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Resumen El proposito de este trabajo es determinar como influye la ingesta de bebidas de reposicion, tanto en reposo como durante la actividad fisica (en cicloergometro), sobre el ritmo de VG a un consumo maximo de oxigeno (VO 2max ) del 70%. Material y metodo 26 ciclistas bien entrenados realizaron una prueba de esfuerzo previa hasta el agotamiento para determinar su VO 2max , y dos pruebas de esfuerzo submaximales al 70 % del VO 2mx , separando cada prueba por una semana. Durante las dos pruebas submaximales, los ciclistas consumieron 200 ml de bebida de reposicion (A o B) marcada con 99m Tc-DTPA y se realizaron adquisiciones gammagraficas gastricas en reposo; posteriormente iniciaron el ejercicio durante 60 minutos a un ritmo de ingesta de 200 ml cada 15 minutos con adquisiciones gammagraficas seriadas. La diferencia en cuanto a composicion quimica entre bebida A y bebida B radica en que la bebida A contiene menor carga en carbohidratos (10,3 gr/100 ml, frente a 15,2 gr/100 ml de la B), proteinas en forma de suero de leche y antioxidantes en forma de zumo de frutas; ambas contienen iones y vitaminas. Resultados durante el reposo, el numero de cuentas gastricas disminuyo significativamente desde el minuto 0 al 25, tanto para la bebida A como para la B (p Conclusiones La bebida A, bebida de reposicion en el mercado con contenido proteico y antioxidantes en forma de zumos de frutas, vacia mas rapido que la bebida B.

Antecedentes: Los estudios epidemiológicos sobre la otitis media aguda (OMA) son muy escasos y en España no existe ninguno de tipo prospectivo Objetivos: Describir la incidencia de la OMA durante el primer año de vida y sus factores de riesgo, con especial atención a la contaminación ambiental Métodos: Estudio de una cohorte prospectiva de 229 recién nacidos durante el primer año de vida estratificados por zonas de contaminación, seguidos por sus pediatras en el centro de salud. La OMA de definió clínicamente. Se aplicó un cuestionario con los factores de riesgo/protectores, incluyendo sexo, hermanos mayores, hábito de fumar, lactancia materna, nivel socioeconómico, nivel de estudios y situación laboral de la madre Resultados: La incidencia de episodios de OMA durante el primer año fue del 45 % y la proporción de niños con al menos un episodio fue del 32 %. Los factores de riesgo independientes fueron el sexo varón (odds ratio ajustada [ORa], 2,03; intervalo de confianza del 95 % [IC 95 %], 1,09–3,7) y vivir en una zona contaminada (ORa, 2,01; IC 95 %, 1,05–3,84). Fueron factores protectores independientes nacer en primavera (ORa, 0,41; IC 95 %, 0,19–0,88) y que la madre tuviera al menos estudios primarios (ORa, 0,53; IC 95 %, 0,24–1,15). Los marcadores socioeconómicos indicaron un menor nivel medio entre las familias cuyos niños tuvieron al menos un episodio de OMA Conclusiones: La contaminación ambiental y el bajo nivel socioeconómico son factores de riesgo de OMA mayores que tener hermanos o que los padres fumen. Un nivel cultural mínimo reduce el riesgo de OMA. Es posible disminuir en parte la incidencia de OMA actuando sobre algunos factores ambientales : Background: Epidemiological studies of acute otitis media (AOM) are scarce and no prospective studies have been performed in Spain Objectives: To describe the incidence of AOM in the first year of life and its associated risk factors, with special focus on air pollution Methods: We performed a prospective cohort study of 229 newborn infants during the first year of life stratified by pollution zones, and followed-up by their pediatricians in their health center. AOM was defined on clinical grounds. A questionnaire on risk/protective factors included items on the following: sex, older siblings, smoking, breastfeeding, socioeconomic status, parental education and the mother's occupational status Results: The incidence of AOM episodes during the first year of life was 45 % and the proportion of children who experienced at least one episode was 32 %. Independent risk factors were male gender (aOR: 2.03; 95 % CI: 1.09–3.7) and living in a polluted area (aOR: 2.01; 95 % CI: 1.05–3.84). Independent protective factors were being born in spring (aOR: 0.41; 95 % CI: 0.19–0.88) and having a mother with at least primary school education (aOR: 0,53; 95 % CI: 0.24–1.15). Socioeconomic markers indicated a lower mean level among families whose children had at least one AOM episode Conclusions: Air pollution and low socioeconomic status are greater risk factors for AOM than having siblings or parents who smoke. A minimum educational level reduces the risk of AOM. The incidence of AOM could be reduced by modifying certain environmental factors

