosis of LA in the Hospital Severo Ochoa, between 1989-2005. RESULTS: We were able to find 68 patients: 39 males and 29 females; the incidence amounts 26 cases/100,000 hospital admissions; mean age 63 years. A biliary source accounted for 37%, 16% were of portal origin, 7% were ascribed to hematogenous dissemination, 4% direct inoculation during a procedure and no cause could be found in 35%. Liver ultrasonography allowed diagnosis in 43% of cases, and CT scan un 57%. Sixty-two percent of LA were larger than 3 cm in diameter; 28% of cases had multiple abscesses. Cultures of abscess fluid were positive in 71%, and blood cultures in 52%. Globally, we were able to isolate the causal microorganism in 73.5% of cases. Hundred percent of patients received antimicrobials, 56% had percutaneous drainage performed and 25% were surgically managed. There were complications in 13%, 9% suffered recurrences and we found a 19% mortality rate. CONCLUSIONS: LA has an ill-defined clinical picture. A history of neurological disease or abdominal tumor, and multiple LA are associated with an increased complication rate. Following factors correlated with increased mortality: Age-adjusted Charlson's morbidity index > or =5; Quick index < 60% and development of complications. Drainage indication has to be individualized.
Asunto(s)
Absceso Hepático , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Absceso Hepático/diagnóstico , Absceso Hepático/terapia , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVES: Fever in hospitalized patients (FHP) is a difficult problem. We study clinical characteristics and predictive parameters of infection, sepsis and outcome. PATIENTS AND METHODS: Prospective study of 204 patients with fever > 38 degrees C admitted in an Internal Medicine ward. In each patient clinical evaluation, complete blood count (CBC) urinalysis (UA), C-reactive protein (CRP), chest X- ray (CXR), blood and urine cultures were performed. RESULTS: 115 patients suffered infection (75.9% nosocomial, 7.4% sepsis), 35 had a non-infectious etiology and 54 an unknown cause. CBC and CRP did not distinguish infection, bacteremia or sepsis. In UA, positive nitrites, leukocytes and bacteriuria were predictive of infection. 18.6% of the patients were diagnosed by CXR. 18% of urine cultures and 13% of blood cultures were positive. 71.6% received antibiotics (deemed unnecessary in 18%). Microbiological results modified 25% of initial treatments. Average hospital stay was 17 days; 16.7% died. Chronic lung disease, fever duration, dysphagia and urinary tract alterations predict infection. Obesity, diabetes mellitus, liver failure, immunocompromised host, central vascular access, fever duration and nosocomial infection predict bacteremia. Sepsis is more prevalent in males, with malignancy and vascular or nosocomial infection. Chronic liver disease, nosocomial infection, severe lung infection and sepsis increase mortality. CONCLUSIONS: Clinical diagnosis of FHP is inaccurate. Infection is it s most frequent cause; UA, CXR, and blood and urine cultures are useful. FHP increases mortality and hospital stay. We have established predictable models of infection, bacteremia, sepsis and mortality. However, its sensibility and specificity are low.
Asunto(s)
Bacteriemia/mortalidad , Fiebre de Origen Desconocido/etiología , Sepsis/mortalidad , Anciano , Bacteriemia/diagnóstico , Femenino , Fiebre de Origen Desconocido/mortalidad , Hospitalización , Humanos , Infecciones/diagnóstico , Infecciones/mortalidad , Masculino , Pronóstico , Estudios Prospectivos , Sepsis/diagnósticoRESUMEN
Objetivos: La fiebre en pacientes hospitalizados (FI) es un problema complejo. Se pretenden establecer las características de estos pacientes y parámetros predictívos de infección, sepsis y evolución. Pacientes y métodos: Estudio prospectivo de 204 pacientes con temperatura > 38 ºC ingresados en Medicina Interna. En cada paciente se realizó evaluación clínica, hemograma, sistemático de orina (SO), proteína C reactiva (PCR), radiografía de tórax (RXT), hemocultivos y urocultivo. Resultados: Tuvieron infección 115 pacientes (nosocomial:75.9%, sepsis: 7.4%), causa no infecciosa 35 y no filiada 54. Hemograma y PCR no discriminaron infección, bacteriemia ni sepsis. En SO, la positividad de nitritos + leucocituria + bacteriuria, tiene valor predictívo para urocultivo positivo. La RXT diagnosticó 18,6% de pacientes. Fueron positivos 18% de urocultivos y 13% de hemocultivos. Se administraron antibióticos a 71,6% de pacientes (innecesarios en 18%). Los resultados microbiológicos modificaron 25% de tratamientos iniciales. Evolución: estancia: 17 días, mortalidad: 16,7%. Existieron variables asociadas a infección (enfermedad pulmonar crónica, duración de la fiebre, alteraciones en la deglución y en vías urinarias), bacteriemia (diabetes, obesidad, hepatopatía crónica, inmunodepresión, vía vascular central, duración de la fiebre e infección nosocomial), sepsis (varón, neoplasia, infecciones vascular y nosocomial) y mortalidad (hepatopatía crónica descompensada, infección nosocomial, infección respiratoria de vías bajas y sepsis). Conclusiones: El diagnóstico de sospecha de FI tiene baja fiabilidad. La causa más frecuente es la infección. Tienen utilidad diagnóstica: SO, RXT, hemocultivos y urocultivo. Nuestros modelos predictívos de infección, bacteriemia, sepsis y mortalidad, tuvieron baja sensibilidad y especificidad
