Impact of nosocomial pneumonia on the outcome of mechanically-ventilated patients.

: BACKGROUND: Nosocomial pneumonia (NP) is a common complication in mechanically-ventilated patients and is considered to be one of the most common causes of morbidity and mortality. However, assessment of the associated mortality is not staightforward as it shares several risk factors with NP that confound the relationship. The aim of this study was to evaluate the impact of NP on the mortality rate in an intensive care unit.

[Reiter syndrome: atypical complication of treatment with BCG].

Objective: To report a case of Reiter's syndrome, an uncommon complication after intravesical BCG therapy. The etiology, clinical features, diagnostic difficulties and treatment of this condition are discussed.

Methods/results: A 56-year-old patient with superficial bladder carcinoma developed conjunctivitis, urethritis and arthritis of the right knee and wrist after the fourth BCG instillation.

Oral iron cutaneous adverse reaction and successful desensitization.

Background: The oral administering of iron preparations sometimes produces adverse gastrointestinal effects. In contrast, cutaneous reactions are extremely rare.

Objective: We report a patient with several episodes of generalized pruritus and erythematous maculopapular eruption after receiving oral compounds of iron and on whom desensitization with oral iron was attempted.

[Epileptic crisis and multiple sclerosis: anatomo-clinical correlation].

Introduction: The prevalence of epilepsy in multiple sclerosis (MS) is low and the occurrence of an epileptic seizure as a first sign of this illness is even more infrequent. The relationship between both these illnesses is not clear; as epilepsy is a common condition, a coincidental association only could exist between the two diseases.

Objective: To establish a nexus of causality between epilepsy an MS.

Role of different routes of tracheal colonization in the development of pneumonia in patients receiving mechanical ventilation.

Study Objective: To evaluate the importance of the different pathogenic pathways involved in the development of ventilator-associated pneumonia (VAP).

Design: Prospective study.

Setting: An 18-bed medical and surgical ICU.

[Acute cerebral ischemia in patients under 45 years of age: a study in a series of 68 patients].

Objective: To study acute cerebrovascular ischemia in young persons in our environment.

Patients And Methods: A retrospective study was made of 68 patients, aged between 15 and 45, with transient ischemic accidents (TIA) or cerebral infarcts. Etiological factors, clinical features, diagnostic groups according to the TOAST classification and prognosis were analyzed.

[Blue nevus of the prostate. Differential diagnosis of prostatic pigmented lesions].

Objective: To describe a case of blue nevus of the prostate and propose a more precise terminology in order to avoid the confusion arising from the presence of melanin pigment in the prostatic epithelium and/or stroma.

Methods/results: A 58-year-old patient with adult polycystic kidney is described. The patient demonstrated clinical and radiological findings compatible with benign prostatic hyperplasia and had a PSA of 11.

[Nephrogenic adenoma in intestinal mucosa. A case in urethro-sigmoid anastomosis].

Objective: To describe a case of nephrogenic adenoma occurring in the intestinal mucosa of the neobladder urethro-sigmoid anastomosis in a patient who had undergone cystectomy for a bladder carcinoma.

Methods/results: Of 14 cases of nephrogenic adenoma in 11 patients, one involved the lamina propria of large bowel mucosa. A 67-year-old patient submitted to radical cystoprostatectomy and orthotopic bladder substitution using a detubulized sigmoid neobladder due to multicentric G3 pTa, pTis urothelial bladder carcinoma had two episodes of stricture of the distal anastomosis.

[Metanephric renal adenoma].

Objective: To describe a case of metanephric adenoma, a rare and little known tumor with no potential to malignancy. This tumor type can occasionally coexist with Wilms' tumor, with which it is histogenically related.

Methods/results: A 54-year-old female patient was referred to the Urology Service for a small mass in the left kidney that had been incidentally detected during an ultrasound evaluation.

[Sclerosing adenosis of the prostate].

Objectives: To describe the anatomoclinical characteristics of 4 cases of sclerosing adenosis of the prostate in order to determine the diagnostic features and clinical significance of this disease entity, which histologically mimicks adenocarcinoma of the prostate.

Methods: Specimens from our Pathological Anatomy Service obtained by transurethral resection (TUR) and prostatic adenomectomy, with a clinical diagnosis of a benign pathology, were reviewed. Three cases with a histological diagnosis of sclerosing adenosis of the prostate were found over the last 10 years.

Treatment of chronic iliac artery occlusions with guide wire recanalization and primary stent placement.

Purpose: To evaluate the results of primary stent placement without initial thrombolysis in the treatment of iliac occlusions.

Materials And Methods: During a 3-year period, 61 iliac artery occlusions were treated in 59 patients. The mean length of the occluded segment was 10 cm (range, 4-25 cm).

Experience with the use of polytetrafluoroethylene pericardial membrane (preclude pericardial membrane) for retroperitoneal closure after abdominal aortic surgery.

Objective: The purpose of the present publication is to assess the outcome after closure of the retroperitoneum with a patch of polytetrafluorethylene surgical membrane (Preclude Pericardial Membrane. PPM) after abdominal aortic surgery.