Resumen Objetivo Valorar la incidencia de complicaciones urologicas (fistula y estenosis) en nuestra serie de trasplante renal, analizar las variables que pueden influir en su aparicion y los tratamientos aplicados. Asimismo valorar los resultados en cuanto a la supervivencia del organo y del paciente Material y metodos Se estudian 250 trasplantes renales realizados en el periodo comprendido entre julio de 1985 y octubre de 1998. La relacion entre las variables se efectuo mediante el test χ2 de Pearson y el test exacto de Fisher; los contrastes de medias con la t de Student; la supervivencia del organo y del paciente, mediante el analisis de curvas de supervivencia segun el metodo de Kaplan y Meier; y la comparacion entre curvas de supervivencia se realizo con el test de Mantel y Cox Resultados De los 250 trasplantes, 46 pacientes sufrieron complicaciones, 29 fistulas (11,6%) y 21 estenosis (8,4%). La localizacion mas frecuente de ambas complicaciones fue la union uretero-vesical. La presencia de fistula urinaria no influye negativamente de manera significativa en la supervivencia del injerto (p Conclusiones La tasa de aparicion de las complicaciones estudiadas fue de un 18,4%, tratandose de un 11,6% de fistulas y 8,4% de estenosis. La localizacion mas frecuente fue la union uretero-vesical. La presencia de estenosis se correlaciona con el aumento de la edad de los donantes. La tecnica de reimplante ureteral no influyo en los resultados de manera significativa. No encontramos repercusion estadisticamente significativa entre las complicaciones estudiadas y la supervivencia del paciente

Profilins are plant allergens responsible for cross-reactivities in pollen and fruit-allergic patients. A two-site enzyme-linked immunosorbent assay has been developed for the quantification of profilins and its suitability for quantifying profilin in different plant extracts has been evaluated. The assay is based on two profilin-specific monoclonal antibodies (mAbs) with different epitope specificities. These antibodies were immobilized on ELISA plates and incubated with samples containing profilin. Bound profilin was detected by a combination of biotinylated profilin-specific antiserum and peroxidase-streptavidin conjugate. The optimized ELISA measured profilin concentrations ranging from 4 to 250 ng/ml and could quantify profilins from plant species of a variety of different botanical families. No reactivity to mites, molds, or crustaceans was detected, suggesting that the immunoassay is plant-specific. The results indicate that this sensitive profilin-assay will be helpful both for quantifying the profilin content of allergenic extracts intended for clinical use and for studying cross-reactivities between pollen extracts.

En el marco de las investigaciones basicas dirigidas a esclarecer los mecanismos inmunologicos que configuran la respuesta del huesped frente a la infeccion por Mycobacterium tuberculosis , se han valorado los niveles de receptor soluble de interleucina 2 (sIL-2R) en exudados pleurales tuberculosos, en comparacion con liquidos de etiologia no micobacteriana. Para ello, se han estudiado 40 enfermos con derrame pleural: 10 con pleuresia tuberculosa, 10 con neoplasia, 10 con neumonia bacteriana no tuberculosa y 10 con trasudado. La determinacion de la concentracion de sIL-2R se efectuo mediante tecnica ELISA. En pacientes con tuberculosis, el valor de sIL-2R en liquido pleural fue 14.666 ± 5.634 U/ml, significativamente superior a los niveles encontrados en cualquier otro grupo de patologia, que fueron 4.341 ± 2.655 U/ml en los derrames neumonicos, 5.542 ± 3.682 U/ml en los neoplasicos y 1.377 ± 125 U/ml en los trasudados En la tuberculosis pleuropulmonar, la compartimentalizacion de la respuesta inmune de la cavidad pleural determina la existencia de niveles significativamente mas elevados de sIL-2R con respecto a los detectados en los liquidos pleurales de otraetiologia. Esta observacion, asi como la demostracion de una estrecha correlacion entre sIL-2R y ADA, permite plantear la posible utilizacion de esta molecula como un parametro accesorio en el diagnostico diferencial de los derrames pleurales, aunque en este estudio no parece alcanzar el grado de fiabilidad de la ADA.

El sindrome de sobreexpansion pulmonar (SSP) se produce al expandirse el contenido gaseoso en el arbol pulmonar. Se describen 22 casos ocurridos tras buceo, que constituyen un 10,2% de los accidentes tratados en centros hiperbaricos de la Armada Espanola (1969-1990). La hemoptisis (27,2%), el enfisema subcutaneo (22,7%) y el dolor toracico (9,1%) fueron los sintomas/signos toracopulmonares mas frecuentes. Los trastornos de conciencia (54,5%) y alteraciones motoras (22,7%) fueron los sintomas neurologicos mas constantes. El mayor indice de SSP se registro durante maniobras de entrenamiento realizadas en distintos cursos de buceo, de los que se recuperaron sin secuelas el 91% de los accidentados, gracias al tratamiento recompresivo rapido y profundo (50 m). Se describen protocolos de aplicacion de tablas terapeuticas y se destacan las ventajas de las tablas de oxigeno con respecto a las de aire. Finalmente, se justifica la necesidad de disponer de una camara hiperbarica operativa cercana, ante la eventualidad de este tipo de accidentes.

Liver abscess due to Mycobacterium tuberculosis associated with pulmonary tuberculosis is a rare diagnosis, particularly in patients without AIDS. We report the case of a male immigrant with no HIV infection who developed a tuberculous liver abscess and pulmonary tuberculosis simultaneously. Ziehl-Neelsen stain, PCR and Lowenstein-Jensen culture of material sampled from the abscess established the microbiological diagnosis. The patient's course was good, with disappearance of symptoms and the abscess after tuberculostatic treatment and drainage of the abscess with monitoring by computed tomography.

