Usefulness of microscopic examination of intracellular organisms in lavage fluid in ventilator-associated pneumonia.

Study Objective: To assess the usefulness of quantification of bronchoalveolar lavage (BAL) cells containing intracellular organisms (ICO) in the diagnosis of ventilator-associated pneumonia.

Design: The reliability of cytologic analysis in comparison with the protected specimen brush (PSB) and BAL quantitative cultures has been assessed in a prospective study.

Setting: An intensive care unit of a tertiary-referral teaching hospital.

The axio-somatic model in embryonic and tumoral development.

The growth and evolution of human tissues observed in embryogenesis and neoplasia are both reduced to a cellular theoretical axio-somatic model. The unlimited expansion and phenotype change of the model, are assured by the continuous generation of new cellular mitotic phenotypes which are grafted in a sequential order. Neogeneration results from the interaction between two cells of specific origins and situations: (a) axial cells of actual germ cell origin, generators and vectors of mitotic potential, (b) mitotically exhausted somatic cells of distal phenotypes, involved in meiotic recombinations, generating potential of neodifferentiation.

Extended cervical mediastinoscopy: prospective study of fifty cases.

To assess the usefulness of extended cervical mediastinoscopy (ECM) in the staging of bronchogenic carcinoma, an ECM was performed prospectively in 50 patients with bronchogenic carcinoma of the left lung. The ECM was used after evaluation of disease operability and computed tomographic findings, and was performed simultaneously with standard cervical mediastinoscopy. In ECM, using the same cervical incision as in a standard cervical mediastinoscopy, dissection is performed behind the anterior face of the sternum.

[Paroxysmal dystonia as the first manifestation of multiple sclerosis].

We discuss the case of a patient with episodes of left unilateral paroxysmal dystonia as first manifestation of multiple sclerosis, secondary to a demyelinization lesion in posterior arm of right internal capsule, detected by nuclear magnetic resonance (NMR). These episodes diminished with carbamazepine at low doses.

Comparative efficacy of bronchoalveolar lavage and telescoping plugged catheter in the diagnosis of pneumonia in mechanically ventilated patients.

The relative efficacy of telescoping plugged catheter (TPC) and bronchoalveolar lavage (BAL) in the diagnosis of pneumonia in mechanically ventilated patients has been compared in 45 subjects suspected of having pneumonia because of the presence of clinical and radiographic criteria. Diagnosis of pneumonia was strongly suggested in 25 of the 45 patients, and definitely confirmed in 10 of them. The diagnostic threshold to assess a quantitative bacterial culture as positive was a growth on BAL of > or = 10(5) cfu/ml and on TPC of > or = 10(3) cfu/ml.

[Lateral isolated neurofibroma of the neck].

The neurofibroma (NF) of the neck is a neurogenic tumor seldom presented. Sometimes solitary, as the case reported, or within the context of von Recklinghausen's disease. When diagnosis is doubtful either the TAC, the RMN of the PAAF show its usefulness.

Experimental tracheal revascularization with omentum.

We assessed omental revascularization of heterotopic tracheal implants in rats, and investigated the influence of factors that can enhance revascularization. The trachea of the donor animal was excised in two parts, and each tracheal allograft was implanted in the omentum of two recipients. The influence of mechanical factors was evaluated by applying traction at both ends of the graft with and without drainage of the tracheal lumen, and the influence of pharmacologic factors by giving cefonicid, hydrocortisone, cefonicid plus hydrocortisone, or cyclosporine and azathioprine during the postoperative period.

Squid hypersensitivity: a clinical and immunologic study.

Hypersensitivity to mollusk has rarely been described in the literature. Among the mollusks, the cephalopods are a group of great importance as a food source. We report seven patients who had had symptoms highly suggestive of IgE-mediated reactions after ingesting squid or inhaling vapors from cooking squid.

[Epidemiology of respiratory syncytial virus infections in the Canary Islands].

Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in young children. Outbreaks of RSV infection occur yearly during the winter or spring in temperate climates. Our study of 634 hospitalized children under 3 years of age with bronchiolitis and pneumonia (November 1988 to January 1990) revealed that 227 (35.

[Simultaneous coronary and carotid surgeries].

Two patients with severe coronary artery disease and significant stenosis of the left internal carotid artery were operated upon. A combined or simultaneous operation was performed in both, carotid endarterectomy plus coronary artery bypass surgery was performed. The patients are symptoms-free after the operation and with evidence of satisfactory reconstruction in the carotid and coronary arteries.

