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Showing papers by "Hospital General Universitario Gregorio Marañón published in 1990"


Journal ArticleDOI
TL;DR: In patients with suspected catheter-related infections but negative superficial cultures, the possibility of infection may reasonably be ruled out, thereby avoiding many unnecessary catheter withdrawals.
Abstract: A prospective study was done in 139 intravascular catheters (IVCs) that had been removed for different reasons. The purpose of the study was to compare laboratory procedures for the diagnosis of catheter-related infections and also to attempt to clarify the present controversy regarding the portal of entry of such infections. The IVCs were removed by one of us and multiple samples were studied according to a standard procedure. Semi-quantitative cultures were performed of the tips, the interior of the hub, and the skin around the insertion point. Quantitative cultures were performed of the infusion fluid and of the IVC tips. Of the 139 IVCs studied, 53 (38.1%) were infected (greater than or equal to 15 colony-forming units per plate in the semiquantitative culture). Semi-quantitative and quantitative cultures gave comparable results, but the semiquantitative procedure proved to be easier and faster. All but three infected catheters had a positive (greater than or equal to 15 colony-forming units per plate) skin and/or hub culture (superficial cultures), with microorganisms identical to those isolated in the IVC tip. Our results showed two possible and differentiable portals of entry. Thirty (56.6%) had external origin (semiquantitative skin culture positive), 12 (22.6%) had an internal origin (semiquantitative hub culture positive), and 8 (15.1%) had both origins. All catheters with negative superficial cultures had a negative tip. The predictive value of positive superficial cultures in the diagnosis of catheter-related infection was 66.2% and that of negative cultures was 96.7%. In patients with suspected catheter-related infections but negative superficial cultures, the possibility of infection may reasonably be ruled out, thereby avoiding many unnecessary catheter withdrawals.

169 citations


Journal Article
TL;DR: An increase in IL-1 activity was obtained when eosinophils were stimulated with LPS and treated with indomethacine, suggesting that this IL may enhance the proinflammatory action of eos inophils.
Abstract: The presence of IL-1 mRNA in eosinophils from mice infected with larvae of the parasite Mesocestoides corti was investigated by in situ hybridization technique. S35 labeled cDNA probe for alpha IL-1, hybridized with mRNA in murine eosinophils and macrophages. After 6 h of LPS stimulation eosinophils were able to express mRNA in their cytoplasm. This expression was highly increased by the addition of indomethacine. The IL-1 mRNA expression in murine macrophages was higher than in eosinophils in LPS-stimulated cells. This difference was statistically significant, p less than 0.001. To test if eosinophils may produce and release IL-1 in the culture medium, we isolated these cells in a Percoll gradient. Cell preparations with a purity exceeding 94% were cultured with various stimuli and their supernatants were tested for IL-1 activity. Eosinophils produced 169.65 +/- 73 U/ml when stimulated with LPS (n = 14). A dose-dependent response was obtained when the eosinophils were in the presence of the calcium ionophore A23187. Controls were performed to rule out the contribution of the contaminating population on the thymocyte proliferating activity. They were also used to detect other possible causes of interference in the assay, such as leukotrienes or TNF. IL-1 in supernatants was also detected using a conversion assay such as EL-4 thymoma cells. IL-1 activity was first detected in culture supernatants 18 h later, maximal production being in the first 24 h. In accordance with our hybridization results, an increase in IL-1 activity was obtained when eosinophils were stimulated with LPS and treated with indomethacine. The factor had a molecular mass between 16 to 20 kDa that corresponded to the described for murine IL-1. Inasmuch as IL-1 is an important mediator of inflammatory reactions this IL may enhance the proinflammatory action of eosinophils.

65 citations


Journal ArticleDOI
TL;DR: A description is given of a case of complete obstruction of the internal carotid in a patient wearing a lap-shoulder belt, presumed due to direct contusion of the vessel at the C2 level.
Abstract: A description is given of a case of complete obstruction of the internal carotid in a patient wearing a lap-shoulder belt. This was presumed due to direct contusion of the vessel at the C2 level.

