[Giant cell arteritis: diagnostic value of a second biopsy of the temporal artery (author's transl)]. / Arteritis de células gigantes. Valor diagnóstico de una sequnda biopsia de la arteria temporal.

A 79-year old female patient with antecedents of headache and fever, was admitted because of fatigue, anorexia, anemia and elevated ESR. After admission she presented with rheumatic polymyalgia and synovial effusion in the knee. A first biopsy of the temporal artery was normal. After dismissing other possible causes a second biopsy of the contralateral temporal artery was bone and confirmed giant cell arteritis. Diagnostic value of a second temporal artery biopsy is discussed and justified by: a) a confirmed diagnosis is necessary for prolonged treatment with corticosteroids, b) if it is decided to treat the rheumatic polymyalgia with lower doses of corticosteroids than for temporal arteritis the certainty that no temporal arteritis is present and c) shortening the hospital stay and lowering the cost and number of diagnostic procedures. The frequency of arthritis and synovial effusion in temporal arteritis are also discussed.

[Spontaneous peritonitis due to Clostridium perfringens in three patients with cirrhosis (author's transl)]. / Peritonitis espontánea por Clostridium perfringens en tres enfermos cirróticos.

Three cases of spontaneous peritonitis due to Clostridium perfringens in cirrhotic patients with a fatal outcome are reported. The diagnosis was made clinically in two patients and by post-mortem examination in the third. One patient had elevated values of serum alpha-fetoprotein. These cases are compared with three other reported cases in the literature. Blood cultures were negative in the three patients, a fact that lends support to the theory of transmural migration of bacteria. In the authors' experience C. perfringens is the third most frequent agent responsible for spontaneous peritonitis in cirrhosis, preceded by E. coli and Streptococcus and followed by Klebsiella, a surprising fact given the scarce number of reported cases. Routine abdominal paracentesis is recommended in any cirrhotic patient with ascites, followed by appropriate antibiotic treatment whenever positive cultures are obtained. The efficacy of treatment is probably doubtful. The literature on antibiotic treatment of spontaneous peritonitis in cirrhosis is reviewed.

[Bacteremia and sepsis due to Streptococcus agalactiae. Study of eight cases (author's transl)]. / Bacteriemia y sepsis por Streptococcus agalactiae. Presentación de ocho casos.

During a period of 29 months positive hemocultures to Streptococcus agalactiae corresponding to eight adult patients have been observed. These bacteria were apparently responsible for the clinical picture in five patients. In other two patients S. agalactiae appeared in the course of a sepsis caused by other germ. The remaining patient had a transient bacteremia and no treatment was required. Septic shock and bacterial endocarditis were the cause of death in two patients. Six patients cured. Literature on this subject is reviewed and the better prognosis of sepsis due to S. agalactiae in adults than in neonates is stressed. Endocarditis and meningitis occur as severe complications with poor prognosis. In patients with endocarditis the administration of penicillin and gentamicin as well as the consideration of early surgical replacement of the affected heart valve is recommended. Intravenous penicillin and gentamicin associated with intrathecal gentamicin are indicated in meningeal infections. Vancomycin is a good substitutive antibiotic in patients with penicillin hypersensibility.

Plasma cell dyscrasia with polyneuritis and dermato-endocrine alterations. Report of a new case outside Japan.

A new syndrome has been described comprising polyneuropathy, oedema, hyperpigmentation and thickening of the skin, gynaecomastia in males and amenorrhoea in females, monoclonal gammopathy, papilloedema and diabetes. There is frequent osteosclerosis with or without plasmacytoma, hepatosplenomegaly and polycythaemia. There is a good response to corticosteroids, immunosuppressive drugs and occasionally to excision or irradiation of the plasmacytoma. This syndrome was first described in Japan, and is still seen predominantly there, and only occasionally in other areas. An example in a 51-year-old Spanish female is described: she had a spectacular response to prednisone and melphalan. The aetiopathogenic possibilities are discussed.