To assess the usefulness of the telescoping plugged catheter in the diagnosis of nosocomial pneum... more To assess the usefulness of the telescoping plugged catheter in the diagnosis of nosocomial pneumonia. Prospective study. A total of 103 ventilated patients with suspected pneumonia were prospectively studied over 20 months. The quantitative cultures of the protected brush specimen detected pulmonary bacterial infection (greater than 10(3) cfu/mL) in 49 (47.5%) patients. Subsequent follow-up confirmed pneumonia in 41 patients; in only one patient was a positive protected brush specimen culture established as a false-positive result. There were 54 patients with less than 10(3) cfu/mL and the diagnosis was excluded in 36 of them. We identified eight patients with false-negative protected brush specimen cultures. The results obtained by this technique allowed us to modify treatment in 49 (47.5%) patients. The telescoping plugged catheter demonstrated significant bacterial infection in a relatively small proportion of patients in whom bacterial lung infection was suspected. This technique can be safely performed and is a sensitive and specific method to establish the cause of pneumonia, thus allowing specific treatment and the avoidance of inappropriate antibiotic therapy.
Submerged plants are thought to negatively affect phytoplankton crops in the temperate zone by a ... more Submerged plants are thought to negatively affect phytoplankton crops in the temperate zone by a number of mechanisms, including nutrient and light limitation, and enhancement of top-down control by offering diurnal refuge for zooplankton against visual predation, and by favouring piscivores. In 1997–1998, Lake Blanca (34° 54′ S, 54° 50′ W), a yellow-brownish shallow lake in Uruguay, suffered a severe water level reduction (associated with El Niño events between 1995–1997) that resulted in a massive fish kill and an extensive colonisation by Egeria densa. A clear water phase is established nowadays in the system (Secchi depth > 1 m), despite a fish community restricted to two small omnivorous–planktivorous fish: Jenynsia multidentata and Cnesterodon decemmaculatus. We studied the effects of E. densa on bottom-up and top-down controls on phytoplankton by comparing physical, chemical, and biological characteristics between submerged plant beds and sites without plants, from autumn 2000 to autumn 2001. The water column had low to intermediate nutrient concentrations, and phytoplankton community was highly diverse with a low to moderate biomass (mean Chl-a = 10.6 μg l−1). The water level, recovered during the study, promoted a dilution process that explained the temporal pattern of many chemical variables. Macrophyte PVI represented 28–39% of the lake volume (annual mean biomass = 174 g DW m−2). The zooplankton community was generally dominated by copepods in terms of biomass. Fish and zooplankton were significantly associated with submerged plant beds. In spite of the high biomass and density of omnivorous-planktivorous fish (115 kg ha−1, 13 ind m−2), zooplankton strongly affected phytoplankton spatial and temporal variation. The most important differences of algal biomass between zones coincided with a high herbivorous zooplankton biomass and/or with plants occupying the entire water column during the low level period. Medium-sized zooplankton declined with fish reproduction. The consequent stronger predation of juvenile fish seemed to decrease macrophyte efficiency as a zooplankton refuge in summer. E. densa bottom-up mechanisms would also be present, contributing to maintaining clear water. Besides the usually described nutrient and light limitation, the internal production of humic substances could enhance the observed top-down effect.
To assess the usefulness of extended cervical mediastinoscopy (ECM) in the staging of bronchogeni... more 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. The aortic arch is reached at the level of the origin of the innominate artery. The mediastinoscope is then passed by sliding it along the left anterolateral face of the aortic arch until it reaches the aortopulmonary window. Extended cervical mediastinoscopy was considered positive when a nodal biopsy result consistent with a neofomative process or direct invasion of the mediastinal structures was found. Four patients with positive standard cervical mediastinoscopy and negative ECM were excluded. A false negative ECM was defined as the presence of infiltrated adenopathies at the paraaortic level detected on postoperative histologic study. The ECM was positive in 5 patients in whom operation was contraindicated. Resectability in the remaining 41 patients was 97.6%. Postoperative pathologic study showed infiltrated adenopathy in 3 patients (2 subcarinal, 1 subaortic) accounting for 40 true negatives (the subtarinal group is inaccessible by ECM). This study suggests that ECM has outstanding specificity (100%), sensitivity of 83.3%, and a diagnostic accuracy of 97.8%. A positive predictive value of 100% and a negative predictive value of 97.5% were also identified by this study. We conclude that ECM is a useful technique to assess involvement of the aortopulmonary window in the preoperative staging of bronchogenic carcinoma of the left lung.
