Intracranial complications of sinogenic and otogenic infections in children: an ESPN survey on their occurrence in the pre-COVID and post-COVID era.

BACKGROUND: COVID-19 pandemic is thought to have changed the epidemiology of some pediatric neurosurgical disease: among them are the intracranial complications of sinusitis and otitis (ICSO). According to some studies on a limited number of cases, both streptococci-related sinusitis and ICSO would have increased immediately after the pandemic, although the reason is not clear yet (seasonal changes versus pandemic-related effects). The goal of the present survey of the European Society for Pediatric Neurosurgery (ESPN) was to collect a large number of cases from different European countries encompassing the pre-COVID (2017-2019), COVID (2020-2021), and post-COVID period (2022-June 2023) looking for possible epidemiological and/or clinical changes. MATERIAL AND METHODS: An English language questionnaire was sent to ESPN members about year of the event, patient's age and gender, presence of immune-deficit or other favoring risk factors, COVID infection, signs and symptoms at onset, site of primary infection, type of intracranial complication, identified germ, type and number of surgical operations, type and duration of medical treatment, clinical and radiological outcome, duration of the follow-up. RESULTS: Two hundred fifty-four cases were collected by 30 centers coming from 14 different European countries. There was a statistically significant difference between the post-COVID period (129 children, 86 cases/year, 50.7% of the whole series) and the COVID (40 children, 20 cases/year, 15.7%) or the pre-COVID period (85 children, 28.3 cases/year, 33.5%). Other significant differences concerned the presence of predisposing factors/concurrent diseases (higher in the pre-COVID period) and previous COVID infection (higher in the post-COVID period). No relevant differences occurred as far as demographic, microbiological, clinical, radiological, outcome, morbidity, and mortality data were concerned. Paranasal sinuses and middle ear/mastoid were the most involved primary site of infection (71% and 27%, respectively), while extradural or subdural empyema and brain abscess were the most common ICSO (73% and 17%, respectively). Surgery was required in 95% of cases (neurosurgical and ENT procedure in 71% and 62% of cases, respectively) while antibiotics in 99% of cases. After a 12.4-month follow-up, a full clinical and radiological recovery was obtained in 85% and 84% of cases, respectively. The mortality rate was 2.7%. CONCLUSIONS: These results suggest that the occurrence of ICSO was significantly increased after the pandemic. Such an increase seems to be related to the indirect effects of the pandemic (e.g., immunity debt) rather than to a direct effect of COVID infection or to seasonal fluctuations. ICSO remain challenging diseases but the pandemic did not affect the management strategies nor their prognosis. The epidemiological change of sinusitis/otitis and ICSO should alert about the appropriate follow-up of children with sinusitis/otitis.

Primary mediastinal large B-cell lymphoma: Outcome of a series of pediatric patients treated with high-dose methotrexate and cytarabine plus anti-CD20.

Between 2007 and 2013, 13 children diagnosed with primary mediastinal large B-cell lymphoma (PMLBL) were treated according to a modified version of AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) LNH-97 protocol based on high-dose methotrexate, anthracyclines, and addition of anti-CD20. Ten patients achieved a continuous complete remission with front-line therapy. The overall 5-year survival was 91.7%, and event-free survival was 83.9%, with only one patient dying of progressive disease. Despite the few cases, these results demonstrate that this therapy, which includes anti-CD20, given in a multicenter setting, is feasible with acceptable toxicity in children with PMLBL.

Metastatic neuroblastoma in infants: are survival rates excellent only within the stringent framework of clinical trials?

