Enterococcus faecium small colony variant endocarditis in an immunocompetent patient.

Small colony variants (SCV) are slow-growing subpopulations of bacteria usually associated with auxotrophism, causing persistent or recurrent infections. Enterococcus faecalis SCV have been seldom described, and only one case of Enterococcus faecium SCV has been reported, associated with sepsis in a leukaemia patient. Here we report the first case described of bacteraemia and endocarditis by SCV E. faecium in an immunocompetent patient.

Multicentric observational study of pain after the use of a self-gripping lightweight mesh.

INTRODUCTION: Investigation in the field of inguinal hernia surgery is now focused on postoperative pain. The extended use of lightweight meshes and alternative methods of fixation may play a relevant role in the reduction of pain. In this study, a new self-gripping lightweight polypropylene mesh is tested. METHODS: A multicentric, observational study was scheduled to prospectively evaluate this new mesh. Ten centers agreed to participate. Only primary, type 1 or 2 uncomplicated hernias in adults were included. The mesh was placed as a Lichtenstein procedure without any fixation. A complete pain questionnaire was followed at 1 week, and at 1, 3 and 6 months postoperatively. The principal goal of the study was to evaluate maximum pain score at 6 months. Pain was assessed by a visual analog scale. A total of 256 patients were operated. Mean operative time was 35.6 min; 76.2% of patients were operated in an ambulatory setting. RESULTS: There were a few postoperative complications: 2 wound infections, 17 seromas, 21 hematomas, 6 orchitis. The incidence of acute pain was 27.3% at week 1 and 7.5% at month 1. The incidence of chronic pain was 3.6% at month 3 and 2.8% at month 6. No recurrences or long-term complications were observed. CONCLUSION: This self-gripping mesh can be used safely in type 1 and 2 primary, uncomplicated inguinal hernia with minimal morbidity and most patients under ambulatory setting. The registered incidence of chronic pain is lower than 3%.

Prosthetic mesh used for inguinal and ventral hernia repair: normal appearance and complications in ultrasound and CT.

The use of prosthetic mesh has now become accepted practice in the treatment of patients with both inguinal and ventral hernias. This pictorial review illustrates the various radiological appearances of these meshes and also demonstrates the post-operative complications associated with their implantation.

[Juvenile spondyloarthropathies: descriptive study of 40 patients]. / Espondiloartropatías juveniles: estudio descriptivo de 40 pacientes.

OBJECTIVE: The objective of this study was to describe the clinical characteristics of children with spondyloarthropathies diagnosed in our unit. PATIENTS AND METHODS: We analyzed the patients with SEA syndrome, undifferentiated spondyloarthropathy, psoriatic arthritis, arthritis associated with inflammatory bowel disease and reactive arthritis with onset symptoms before the age of 16. RESULTS: Forty patients were diagnoses as suffering from spondyloarthropathy (29 boys and 11 girls). Eight presented a SEA syndrome, 8 undifferentiated spondyloarthropathy, 8 psoriatic arthritis, 6 arthritis associated with inflammatory bowel disease and 10 with reactive arthritis. No patient met ankylosing spondylitis criteria. In ten children the initial diagnosis was chronic juvenile arthritis. The articular disease had a relapsing and remitting course in one third of the patients. Almost 50% had only one episode and 7 patients had one prolonged course. In general, the functional outcome was good. CONCLUSIONS: Juvenile spondyloarthropathies are a group of rheumatic diseases with common clinical characteristics and differ from chronic juvenile arthritis. Their early recognition is important with regard to treatment and prognosis.

Colorectal adenocarcinoma: quality of the assessment of lymph node metastases.

PURPOSE: We have studied 193 cases of colorectal adenocarcinoma from a population-based register to determine the minimum number of lymph nodes to be examined to provide an accurate assessment of the presence of nodal metastases. METHODS: The mean total number of lymph nodes identified per surgical specimen was 11 +/- 6.8 (range, 1-36) using traditional dissection. One hundred eighteen specimens (61 percent) were classified as Dukes B. Seventy-five (39 percent) had lymph node metastases (Dukes C) with a mean of 3.3 +/- 4.7 positive lymph nodes per specimen. With binomial distribution we calculate the probability to find at least one positive node in a sample size n with a determined proportion of positive nodes. RESULTS: The error probability in the ganglionar assessment by traditional dissection was 0.05 with 6 examined lymph nodes and 0.01 with 10 examined nodes. CONCLUSION: We must provide the pathologist with a minimum of six examined lymph nodes per surgical specimen for an optimal Dukes B assessment.