A multicenter study of 638 cases of community-acquired pneumonia due to Streptococcus pneumoniae ... more A multicenter study of 638 cases of community-acquired pneumonia due to Streptococcus pneumoniae (SP-CAP) was performed to assess current levels of resistance. Of the pneumococcal strains, 35.7% had an minimum inhibitory concentration (MIC) of penicillin of > or =0.12 microg/mL (3 isolates had an MIC of 4 microg/mL), 23.8% had an MIC of erythromycin of 128 microg/mL, and 22.2% were multidrug resistant. Logistic regression determined that chronic pulmonary disease (odds ratio [OR], 1.44], human immunodeficiency virus infection (OR, 1.98), clinically suspected aspiration (OR, 2.12), and previous hospital admission (OR, 1.69) were related to decreased susceptibility to penicillin, and previous admission (OR, 1.89) and an MIC of penicillin of MIC > or =0.12 microg/mL (OR, 15.85) were related to erythromycin resistance (MIC, > or =1 microg/mL). The overall mortality rate was 14.4%. Disseminated intravascular coagulation, empyema, and bacteremia were significantly more frequent among patients with penicillin-susceptible SP-CAP. Among isolates with MICs of penicillin of > or =0.12 microg/mL, serotype 19 was predominant and was associated with a higher mortality rate. In summary, the rate of resistance to beta -lactams and macrolides among S. pneumoniae that cause CAP remains high, but such resistance does not result in increased morbidity.
Allergy to mollusk has rarely been described. The limpet, belonging to Phylum mollusca, is one of... more 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 alter ingestion of this mollusk. Type I hypersensitivity to limpet antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, and histamine release test to cooked limpet extract. The controls did not react to any of these tests. Allergic activity was only found with a cooked limpet extract; this suggests that tile offending antigen/s may have been released by cooking this food.
To assess the usefulness of the telescoping plugged catheter in the diagnosis of nosocomial pneum... more To assess the usefulness of the telescoping plugged catheter in the diagnosis of nosocomial pneumonia. Prospective study. A total of 103 ventilated patients with suspected pneumonia were prospectively studied over 20 months. The quantitative cultures of the protected brush specimen detected pulmonary bacterial infection (greater than 10(3) cfu/mL) in 49 (47.5%) patients. Subsequent follow-up confirmed pneumonia in 41 patients; in only one patient was a positive protected brush specimen culture established as a false-positive result. There were 54 patients with less than 10(3) cfu/mL and the diagnosis was excluded in 36 of them. We identified eight patients with false-negative protected brush specimen cultures. The results obtained by this technique allowed us to modify treatment in 49 (47.5%) patients. The telescoping plugged catheter demonstrated significant bacterial infection in a relatively small proportion of patients in whom bacterial lung infection was suspected. This technique can be safely performed and is a sensitive and specific method to establish the cause of pneumonia, thus allowing specific treatment and the avoidance of inappropriate antibiotic therapy.