25 citations


Journal ArticleDOI
TL;DR: This case demonstrates the possible endovascular complications of salmonella bacteremia in elderly people and that endocarditis should be included among the invasive infections due to ampicillin-resistant Salmonella that could potentially be treated with the newer cephalosporins.
Abstract: A case of ampicillin-resistant salmonella bacteremia complicated by endocarditis in a 78year-old man is presented. Previous rheumatic valvular heart disease and the lack of response to initial treatment with chloramphenicol prompted us to consider this diagnosis. There was a good clinical response after treatment with ceftriaxone alone and corresponding improvement on the echocardiogram. This case demonstrates the possible endovascular complications of salmonella bacteremia in elderly people and that endocarditis should be included among the invasive infections due to ampicillin-resistant Salmonella that could potentially be treated with the newer cephalosporins. An increasing number of infections due to antibioticresistant non-typhi species of Salmonella are being reported in the literature. When such infections are encountered, physicians face a therapeutic challenge, which has prompted the search for alternatives to current therapy. Efflcacy of treatment of systemic infections caused by antibiotic-resistant Salmonella non-typhi species with third-generation cephalosporins has been demonstrated in several clinical studies [1, 2]. However, none of these reports has dealt with cases of endocarditis. We have recently managed a patient who developed endocarditis due to ampicillinresistant Salmonella enteritidis and was successfully treated with a third-generation cephalosporin.

21 citations



Journal ArticleDOI
TL;DR: Results revealed that the activity of phospholipase A increased whereas that of acyl-CoA:lysophosphatidylcholine acyltransferase decreased, and the possible significance of microsomal lipid alterations in the pathogenesis of respiratory distress induced by oleic acid is discussed.

11 citations


Journal Article
TL;DR: It was concluded that antibiotic prophylaxis for renal transplantation was useless in patients with visible hematoma and 3 of 10 with perirenal blood collection had wound infection.
Abstract: The effectiveness of antibiotic prophylaxis was evaluated in the immediate postoperative period of renal transplantation (RT). Before RT, the patients were randomly assigned to one of the following groups: 1) cefotaxime (intravenous infusion of 1 g one hour before the operation). 2) Ceftriaxone (1 g i.v. given in a similar way). 3) Control (without antibiotics). Patients who required antibiotic therapy during the first 3 postoperative weeks were excluded. 20 recipients of cadaveric renal grafts were included in each group. There were 39 males and 21 females with a mean age of 39.9 years. One patient from the cefotaxime group (5%), 2 from the ceftriaxone group (10%) and 2 from the control group (10%) developed infection of the surgical wound, all due to grampositive organisms. 19 patients had urinary tract infections: 7 from the control group (35%), 7 from the cefotaxime group (35%), and 5 from the ceftriaxone group (25%). The development of wound infection was not correlated with urea, creatinine, hemoglobin or total protein levels, or with urinary tract infection or fistula, diabetes or fever. The mean packed red cell volume of the patients who developed wound infection was 24.7 +/- 1.2 vs 28.6 +/- 6.6 in those who did not (p less than 0.01). All patients with visible hematoma and 3 of 10 with perirenal blood collection had wound infection. It was concluded that antibiotic prophylaxis for renal transplantation was useless in our patients.

7 citations


Journal Article
TL;DR: In this article, two brothers developed a slowly progressive paraparesis during adulthood, with very long chain fatty acid (VLCFA) concentrations consistent with severe demyelination of the centrum semiovale.
Abstract: Two brothers developed a slowly progressive paraparesis during adulthood, lately associated in one to primary adrenal and gonadal insufficiency but no electrophysiological evidence of peripheral nerve involvement. Both patients and an asymptomatic sister had increased plasma concentrations of very-long chain fatty acids (VLCFA). A CT-scan of the propositus was initially normal but showed at follow-up diffuse white matter hypodensities consistent with severe demyelination of the centrum semiovale. The appearance of the lesions remained unchanged for the next two years without clinical evidence of supraspinal changes in despite of progression of the paraparesis. We believe that these observations further support a link between the severe infantile variety of adrenoleukodystrophy and the more protracted adult-onset variants. Further, CT-scan in families with spastic paraparesis may be of help in detecting early evidence of an underlying diffuse white matter disorder, eventually supported by more conclusive studies as VLCFA determinations.

4 citations


Journal Article
TL;DR: Two patients with RSDS associated to breast cancer are presented: one case presenting fasciitis and polyarthritis and another case also associated to polymyalgia rheumatica.
Abstract: Reflex sympathetic dystrophy syndrome (RSDS) is a rare entity of unknown etiopathogenesis, associated to different precipitating factors such as malignant tumors of several localizations. A new clinical variety has been recently described which has been denominated palmar fasciitis and polyarthritis syndrome. We present here two patients with RSDS associated to breast cancer: one case presenting fasciitis and polyarthritis and another case also associated to polymyalgia rheumatica. We emphasize the importance of reducing the tumor mass in the treatment of this syndrome, as well as including it in the gammagraphic differential diagnosis of bone metastasis.

