[Pulmonary lymph node in acute juvenile paracoccidioidomycosis (a case report)]. / Linfonodo pulmonar na paracoccidioidomicose aguda infantil (relato de um caso).

The primary complex like Ghon was observed in a child's clinical roentgenographic study. C.S., white, male, 6 years old, was born in Curitiba (PR), Brazil and living in Guaratingueta (SP), Brazil, developed "common cold", bimodal diary fever, chills, shake and sweats. Dyspnea, cough with general lymphadenopathy. Foot and right shoulder arthralgias. Six months ago visited a cave, equitation practice, dog and cat contacts and no transfusion, frontal sweats, fever (38.4 degrees C). T.A. was 8/6, tachycardia in generalized lymphadenopathy. Cardiopulmonary system was normal, mesogastric tumoral mass, hepatosplenomegaly and no ascites. Bone marrow with eosinophilia; nodule demonstrated presence of P. brasiliensis, hypoalbuminemia; hyperglobulinemia; anemia; leukocytosis with eosinophilia. Immunodiffusion with exoantigen 43 kd of P. brasiliensis was 1/32. Primary complex like Ghon was observed in interstitial pneumonia followed by mediastinal and mesogastric mass (35 to 40 days). Clavicular osteolytic lesions (45 to 60 days) appeared during paracoccidioidomycosis therapy. Recovery was observed 2 months after treatment of acute infantile paracoccidioidomycosis.

[The cerebrospinal fluid in bacterial meningitis]. / Aspectos dos líquidos cefalorraquidianos nas meningites bacterianas.

Samples of 1815 cerebrospinal fluid (CSF) were studied in a meningitis outbreak during 1989 in São Paulo, Brazil. Neisseria meningitis 56% with 44% type B, Haemophilus influenzae 17%, from which 72% in children (days to 3-year-old) and Streptococcus pneumoniae 14% from which 60% in children (day to 1-year-old) of 443 (24%) of all strains. Cytochemistry study showed: purulent or turbidity aspects in 70 to 79% positive bacterioscopy or culture of CSF; white cells count > 500/mm3; glucose < 45 mg/dl; protein > 90 mg/dl in 90% of all patients. We concluded that: CSF prognostic factors: (aspect and cytochemistry) were correlated with bacterial meningitis. Bacterioscopy and positive cultures were correlated to NM, SP and HI isolation from these patients (Goodman Test).

[A retrospective therapeutic study of neurocryptococcosis in 112 AIDS and non-AIDS patients]. / Estudo retrospectivo terapêutico da neurocriptococose em 112 aidéticos ou não.

UNLABELLED: A total of 112 AIDS and no AIDS cryptococcosis patients admitted at Emílio Ribas Hospital--São Paulo, Brazil, were treated with amphotericin B (AMB) or amphotericin B and 5 fluorocytosine (5FC). Age, race, predisposing and epidemiological factors, respiratory symptoms were evaluated. Goodman tests applied in three patients groups (I, II and III) with associate or unique therapy revealed: 1. prognostic factors: leukocytes ang glucose showed similar response in groups I, II and III and protein spinal fluid after 1.5g/AMB; 2. India ink tests and Cryptococcus culture were often positive until 1.0g/AMB; 3. significant hypokalemia during monotherapy. Hypo and hyperkalemia had similar data in associate therapy; 4. significant difference in adverse reactions often appeared above 0.7g AMB/250g 5FC; 5. early and late death were common in group III (unique) and group I (no AIDS) and III (2.5 to 4.0g) respectively; 6. similar remission and deaths were verified in AIDS/cryptococcosis. CONCLUSIONS: adverse reactions were observed above 0.75g/AMB plus 250g 5FC. Association was important in initial therapy and AMB maintenance permitted late relapses.

[Internship in a community hospital. Experience gained in the "Faculdade de Ciências Médicas e Biológicas de Botucatu" (author's transl)]. / Internato em hospital de escola médica, não universitário. Experiência da Faculdade de ciéncias Médicas e Biológicas de Botucatu

Currently the verification of the equivalence between an University Hospital (U.H.) and a Community Hospital (C.H.), in means of internship accomplishment is an important subject. The F.C.M.B.B. has accumulated experience in this matter, since among the 514 doctors graduated at this school, in the period of 1968 to 1973: 309 accomplished their internship at Botucatu (U.H.); and the remainers 205 at C.H.s. The author's purpose was to try to evaluate the existence, or not, of this equivalence. Thus two different questionnaries were elaborated, one that was answered by two kinds of intern's instructors (total 58): the teaching staff of U.H. (33), and the physicians belonging to the staff of one of the C.H.s. The other was submitted to two groups of ex-interns (total: 73): ex-interns from U.H. (53) and from C.H.s. (20). Both, ex-interns and teachers, were selected by chance. The answers were analysed by stablishing a comparison between the two groups: U.H. and C.H. The results were analysed by chi2 (chi-square) using the Yates correction for 2 X 2 tables. They seem to suggest that there is an equivalence between U.H.s. and C.H.s. in means of internship accomplishment, since certain characteristics are observed by the C.H.s.

[Acute pneumonia treatment with a new antibiotic (tobramycin) (author's transl)]. / Tratamento de pneumonias agudas com um novo antibiótico (tobramicina).

The authors have studied a new antibiotic Tobramycin in 30 patients with acute infectious pulmonary disease, denominated type I, II and III, according to associated factors, severity and previous pulmonary alterations, being 29 patients included in type II and III. The pneumonia diagnosis has obeyed to clinical, laboratorial, radiological and microbiological criteria. The results after the Tobramycin therapy in 28 evaluable cases were: 3 failures and 25 therapeutic successes. The gram negative bacteria predominated among the causative pathogens and, in 14 patients, strains of Klebisiella Enterobacter group were isolated. The M.I.C. for the pathogenic isolated bacteria in acute pulmonary processes was less than 1,0 microgram/ml in 26 cases. Adverse reactions were observed in 13 patients, from which 9 have presented only laboratorial alterations. The remaining 4 patients have also presented clinical manifestations. These findings were similar to those reported for other aminoglicosides.