Introduction. SIOPEN INES protocol yielded excellent 5-year survival rates for MYCN-non-amplified metastatic neuroblastoma. Patients deemed ineligible due to lack or delay of MYCN status or late registration were treated, but not included in the study. Our goal was to analyse survival at 10 years among the whole population. Materials and methods. Italian and Spanish metastatic INES patients’ data are reported. SPSS 20.0 was used for statistical analysis. Results. Among 98 infants, 27 had events and 19 died, while 79 were disease free. Five- and 10-year event-free survival (EFS) were 73 and 70 %, and overall survival (OS) was 81 and 74 %, respectively. MYCN status was significant for EFS, but not for OS in multivariate analysis. Conclusions. The survival rates of patients who complied with all the inclusion criteria for INES trials are higher compared to those that included also not registered patients. Five-year EFS and OS for INES 99.2 were 87.8 and 95.7 %, while our stage 4s population obtained 78 and 87 %. Concerning 99.3, 5-year EFS and OS were 86.7 and 95.6 %, while for stage 4 we registered 61 and 68 %. MYCN amplification had a strong impact on prognosis and therefore we consider it unacceptable that many patients were not studied for MYCN and probably inadequately treated. Ten-year survival rates were shown to decrease: EFS from 73 to 70 % and OS from 81 to 74 %, indicating a risk of late events, particularly in stage 4s. Population-based registries like European ENCCA WP 11-task 11 will possibly clarify these data (AU)

No disponible

Metastatic neuroblastoma in infants: are survival rates excellent only within the stringent framework of clinical trials?

INTRODUCTION: SIOPEN INES protocol yielded excellent 5-year survival rates for MYCN-non-amplified metastatic neuroblastoma. Patients deemed ineligible due to lack or delay of MYCN status or late registration were treated, but not included in the study. Our goal was to analyse survival at 10 years among the whole population. MATERIALS AND METHODS: Italian and Spanish metastatic INES patients' data are reported. SPSS 20.0 was used for statistical analysis. RESULTS: Among 98 infants, 27 had events and 19 died, while 79 were disease free. Five- and 10-year event-free survival (EFS) were 73 and 70 %, and overall survival (OS) was 81 and 74 %, respectively. MYCN status was significant for EFS, but not for OS in multivariate analysis. CONCLUSIONS: The survival rates of patients who complied with all the inclusion criteria for INES trials are higher compared to those that included also not registered patients. Five-year EFS and OS for INES 99.2 were 87.8 and 95.7 %, while our stage 4s population obtained 78 and 87 %. Concerning 99.3, 5-year EFS and OS were 86.7 and 95.6 %, while for stage 4 we registered 61 and 68 %. MYCN amplification had a strong impact on prognosis and therefore we consider it unacceptable that many patients were not studied for MYCN and probably inadequately treated. Ten-year survival rates were shown to decrease: EFS from 73 to 70 % and OS from 81 to 74 %, indicating a risk of late events, particularly in stage 4s. Population-based registries like European ENCCA WP 11-task 11 will possibly clarify these data.

Five to ten years follow-up after coiling of 241 patients with acutely ruptured aneurysms. A single centre experience.

Endovascular treatment has assumed a role of first choice in the management of ruptured intracranial aneurysms. We describe the clinical and morphological data after the treatment of 258 ruptured intracranial aneurysms in 241 patients, in order to evaluate the safety and the efficacy of the endovascular treatment. Two hundred and forty-one patients with saccular ruptured aneurysms were treated at our institution between 2000 and 2005. After the endovascular treatment a clinical and angiographic follow-up was conducted. The clinical follow-up was carried out with a medical examination and telephonic interviews and mRS was used for evaluation. Two hundred and forty-nine acutely ruptured aneurysms were successfully treated and immediately after the endovascular procedure 81.9% of the aneurysms resulted completely occluded, 12.1% had a residual neck and 6% revealed a residual sac. The evolution of each grade was evaluated at six months and two years. During the follow-up we observed five early and one late re-bleedings. Twenty-four patients underwent a second procedure. After the discharge and up to ten years 73.1% of patients had a good clinical outcome (mRS0-1), 8.9% died and the remainder showed moderate-severe disability (mRS2-3). The long-term stability of the anatomical result is a critic-al issue of this approach because eventual re-bleedings may occur even after several months or years. A careful clinical and radiological follow-up for up to two years after the embolization may prevent recurrences but may not be sufficient.