Effect of recombinant human erythropoietin treatment on hemodynamic parameters in continuous ambulatory peritoneal dialysis and hemodialysis patients.

We studied the hemodynamic changes and the incidence of hypertension after correction of anemia with recombinant human erythropoietin (rhEPO) in 25 hemodialysis (HD) and in 27 continuous ambulatory peritoneal dialysis (CAPD) patients with a mean age of 44.6 years and a mean time on dialysis of 43.6 months.

Peritoneal dialysis efficiency in CAPD patients in treatment with rHuEPO.

Possible modifications in peritoneal behaviour that can be caused by erythropoietin (EPO) treatment and/or correction of anemia in the ultrafiltration and peritoneal diffusion were studied in 24 CAPD patients. The evolution of the patients on the medium run was also studied. The dialysate to plasma ratio, the peritoneal clearance and the mass transfer coefficient of urea and creatinine and the ultrafiltration volume were studied, baseline, after reaching the hemoglobin target, and after eight months of treatment.

Low turnover bone disease is the more common form of bone disease in CAPD patients.

CAPD is considered a risk factor for low turnover bone disease. This was previously attributed to aluminum accumulation. We evaluated by biochemical and histomorphometric parameters (including double tetracycline labelling), 26 patients maintained on CAPD for 12-14 months.

Allergy to limpet.

Allergy to mollusk has rarely been described. The limpet, belonging to Phylum mollusca, is one of the most frequent mollusks in the Canary Islands, as in all warm maritime regions. We report two cases of atopic patients who developed anaphylactic reactions after ingestion of this mollusk.

Effect of cigarette smoking on the humoral immune response in pigeon fanciers.

Tobacco smoking is associated with increased prevalence of various diseases. In this study, we have used an indirect enzyme-linked immunosorbent assay (ELISA) to investigate the specific IgG response to pigeon serum and its relationship to tobacco smoking. In a large group of pigeon fanciers the development of pigeon breeder's disease and some of the clinical features were also investigated.

[The hematological manifestations in 111 patients with systemic lupus erythematosus].

Hematologic alterations are frequent in SLE. The hematologic changes of 111 patients diagnosed as suffering from SLE are described, associating them to 89 clinical, biological and hystological variables. The most frequent alteration was normocytic and normochromic anemia.

Reliability of the bronchoscopic protected catheter brush in the diagnosis of pneumonia in mechanically ventilated patients.

Objective: To assess the usefulness of the telescoping plugged catheter in the diagnosis of nosocomial pneumonia.

Design: Prospective study.

Patients: A total of 103 ventilated patients with suspected pneumonia were prospectively studied over 20 months.

[The usefulness of the double-light telescopic catheter in the diagnosis of bacterial pneumonia in patients under mechanical ventilation].

Fifty-eight patients who presented clinical criteria of pneumonia (fever, leukocytosis, purulent tracheo-bronchial secretions, and lung infiltrate of recent appearance in X-ray) were prospectively studied in order to determine the cost effectiveness [correction of rentability] of quantitative culture of bronchial secretions by means of a telescopic catheter (TC) in the diagnosis of bacterial pneumonia in patients under mechanical ventilation. In 25 patients (43%) a positive culture was obtained above 10(3) UFC/ml, confirming the pneumonia diagnosis in 17 cases and detecting a false positive result in one patient. In no case with a count less than 10(3) UFC/ml pneumonia diagnosis could be confirmed, being this diagnosis excluded in 24 of 33 patients with a count lower than 10(3) UFC/ml.

Endobronchial actinomycosis associated with a foreign body.

We describe our findings in a 58-year-old mentally retarded patient with endobronchial actinomycosis surrounding an aspirated chicken bone foreign body. To our knowledge, this is the first report of such an occurrence.

[Needle biopsy of pancreatic masses].

We report the results of 66 ultrasound or CT guided needle aspirations in 59 patients with pancreatic masses, from 1983 to 1987. Cytologic and histologic samples were obtained in 45 cases. Histologic samples, formed by minute tissue fragments, were paraffin embedded for standard sections (minibiopsy).

[Bronchoalveolar lavage in patients surgically treated with extracorporeal surgery].

Nineteen selected patients were operated of coronary artery bypass surgery or aortic valvular replacement. In this cohort a bronchoalveolar lavage was performed before and after cardiopulmonary bypass. A rise in the polimorphonuclear neutrophils count was found in the post-bypass lavage group.