Objectives: Fever in hospitalized patients (FHP) is a difficult problem. We study clinical characteristics and predictive parameters of infection, sepsis and outcome. Patients and methods: Prospective study of 204 patients with fever > 38 ºC admitted in an Internal Medicine ward. In each patient clinical evaluation, complete blood count (CBC) urinalysis (UA), C-reactive protein (CRP), chest X- ray (CXR), blood and urine cultures were performed. Results: 115 patients suffered infection (75.9% nosocomial, 7.4% sepsis), 35 had a non-infectious etiology and 54 an unknown cause. CBC and CRP did not distinguish infection, bacteremia or sepsis. In UA, positive nitrites, leukocytes and bacteriuria were predictive of infection. 18.6% of the patients were diagnosed by CXR. 18% of urine cultures and 13% of blood cultures were positive. 71.6% received antibiotics (deemed unnecessary in 18%). Microbiological results modified 25% of initial treatments. Average hospital stay was 17 days; 16.7% died. Chronic lung disease, fever duration, dysphagia and urinary tract alterations predict infection. Obesity, diabetes mellitus, liver failure, immunocompromised host, central vascular access, fever duration and nosocomial infection predict bacteremia. Sepsis is more prevalent in males, with malignancy and vascular or nosocomial infection. Chronic liver disease, nosocomial infection, severe lung infection and sepsis increase mortality. Conclusions: Clinical diagnosis of FHP is inaccurate. Infection is its most frequent cause; UA, CXR, and blood and urine cultures are useful. FHP increases mortality and hospital stay. We have established predictibles models of infection, bacteremia, sepsis and mortality. However, its sensibility and specificity are low
Asunto(s)
Masculino , Femenino , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Humanos , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/etiología , Fiebre/etiología , Fiebre/diagnóstico , Infección Hospitalaria/mortalidad , Sensibilidad y Especificidad , Reproducibilidad de los Resultados , Estudios Prospectivos , Estudios de Cohortes , Valor Predictivo de las PruebasRESUMEN
No disponible
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Femenino , Adulto , Humanos , Pielonefritis Xantogranulomatosa/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Metastatic infiltration is most frequent than primary pericardiac tumors. Most frequent tumors are adenocarcinoma and lymphomas. A retrospective analysis of 18 oncological patients with significant pericardiac effusion (SPE) is carried out. The conclusions of the study are: SPE can be the first manifestation of a neoplasm; frequently, pericardiac tamponade (PT) has a neoplastic origin; thorax is the most frequent localization of the primary tumor; pericardiac fluid (PF) cytology analysis has low diagnostic yield; most useful diagnostic tests are thoracocentesis, thorax computerized tomography (CT) and bronchoscopy; SPE in a neoplasm suggest poor short-term prognosis; poor prognosis variables in this series were primary tumor unfavorable histology, advanced tumor disease and (probably) presentation as PT.
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Neoplasias/complicaciones , Derrame Pericárdico/etiología , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/mortalidad , Taponamiento Cardíaco/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias/mortalidad , Neoplasias/patología , Derrame Pericárdico/patología , Derrame Pericárdico/terapia , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
Seventy-three patients with significant pericardiac effusion (SPE) are analyzed retrospectively. The results concerning etiology, clinical findings, evolution, echocardiography findings and pericardiac effusion (PE) findings are summarized. Conclusions drawn are: 1) the pericardiac effusion (PE) is a difficult diagnosis without the assistance of the echocardiogram; 2) the echocardiogram signs of hemodynamic alterations have prognostic value; 3) the most frequent causes of SPE are: tumors, idiopathic acute pericarditis, and iatrogenesis; 4) in an important percentage of DPS patients the cause is not identified; 5) the clinical presentation as pericardiac tamponade (PT) is most frequent in the tumors; 6) the analysis of the PE has a low yield, which means that diagnostic pericardicentesis is not justified in all patients with SPE; 7) the pericardiac biopsy hasa low diagnostic yield; 8) the predictive mortality factors are: presentation as PT and tumor etiology, and 9) because of the dynamic character of the SPE, it is important to carry out a progress follow-up of it.