El acceso vascular sigue siendo un problema a resolver / Vascular access is still an unresolved problem

El acceso vascular para el tratamiento endovascular de los aneurismas de aorta puede ser una limitante o una causa grave de morbilidad o mortalidad. La presunción, la posibilidad de realizarmaniobras adyuvantes o la combinación con cirugía abierta pueden ser determinantes al momento de planear o finalizar el procedimiento. Se describen una variedad de procedimientos utilizados para modificar la anatomía desfavorable de las arterias ilíacas. La angioplastía con dilatadores o balón, la utilización de ciertas guías y accesos o la realización de conductos pueden ser claves al momento de realizar la cirugía.

O acesso vascular para o tratamento endovascular dos aneurismas da aorta pode ser uma limitante ou uma causa grave de morbilidade ou mortalidade. Como presunção, a possibilidade derealizar manobras adjuvantes ou a combinação com cirurgia aberta podem ser determinantes no momento de planejar ou finalizar o procedimento. Descrevem-se uma variedade de procedimentos utilizados para modificar a anatomia desfavorável das artérias ilíacas. A angioplastia com dilatadores ou balão, a utilização de certas guias e acessos ou a realização de canais podem ser fundamentais no momento de realizar a cirurgia.

The vascular access in the treatment of aortic aneurysms may be a limiting factor or a severe cause of morbidity and mortality. The possibility of carrying out adjuvant procedures or combiningthem with open surgery may be determining factors at the moment of planning or completing the procedure. A series of procedures used to modify the unfavourable anatomy of the iliac arteries are here in described. Dilator or balloon angioplasty, the use of certain guidewires and routes of access or the carrying out of conduits may be key at the moment of carrying out the surgery.

Aneurisma micótico de arteria axilar / Mycotic axillary artery aneurysm

Introducción. El aneurisma micótico de la arteria axilar es infrecuente y generalmente es consecuencia de untraumatismo arterial o de abuso de drogas intravenosas. La mayoría de las comunicaciones son de la etapa preantibiótica,cuando la etiología predominante era la endocarditis bacteriana y presentaban una evolución clínica fatal. Casoclínico. Mujer de 44 años con diagnóstico de endocarditis bacteriana de válvula mitral que presentó un aneurisma micóticode arteria axilar; se trató exitosamente mediante resección aneurismática y puente subclaviohumeral con vena safena,acompañado de antibioticoterapia sistémica específica. Conclusión. El aneurisma micótico de arteria axilar por endocarditisbacteriana es infrecuente. La resección aneurismática y la reconstrucción vascular con vena, sumada a la antibioticoterapiaespecífica, constituye el tratamiento de elección(AU)

Introduction. Mycotic axillary artery aneurysm is rare and usually follows arterial trauma or intravenousdrug abuse. Most of the reports are from the pre-antibiotic era when these cases were generally caused by bacterialendocarditis and were usually fatal. Case report. A 44 year-old female with mitral valve bacterial endocarditis presentedwith axillary artery mycotic aneurysm. Patient received an aneurismal resection and a subclavian-brachial bypass withsafenous vein. Conclusion. Resection of the aneurysm, bypass with vein and antibiotic therapy is the treatment of choiceof this rare disease(AU)

Muscle metastasis from hepatocellular carcinoma in a patient treated with TACE.

The authors describe a rare case of hepatocellular carcinoma that metastasized to the pectineal muscle of the right thigh. The patient had been treated with surgical procedures and with multiple sessions of transarterial chemoembolization, one of which was complicated by a right femoral artery hematoma at the catheter insertion site. It is unclear whether the muscle metastasis was caused by blood-borne spread or by tumor-cell seeding caused by the TACE procedure.

