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P378 Community-acquired pneumococcal pneumonia in a rural area
Abstracts B. Herreros, la (Madrid,
P. Merino, E)
S. Monzon,
G. Palacios,
I European A. Mubark,
Journal
of Internal
P. Gargantil-
Background: The incidence of primary carcinoma of the lung reaches its peak at the age of 55-65 years, being less frequent in young people. Most of them present with symptons due to central enlargement, and in a minor degree secondary to either pheripheric enlargement or extension. These data correspond to the majority, but we have to bear in mind that there may be some exceptions in certain groups, id youngsters. Objective: To assess what differences we can find between lung cancer in young people (less than 50 years) and in the adult, both in the way of clinical presentation and in the histology. Methods: Retrospective study of patients diagnosed from lung cancer in our hospital in 1999 pooled with those below 50 years diagnosed in 2000. Resulfs: The total amount of cases were 227, with 187 of them aged over 50 years and 40 below 50 years. In the adults, those who present with local enlargement exceed 60% of the cases, while most young people had symptons due to extension, mainly with brain methastases (about 25%) and secondly with bony methastases. The main radiologic pattern was a nodule or a mass. With respect to the pathology the results were: squamous cell (young people - elderly): 41-22%, adenocarcinoma 25-41% and small cell 21-318. Conclusion: Lung cancer in young people mainly present with symptons related to long distance extension, which confers a poor prognosis. This severity has probably something to do with histology, as in our study both adenocarcinoma and small cell lung cancer are more frequent in young people.
P378 Community-acquired pneumococcal pneumonia F.J. Cabello, .I. Aguilar, A. Lopez-Cozar, J.M. (Mdlaga. Badajoz, E)
in a rural area Ignacio, M.J. Perez
Aims: To analyze the clinical presentation and microbiological findings of patients with diagnosis of community-acquired pneumonia and streptococcus pneumoniae isolation in a rural area. Material and methods: We investigated the clinical, radiological and microbiological features of the patients with pneumonia diagnosed between january 1999 and march 2000 in whom a significant isolation of pneumococcus was obtained. Resultst Of the 23 patients studied (13 men, 10 women; mean age 61 years old), 15 patients had another morbidity condition (chronic obstructive lung disease and cardiopathy the most frecuent). A cough with purulent expectoration, fever and dyspnea were the most common symptoms. The radiographics findings showed bilateral lung infiltrates in 8 cases and lobar infiltrates in another 8 cases, being right lower and left lower the most frecuently lobes involvement. Pleural effusion had two patients. Streptococcus pneumoniae were isolated in 10 blood culture samples. 9 of sputum culture. 2 of pleural effusion culture and 2 of bronquial secretions aspiration. The serotype 3 was the most common isolated. Bacteriological sensibility study revealed a resistance to penicilin in 34% of the pneumococcus. 30% to cefuroxime, 26% to erythromycin and 15% to cefotaxime. Conclusion: In our rural area, community-acquired pneumococcal pneumonia is more frecuently presented in a patient nearly 60 years old with preexisting disease and lung infiltrates in lower lobes. Streptococcus pneumoniae has a high resistance to penicilin (34%). erythromycin (26%) and third generation cephalosporin (15%) in our area.
P379 Thoracic empyema: analysis P. Sanz, J.M. Barragan, D. Navarro (Avila, E)
of 72 cases Sanchez-Fuentes.
M.
Martin-AZ&ate,
C.
Medicine
14 (2003)
SILT159
s131
Object: To know the epidemiological characteristics, evolution and mortality of thoracic empyemas diagnosed in our hospital from 1989 to 2002. Methods: Retrospective study of patients diagnosed of thoracic empyema. Results: We found 72 patients: males 61, females 11. The predisposing conditions were decrease alertness, mouth infections and alcoholism. The main clinical features were fever (69%) pleuritic chest pain (68%) cough (57%). dyspnea (47%). and purulent sputum (37%). Gram stain of pleural fluid was positive in 24% of patients, and 39% had positive culture of pleural fluid (78% bacteria gram+, 19% bacteria gramand 3% tuberculosis). 9% of patients had blood culture positive. The patients were treated with chest tube drainage and broad spectrum antibiotics (beta-lactam in combination with clindamicin) or anti-tuberculous medication. Surgical treatment was indicated in 6 cases (11%). Severe complications were presented in 6 cases (8%): pneumothorax, bronchopleural fistula, shock and acute respiratory distress syndrome. The empyema mortality was 8%.
P380 Sarcoidosis: review of 40 cases E. Fernandez Bouza, M.A. Iglesias Fuente, P. Sesma (A Coruiia, E)
Olleros,
M.A.
