[Recurrent bacterial meningitis]. / Meningite bacteriana recorrente.

BACKGROUND: Recurrent bacterial meningitis (RBM) is an unusual entity and usually poses a considerable diagnostic challenge. Different conditions can predispose for recurrence of episodes and the isolated pathogen can guide the diagnosis. The aim of this study was to characterize all RBM admitted to our tertiary paediatric hospital. METHODS: Retrospective analysis of the medical records of all children with RBM, between January 1994 and December 2007 (14 years). RESULTS: During this period, 107 children with bacterial meningitis (BM) were admitted. Among those, 10 (9.3%) had more than 1 episode of BM. Five (4.7%) had cerebrospinal fluid shunt. In the other 5 (4.3%), 11 episodes of BM were identified. S. pneumoniae was isolated in the majority of episodes (4) followed by N. meningitis (2). An anatomical defect, namely post-traumatic CSF leakage, was present in 3 children and S. pneumoniae was isolated in all. A predisposing condition has not yet been identified in 2 children and no anatomical defect or immunodeficiency was found despite full investigation. CONCLUSIONS: It was identified a high proportion of RBM compared to other series, that could be explained by the fact of being a tertiary hospital. An anatomical defect was the most frequent cause and S. pneumoniae the most frequent bacteria. In cases without an obvious predisposing condition an exhaustive evaluation, including search for anatomical and immunological defects, was performed but no changes were identified.

Cutaneous Rosai-Dorfman disease.

Rosai-Dorfman disease is a self-limited benign disease. Rosai and Dorfman first described it in 1969, and the etiology of the disease remains unknown. Main manifestations are cervical adenopathy associated with fever, leukocytosis with neutrophilia and polyclonal gamaglobulinemia. Although the skin is the most common site of extra nodal disease, Rosai-Dorfman disease restricted to the skin is very rare with only a few cases described in the literature. This paper reports a rare case of cutaneous Rosai-Dorfman with skin as the sole site, and reviews the controversies of diagnosis and treatment.

Doença de Rosai-Dorfman cutânea / Cutaneous Rosai-Dorfman Disease

Doença de Rosai-Dorfman é uma doença benigna e autolimitada. Tem etiologia desconhecida e foi descrita pela primeira vez por Rosai e Dorfman em 1969. As manifestações clássicas incluem linfadenopatia cervical usualmente acompanhada por febre, leucocitose com neutrofilia e hipergamaglobulinemia policlonal. Apesar de a pele ser o principal sítio extranodal da doença, sua manifestação restrita à pele costuma ser bastante rara com poucos casos descritos na literatura. O trabalho tem como objetivo relatar um caso de Doença de Rosai-Dorfman cutânea com revisão da literatura onde são abordados os diferentes aspectos do diagnóstico e do tratamento dessa doença.

Rosai-Dorfman disease is a self-limited benign disease. Rosai and Dorfman first described it in 1969, and the etiology of the disease remains unknown. Main manifestations are cervical adenopathy associated with fever, leukocytosis with neutrophilia and polyclonal gamaglobulinemia. Although the skin is the most common site of extra nodal disease, Rosai-Dorfman disease restricted to the skin is very rare with only a few cases described in the literature. This paper reports a rare case of cutaneous Rosai-Dorfman with skin as the sole site, and reviews the controversies of diagnosis and treatment.

Estudio descriptivo y factores pronósticos del alcoholismo en la comuna de Peñaflor / Descriptive study and pronostic factors of alcoholism in Peñaflor commune

Se entregan resultados del seguimiento de 60 pacientes alcohólicos incorporados a un Club de Recuperados Alcohólicos, 4 años posterior al ingreso de éstos al Programa de Rehabilitación y tratamiento del alcoholismo de la comuna de Peñaflor. Se analizan los factores que influyen en la rehabilitación y en la presencia de recaídas en este programa. Los 60 pacientes ingresaron a este programa en el año 1982 y junto a otros 60 alcohólicos constituyen un total de 120 pacientes que se encuentran actualmente en tratamiento. Por constituir éste el primer grupo de pacientes tratados y tener un seguimiento por lo tanto mayor, analizamos los factores que permitieron que un grupo de ellos se mantuvieran en este Club. Un 30% nunca presentaron ingesta de alcohol y un 25% tuvieron recaídas, pero se mantuvieron en el Programa. Se ha elaborado un índice para medir en los pacientes con recaídas la frecuencia y duración de éstas previa y posterior al ingreso al programa. Se analizan posteriormente los factores asociados en aquel grupo que continúa la ingesta de alcohol y que se mantienen en el programa comparándolos con aquellos que no han recaído y con los que abandonaron el Club. Se concluye que los pacientes con recaídas se agrupan mayoritariamente en el tipo de beber inveterado o mixto, presentando así mismo mayores alteraciones psiquiátricas. Los factores socio-culturales impresionan como un gatillante inicial en la mantención del beber patológico. La presencia de cuadros psicóticos en los diversos grupos de pacientes no se demuestra estadísticamente significativo con respecto al pronóstico de esta enfermedad, aunque se observe un porcentaje mayor de episodios psicóticos en los pacientes que experimentaron recaídas y menores porcentajes de episodios psicóticos previos al ingreso al programa en aquellos que nunca tuvieron ingesta de alcohol una vez incorporados al Club de recuperados alcohólicos