[Achromobacter xylosoxidans bacteremia in a patient with community-acquired pneumonia]. / Bacteriemia por Achromobacter xylosoxidans en un paciente con neumonía adquirida en la comunidad.

Achromobacter xylosoxidans is a rare cause of bacteremia, and little information on treatment is available. The majority of patients who have developed Achromobacter bacteremia have presented predisposing causes to the infection. A case of community-acquired pneumonia and bacteremia due to A. xylosoxidans in a previously healthy patient is reported. Achromobacter is usually resistant to ampicillin, cephalosporins (1st, 2nd, and 3rd generation), aminoglycosides, and fluoroquinolones. Piperacillin, piperacillin-tazobactam, and trimethoprim-sulfamethoxazole inhibit most isolates.

[Diagnostic value of abdominal pain in intra-abdominal desmoid tumor]. / Valor diagnóstico del dolor abdominal en el tumor desmoide intra-abdominal.

Desmoid tumors are rare, less than 0.1% of all tumors (6.2%). The word desmoid has been recognized since 1838, and applied to non-encapsulated tumors, of connective origin and locally infiltrative. Generally, their course is painless and the recurrence rate is high if resection has not been complete. Most of these tumors can be found in different anatomic areas, most commonly the anterior abdominal wall although other sites, intra- or extra-abdominal, have been reported. We describe the case of a 50 year old female patient, with abdominal pain caused by an intraabdominal desmoid tumor.

[Symptomatic malignant melanoma of the small intestine]. / Melanoma maligno sintomático de intestino delgado.

A 46-year-old woman presented with abdominal pain, nausea vomiting and abdominal distention. Small bowel x-rays and CT scan of the abdomen revealed small bowel obstruction due to malignant melanoma. The diagnosis of cutaneous melanoma was performed 8 years prior to admission on one lesion in the back. Patient received surgical treatment. Completed resection of an involved jejunal [correction of ileal] segment was performed. Three tumor masses were found at laparotomy. Metastasis from malignant melanoma at the gastrointestinal tract occurs frequently though rarely are these intestinal lesions symptomatic. The efficacy of surgical treatment for symptomatic metastatic melanoma is justified to relief symptoms and prolonged survival.

Cerebrospinal fluid cell counts and chemistries in bacterial meningitis.

We evaluated the records of 428 patients with bacterial meningitis to document initial cerebrospinal fluid (CSF) findings and detail their changes during therapy. Compared to patients with an initial polymorphonuclear cell predominance in the CSF, patients with initial CSF lymphocytosis had lower CSF leukocyte counts, milder CSF chemical abnormalities, and a lower frequency of positive CSF Gram stains and cultures. These findings suggest that CSF lymphocytosis may represent an early phase of infection. A low CSF leukocyte count was associated with a poor outcome, presumably reflecting an inadequate host response to infection. The CSF white cell count increased during the first 24 hours of therapy in 45% of cases. Morbidity and case fatality rates were not significantly increased in this group, suggesting that an initial rise in the CSF leukocyte count does not reflect a poor response to therapy.