Bypass iliopoplíteo por el agujero obturador / No disponible

No disponible

Fístula aortobronquial por aneurisma de aorta: tratamiento endovascular / Aortobronchial fistula due to thoracic aorta aneurysm - endovascular approach

Introducción. El aneurisma de aorta torácica complicado con una fístula aortobronquial es una entidad poco común que, sin control de su evolución, posee baja supervivencia debido a la hemoptisis masiva. La cirugía convencional se asocia a una alta tasa de mortalidad perioperatoria. Actualmente, el tratamiento endovascular ofrece una solución menos invasiva para esta patología. Presentamos un caso clínico y realizamos una revisión bibliográfica de esta entidad infrecuente, así como de los métodos de diagnóstico y las alternativas terapéuticas. Caso clínico. Varón de 67 años con hemoptisis masiva y descompensación hemodinámica a causa de una fístula aortobronquial por aneurisma verdadero de la aorta torácica de 6,7 cm diagnosticado por tomografía computarizada (TC), angiorresonancia y angiografía. El paciente fue sometido a un tratamiento endovascular con endoprótesis autoexpandible de politetrafluoroetileno (TAG Excluder 40 × 200 mm), previa colocación de urgencia de un balón oclusor aórtico, hasta lograr la compensación hemodinámica. No se registraron episodios de hemoptisis en el seguimiento. Los estudios fibrobroncoscópicos en el período postoperatorio fueron negativos. La TC de tórax de control mostró la exclusión completa del aneurisma. Conclusión. El tratamiento endovascular es una alternativa terapéutica segura para la resolución de un aneurisma verdadero de la aorta torácica complicado con una fístula aortobronquial

Introduction. Aneurysm of the thoracic aorta complicated with acute haemoptysis due to aortobronchial fistula is a lifethreating uncommon pathology. Open surgery is associated to a high perioperative mortality rate. Actually, endovascular approach offers a less invasive solution for this problem. We present a case report, and perform a bibliographic review of this unusual disease, as well a diagnostic images methods and current therapy modalities. Case report. A 67 years old male patient with a history of massive haemoptysis and unstable hemodynamically due to aortobronchial fistula secondary to a 6.7 cm thoracic aorta aneurysm, diagnosed by CT scan, angioresonance, and angiography. The patient was treated successfully by endovascular approach with a PTFE endograft (TAG Excluder 40 × 200 mm) being previously treated with an aortic occlusion balloon catheter. There were no episodes of haemoptysis in the postoperative period, and the fibrobronchoscopy was normal. CT scan showed total aneurysm exclusion. Conclusion. Endovascular approach is a safe alternative treatment when dealing with complicated thoracic aorta aneurysm due to aortobronchial fistula

Recuperación posquirúrgica en revascularización infrainguinal / Post-surgical recovery after infrainguinal revascularization

Introducción. En la revascularización del miembro inferior, tradicionalmente se consideraban los resultados de permeabilidad del bypass y la salvación de extremidad. Sin embargo, dado que la enfermedad arterial es sistémica y progresiva, deben evaluarse otros aspectos como las reintervenciones quirúrgicas, las readmisiones hospitalarias, la recuperación funcional y la supervivencia. Objetivo. Analizar los resultados de recuperación posquirúrgica en pacientes sometidos a revascularización infrainguinal. Pacientes y métodos. Revisión de las historias clínicas y el seguimiento clínico de 245 pacientes revascularizados por isquemia crítica debida a arteriopatía obstructiva crónica del miembro inferior. Se utilizaron los programas SPSS 11.5 y MEDCALC 7.1. Se realizaron bypasses infrapatelares, suprapatelares y secuenciales en 137, 92 y 16 pacientes, respectivamente. Resultados. La salvación del miembro inferior fue del 71% a los seis meses, 66% al año y 60% a los tres años. El 66,1% de los pacientes requirió al menos una reoperación y el 69,5% fue reingresado una vez. Sólo 92 pacientes (38,9%) curaron las lesiones tróficas y 44 (18,64%) deambularon de forma independiente. La supervivencia actuarial fue de 80% a los seis meses, 73% al año y 56% a los tres años. Solamente 32 pacientes (13,55%) presentaron resultados posquirúrgicos ideales, es decir, salvaron el miembro inferior, curaron sus lesiones, deambularon y no requirieron reoperaciones ni readmisiones hospitalarias por patología cardiovascular. Conclusiones. Aun con buenos resultados de salvación de extremidad, la revascularización infrainguinal por isquemia crítica presentó una baja tasa de recuperación posquirúrgica, por la continua necesidad de reoperaciones y readmisiones hospitalarias, y la escasa posibilidad de deambulación y curación de lesiones en el seguimiento