Exogenous lipoid pneumonia is a rare disease which is often underdiagnosed. Exogenous lipoid pneumonia has traditionally been considered a chronic process secondary to continued aspiration or inhalation of fatty substances. In its acute form exogenous lipoid pneumonia sometimes coincides with accidental massive aspiration of lipidic material, as has been traditionally described for fire eaters. We review the literature and report a case of acute lipoid pneumonia secondary to accidental aspiration of vaseline used to place a nasogastric tube, which had been inserted for gastric lavage after a suicide attempt by flurazepam ingestion.

We studied the epidemiological characteristic of tuberculosis in Lorca area, drug resistant and the effect of the immigration population (Ecuador) in this area.A retrospective study for six years ago (1999, January to 2004, December) was realized. Epidemiological data, initial diagnostic probability, mycobacteria stain and cultive, drug resistance, treatment response, and epidemiological differences between immigrants and spain population were compared.Within 158 cases registered, 41.7 percent were immigrants with less than one year in Spain, the most part Ecuador population. We observed that extrapulmonar tuberculosis was lower initial diagnostic probability than pleural disease as well too haemoptisis, pleural pain and weight loss. It was identified positive micobacterial stain in 35.4 percent of respiratory samples. It was successfully results in 74 percent of cases and 13.9 percent of patients were lost, this result was frequently registered in immigrants, The isoniazide resistant in patients with not previous treatment was 5.3 percent and it was 9.5 percent in immigrants and 10.8 percent in Ecuador population.It is necessary improve: the diagnostic of extrapulmonar tuberculosis and avoid loss patient by programs of capture and then the successfully treatments raise. The isoniazide resistant in this area suggest that we must use initial four drug than tree and this manner not raise the drug resistant in the area.

Objetivo: analizar las características epidemiológicas de los casos de tuberculosis del área de salud de la comarca de Lorca, su resistencia a fármacos y el impacto de la población inmigrante mayoritaria (Ecuador) en la misma. Pacientes y métodos: estudio longitudinal, retrospectivo de 6 años de duración (de enero de 1999 a diciembre 2004). Se recogieron datos epidemiológicos de cada caso, probabilidad diagnóstica inicial, tinciones diagnósticas, aislamientos, resistencia a fármacos, respuesta al tratamiento, así como, las diferencias epidemiológicas existentes entre inmigrantes y autóctonos. Resultados: Se identificaron 158 casos, 41.7% eran inmigrantes con menos de 1 año de estancia en nuestro país, mayoritariamente procedentes de Ecuador. Observamos que la tuberculosis extrapulmonar para el clínico tenía una probabilidad diagnóstica baja, mientras que la pleural era alta, junto a síntomas como hemoptisis, dolor pleurítico y constitucionales. En 35.4% de los casos se idéntifico germen por tinción en muestras respiratorias. Se obtuvo un 74% de resultados satisfactorios por el tratamiento y 13.9% de abandono asociado frecuentemente con la inmigración. La resistencia a isoniazida en no tratados fue del 5.3% en el área, 9.5% en el caso de inmigrantes y 10.8% en los oriundos de Ecuador. Conclusión: Se debe mejorar en: la detección de los casos extrapulmonares, evitar el abandono con la captación de los enfermos y la curación de enfermedad. Las resistencias a isoniazida en nuestra área sugiere adaptarse a tratamientos de inicio con cuatro fármacos y no a tres para evitar incremento de resistencias en nuestra área de salud.

9 pages, 3 tables, 1 figure.-- Published online 9 November 2005., [Objective]: The aim of the present study is to investigate the effect of antioxidant polyphenol-rich pomegranate juice (PJ) supplementation for 5 weeks on patients with stable chronic obstructive pulmonary disease (COPD), since the oxidative stress plays a major role in the evolution and pathophysiology of COPD., [Design]: A randomized, double-blind, placebo-controlled trial was conducted., [Subjects]: A total of 30 patients with stable COPD were randomly distributed in two groups (15 patients each)., [Interventions]: Both groups consumed either 400 ml PJ daily or matched placebo (synthetic orange-flavoured drink) for 5 weeks. Trolox Equivalent Antioxidant Capacity (TEAC) of PJ, blood parameters (14 haematological and 18 serobiochemical), respiratory function variables, bioavailability of PJ polyphenols (plasma and urine) and urinary isoprostane (8-iso-PGF2) were evaluated., [Results]: The daily dose of PJ (containing 2.66 g polyphenols) provided 4 mmol/l TEAC. None of the polyphenols present in PJ were detected in plasma or in urine of volunteers. The most abundant PJ polyphenols, ellagitannins, were metabolized by the colonic microflora of COPD patients to yield two major metabolites in both plasma and urine (dibenzopyranone derivatives) with no TEAC. No differences were found (P>0.05) between PJ and placebo groups for any of the parameters evaluated (serobiochemical and haematological), urinary 8-iso-PGF2, respiratory function variables and clinical symptoms of COPD patients., [Conclusions]: Our results suggest that PJ supplementation adds no benefit to the current standard therapy in patients with stable COPD. The high TEAC of PJ cannot be extrapolated in vivo probably due to the metabolism of its polyphenols by the colonic microflora. The understanding of the different bioavailability of dietary polyphenols is critical before claiming any antioxidant-related health benefit., 'Fundación Séneca' (Murcia, Spain), Project PB/18/FS/02 and Spanish CICYT, Project AGL2003-02195.BC has a fellowship from the Spanish ‘Consejo Superior de Investigaciones Científicas’ (CSIC) and ESF (I3P Program).

