Nosocomial transmission of Q fever.
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Cross Infection↗
Biomedical subjects
C Sarriá
Publications and source records attributed to C Sarriá.
[Bile duct obstruction due to non-Hodkin's lymphoma in patients with HIV infection].
Acquired immune deficiency syndrome increases the risk of developing non-Hodgkin's B-cell lymphoma (NHL) (relative risk over 100). NHL tend to be high-grade and to affect the central nervous system and digestive tract. Biliary tract compression is usually due to external compression from enlarged lymph nodes, but is not usually the first manifestation.We describe 2 cases of bile duct obstruction secondary to NHL in patients diagnosed with HIV infection. Histological diagnosis of the lymphoma can be difficult but is necessary so that these patients do not undergo highly aggressive surgical treatment instead of chemotherapy, which currently produces the best results. Therefore, we emphasize the importance of including lymphomas in the differential diagnosis of bile duct obstruction in patients with HIV infection.
Bone Marrow↗
A case of endocarditis due to Granulicatella adiacens.
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Endocarditis, Bacterial↗
[Clinical profile and prognosis of patients with endocarditis and periannular pseudoaneurysms].
INTRODUCTION AND OBJECTIVES: Little information is available on the clinical profile and prognosis of patients with endocarditis and periannular pseudoaneurysms because the presence of pseudoaneurysm itself is considered an indication albeit not an evidence-based indication, for surgery. METHODS: We followed 18 patients (11 males, mean age: 5 +/- 4) with endocarditis and pseudoaneurysm diagnosed by transesophageal echocardiography and/or at surgery over 14 +/- 5 months. RESULTS: Aortic (n = 14; 6 on native valve, 8 on prosthesis) was more frequent than mitral (n = 3; 3 prosthesis) or tricuspid location (n = 1). Auriculoventricular block developed in 6 patients, all with aortic pseudoaneurysm. The most frequently involved microorganisms were staphylococci (n = 5) and streptococci (n = 5). Abscesses were found in 5 patients. Pseudoaneurysm was not considered an indication for surgery. Eleven patients underwent surgery 5 died after surgery (45%), 1 had reinfection and 5 are asymptomatic. The remaining 7 patients received only medical treatment: two died (28%), one developed reinfection and 4 are asymptomatic. The size of the pseudoaneurysm remained stable after 24 months of follow-up in the 4 asymptomatic medically treated patients (maximal diameter: 21 +/- 5 at diagnosis versus 22 +/- 5 at latest follow-up; p = NS). CONCLUSIONS: We conclude that the presence of a pseudoaneurysm identifies a subset of endocarditis patients with a high mortality. Pseudoaneurysms are usually located in an aortic position and around prosthetic material. Medical treatment without surgery should be considered when no other surgical indications exist. Lastly the size of a pseudoaneurysm in medically treated patients does not increase over time
Adult↗
Eustachian valve endocarditis: Is it worth searching for?
BACKGROUND: Only a few cases of eustachian valve endocarditis have been reported. Whether the eustachian valve is an uncommon site for a vegetation to be attached or whether the disease is missed because a systematic approach to this valve is not routinely performed in the search for vegetations is not known. METHODS: Every patient suspected of having endocarditis undergoes a specific approach, which includes a systematic study of the eustachian valve. In 10 patients with large valves but without signs and symptoms of endocarditis, we identified 2 specific findings: width <3 mm and a regular oscillating movement. A blinded evaluation in the 10 control subjects and 30 patients with right-sided endocarditis, including the 5 with eustachian valve endocarditis, showed an agreement of 97% (39/40). RESULTS: Five of 152 patients with right-sided endocarditis were found to have eustachian valve vegetations (3.3%). Patients were young (age range 22-34 years) and all had predisposing factors (3 intravenous drug abusers, 2 central venous lines), fever, and septic pulmonary embolism. Staphylococcus aureus was cultured in all cases. Tricuspid involvement was found in 4 patients, and only 1 patient had isolated eustachian valve endocarditis. All patients did well with culture-guided antibiotics. CONCLUSIONS: Our results suggest that eustachian valve endocarditis may be more frequent than is believed. Thus a systematic interrogation of the eustachian valve should be included in the echocardiographic examination of a patient suspected of having endocarditis.
Adult↗
Amplification of human genomic sequences by human papillomaviruses universal consensus primers.
