Medicina
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A restrictive ventilatory defect is characterized by a decreased total lung capacity (TLC). The objective of this study was to determine the accuracy of spirometry to detect pulmonary restriction in patients with or without airflow obstruction in the spirometry. Five hundred and twenty patients were included. ⋯ Residual volume (RV) (125.72 +/- 64. vs. 77.96 +/- 29.98%, p = 0.0011) and RV/ TLC ratio (56.89 +/- 12.82 vs. 38.43 +/- 13.07%, p = <0.0001) were significantly higher. We conclude that a decreased FVC or VC cannot be considered evidence of ventilatory restriction in the presence of airflow obstruction on spirometry. Diagnosis of "mixed defects" by spirometry is inaccurate and should be avoided without the measurement of lung volumes.
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Multicenter Study
[Adherence with national guidelines in hospitalized patients with community-acquired pneumonia. Results of CAPO study in Argentina].
A committee of six scientific organizations from Argentina developed guidelines for the management of patients with community-acquired pneumonia (CAP). The objective of this study was to evaluate the level of adherence with the recommended care suggested by the guidelines in patients hospitalized with CAP in Argentina. Using quality indicators the management of 436 patients who were hospitalized in 12 Argentinean institutions was evaluated. ⋯ A low level of adherence was found in the areas of switch therapy (53%), prevention of CAP with pneumococcal vaccine (51%) and smoking cessation offered (29%). Using quality indicators it is possible to identify specific areas of management in patients with CAP to a low level of adherence with national guidelines. In Argentina interventions to improve switch therapy and prevention of CAP should be developed.
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The objective of this study was to determine clinical predictors of interstitial lung disease in patients with systemic sclerosis (SSc) and pulmonary involvement as defined by presence of a decreased diffusing capacity for carbon monoxide (DLCO). Forty subjects with SSc were retrospectively evaluated. Patients were categorized according to their level of DLCO (< o > or = 80% of predicted). ⋯ Patients with low DLCO showed a significantly higher prevalence of abnormal HRCT findings suggestive of ILD (82.3% vs. 5.8%, p < or = 0.0001). We conclude that a low DLCO is a frequent finding in SSc patients, strongly associated with HRCT signs of ILD. We have not found clinical factors predictive for a low DLCO.
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Rendu-Osler-Weber syndrome is an autosomal dominant disorder characterized by multiple skin and mucosal telangiectasis and multiorgan arteriovenous malformations. Neurological manifestations may occur because of cerebral arteriovenous malformations, intracranial hemorrhage, and most commonly by ischemic stroke and brain abscess secondary to paradoxical embolization in patients with pulmonary arteriovenous malformations. ⋯ We report the case of a 56 years old woman, with a familial history of Rendu-Osler-Weber syndrome, admitted to intensive care with acute quadriplegia and hypoxemia. Our diagnosis was pulmonary arteriovenous malformations and intramedullary abscess.
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Hydrocephalus is a huge burden, specially in the poor countries with a big proportion of sick children with this condition, against the countries with good sanitarian conditions. In Latinamerica the most common etiological factors of hydrocephalus are associated with bad prenatal controls, neonatal sepsis and consequent meningitis and ventriculitis. The hydrocephalus is a consequence of the damage in the circulation of the cerebrospinal fluid (CSF). ⋯ Neuroendoscopy is a neurosurgical technique everyday most common to manage hydrocephalus and intraventricular lesions in the world. We report an algorythm to use in children younger than 1 year of age with postinfectious hydrocephalus (PIHC) or associated with myelomeningocele. We stress the use of EVT as an alternative because of its low cost to treat hydrocephalus avoiding the complications and dependency of shunts.