Cold urticaria is defined as a urticarial and/or angioedematous reaction of the skin to contact with cold objects, water or air. Types of urticaria associated with infectious diseases, such as mononucleosis, rubeola, varicella, syphilis, hepatitis, and HIV infection have been reported. We present the case of a patient who developed cold urticaria associated with acute serologic toxoplasmosis. The patient was a 34-year-old man who for the previous 2 months had presented cutaneous pruritus accompanied by several papular lesions in parts of the skin exposed to cold as well as those in contact with cold water. The result of an "ice-cube test" was positive. Serologic tests for Toxoplasma gondii showed an IgG level of 68 UI/ml and were positive for IgM, while a test for cryoglobulins was positive. One month later cryoglobulins were negative and a serologic test for T. gondii showed an IgG concentration of 75 UI/ml and positive IgM. Three months later cryoglobulins were still negative, IgG for T. gondii was 84 UI/ml, and IgM was positive. After 6 months cryoglobulins were still negative, IgG level was 68 UI/ml and IgM was still slightly positive. In the final evaluation, 14 months later, IgG level was 32 UI/ml and IgM was negative. The patient continues to present clinical manifestations of cold urticaria, although he has experienced some improvement and his tolerance to cold has increased after treatment with cetirizine.

This study aims to evaluate how rehydration beverage ingestion influences gastric emptying rate (in cycle ergometer) at rest and during exercise at 70 % of maximal oxygen consumption (VO2max).26 well-trained cyclists performed a preliminary maximal test until exhaustion to evaluate their VO2max, and two submaximal exercise tests at 70 % of their mode-specific VO2max. Each test was separated by one week. During the two submaximal tests, cyclists consumed 200 ml of a 99mTc-DTPA labeled rehydration beverage (A or B) and scintigraphy determinations were performed at rest. After, exercise was initiated for 60 minutes with an intake rate of 200 ml every 15 minutes, making gastric serial scintigraphy determinations. The difference regarding chemical composition between A and B drinks resides in the fact that drink A contains a smaller load in carbohydrates (10.3 g/100 ml versus 15.2 g/100 ml of B), proteins in form of serum milk and antioxidants in form of fruit juice. Both contain ions and vitamins.at rest, gastric count number was significantly reduced (p0.000) from 0 to 25 minutes for both A and B beverage. At the end of exercise (60 min), there was greater gastric retention for B beverage than for A, this difference being statistically significant (p0.031).The A beverage, a rehydration drink on the market with protein and antioxidants with fruit juice content, has a faster gastric emptying rate than the B sport beverage.

Objectives:This cross-sectional study was designed to assess the level of stress among residents and stress-related impairment of family life. Subjects and Methods: A 41-item anonymous questionnaire was designed to determine the level of stress and its effects on the residents’ family as well as factors associated with stress during residency training in a tertiary-care hospital accredited with official resident training ‘Medicos Internos Residentes’ in Murcia, Spain. Questionnaires were distributed in sealed nominal envelopes during February and March 2002 to 227 eligible residents. Results: Of the 227 residents, 175 (77%) completed and returned the questionnaires. Forty-two percent of residents recognized that residency training caused an important level of stress and 21% felt that stress interfered with family relationships. Both factors were significantly associated. Feelings of being unsatisfied with supervision of care and achievement of training objectives as well as low satisfaction with residency training and poor assessment of the hospital were significant stressors. Impairment in family life was significantly dependent on degree of satisfaction with residency training and evaluation of the hospital. Conclusion: The data showed that residency training generated stress and impaired family life. These were closely associated with perception of being unsatisfied with the residency training and evaluation.

A pharmacoeconomic analysis was done to compare the efficiency of two treatments in the acute exacerbation of chronic bronchitis: telithromycin and cefuroxime-axetil.Restrospective analysis, modeled through a decision tree. The effectiveness of the treatments was estimated through a randomized and double-blind clinical trial in which 800 mg/day (5 days) of telithromycin were compared with 1,000 mg/day (10 days) of cefuroxime-axetil in patients with acute exacerbation of chronic bronchitis (140 and 142 patients, respectively). Resources use was estimated from clinical trial and from Spanish data, and the unit costs through a health costs dabatase. The model was validated by a panel of Spanish clinical experts.Since the clinical trial was designed to demonstrate equivalence, there were no significant differences of effectiveness among both treatments (with a rate of clinical cure of 86.4% and 83.1%, respectively) which means that an analysis of costs minimization was done. In the average case, the average cost of the disease by patient was 174.83 Euros with telithromycin and 194.68 Euros with cefuroxime-axetil (a difference of 19.85 Euros). The results were maintained in the analysis of sensitivity, with favorable differences for telithromycin that ranged between 18.04 Euros and 22.25 Euros.With telithromycin up to 22 Euros by patient with acute exacerbation of chronic bronchitis could be saved, in comparison with cefuroxime-axetil.