Detection of human papillomaviruses DNA (HPV) in tumour samples is often determined by a PCR based approach with standard universal consensus oligonucleotides. It is shown that these primers under the same amplification conditions can amplify a human genomic sequence of 1361 nucleotides in oral carcinomas and normal DNA samples. This sequence is detected more easily as the copy number of HPV DNA decreases. Therefore, in tumour samples that have a low copy number of HPV or that are contaminated by normal tissue there is a potential risk of misidentification of the presence of HPV if this observation is not taken into account.
Base Sequence↗
Clinical, anatomic, and echocardiographic characteristics of aneurysms of the mitral valve.
This study describes the clinical, anatomic, echocardiographic, and Doppler features of 13 patients with mitral valve aneurysms. Eleven patients had definitive criteria for infective endocarditis. Transesophageal echocardiography was superior to conventional echocardiography in detecting and assessing aneurysms. Patients with heart failure required surgery. Echocardiographic detection of this lesion should not be, by itself, an immediate surgical indication.
Adult↗
Clinical course, microbiologic profile, and diagnosis of periannular complications in prosthetic valve endocarditis.
Whether periannular extension of prosthetic valve endocarditis (abscesses, pseudoaneurysms, fistulas) is related to the etiologic agent, the clinical course and the prognosis is still unknown. Likewise, transesophageal echocardiographic accuracy in detecting periannular complications in prosthetic recipients remains unsettled. We retrospectively analyzed data from 87 patients with anatomically proven prosthetic valve endocarditis who underwent a transesophageal echocardiographic examination. Periannular complications (30 abscesses, 18 pseudoaneurysms, 8 fistulas; 8 with >1) were found in 46 patients; results were compared with the remaining 41 without complications. Transesophageal echocardiography correctly identified 27 abscesses (90%) and all pseudoaneurysms and fistulas. One diagnosis of pseudoaneurysm by echocardiography was not found at surgery. No statistical differences were found regarding age, sex, type of prosthesis (mechanical vs biologic), and etiologic agent. Periannular complications were more frequent in aortic location (70% vs 20% in mitral position; p <0.001) and in early (within 6 months after surgery) endocarditis (63% vs 38% in late endocarditis; p = 0.04). The same percentage of patients from both groups underwent surgery (98% with and 90% without complications). At discharge, 62% and 67% of patients were alive, respectively. Thus, periannular complications in prosthetic valve endocarditis are more frequent in aortic location and within 6 months after surgery. Neither the type of prosthesis nor the etiologic agent are related to the presence of periannular complications. Short-term prognosis in patients who underwent surgery is not affected by the presence of periannular complications.
Abscess↗
Microscopic polyangiitis. A systemic vasculitis with a positive P-ANCA.
A young girl presented with a purpuric rash on lower limbs, fever, eosinophilia, peripheral neuropathy and progressive renal insufficiency. She developed vesicles, purpuric macules and papules on the head, several nodules on the palmar sides of hands and fingers, splinter haemorrhages, and a disfiguring, facial oedema. A renal biopsy specimen disclosed a focal and segmental necrotizing glomerulonephritis with crescents. Peripheral ANCA with antimyeloperoxidase specificity [P-ANCA (MPO)] was positive and cytoplasmic ANCA with PR3 specificity was negative. Treatment with prednisone and cyclophosphamide was started with a good clinical response, stabilization of renal insufficiency and disappearance of P-ANCA (MPO). Our case fulfils the diagnostic criteria for microscopic polyangiitis (microscopic polyarteritis, MPA), namely a segmental necrotizing and crescentic glomerulonephritis associated with extrarenal vasculitis involving small-sized vessels, without granulomas or asthma. This is a rare disease, which has a poor prognosis in the absence of aggressive therapy, and is infrequently reported in dermatological journals.
Adolescent↗
Usefulness of transesophageal echocardiography for diagnosis of infected transvenous permanent pacemakers.
BACKGROUND: Transesophageal echocardiography is superior to transthoracic echocardiography in detecting left-sided valvular vegetations. There are no data on the value of transesophageal echocardiography in the diagnosis of infected transvenous permanent pacemakers. METHODS AND RESULTS: Transthoracic and transesophageal echocardiography was performed in 10 patients for whom there was clinical suspicion of infected permanent transvenous pacemakers. Transthoracic echocardiography detected pacemaker lead vegetations in 2 patients, whereas transesophageal echocardiography visualized pacemaker lead vegetations in 7 patients. Surgical confirmation was obtained in 6 of these 7 patients. Most patients had more than one pacemaker electrode in place. Local complications at the generator pocket were present in 6 patients. Staphylococcus was the predominant causative organism. CONCLUSIONS: Transesophageal echocardiography is superior to transthoracic echocardiography in the detection of pacemaker lead vegetations.
Aged↗