Vancomycin treatment of cerebrospinal fluid shunt infections. Report of two cases.

The successful use of vancomycin is reported in two children with shunt infections due to Staphylococcus epidermidis which failed to respond to shunt removal. The previously reported experience with this drug is reviewed. The use of vancomycin should be considered in cases of shunt infections due to susceptible microorganisms and refractory to other therapeutic measures.

Recognition and management of central nervous system hemorrhage in hemophilia.

18 central nervous system bleeding episodes in 8 patients with hemophilia A, B, or von Willebrand's disease are reviewed. Survival was seen in 17 of the 18 episodes. There was no mortality from uncontrolled bleeding and permanent neurological sequelae were seen in 8 instances. Management consisted of the use of neurological procedures to define the site of bleeding, therapeutic neurological or neurosurgical treatment where indicated, and vigorous factor replacement under laboratory control. The optimal duration of replacement therapy appears to be 14 days. Trauma as a precipitant was found in only 40% of the episodes with no other common etiologic factor.

Nocardia asteroides osteomyelitis.

Nocardia asteroides osteomyelitis has previously been described only in acutely ill patients. It may occur as an isolated event or part of the disease spectrum of disseminated nocardiosis. An 84 year old immune competent man with N. asteroides right tibial osteomyelitis had an unusual presentation, presumed mechanism of disease and outcome. His course affords an opportunity to review the literature on N. asteroides osteomyelitis and to discuss the unique features of his case.

Unusual case of adrenal cortical carcinoma in a female infant.

Adrenal cortical carcinoma in a 4 1/4-month-old girl was treated by surgery in combination with actinomycin D, cyclophosphamide, and 5-fluorouracil given daily for 5 days every third week for 13 1/2 months. Postoperative hypertension and raised 24-hour 17-hydroxy- and 21-oxosteroids suggested residual microscopical tumour activity. These findings resolved during chemotherapy. The patient is alive and well 22 months after completing chemotherapy. Adrenal cortical carcinoma may rarely mimic neuroblastoma or nephroblastoma when the tumour is not clinically secretory.

Bacteroides peritonitis associated with colon cancer in a continuous ambulatory peritoneal dialysis patient.

Peritonitis is not an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD). We report a case of Bacteroides fragilis-induced bacterial peritonitis, probably due to clinically occult malignancy, in a 76-year-old woman on CAPD.