Introduction: it is during Medical Residency Training (MIR) that knowledge, abilities and habits are acquired, which will shape professional activity in the future. It is therefore very likely that residents who do not acquire the necessary habits and knowledge for research activities will eventually not carry out these activities in the future. The aim of this study was to analyze the level of satisfaction of residents with his or her scientific and research training, and to determine any deficiencies with respect to this training. Materials and methods: the aim of the questionnaire used was to determine the level of satisfaction of residents regarding their scientific and research training during their residency period. Questionnaires were usually distributed via internal mail to all residents (MIR physicians) registered at a third level teaching hospital, with a completion rate of 78% (n = 178). Results: as far as the evaluation of scientific training is concerned, 68% of residents were dissatisfied or very dissatisfied. With respect to scientific studies carried out, 49% of residents had not taken part in any, but the number of studies carried out increases as the residency progresses. On the other hand, 22% of residents reported not having started their doctoral thesis, 50% having attended doctorate courses, 24% having a title for their thesis, and only 4% having written a thesis. Doctorate courses, thesis topics, and written theses increase with the year of residency, and a greater activity may be seen in this respect in surgical departments. If we analyze help available to residents for their carrying out scientific activities, 55% reported that only selected assistant doctors would offer help, and 21% reported that no doctors would offer help. Dissatisfaction with research training increases with the year of residency. With regard to main specialist fields, it can be seen that residents in surgical fields carry out more theses, whereas central fields report less facilities. Finally, if we evaluate the influence that these variables may have on the general satisfaction of residents with his or her residency, these variables are seen to be significant factors of dissatisfaction. Conclusions: most residents are dissatisfied with their scientific training and have relatively few facilities for developing such skills, which in turn results in a scarce number of scientific studies and doctoral theses.

Epidemiological studies of acute otitis media (AOM) are scarce and no prospective studies have been performed in Spain.To describe the incidence of AOM in the first year of life and its associated risk factors, with special focus on air pollution.We performed a prospective cohort study of 229 newborn infants during the first year of life stratified by pollution zones, and followed-up by their pediatricians in their health center. AOM was defined on clinical grounds. A questionnaire on risk/protective factors included items on the following: sex, older siblings, smoking, breastfeeding, socioeconomic status, parental education and the mother's occupational status.The incidence of AOM episodes during the first year of life was 45 % and the proportion of children who experienced at least one episode was 32 %. Independent risk factors were male gender (aOR: 2.03; 95 % CI: 1.09-3.7) and living in a polluted area (aOR: 2.01; 95 % CI: 1.05-3.84). Independent protective factors were being born in spring (aOR: 0.41; 95 % CI: 0.19-0.88) and having a mother with at least primary school education (aOR: 0,53; 95 % CI: 0.24-1.15). Socioeconomic markers indicated a lower mean level among families whose children had at least one AOM episode.Air pollution and low socioeconomic status are greater risk factors for AOM than having siblings or parents who smoke. A minimum educational level reduces the risk of AOM. The incidence of AOM could be reduced by modifying certain environmental factors.

A pharmacoeconomic analysis was carried out comparing the efficacy of two treatment options for community-acquired pneumonia (CAP): telithromycin and clarithromycin. It was a retrospective analysis using a decision tree model. The efficacy of the two treatment options was estimated from a randomized, double-blind clinical trial, in which 800 mg/day oral telithromycin for 10 days was compared to 1000 mg/day oral clarithromycin for 10 days in patients with CAP (162 and 156 respectively). The use of resources was estimated based on the clinical trial and Spanish sources, and the unit costs from a Spanish health costs database. Costs were evaluated for the acquisition of antibiotic treatments, change of antibiotic due to therapeutic failure, hospital admissions, adverse reactions to treatment, primary care visits, tests and indirect costs (working days lost). The model was validated by a panel of Spanish clinical experts. As the clinical trial was designed to show equivalence, there were no significant differences in efficacy between the treatment options (clinical cure rate 88.3% and 88.5%, respectively), and a cost minimization analysis was performed. In the base case, the average cost of the disease per patient was 308.29 euros with telithromycin and 331.5 euros with clarithromycin (a difference of 23.21 euros). The results were stable in the susceptibility analysis, with differences favorable to telithromycin ranging between 5.50 and 45.45 euros. Telithromycin results in a cost savings of up to 45.45 euros per CAP patient compared to clarithromycin.