Asunto(s)
Taponamiento Cardíaco/etiología , Derrame Pericárdico/etiología , Pericarditis/complicaciones , Pericardio/patología , Adolescente , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos , Taponamiento Cardíaco/mortalidad , Taponamiento Cardíaco/cirugía , Causas de Muerte , Ensayos Clínicos como Asunto , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/mortalidad , Derrame Pericárdico/terapia , Pericarditis/epidemiología , Pericarditis/terapia , Pericardio/diagnóstico por imagen , Pericardio/cirugía , Estudios Retrospectivos , España/epidemiologíaRESUMEN
La linfadenitis histiocítica necrotizante (LHN) o enfermedad de Kikuchi-Fujimoto es una entidad anatomoclínica poco frecuente; afecta preferentemente a mujeres jóvenes e individuos de razas orientales y se caracteriza por fiebre, adenopatías preferentemente cervicales, afectación sistémica y, ocasionalmente, extraganglionar.Se presentan dos casos de LHN en mujeres jóvenes con afectación cutánea y en uno de los casos con meningitis linfocitaria.Se discuten los aspectos etiológicos, la relación de la LHN con las enfermedades colágeno-vasculares (fundamentalmente el lupus eritematoso sistémico [LES]), los problemas del diagnóstico anatomopatológico y las posibilidades terapéuticas (AU)
Asunto(s)
Femenino , Humanos , Monocitos , Cuello , Linfadenitis Necrotizante Histiocítica , Antiinflamatorios no Esteroideos , Quimioterapia Combinada , Diagnóstico Diferencial , Quimioterapia Combinada , Tejido ConectivoRESUMEN
Necrotizing histiocytic lymphadenitis (NHL) or Kikuchi-Fujimoto disease is an infrequent seen clinicopathologic entity that affects most frequently young women and individuals of eastern races, and that is characterized by fever and adenopathies (basically cervical) and systemic disease even though occasional patients present extranodal disease. We present two young women with NHL and cutaneous affectation, and with lymphocytic meningitis in one of the patients. We discuss the etiology of NHL, the relation of NHL with collagen-vascular diseases (basically systemic erythematous lupus) the problem of the pathologic diagnosis, and the therapeutic possibilities in these patients.
Asunto(s)
Tejido Conectivo/patología , Linfadenitis Necrotizante Histiocítica/patología , Antibacterianos , Antiinflamatorios no Esteroideos/uso terapéutico , Diagnóstico Diferencial , Quimioterapia Combinada/uso terapéutico , Femenino , Linfadenitis Necrotizante Histiocítica/tratamiento farmacológico , Humanos , Monocitos/patología , CuelloRESUMEN
Escanear (AU)
Asunto(s)
Adulto , Masculino , Femenino , Humanos , Enfermedades de la Médula Espinal , Tuberculosis Meníngea , Vértebras Torácicas , Infecciones por VIH , Aracnoiditis , Vértebras CervicalesRESUMEN
No disponible
Asunto(s)
Adulto , Femenino , Humanos , Linfocitos , Inflamación , Enfermedad de Still del Adulto , Enfermedades de la HipófisisRESUMEN
Radiculomyelitis (arachnoiditis) (RMA) is a severe complication of tuberculous meningitis (TM). Two patients with HIV infection and TM are here reported. These patients developed RMA. In Spain only four cases of RMA have previously been reported (only one of them was HIV-positive). Clinical manifestations (subacute paraplegia, radicular pain, sensitive level and neurogenic bladder) are reported. Cerebrospinal fluid had inflammatory features, wit predominance of mononuclear cells and remarkable increase in protein content. Magnetic resonance imaging (MRI) is the most suitable diagnostic method. The therapeutic possibilities of this complication are discussed.
Asunto(s)
Aracnoiditis/microbiología , Infecciones por VIH/complicaciones , Enfermedades de la Médula Espinal/microbiología , Tuberculosis Meníngea/complicaciones , Adulto , Vértebras Cervicales , Femenino , Humanos , Masculino , Vértebras TorácicasRESUMEN
No disponible