Introduction. The outcome of infrainguinal bypass surgery for limb salvage has traditionally been assessed by graft patency rates and limb salvage rates. However, since the peripheral arterial occlusive disease is progressive and systemic, other aspects must be evaluated such as reoperation rate, hospital readmission rate, functional recovery and survival. Aim. To analyze the results of post-surgical recovery in patients with infrainguinal bypass surgery. Patients and methods. Review of clinical records of 245 patients who underwent infrainguinal bypass surgery for critical limb ischemia. Statistical programs SPSS 11.5 and MEDCALC 7.1 were used. Infrapatelar suprapatelar and sequential bypasses were performed in 137, 92 and 16 patients, respectively. Results. The limb salvage rates were 71% at six months, 66% at the first year and 60% at three years. After operation, 66.1% of patients required at least one reoperation and 69.5% of patients, hospital readmission. Complete wound healing was achieved in 92 patients (38.9%) and 44 patients (18.64%) lived in independent form. The survival rates were 80% at six months, 73% at 1 year and 56% at three years. Only 32 patients (13.55%) had ideal surgical results, which consisted on saving the limb, complete wound healing, lived in independent form and no required reoperation or hospital readmissions for cardiovascular pathology. Conclusions. Despite the good results of salvage, the infrainguinal revascularization for critical limb ischemia had a low rate of functional recovery, due to the continuous necessity of reoperation and hospital readmissions, the lack of autonomy and wound healing in the follow-up

A highly accurate method for monitoring histological recovery in patients with celiac disease on a gluten-free diet using an endoscopic approach that avoids the need for biopsy: a double-center study.

BACKGROUND AND STUDY AIM: Endoscopy with duodenal biopsy is often performed in order to assess histological recovery in patients with celiac disease who are on a gluten-free diet. Use of the "immersion" technique during upper endoscopy allows visualization of duodenal villi or detection of total villous atrophy. In this two-center study, we investigated the accuracy of the immersion technique in predicting histological recovery in patients on a gluten-free diet whose initial diagnosis of celiac disease had been made on the basis of total villous atrophy. PATIENTS AND METHODS: The immersion technique was performed in 62 patients with celiac disease who were being treated and who had been referred for follow-up (26 patients at the Rome center and 36 patients at the Vicenza center). All these patients had an initial diagnosis based on positive antibodies and biopsy-proved duodenal total villous atrophy. At the follow-up examination, the duodenal villi were re-evaluated as present or absent by one endoscopist at each center, and the results were compared with the histology. RESULTS: At the follow-up endoscopy, the duodenal villi were found to be present in 51 patients and absent in 11. The sensitivity, specificity, positive predictive value, and negative predictive value of the immersion technique for detecting the presence or absence of villi were all 100 %. CONCLUSIONS: This study demonstrated the feasibility and the high level of accuracy of the immersion technique in predicting the histological recovery of duodenal villi in patients with celiac disease who are following a gluten-free diet. An endoscopy-based approach that avoids the need for biopsy could be useful for monitoring the dietary adherence and/or response of patients with an initial diagnosis of celiac disease based on total villous atrophy.