Exposure to an increasing amount of products in the work environment is leading to new cases of occupational asthma among workers. We report the case of a worker at a pharmaceutical plant who developed occupational rhinitis and bronchial asthma due to HBTU: 2-(1H-benzotriazol-1-yl)-1,1,3,3-tetramethyluronium hexafluorophosphate and TBTU: 2-(1H-benzotriazol-1-yl)-1,1,3,3-tetramethyluronium tetrafluoroborate sensitization, two chemical products widely used in peptide synthesis and coupling. Skin tests (prick test) with HBTU and TBTU solutions in PBS were positive at a concentration of 1 mg/ml. Skin tests with the same solutions in 10 atopic controls yielded a negative result. Nasal challenge tests with these products were positive with HBTU at a concentration of 0.01 mg/ml and TBTU at a concentration of 1 mg/ml. In both cases PNIF (peak nasal inspiratory flow) decreased by more than 60% and severe sneezing and rhinorrhea were induced. Nasal challenge tests performed on 10 atopic controls with TBTU and HBTU at a concentration of 1 mg/ml were negative. We conclude that the patient presents occupational rhinitis and bronchial asthma due to TBTU and HBTU; the operational mechanism is probably immunological IgE-mediated given the positive prick tests and nasal challenge with these products.

Liver abscess due to Mycobacterium tuberculosis associated with pulmonary tuberculosis is a rare diagnosis, particularly in patients without AIDS. We report the case of a male immigrant with no HIV infection who developed a tuberculous liver abscess and pulmonary tuberculosis simultaneously. Ziehl-Neelsen stain, PCR and Löwenstein-Jensen culture of material sampled from the abscess established the microbiological diagnosis. The patient's course was good, with disappearance of symptoms and the abscess after tuberculostatic treatment and drainage of the abscess with monitoring by computed tomography.

Varicella is a disease in childhood. When it affects adults, serious complications can develop, the most frequent and most dangerous being pneumonia. Acute renal failure is an exceptional complication which infrequently is reported in relevant current literature. The association of pneumonia with acute renal failure in a patient with varicella is unusual. We report a varicella case in an adult patient who suffered from pneumonia with respiratory distress syndrome and acute renal failure, both of them had a favourable clinical course.

Histiocytosis X or Langerhans cell histiocytosis is an infrequent disease, which consists on proliferation of Langerhans cells. The etiology is unknown. Diagnosis is reached by electron microscope study of the biopsy, in which the Birbeck intracytoplasmatic granules of the Langerhans cells are found and/or by immunohistochemistry procedures able to detect S-100 antigen and CD1 cells. Diagnosis can also be reached with a bronchoalveolar lavage in which CD1 cells will appear in a score higher than 5%. We present the case of a 16 year-old girl that first appeared with a pulmonary lesion with a honey comb X-ray pattern and unsyntomatic mandibular bone affectation. Diagnosis was reached by biopsy study using S-100 antigen detection procedures. We consider this case an important one due to the infrequency of this particular disease.

Varicella is a disease in childhood. When it affects adults, serious complications can develop, the most frequent and most dangerous being pneumonia. Acute renal failure is an exceptional complication which infrequently is reported in relevant current literature. The association of pneumonia with acute renal failure in a patient with varicella is unusual. We report a varicella case in an adult patient who suffered from pneumonia with respiratory distress syndrome and acute renal failure, both of them had a favourable clinical course.

The aim of this study is value the incidence of urological complications (fistulae and estenosis) in our serie of renal transplant, to analyze the variables that can influence in their appearance and the treatments used. Likewise, to value the follow-up of theses patients and the survival of the renal graft and of the patient.250 renal transplants are carried out between july of 1985 and october of 1998. The relationship among the variables you makes by means of the test chi 2 of Pearson and the test of Fisher; the contrasts of stockings with the t of Student; the survival of the organ and of the patient, by means of the analysis of curved of survival according to the method of Kaplan and Meier; and the comparison among curved of survival was carried out with the test of Cloth and Cox.Of the 250 transplants, 46 patients suffered for complications, 29 urinary fistulae (11.6%) and 21 estenosis (8.4%). The most frequent localization in both complications was the union uretero-vesical. The presence of urinary fistulae didn't influence negatively in a significant way nor over the survival of the implant (p0.211), neither over the patient's survival. The estenosis appearance was related in a significant way with the donor's age (p0.02). The estenosis presence was not related in a significant way neither with the survival of the implant neither with that of the receiver.The incidence of urological complications was of 18.4% (11.6% estenosis and 8.4% fistulae). The most frequent localization was the union uretero-vesical. The presence of estenosis correlated with the increase of the age of the donors. The technique of reimplante ureteral didn't influence in the results in a significant way. We don't find any relationship between the appearance of urological complications and the patient's survival.

La histiocitosis X o histiocitosis de células de Langerhans es una enfermedad infrecuente, que consiste en la proliferación de células de Langerhans. Su causa es desconocida. Al diagnóstico se llega mediante el estudio de biopsia de la lesión por microscopía electrónica, detectándose los gránulos de Birbeck intracitoplasmáticos de las células de Langerhans, y/o mediante técnicas inmunohistoquímicas, que detecten la proteina S100 y las células CD1. También es diagnóstico un porcentaje mayor del 5% de células CD1 en el lavado broncoalveolar. Presentamos el caso de una paciente de 16 años, que se manifestó como una lesión pulmonar con un patrón radiológico en panal de miel y una afectación ósea mandibular asintomática. Al diagnóstico se llegó mediante el estudio de la biopsia pulmonar por técnicas de detección de proteína S100. Consideramos de interés este caso por la infrecuencia de esta enfermedad.