Experimental Design: Retrospective review of 7 operated patients with a patch of PPM covering their abdominal aortic synthetic graft.

Surgical indications for treatment of pulmonary tuberculosis.

Surgery for pulmonary tuberculosis (PTB) has passed through various stages throughout history, having been the treatment of choice in the past. It has now been relegated to second place for treatment of this disease. One of the most strongly debated surgical indications has been clinical picture of multidrug resistance with the focus of pulmonary tuberculous activity located in a segment, lobe, or lung.

[Wallstent endoprostheses implanted by fluoroscopic guidance in the palliative treatment of malignant esophageal obstructions and esophago-tracheal fistulas].

Purpose: The objective of this study was to present our experience with metallic stents (Wallstent) for palliation of dysphagia due to malignant esophageal obstruction and esophagotracheal fistula.

Patients And Methods: From August 1994 to July 1996 20 uncovered and 6 covered stents were inserted in 16 consecutive patients with dysphagia grade 3 (n = 4) or grade 4 (n = 12) caused by incurable malignant obstructions. The obstruction was in the proximal (n = 4), in the middle (n = 3) and the distal (n = 9) third of the esophagus.

Cragg Endopro System I: early experience. I. Femoral arteries.

Purpose: This work describes the early experience with the Cragg Endopro System I. The safety and efficacy of this device in the treatment of atherosclerotic lesions of the femoral arteries are evaluated.

Materials And Methods: Eleven patients with complex femoral artery lesions were treated.

Surgical treatment of primary spontaneous pneumothorax with video-assisted thoracic surgery.

We report the results of our experience using video-assisted thoracoscopic surgery (VATS) to treat primary spontaneous pneumothorax (PSP) from January 1992 until December 1994 in a multicentered co-operative study. A total of 132 patients (110 males and 22 females, aged 13-38 yrs, mean age 26 yrs) were treated by VATS to deal with the PSP that they presented with. A standard VATS technique was used.

Transjugular liver biopsy: a review of 77 biopsies using a spring-propelled cutting needle (biopsy gun).

Seventy-seven transjugular liver biopsies were performed with a coaxial, spring-loaded, 18-gauge cutting needle, the Biopty gun (Bard Biopsy System, Covington, GA, USA) on consecutive patients between July 1993 and February 1995. Fifty men and 27 women were included in the study; the mean age was 45 years (range 15-69 years). The average number of punctures per patient was 5.

Evaluation of a directly observed six months fully intermittent treatment regimen for tuberculosis in patients suspected of poor compliance.

Background: Although a priority for tuberculosis control is to achieve the maximum cure rate, compliance with chemotherapy in specific high risk groups (homeless, intravenous drug abusers, chronic alcoholics) is usually poor.

Methods: From January 1990 to December 1994 102 patients with tuberculosis (96 pulmonary, six extrapulmonary) who were poorly compliant with treatment were treated with a six month fully intermittent (twice weekly) directly observed regimen. They comprised 71 homeless subjects, 50 chronic alcoholics, 23 intravenous drug abusers, nine infected with HIV, and 11 who had previously abandoned a daily antituberculosis regimen; 53 had more than one of these risk factors.

[Is there a place for radical prostatectomy without lymphadenectomy?].

Objectives: Herein we present the procedure we have followed to determine N+ low-risk factors which allow us to identify those patients with prostate cancer in whom radical perineal prostatectomy (RPP) can be performed without a previous staging lymphadenectomy, thereby maintaining the oncological principles but with less morbidity.

Methods: In a series of 88 patients who underwent RPP, we identified an N+ low-risk factor group; i.e.

[Listeriosis in the nonpregnant adult during an epidemic outbreak on Grand Canary].

Twenty-two cases of community-acquired epidemic listeriosis were recorded from December 31st, 1991, to May 15th, 1993, at the Nuestra Señora del Pino Hospital, Las Palmas. The incidence during this outbreak was 31 times higher than the corresponding incidence in the last few years. Twelve cases occurred in pregnant women and/or neonates and ten in non-pregnant adult individuals.

Transbronchial fine needle aspiration in clinical practice.

We review our experience of transbronchial fine needle aspiration (TBFNA) over a 3-year period. A total of 112 TBFNAs were performed on 95 patients. Four aspirates were from peripheral lung lesions, 20 from non-ulcerated submucosal infiltrative lesions, 19 from mediastinal abnormalities close to the tracheobronchial tree, and the remaining 69 were for staging of bronchogenic carcinoma with apparent mediastinal lymph node spread, evaluated by chest computed tomography (CT).

Clinical and immune aspects of idiopathic acute tubulointerstitial nephritis and uveitis syndrome.

Five patients with idiopathic interstitial nephritis and uveitis without bone marrow granulomas were followed-up for 1 year. Ophthalmological examination revealed bilateral anterior uveitis. Light microscopy of the renal tissue revealed predominant lymphocyte infiltration of the interstitium.