Castro
Mao,
R. de la
Objective: To examine the clinical. radiological, and histological characteristics of sarcoidosis in our community (Ferrol. Spain). Methods: We retrospectively analysed the medical records of patients diagnosed as having sarcoidosis between 1995 and 2002. Results: We found 40 cases of sarcoidosis. There were 22 male and 18 female. Mean age at onset was 46 years (range, 24-76). There was no clear seasonal effect. The most frequent clinical manifestation at disease onset were arthralgiajarthritis (16 cases), malaise (12). fever (11). erythema nodoso ( 11) and Lofgren syndrome ( 10). Chest X-ray gave the following staging at disease onset: 0 (2 cases), I (17). II ( 16). and 111 (5). As expected, chest CT scan was comparatively more sensitive in detecting sarcoidosis-related abnormalities than CT of the abdomen. As to the lab findings, 20 patients (50%) had elevated blood levels of angiotensin-converting enzyme. Bronchoalveolar lavage showed lymphocytosis in 12 out of 17 cases. Diagnostic biopsy was performed in 23 cases: lung (12 cases), adenopathy (7) skin (3). liver (2) and parotid gland ( 1). While 21 patients (stage 0, 1 case; stage I. 12 cases; stage II, 6 cases; stage III, 2 cases) did not receive corticosteroid treatment at the time of diagnosis, 19 patients (stage I, 5 cases; stage II, 9 cases; stage III, 5 cases) did receive such a treatment. Disease relapses were found to occur more frequently in the latter group. Conclusions: Most of the clinical characteristics of our sarcoidosis patients are in keeping with those reported in other series. However. we failed to detect a female preference or any seasonal effect, The observation that patients on corticosteroid therapy from onset of disease had a slightly worse prognosis than those who did not, most likely reflects between-group differences in disease severity at symptom onset,
P381 Severity assessment of community an Internal Medicine Ward F. Tavares, M. Fonseca, T. Berger,
acquired
pneumonia
V. Marujo,
C. Ferreira
admitted (Lisboa,
to P)
Community acquired pneumonia (CAP) represents a substantial burden on internal medicine ward admissions and on hospital costs. Risk stratification and the decision to hospitalise are critical issues, as near 40% of those treated as inpatients could potentially be managed at home. Patients and methods: Our group retrospectively applied a protocol based on the Pneumonia Severity Index (PSI) to all patients admitted
P. Merino, E)
S. Monzon,
G. Palacios,
I European A. Mubark,
Journal
of Internal
P. Gargantil-
Background: The incidence of primary carcinoma of the lung reaches its peak at the age of 55-65 years, being less frequent in young people. Most of them present with symptons due to central enlargement, and in a minor degree secondary to either pheripheric enlargement or extension. These data correspond to the majority, but we have to bear in mind that there may be some exceptions in certain groups, id youngsters. Objective: To assess what differences we can find between lung cancer in young people (less than 50 years) and in the adult, both in the way of clinical presentation and in the histology. Methods: Retrospective study of patients diagnosed from lung cancer in our hospital in 1999 pooled with those below 50 years diagnosed in 2000. Resulfs: The total amount of cases were 227, with 187 of them aged over 50 years and 40 below 50 years. In the adults, those who present with local enlargement exceed 60% of the cases, while most young people had symptons due to extension, mainly with brain methastases (about 25%) and secondly with bony methastases. The main radiologic pattern was a nodule or a mass. With respect to the pathology the results were: squamous cell (young people - elderly): 41-22%, adenocarcinoma 25-41% and small cell 21-318. Conclusion: Lung cancer in young people mainly present with symptons related to long distance extension, which confers a poor prognosis. This severity has probably something to do with histology, as in our study both adenocarcinoma and small cell lung cancer are more frequent in young people.
P378 Community-acquired pneumococcal pneumonia F.J. Cabello, .I. Aguilar, A. Lopez-Cozar, J.M. (Mdlaga. Badajoz, E)
in a rural area Ignacio, M.J. Perez
Aims: To analyze the clinical presentation and microbiological findings of patients with diagnosis of community-acquired pneumonia and streptococcus pneumoniae isolation in a rural area. Material and methods: We investigated the clinical, radiological and microbiological features of the patients with pneumonia diagnosed between january 1999 and march 2000 in whom a significant isolation of pneumococcus was obtained. Resultst Of the 23 patients studied (13 men, 10 women; mean age 61 years old), 15 patients had another morbidity condition (chronic obstructive lung disease and cardiopathy the most frecuent). A cough with purulent expectoration, fever and dyspnea were the most common symptoms. The radiographics findings showed bilateral lung infiltrates in 8 cases and lobar infiltrates in another 8 cases, being right lower and left lower the most frecuently lobes involvement. Pleural effusion had two patients. Streptococcus pneumoniae were isolated in 10 blood culture samples. 9 of sputum culture. 2 of pleural effusion culture and 2 of bronquial secretions aspiration. The serotype 3 was the most common isolated. Bacteriological sensibility study revealed a resistance to penicilin in 34% of the pneumococcus. 30% to cefuroxime, 26% to erythromycin and 15% to cefotaxime. Conclusion: In our rural area, community-acquired pneumococcal pneumonia is more frecuently presented in a patient nearly 60 years old with preexisting disease and lung infiltrates in lower lobes. Streptococcus pneumoniae has a high resistance to penicilin (34%). erythromycin (26%) and third generation cephalosporin (15%) in our area.