3 citations


01 Jan 1990
TL;DR: Histopathologic picture showed granulomatous infiltrates filling the full-thickness of the dermis, with abundant number of multinuclead giant cells foreign-body-type and Langhans- type and mixed inflamatory infiltrate.
Abstract: We report a 39 year old female, who 6 years later of accidental injury with cactus bristles, developed granulomatous lesions in her face with an ulcerative tendency. Histopathologic picture showed granulomatous infiltrates filling the full-thickness of the dermis, with abundant number of multinuclead giant cells foreign-body-type and Langhans-type and mixed inflamatory infiltrate. In the dermo-hipodermal limit, several foreing bodies were found with a thorny or barb shape, some of them into the giant cells, with were PAS positive and showed a brilliant refractile aspect under polaroscopic examination.

3 citations


Journal Article
TL;DR: The case of a 43 year-old male, attending the clinic on a testicle tumour consultation, in which in spite of the previously mentioned circumstances a preoperative diagnosis of trifid Ureter with ipsilateral ureterocele and renal dysplasia was reached owing to the use of C.A.T.
Abstract: Ureteral triplicity is a rare abnormality of which there are less than a hundred cases reported up to date. The possible absence of clinical signs can explain why this malformation passes unnoticed specially when there are blind branches and dysplastic renal segments. The paper presents the case of a 43 year-old male, attending the clinic on a testicle tumour consultation, in which in spite of the previously mentioned circumstances a preoperative diagnosis of trifid ureter with ipsilateral ureterocele and renal dysplasia was reached owing to the use of C.A.T.

Journal Article
TL;DR: It is concluded that after 8 years of follow-up the M-H valve prosthesis shows an excellent clinical performance and mechanical reliability, and the incidence of valve-related complications was in the low range of that reported with other mechanical prostheses.
Abstract: During the period from January to September 1986, 182 Medtronic-Hall (M-H) heart valve prostheses were implanted in 89 patients, mainly because of rheumatic valve disease (68.5%). The patients were divided in two groups. Group I consisted of 83 patients with aortic and mitral valve replacement. Six patients with tricuspid valve replacement plus aortic and/or mitral valve replacement constituted group II. In group I the majority of the patients (86.7%) were in functional class III or IV (NYHA). Twenty three patients had undergone at least one previous cardiac operation. Hospital mortality was 6.02% (5/83). In group II the patients were in functional class III or IV (NYHA). Hospital mortality was 33.3% (2/6). Death occurred in the operating room in only one instance. Follow-up was completed in 98.9% and extended from 27 months to 8 years (348.7 patient years in group I and 23.08 patient years in group II). The overall 5 and 8 years actuarial survival, freedom of thromboembolism and freedom from endocarditis rates in group I were: 80.8 +/- 4.4% and 72.7 +/- 5.2%; 89.8 +/- 4% and 85.8 +/- 4.7%; 94.8 +/- 1.2 and 93.1 +/- 1.7%. In group II, actuarial studies were not carried out because of the scanty number of cases. There were another complications in group I: haemorrhage due to anticoagulation in 6 cases, hemolysis in 8 instances and periprosthetic leaks in 2 cases. There were no cases of structural failure. We conclude that after 8 years of follow-up the M-H valve prosthesis shows an excellent clinical performance and mechanical reliability, and the incidence of valve-related complications was in the low range of that reported with other mechanical prostheses.

Journal Article
TL;DR: Three new cases of diffuse pulmonary lymphangioleiomyomatosis are presented, including a female patient who presented repeated pneumotorax and dyspnea without evidence by CT scan and gynecological ultrasound of extrathoracic lesions, associated to undifferentiated breast carcinoma.
Abstract: Three new cases of diffuse pulmonary lymphangioleiomyomatosis are presented. Case number 1 is a female patient who presented repeated pneumotorax and dyspnea without evidence by CT scan and gynecological ultrasound of extrathoracic lesions. This patient did not respond to medroxiprogesterone and died 5 years after the initial diagnosis having suffered chronic, severe, global respiratory failure for 4 years. Case number 2 is a female patient who presented dyspnea, chyloptysis and chylothorax, with iliac, paraaortic and mediastinic lymphangioleiomyomas. The last time she was seen, she was still alive after 6 years without treatment. Case number 3 presented lymphangioleiomyomatosis associated to undifferentiated breast carcinoma. The evolution was apparently slow probably because it was diagnosed 14 years after menopause, and died due to a relapse of the neoplasia. All three patients had radiographic images and respiratory functional studies characteristic of this disease and diagnosis was confirmed by biopsy. The literature is reviewed.