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Objetivo: Comparar la eficacia y seguridad de levofloxacino frente al tratamiento estándar con betalactámicos en pacientes con Neumonía Adquirida en la Comunidad que cumplen criterios de ingreso hospitalario (NACH). Pacientes y métodos: Estudio prospectivo de un año de duración de 49 pacientes (ptes.) ingresados en el Servicio de Medicina Interna, diagnosticados de NACH con asignación aleatoria a recibir.- I: cefotaxima o ceftriaxona, II: amoxicilina-clavulánico, (las dos previas asociadas o no a un macrólido) o, III: levofloxacino. Se realizó Rx. tórax a los 7 -10 días, al mes y, posteriormente si era necesario. Resultados: 29 ptes. recibieron pauta estándar (I o II) y 20 ptes. levofloxacino. Eran varones el 84%, con edad media de 70,9 años, 57% con enfermedad de base moderada o grave, y 55% con criterios de gravedad inicial. En el 47% de los casos se llegó a diagnóstico etiológico, siendo en un tercio de los casos bacilos gramnegativos. Se produjo la curación en el 94% de los pacientes y éxitus en 2 pacientes (5%). No se observaron diferencias entre los dos grupos en las características demográficas, enfermedad de base ni gravedad inicial. No se detectaron diferencias en los efectos secundarios, complicaciones, estancia hospitalaria o porcentaje de curaciones. La necesidad de prolongar el tratamiento fue mayor en el grupo estándar que en el tratado con levofloxacino (52 vs 15%, p: 0,02). Conclusiones: En población mayor y con gravedad inicial el tratamiento con levofloxacino puede ser una alternativa válida al tratamiento estándar (AU)

Objective: To compare the effectiveness and security of levofloxacin treatment in front betalactamic therapy in patient with community-acquired pneumonia that require hospitalization (CAPH). Patient and methods: A prospective and randomized study along a year from 49 patients diagnosed of (CAPH) that were admitted in the Internal Medicine Service. The patients were assigned randomly to receive.- I: cefotaxime or ceftriaxone, II: amoxicillin/ clavulanate (both could be associated or not with a macrolide) or III: levofloxacin. It was accomplished Rx. thorax to 7 -10 days, to the month and, other reviews if was necessary. Results: 29 cases were in standard therapy (I or II) and 20 cases received levofloxacin therapy. Male 84 %, half age 70,9 years old, 57 % with moderate or severe underlying disease, and 55 % with approaches of initial severity criteria. In 47 % of the cases we arrived to etiologic diagnosis, in the third of the cases were BGN. The cure took place in 94 % of the patients and 2 patients died (5%). No differences were observed regarding demographic characteristics, underlying disease and severity. No differences were detected in: the secondary effects, complications, hospital stay or, mean stay or percentage of cures. The necessity to prolong the therapy was bigger in the standard group in front of the group tried with levofloxacin (52 % vs. 15 %, p:0.02). Conclusions: In bigger population and with initial severity the treatment with levofloxacin can be a valid alternative to the standard therapy (AU)

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OBJECTIVE: To compare the effectiveness and security of levofloxacin treatment in front betalactamic therapy in patient with community-acquired pneumonia that require hospitalization (CAPH). PATIENT AND METHODS: A prospective and randomized study along a year from 49 patients diagnosed of (CAPH) that were admitted in the Internal Medicine Service. The patients were assigned randomly to receive.-I: cefotaxime or ceftriaxone, II: amoxicillin/clavulanate (both could be associated or not with a macrolide) or III: levofloxacin. It was accomplished Rx. thorax to 7-10 days, to the month and, other reviews if was necessary. RESULTS: 29 cases were in standard therapy (I or II) and 20 cases received levofloxacin therapy. Male 84%, half age 70.9 years old, 57% with moderate or severe underlying disease, and 55% with approaches of initial severity criteria. In 47% of the cases we arrived to etiologic diagnosis, in the third of the cases were BGN. The cure took place in 94% of the patients and 2 patients died (5%). No differences were observed regarding demographic characteristics, underlying disease and severity. No differences were detected in: the secondary effects, complications, hospital stay or, mean stay or percentage of cures. The necessity to prolong the therapy was bigger in the standard group in front of the group tried with levofloxacin (52% vs. 15%, p:0.02). CONCLUSIONS: In bigger population and with initial severity the treatment with levofloxacin can be a valid alternative to the standard therapy.

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We report a patient treated with periodic hemodialysis, who suffered the appearance of a mass in the forearm with compression of flexor muscles, median nerve and arteriovenous fistula. X-ray examination revealed a calcified and multiloculated mass which displace forearm vessels. We discuss the physiopathology, differential diagnosis and surgical treatment of the process.

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Herein we describe a patient with noninsulin dependent diabetes mellitus who developed acute anuric renal failure following eye surgery. This condition, ascribable to diabetic neurogenic bladder and probably to the use of anticholinergic agents, improved following placement of a urethral catheter. The physiopathological mechanisms and treatment are discussed.

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We describe a 76-year-old woman with severe uterine prolapse with secondary bilateral ureterohydronefrosis and acute renal failure, which improved after the reposition of the uterus. Physiopathological mechanisms and treatment of obstructive uropathy related with uterine prolapse are discussed.

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The nature and incidence of haematological side-effects of sulphasalazine was sought in a retrospective study of 130 sulphasalazine-treated patients with chronic inflammatory arthritis. Macrocytosis was seen to occur in 27 patients (20.8%) and four patients (3%) developed a macrocytic anaemia. Only eight of 23 macrocytic patients had low red cell folate levels, three of whom were anaemic. An increased risk of developing macrocytosis was seen with doses of sulphasalazine greater than 2 g per day. In most patients the macrocytosis was noted during the first 6 months but did occur in the second and third 6-month period of treatment. Only one patient (0.8%) developed neutropenia and no cases of thrombocytopenia were observed. Regular blood counts should be performed while patients remain on treatment but haematological side-effects are seldom the reason for withdrawal of sulphasalazine.

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Several markers of humoral and cellular immunity were studied in 49 untreated patients with malignancies of different anatomical locations, histological types and clinical stages. The proportion of EAC rosettes, levels of immunoglobulins as well as levels of the C3 and C4 components of the complement system were within the normal range (p.n.s.). The proportion of T lymphocytes, measured by the classical E rosette method at 4 degrees C, was significantly decreased in the whole group when compared with a control population (mean 46,27 +/- 12,34, p less than 0.0005), regardless of the anatomical origin of the tumor. In patients with lung cancer (45,52 +/- 10,37), those with the epidermoid type (51 +/- 9,45) had a reduced number of E rosettes when compared with controls (58,87 +/- 5,53 p less than 0.005) but they were still greater in number than in the other histological types (43,16 +/ 9,97 p less than 0.025). We found no relationship between the proportion of E rosettes and the clinical stage. The number of T lymphocytes with E rosettes after incubation at 30 degrees C was within normal limits in most patients, except in those cases with lung cancer at an early clinical stage (23,94 +/- 5,85 p less than 0.005). Our findings would support the hypothesis of a deficiency in cellular immunity in patients with malignancies, which could favour the progression of the disease.

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