[Management of a 4MRGN Acinetobacter baumanii outbreak in a burn unit]. / Management eines Ausbruches mit 4 MRGN Acinetobacter baumannii in einem Brandverletzten-zentrum.

Patients with 4MRGN Acinetobacter baumanii infections in a burn unit represent great challenge. The structured management with 7 involved patients in such a situation is presented. After discovering the infectious trigger a management team is established. An immediate stop for further admissions was announced and all infected room areas and medical equipment were analysed for infection foci. The infected patients were transferred to regional hospitals or a rehabiltation hospital after finishing all surgical procedures. In one case, for whom further operations were needed, a transfer to a separated area of the intermediate care unit (IMC) within the hospital was arranged. The performed analysis of infection foci indicated a bronchoscopy tower to be the infection source. The outbreak was terminated after transferring all patients, final disinfection and subsequent nebulisation with 5-6% hydrogen peroxide within 18 days.

Combinación de insulina con sulfonilureas en pacientes diabéticos tipo II con control deficiente: estudio abierto / Combination therapy of insulin and sulfonylureas in type II diabetic patients with deficient control. An open study

El tratamiento combinado con insulina y sulfonilureas en pacientes diabéticos tipo II que no responden al tratamiento oral con hipoglucemiantes ha sido un tema de interés reciente. Varios estudios han demostrado mejoría en el control metabólico de la glucemia; sin embargo, no se han determinado las características que presentan los pacientes en los que se obtiene un mayor beneficio. En este estudio, durante 12 semanas evaluamos los resultados alcanzados con el tratamiento combinado de hipoglucemiantes orales por la mañana y de insulina a bajas dosis antes de la cena, en 35 pacientes diabéticos tipo II con falla secundaria a las sulfonilureas. Se demostró una mejoría significativa en el grupo estudiado, tanto en la glucemia de ayuno (de 14.9 a 7.81 mmol/l) como en la postprandial (de 14.09 a 10.86 mmol/l). Fue más notorio el beneficio en aquellos que al inicio del estudio presentaron cifras más altas de glucemia y de péptido C, así como en quienes tuvieron una mejor función renal valorada por medio del filtrado glomerular. La edad, el peso y el tiempo de evolución de la diabetes, no mostraron correlación. Se concluye que la terapia combinada es una buena elección, más aún si tomamos en cuenta los marcadores que correlacionan con un mayor beneficio

L-prolineaminopeptidase activity as a tool for identification and differentiation of Serratia marcescens, Serratia liquefaciens and Hafnia alvei strains.

S. marcescens (316 strains), S. liquefaciens (10 strains) and Hafnia alvei (20 strains), in contrast to 18 other Enterobacteriaceae species, hydrolyzed L-proline-4-nitroanilide within 30 min at 37 degrees C. In this way, rapid identification of these species is possible. The substrate is applied in solution or in a paper disc. The substrate optimum of Hafnia alvei strains proved to be 16 times lower than that of the Serratia spp. Application of a tenth of the substrate concentration necessary for identification of Serratia spp. allows a rapid differentiation between the two species.

Serum growth hormone and ultrastructural studies of adenohypophysial tissue in bromocriptine treated acromegalic patients.

The therapeutic effectiveness of bromocriptine as well as the post-operative ultrastructural aspects of treated pituitary adenomas were investigated in five acromegalic patients. Although concentrations of GH basal decreased and the glucose tolerance test and the TSH responses were significantly improved, the release of GH induced by TRH was not prevented by the dopaminergic agonist. Adenomatous cells were densely granulated and contained a dilated endoplasmic reticulum. Misplaced exocytosis was frequently observed. These findings clearly indicate that bromocriptine inhibits the spontaneous release of GH but does not interfere with the abnormal GH response to TRH. This suggests a separate site of action. The drug seems not to block the synthesizing activity of the adenomatous cell, a finding in accordance with clinical observations that warns against its use as a single therapeutic agent.