[Pleurisy caused by Mycobacterium flavescens].
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Biomedical subjects
Publications and source records attributed to J Lacasa.
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The clinical case of a female patient suffering a benign retrosternal goitre which first appeared as a superior vena cava syndrome, is presented. After confirming the diagnosis with an intrathoracic CT scan, a subtotal bilateral thyroidectomy was performed resulting in a complete remission of the clinical picture. A literature review is performed commenting on some clinical, diagnostic and therapeutical aspects.
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A case is described of cholecystocolonic fistula with colonic obstruction by a gallstone, an infrequent form of presentation of the bilioenteric fistulas. We briefly review the etiopathogenesis, symptomatology, diagnosis and therapy of this condition.
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After the evaluation of 129 serum samples of persons who had ingested boar sausage infested by Trichinella spiralis, 48 individuals (40 adults and 8 children) with a mean age of 38.8 years were diagnosed of trichinosis. The incubation time was 17 days (range 2 to 44 days). The following clinical features were outstanding: facial and eyelid edema (50%), diffuse limb myalgia (43%), fever (37%), conjunctivitis (25%), headache (16%), and abdominal pain (16%). Remarkably, 33% of the diagnosed patients were asymptomatic. The diagnosis was made by an indirect immunofluorescence technique (IIF), which was considered as positive when the titer was higher than 1/20 after considering seroconversion at the beginning of the disease and after 4-6 weeks. Among laboratory abnormalities there was leukocytosis in 15 patients and eosinophilia in 37. The GOT, GPT and CPK enzymes were only slightly increased in a small proportion of patients (8, 10, and 31%, respectively). Forty patients were treated with thiabendazole, associated or not to corticosteroids, which was well tolerated. Eight patients were not treated. One year after the diagnosis a new laboratory control was undertaken in 43 patients (all asymptomatic). Eosinophilia was still present in 12, and the titers against Trichinella were high in all. However, the percentage of the titer was smaller than at the beginning of the outbreak.
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We analyze retrospectively all bacteremic episodes seen between January and December, 1987 in our institution. From a total number of blood cultures performed of 897, 145 were positive (16%), and 67 of them considered as contamination (7.5%). There were 78 episodes of bacteremia in 74 patients, 38 males and 36 females. Forty-eight episodes were community-acquired and 30 were nosocomial bacteremia episodes. Aerobic bacteria were isolated in 64 cases, anaerobic bacteria in 9 cases and polymicrobial bacteremia in 5 cases. The most commonly isolated microorganism was S. epidermidis in nosocomial cases and E. coli in community-acquired cases. Predisposing conditions registered were diabetes mellitus in 16 cases (20%), cirrhosis of the liver in 3 (4%), corticosteroid therapy in 7 (9%) and surgical procedures in 19 (24%). Shock was seen in 16 cases (20%), DIC in 8 cases (10%) and ARDS in 5 (6.5%). Appropriate antibiotic treatment was used in 60 episodes (77%). Seventeen patients (22%) died. Prognostic factors identified were: nosocomial bacteremia (p less than 0.05), corticosteroid prior therapy (p less than 0.05), underlying disease UF or RF (p less than 0.0001) and the presence of shock (p less than 0.0001). Mean hospital stay was 20.1 days in bacteremic patients vs. 7.6 days in non bacteremic patients (p less than 0.00001).
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