Submerged plants are thought to negatively affect phytoplankton crops in the temperate zone by a ... more Submerged plants are thought to negatively affect phytoplankton crops in the temperate zone by a number of mechanisms, including nutrient and light limitation, and enhancement of top-down control by offering diurnal refuge for zooplankton against visual predation, and by favouring piscivores. In 1997–1998, Lake Blanca (34° 54′ S, 54° 50′ W), a yellow-brownish shallow lake in Uruguay, suffered a severe water level reduction (associated with El Niño events between 1995–1997) that resulted in a massive fish kill and an extensive colonisation by Egeria densa. A clear water phase is established nowadays in the system (Secchi depth > 1 m), despite a fish community restricted to two small omnivorous–planktivorous fish: Jenynsia multidentata and Cnesterodon decemmaculatus. We studied the effects of E. densa on bottom-up and top-down controls on phytoplankton by comparing physical, chemical, and biological characteristics between submerged plant beds and sites without plants, from autumn 2000 to autumn 2001. The water column had low to intermediate nutrient concentrations, and phytoplankton community was highly diverse with a low to moderate biomass (mean Chl-a = 10.6 μg l−1). The water level, recovered during the study, promoted a dilution process that explained the temporal pattern of many chemical variables. Macrophyte PVI represented 28–39% of the lake volume (annual mean biomass = 174 g DW m−2). The zooplankton community was generally dominated by copepods in terms of biomass. Fish and zooplankton were significantly associated with submerged plant beds. In spite of the high biomass and density of omnivorous-planktivorous fish (115 kg ha−1, 13 ind m−2), zooplankton strongly affected phytoplankton spatial and temporal variation. The most important differences of algal biomass between zones coincided with a high herbivorous zooplankton biomass and/or with plants occupying the entire water column during the low level period. Medium-sized zooplankton declined with fish reproduction. The consequent stronger predation of juvenile fish seemed to decrease macrophyte efficiency as a zooplankton refuge in summer. E. densa bottom-up mechanisms would also be present, contributing to maintaining clear water. Besides the usually described nutrient and light limitation, the internal production of humic substances could enhance the observed top-down effect.
To assess the usefulness of extended cervical mediastinoscopy (ECM) in the staging of bronchogeni... more 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. The aortic arch is reached at the level of the origin of the innominate artery. The mediastinoscope is then passed by sliding it along the left anterolateral face of the aortic arch until it reaches the aortopulmonary window. Extended cervical mediastinoscopy was considered positive when a nodal biopsy result consistent with a neofomative process or direct invasion of the mediastinal structures was found. Four patients with positive standard cervical mediastinoscopy and negative ECM were excluded. A false negative ECM was defined as the presence of infiltrated adenopathies at the paraaortic level detected on postoperative histologic study. The ECM was positive in 5 patients in whom operation was contraindicated. Resectability in the remaining 41 patients was 97.6%. Postoperative pathologic study showed infiltrated adenopathy in 3 patients (2 subcarinal, 1 subaortic) accounting for 40 true negatives (the subtarinal group is inaccessible by ECM). This study suggests that ECM has outstanding specificity (100%), sensitivity of 83.3%, and a diagnostic accuracy of 97.8%. A positive predictive value of 100% and a negative predictive value of 97.5% were also identified by this study. We conclude that ECM is a useful technique to assess involvement of the aortopulmonary window in the preoperative staging of bronchogenic carcinoma of the left lung.
A multicenter study of 638 cases of community-acquired pneumonia due to Streptococcus pneumoniae ... more A multicenter study of 638 cases of community-acquired pneumonia due to Streptococcus pneumoniae (SP-CAP) was performed to assess current levels of resistance. Of the pneumococcal strains, 35.7% had an minimum inhibitory concentration (MIC) of penicillin of > or =0.12 microg/mL (3 isolates had an MIC of 4 microg/mL), 23.8% had an MIC of erythromycin of 128 microg/mL, and 22.2% were multidrug resistant. Logistic regression determined that chronic pulmonary disease (odds ratio [OR], 1.44], human immunodeficiency virus infection (OR, 1.98), clinically suspected aspiration (OR, 2.12), and previous hospital admission (OR, 1.69) were related to decreased susceptibility to penicillin, and previous admission (OR, 1.89) and an MIC of penicillin of MIC > or =0.12 microg/mL (OR, 15.85) were related to erythromycin resistance (MIC, > or =1 microg/mL). The overall mortality rate was 14.4%. Disseminated intravascular coagulation, empyema, and bacteremia were significantly more frequent among patients with penicillin-susceptible SP-CAP. Among isolates with MICs of penicillin of > or =0.12 microg/mL, serotype 19 was predominant and was associated with a higher mortality rate. In summary, the rate of resistance to beta -lactams and macrolides among S. pneumoniae that cause CAP remains high, but such resistance does not result in increased morbidity.
Allergy to mollusk has rarely been described. The limpet, belonging to Phylum mollusca, is one of... more 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 alter ingestion of this mollusk. Type I hypersensitivity to limpet antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, and histamine release test to cooked limpet extract. The controls did not react to any of these tests. Allergic activity was only found with a cooked limpet extract; this suggests that tile offending antigen/s may have been released by cooking this food.
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