Use of Ceftolozane-Tazobactam in Patient with Severe Medium Chronic Purulent Otitis by XDR Pseudomonas aeruginosa.

We present a case of a male Italian patient of 66 years with a history of kidney transplantation in treatment with cyclosporine and methylprednisolone. He visited an ENT clinic and was diagnosed as chronic left purulent otitis media. He began at-home antibiotic therapy with poor benefit. On 09/13/18, he was admitted to the hospital "S. Maria "of Terni for persistence of left ear pain and complete hearing loss. Magnetic resonance imaging (MRI) of the brain showed "in correspondence of the petrous rock and the mastoid…presence of flogistic tissue." Auricular swabs and later surgical drainage of the purulent material were performed and both were positive for extensively drug-resistant (XDR) Pseudomonas aeruginosa sensitive only to colistin in absence of synergism with rifampin. The patient underwent antibiotic therapy with ceftolozane-tazobactam, a new generation cephalosporin with anti-Pseudomonas activity and a ß-lactamase inhibitor, that currently is indicated for the treatment of complicated urinary tract infections and complicated intra-abdominal infections, with complete healing. In literature, it is described a series of 12 patients with severe MDR (multidrug-resistant) Pseudomonas aeruginosa infections (6 pneumonia) who received salvage therapy with ceftolozane-tazobactam after inappropriate empirical and/or suboptimal treatment. This study included a case of a male patient of 45 years, affected by Burkitt lymphoma and severe neutropenia, who presented with otitis and mastoiditis, and isolation of Pseudomonas aeruginosa in surgical drainage of the purulent material of the ear (blood cultures were negative). He underwent antibiotic therapy with ceftolozane-tazobactam at a dosage of 3 g/8 h for 21.3 days. The patient was healed, but a late recurrence was described because of isolation of ceftolozane-tazobactam-resistant Pseudomonas after therapy. The possibility of acquiring resistance to ceftolozane-tazobactam should be considered in patients with previous exposure to beta-lactams and with poor response to these antibiotics.

[Nonocclusive intestinal infarct and necrotizing enterocolitis in the adult]. / Infarto intestinale non occlusivo ed enterocolite necrotizzante dell'adulto.

A case of full-thickness necrosis of the small bowel, and colon, which required partial resection of the jejunum and total resection of the ileum and colon is reported. The case gives the chance for a review of the Literature on intestinal necrosis not caused by vascular occlusion. Nonocclusive intestinal ischemia, acute neonatal necrotizing enterocolitis and adult necrotizing enterocolitis including the Pig-bel disease, common in Papua-New Guinea, are examined. Resemblances and differences in etiology, pathophysiology and clinical findings are discussed. The hypothesis that the process of "bacterial translocation" plays a central role in the pathogenesis of bowel infarction, representing therefore a possible link between infective and vascular mechanisms, is emphasized. Important suggestions on massive intestinal necrosis management are also reported.

[Porcelain gallbladder. Case reports]. / La colecisti a porcellana. Contributo casistico.

The Authors report some observations on gallbladder calcification with the presentation of two clinical cases. The pathologic anatomy and the clinical aspects of this infrequent affection are described. The Authors underline the importance of surgical treatment, considering the frequency of carcinoma in porcelain gallbladder.

[Spontaneous pneumothorax. The therapeutic directions based on 117 cases]. / Il pneumotorace spontaneo. Orientamenti terapeutici sulla base di 117 casi.

117 cases of spontaneous pneumothorax are reviewed. The authors report their experience and consider surgical drain to be the best method in most cases to achieve a rapid recovery. Surgical management or conservative approach can also to be used in selected patients.

[Celiac-mesenteric insufficiency. Apropos of a case of aorto-hepatic bypass]. / L'insufficienza celiaco-mesenterica. A proposito di un caso di by-pass aorto-epatico.

The Authors report a case of coeliac axis atheromatous obstruction, with superior mesenteric artery steal. The coeliac axis, stopped up the origin was indirectly revascularized by hepatic artery. The early diagnosis of chronic intestinal ischaemia should avoid the intestinal infarction. The development of intravenous digital angiography will certainly help an early diagnosis.

[Acute cholecystitis. Early diagnostic study using cholescintigraphy with Tc99m-IDA]. / La colecistite acuta. Indagine diagnostica precoce con la colescintigrafia con IDA-99mTc.

34 patients admitted for suspected acute cholecystitis were evaluated using 99mTc IDA cholescintigraphy. The results of these studies are reviewed and compared with other diagnostic tests and the subsequent clinical diagnosis. Cholescintigraphy proved to be a safe, simple, highly accurate and sensitive technique. Therefore, 99mTc-IDA cholescintigraphy is proposed as the initial procedure of choice in the evaluation of patients with suspected acute cholecystitis.

[Revascularization of the hepatic artery. Apropos of a case]. / Rivascolarizzazione dell'arteria epatica. A proposito di un caso.

A case of emergency revascularisation of the hepatic artery for liver necrosis following its forced ligature during corpo-caudal pancreatectomy for cancer of the pancreas in referred. Necrosis protection mechanisms, namely higher portal flow, increase in O2 extraction and collateral circulation are analysed. The therapeutic aids for preventing this serious event are presented. It is considered that peripheral expansion of the hepatic artery thrombosis prevented the installation of a valid collateral circulation, although the hypothesis of a reduction in portal flow should not be ignored.