[Varicella pneumonia in adults: study of 17 cases].
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Biomedical subjects
Publications and source records attributed to F García Martín.
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Pneumococcal disease is a major cause of morbidity, hospitalization and mortality. Two age groups show a greater incidence and severity of the disease: children under the age of 5 years (mainly during the first 2 years of life) and adults aged more than 65 years. The heptavalent pneumococcal conjugate vaccine, which was commercialized in Spain in June 2001, is efficacious in children aged less than 2 years and, unlike the non-conjugate 23-valent vaccine, it induces immunological memory. In Spain the heptavalent vaccine covers 80 % of serotypes causing pneumococcal invasive disease and acute otitis media in children aged 2-59 months. The heptavalent vaccine has been shown to be immunogenic, efficacious and safe. It has proven efficacy in the prevention of invasive disease caused by the seven vaccine serotypes. In addition, it significantly decreases pneumonia and also prevent acute otitis media. The vaccine is preferably indicated in children aged less than 2 years; children aged 2-5 years may also benefit from the vaccine but those in risk groups should be prioritized. Greater knowledge of the epidemiology of pneumococcal disease and the efficiency of this vaccine in Spain will determine whether it should be included in the immunization schedule.
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We studied 6 families with autosomal dominant polycystic kidney disease (ADPKD), to compare patients with normal renal function and healthy family members. From 38 subjects, 20 were carried of the genetic abnormality associated to the disease (however, in 4 renal cysts were absent) and 18 were healthy relatives. We did not found any difference between the two groups in respect to clinical manifestations, physical examination or blood chemistry and renal function tests studied, except an increase of phosphaturia in ADPKD patients. However, an increase in kidney size in ADPKD was noted, more evident in hypertensive patients. The blood pressure was correlated with kidney size in patients with ADPKD, but not in healthy relatives. We conclude that in early stages of the disease, patients with ADPKD do not have clinical or analytical abnormalities although they have an increase in kidney size. Genetic studies have great value to detect patients in early stages of the disease.
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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.
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.
The results of an epidemiological survey in Spain organized by the "Spanish Pediatric Association" of children born to HIV+ mothers from 1981-1989 are presented. The objectives were, a) to document in the different parts of Spain the number of HIV+ children born to HIV+ mothers, and b) to identify the risk factors involved in the HIV infection. Only in public hospitals, a total of 1938 HIV+ children born to HIV+ mothers were identified. A systematic yearly increase of HIV+ newborns was evident since 1985. Madrid, Catalonia, Valencia, Basq and Andalucia communities incorporated 85% of all cases. 93% of mothers were IVDU and 51% of them were married. Prematurity occurred in 27% of cases and low birth weight in 33% of NB's. The rate of transmission in children over 18 months of age was 25.6% Breast feeding could be a risk factor in the transmission of HIV infection observed in children over 18 months of age. No other maternal risk factors responsible for the HIV transmission were identified. 12% of children died with AIDS. Clinical classification and evolution of HIV infection did not significantly differ from similar studies in other parts of the world. In spite of only public hospitals being involved, Spain has more identified HIV+ children than Italy, Switzerland, Federal Republic of Germany, United Kingdom, Sweden and Belgium combined. The pediatric centres with large number of cases require interdisciplinary pediatric specialized units to cope with the increase demand of medical services, now inadequate and insufficient. To fight drug use and HIV infection in Spain, health education and family support, are indispensable in trying to arrest the continuous spread the HIV infection.
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Treatment of anemia with human recombinant erythropoietin (EPO-R) and its effect on bone marrow was studied in 10 anemic patients on periodic hemodialysis (HD). Blood transfusion was not required once treatment started. Hemoglobin (Hb) levels normalized at six months in all patients (7.2 +/- 0.2 vs 12.4 +/- 3 g/dl, p less than 0.01). Serum ferritin levels decreased progressively as Hb increased (r = -0.5609), and six patients needed iron supplement since the third month. Bone marrow iron deposits decreased significantly (p less than 0.001), together with an increase of cellularity and improvement of erythrodysplasia. EPO-R was associated with worsening hypertension in previously hypertensive patients, although it could be controlled with more aggressive treatment. Thrombotic events either systemic or at the vascular access, were not observed. EPO-R corrects the anemia in uremic patients undergoing HD. Iron stores and blood pressure in hypertensive patients on treatment with EPO-R must be monitored regularly.
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The Growth Hormone Releasing Hormone (GH-RH) constitutes the most potent and specific stimulus for Growth Hormone secretion. Nevertheless, in some pathologic situations a Prolactin (PRL) response to GH-RH stimulus is also observed. In order to evaluate the possible effect of GH-RH over seric levels of PRL in uremic patients we carried out a study in a group of ten male patients on hemodialysis (HD), who were given an acute stimulus of GH-RH (an IV 50 mcg. bolus) immediately before and after the HD session, with blood extractions at times -15, 0, 15, 30, 45, 60, and 90 minutes for PRL determinations. The same procedure was carried out in 8 healthy controls. Basal PRL levels in the HD group (14 +/- 3.2 micrograms/L) were significantly greater (p less than 0.01) than control group (3.8 +/- 1.4 micrograms/L). There was no PRL response to GH-RH either in uremic patients before or after HD or in healthy controls. Our results show that there is a significant increase in PRL levels in uremic patients both before and after dialysis with a GH-RH response comparable to healthy subjects.
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A circulating lupus anticoagulant factor was detected in a 38-year-old man with end-stage renal disease and a 'lupus-like' syndrome with a diffuse proliferative glomerulonephritis. When treated with steroids, the 'lupus' complications were controlled and the anticoagulant factor disappeared; however, renal function did not recover and the patient commenced regular haemodialysis. Four months later the patient received a cadaver kidney transplant. At transplantation and during follow-up there was neither clinical nor laboratory evidence of lupus activity, but 19 months after transplantation, when steroids were tapered to a low dose, the lupus anticoagulant factor was detected, and renal-vein thrombosis complicated by sepsis led to the patient's death. A membranous glomerulonephritis was found on autopsy. This is the first time in which a (probably 'de novo') membranous glomerulonephritis has been detected in the allograft of a patient with circulating lupus anticoagulant factor.
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