P379 Thoracic empyema: analysis P. Sanz, J.M. Barragan, D. Navarro (Avila, E)
of 72 cases Sanchez-Fuentes.
M.
Martin-AZ&ate,
C.
Medicine
14 (2003)
SILT159
s131
Object: To know the epidemiological characteristics, evolution and mortality of thoracic empyemas diagnosed in our hospital from 1989 to 2002. Methods: Retrospective study of patients diagnosed of thoracic empyema. Results: We found 72 patients: males 61, females 11. The predisposing conditions were decrease alertness, mouth infections and alcoholism. The main clinical features were fever (69%) pleuritic chest pain (68%) cough (57%). dyspnea (47%). and purulent sputum (37%). Gram stain of pleural fluid was positive in 24% of patients, and 39% had positive culture of pleural fluid (78% bacteria gram+, 19% bacteria gramand 3% tuberculosis). 9% of patients had blood culture positive. The patients were treated with chest tube drainage and broad spectrum antibiotics (beta-lactam in combination with clindamicin) or anti-tuberculous medication. Surgical treatment was indicated in 6 cases (11%). Severe complications were presented in 6 cases (8%): pneumothorax, bronchopleural fistula, shock and acute respiratory distress syndrome. The empyema mortality was 8%.
P380 Sarcoidosis: review of 40 cases E. Fernandez Bouza, M.A. Iglesias Fuente, P. Sesma (A Coruiia, E)
Olleros,
M.A.
Castro
Mao,
R. de la
Objective: To examine the clinical. radiological, and histological characteristics of sarcoidosis in our community (Ferrol. Spain). Methods: We retrospectively analysed the medical records of patients diagnosed as having sarcoidosis between 1995 and 2002. Results: We found 40 cases of sarcoidosis. There were 22 male and 18 female. Mean age at onset was 46 years (range, 24-76). There was no clear seasonal effect. The most frequent clinical manifestation at disease onset were arthralgiajarthritis (16 cases), malaise (12). fever (11). erythema nodoso ( 11) and Lofgren syndrome ( 10). Chest X-ray gave the following staging at disease onset: 0 (2 cases), I (17). II ( 16). and 111 (5). As expected, chest CT scan was comparatively more sensitive in detecting sarcoidosis-related abnormalities than CT of the abdomen. As to the lab findings, 20 patients (50%) had elevated blood levels of angiotensin-converting enzyme. Bronchoalveolar lavage showed lymphocytosis in 12 out of 17 cases. Diagnostic biopsy was performed in 23 cases: lung (12 cases), adenopathy (7) skin (3). liver (2) and parotid gland ( 1). While 21 patients (stage 0, 1 case; stage I. 12 cases; stage II, 6 cases; stage III, 2 cases) did not receive corticosteroid treatment at the time of diagnosis, 19 patients (stage I, 5 cases; stage II, 9 cases; stage III, 5 cases) did receive such a treatment. Disease relapses were found to occur more frequently in the latter group. Conclusions: Most of the clinical characteristics of our sarcoidosis patients are in keeping with those reported in other series. However. we failed to detect a female preference or any seasonal effect, The observation that patients on corticosteroid therapy from onset of disease had a slightly worse prognosis than those who did not, most likely reflects between-group differences in disease severity at symptom onset,
P381 Severity assessment of community an Internal Medicine Ward F. Tavares, M. Fonseca, T. Berger,
acquired
pneumonia
V. Marujo,
C. Ferreira
admitted (Lisboa,
to P)
Community acquired pneumonia (CAP) represents a substantial burden on internal medicine ward admissions and on hospital costs. Risk stratification and the decision to hospitalise are critical issues, as near 40% of those treated as inpatients could potentially be managed at home. Patients and methods: Our group retrospectively applied a protocol based on the Pneumonia Severity Index (PSI) to all patients admitted