Exogenous lipoid pneumonia is a rare disease which is often underdiagnosed. Exogenous lipoid pneumonia has traditionally been considered a chronic process secondary to continued aspiration or inhalation of fatty substances. In its acute form exogenous lipoid pneumonia sometimes coincides with accidental massive aspiration of lipidic material, as has been traditionally described for fire eaters. We review the literature and report a case of acute lipoid pneumonia secondary to accidental aspiration of vaseline used to place a nasogastric tube, which had been inserted for gastric lavage after a suicide attempt by flurazepam ingestion.

La aspiración bronquial de cuerpos extraños es más frecuente en niños. La etiología más usual son los cuerpos extraños de origen vegetal, que no se aprecian en una Rx simple de tórax. Las manifestaciones clínicas son variables, incluyendo la sensación de ahogo, tos y sibilancias. La hemoptisis es un síntoma infrecuente, relacionándose su aparición, generalmente, con la existencia de bronquiectasias. Presentamos el caso de un niño que presentó hemoptisis de repetición y neumonitis local por Eikenella Corrodens tres años después de la aspiración de una espiga. Se llegó al diagnóstico de la broncoaspiración tras la expulsión del cuerpo extraño, días después de la realización de un lavado broncoalveolar. Lo inusual de este caso es la presentación clínica de hemoptisis de repetición, el largo periodo asintomático tratándose de un cuerpo extraño de origen vegetal y la neumonitis por Eikenella Corrodens asociada a la existencia de un cuerpo extraño intrabronquial.

Dirythromycin has several pharmacokinetic characteristics (long half life and high tissue concentrations) which suggest the possibility of administering shorter treatments than those conventionally used. The aim of this study was to determine and compare the efficacy of a 5 day treatment with dirythromycin once a day, versus diacetylmidecamycin twice a day over 7 days in the treatment of patients with acute bronchitis and acute exacerbations of chronic bronchitis.A parallel, multicentric, randomized, double blind clinical study was carried out in 8 Spanish hospitals.One hundred seventy-four patients were included in the study, with 87 (80 evaluable) being randomly assigned to receive dirythromycin (500 mg/day over 5 days) and 87 (83 evaluable) diacetylmidecamycin (600 mg, twice daily over 7 days). A favorable symptomatic response (cure or improvement) was observed in 72/80 of the first group (90%) and in 74/83 (89.2%) of the second group. No statistically significant differences were found in the efficacy and safety between the two treatment groups in either the evaluable patients or on intention to treat analysis.The results of this study suggest that the administration of dirythromycin, once a day over 5 days, is as safe and effective as diacetylmidecamycin, twice a day over 7 days, in the treatment of acute bronchitis and acute exacerbations of chronic bronchitis.

In pulmonary thromboembolism (PTE) metabolic changes can occur, as in serum levels of angiotensin converting enzyme (ACE); therefore, the measurement of serum levels of this enzyme might be useful for PTE evaluation. The objective of this study was to determine changes in serum ACE in patients with PTE and their possible variations after therapy. MATERIALS AND THERAPY: Thirty-one patients with PTE were studied (15 males and 16 females). The mean age was 56 +/- 16 years (range 19-82 years). The patients were included if they had: a) a suspect diagnosis of PTE; b) confirmed by high probability V/Q gammagraphy, or c) data of intermediate or low probability with positive lower limb phlebography. Patients with associated diseases, under therapy with ACE inhibitors or lost during the six months of therapy were excluded from the study.Patients were evaluated in the acute phase of PTE and after therapy (six months later). Biochemical, gasometric, spirometric, V/Q gammagraphy and ACE parameters were investigated. All of them were compared with reference values and those obtained in both phases of PTE.The Student "t" test was used for independent parameters with the Bonferroni correction for multiple contrast and a = 0.05. The Pearson regression analysis was used for correlations. The ROC curve was used to study its usefulness at diagnosis.ACE decreased by a 20.5% in the acute phase (31.69% +/- 10.34 mumol/min/l) and turned to normal values (39.91 +/- 9.75 mumol/min/l) at post-therapy phase. This decrease was related with acute hypoxia and a decrease in the lung vascular bed. The analysis of the ROC curve showed an area of 0.69 and a negative predictive value of 91.67% for ACE values higher than 46 mumol/min/l.ACE activity is a marker for pulmonary pathology which might be indicative of injury and/or decrease of the lung vascular bed; its measurement can be useful in the clinical follow-up of PTE. A return to normal values should be interpreted as improvement in the perfusion of the lung vascular bed.

In order to better understand the immunological mechanisms involved in host protection against Mycobacterium tuberculosis infection, we studied soluble interleukin 2 receptor (sIL-2R) concentration in tuberculous pleural exudates as well as in pleural fluids of non-mycobacterial etiology. We collected pleural fluid from 40 patients: 10 with tuberculous bacterial pneumonia and 10 with trasudate. Soluble IL-2R was measured in the stored specimens using a standard ELISA technique. In patients with tuberculosis, sIL-2R in pleural fluid was 14,666 +/- 5,634 U/ml, significantly higher than was detected in any other group, being 4,341 +/- 2,655 U/ml in pneumonic exudates, 5,542 +/- 3,682 U/ml in neoplastic exudates and 1,377 +/- 125 in trasudates (p0.001). Also, an excellent correlation was demonstrated between adenosine-desaminase (ADA) and sIL-2R in tuberculous pleural fluids, with p0.001 and r = 0.805. In pleuropulmonary tuberculosis, compartmentalization of the immune response in the pleural space is responsible for the significantly higher levels of sIL-2R that were found in tuberculous pleural liquids compared with the ones detected in other diseases. This observation, as well as the demonstration of a good correlation between sIL-2R and ADA, suggest the possible usefulness of this molecule as an additional marker in the differential diagnosis of pleural effusions, though in the present study it appears to be less reliable than ADA.

Pulmonary barotrauma (PB) is caused by expansion of gases in the respiratory system. We describe 22 cases in divers that constituted 10.2% of the accidents treated at the Spanish navy's hyperbaric center (1969-1990). Hemoptysis (27.2%), subcutaneous emphysema (22.7%) and chest pain (9.1%) were the most frequent thoracic-pulmonary signs. Changes in consciousness (54.5%) and motility (22.7%) were the main neurological symptoms. The highest indices of PB were recorded during training exercises in diving courses, with 91% of the trauma patients recuperating with no aftereffects thanks to prompt deep (50 m) recompression. Protocols for applying therapeutic tables are described, and the advantages of using tables for oxygen as opposed to air are discussed. Finally, we justify the need to have a hyperbaric chamber nearby for treating this type of accident.

We have prospectively studied 48 patients previously diagnosed of systemic lupus erythematosus over a mean follow up period of 5.8 years of which 28 presented 36 episodes of infection and 20 did not develop infections. Urinary infections were the most frequent kind of infection followed by pneumonia and bacteriemia; the most frequently isolated microorganism responsible for those infections were E. colii, staphylococcus aureu and P. mirabillis. We have found a risk factors that and impared renal function an steroid treatment over 20 mg/day were significantly associated with a increasing number of infectious precesses. On the contrary, we have observed that only a bad and critical clinical situation had prognostic value and was significantly associated with an increased mortality.

The levels of IgG and IgM antibodies were evaluated in 60 patients with pulmonary tuberculosis, who were compared with a group of 30 tuberculin-negative healthy controls and another group of 10 healthy tuberculin-positive individuals. The technique for the quantification of antibodies against M. tuberculosis was an enzyme immunoassay, using purified tuberculin as antigen. The mean (means) IgG and IgM values and their standard deviations (SD), expressed in optical density units, were as follows: for the tuberculin-negative control group: IgG 0.029 +/- 0.013, IgM 0.032 +/- 0.010; for the tuberculin-positive control group: IgG 0.023 +/- 0.007, IgM 0.033 +/- 0.012; and for the group of patients: IgG 0.054 +/- 0.016, IgM 0.051 +/- 0.017. Fifty per cent of patients (30) were positive for IgG, 46.6% (28) were positive for IgM and 28.3% (17) were positive for both immunoglobulins. Those values higher than the mean of control group plus two SD were considered as positive. In the group of tuberculous patients a significant increase of IgG was observed, which was more marked after two weeks of antituberculous chemotherapy in patients with prolonged course. There appears to be a good correlation between the levels of immunoglobulins and the clinical status.

70 cases of bacteremia caused by Staphylococcus Aureus were studied. 49 (70%) males, and 21 (30%) females; 45 (64.5%) cases being nosocomial and 25 (35.4%) community acquired. The complications were significantly associated to the community acquired bacteremia (p less than 0.001), endocarditis and cutaneous abscesses being the most frequent (4). The group of cases with rapidly lethal prognosis was significantly associated to an increase of mortality (p less than 0.001), while lethal and non-lethal groups showed a decrease in mortality (p less than 0.001). We did not find a statistically significant association between nosocomial and community acquired bacteremias nor between antibiotic therapy and the mortality rate, chi 2 = 1.747.303 (N.S.), chi 2 = 1.323.806 (N.S.).

185 cases of bacteremia admitted at the internal medicine department of "C.S. Virgen de la Arrixaga" in Murcia from 1977 to 1986, were studied retrospectively. The common infection was significantly associated to Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus A group and Neisseria meningitidis and the nosocomial infection was associated to Klebsiella Pneumoniae, Serratia Marcescens y Pseudomonas aeruginosa, Staphylococcus epidermidis and Enterobacter. We did not find significant differences between the common and nosocomial infection caused by E. Coli and Proteus mirabilis. These factors were associated to an increase of mortality: age greater than 40 years, nosocomial infection, Pseudomonas aeruginosa, other associated rapidly lethal diseases, acute clinical state at the beginning of bacteremia, shock and non-correct antibiotic therapy.

La aspiracion de cuerpos extranos es un motivo de consulta neumologica que en ocasiones precisa exploracion broncoscopica urgente, cuando se aspira un producto quimicamente activo. Presentamos el caso de una paciente que aspiro una tableta de sulfato ferroso y que, a pesar de su inmediata extraccion, produjo lesiones persistentes durante 6 semanas en el arbol bronquial. Posteriormente, hacemos una discusion destacando el potencial lesivo de esta sustancia en el arbol traqueobronquial.