Comparative follow up of patients with implanted cardioverter-defibrillators after induction of sustained monomorphic ventricular tachycardias or ventricular fibrillation by programmed stimulation.

OBJECTIVE: To investigate the prognostic value of induced monomorphic ventricular tachycardia (VT) and ventricular flutter or fibrillation (VF) during programmed electrical stimulation in patients with a high risk for sudden arrhythmogenic cardiac death. DESIGN: Prospective cohort study. PATIENTS: 102 patients at high risk for arrhythmogenic sudden cardiac death who received an automated implantable cardioverter-defibrillator (AICD) were evaluated. 56 patients received the AICD for primary prevention and 46 for secondary prevention. 58 patients had induction of a monomorphic VT (VT group) and 44 had induction of a polymorphic VT, ventricular flutter, or ventricular fibrillation (VF group) during programmed electrical stimulation. Average follow up was 20 months in both groups. MAIN OUTCOME MEASURES: Appropriate AICD protocol. RESULTS: In patients who received the AICD for primary prevention, 16 of 32 patients in the VT group, compared with only four of 24 patients in the VF group, received an appropriate AICD protocol (p = 0.02). In the entire study population, 479 appropriate AICD protocols were recorded in 28 (48%) patients in the VT group and 28 appropriate protocols in 11 (25%) patients in the VF group. Cumulative Kaplan-Meier event-free survival curves were significantly different (p = 0.02). CONCLUSION: Induction of VF during programmed electrical stimulation is of no prognostic value even in high risk patients without previously documented ventricular fibrillation.

Intra-aneurysmal pressure after incomplete endovascular exclusion.

PURPOSE: An endoleak results from the incomplete endovascular exclusion of an aneurysm. We developed an experimental model to analyze hemodynamic changes within the aneurysm sac in the presence of an endoleak, with and without a simulated open collateral branch. METHODS: With a latex aneurysm model connected to a pulsatile pump, pressures were measured simultaneously within the system (systemic pressure) and the aneurysm sac (intrasac pressure). The experiments were performed without endoleak (control group) and after creating a 3.5-mm (group 1), 4.5-mm (group 2), and 6-mm (group 3) diameter orifice in the endograft, simulating an endoleak. Pressures were also registered with and without a patent aneurysm side branch. RESULTS: In each endoleak group, the intrasac diastolic pressure (DP) and mean pressure (MP) were significantly higher than the systemic DP and MP (P =.01, P =.006, and P =.001, respectively), although the pressure curve was damped. The presence of an open side branch significantly reduced the intrasac DP and MP. CONCLUSION: In this model, intrasac pressures were significantly higher than systemic pressures in the presence of all endoleaks, even the smallest ones. Intrasac pressures higher than systemic pressure may pose a high risk for aneurysm rupture. Although patent side branches significantly reduce these pressures, the aggressive management of an endoleak should be pursued.

Increased activity of membrane-associated nucleoside diphosphate kinase and inhibition of cAMP synthesis in failing human myocardium.

OBJECTIVE: Chronic heart failure is associated with a decreased responsiveness of the heart to beta-adrenergic receptor agonists. We recently demonstrated a receptor-independent activation of G proteins and modulation of cardiac adenylyl cyclase activity by sarcolemmal membrane-associated nucleoside diphosphate kinase. We wondered whether changes in the activity of nucleoside diphosphate kinase occur in heart failure and contribute to or compensate for the impairment in myocardial receptor-mediated cAMP generation. METHODS: Sarcolemmal membranes were purified from non-failing and failing human left ventricular myocardium. The protein level and activity of nucleoside diphosphate kinase were quantified. The influence of nucleoside diphosphate kinase on adenylyl cyclase activity was determined by measuring the effect of GDP on adenylyl cyclase activity in the absence and presence of nucleoside diphosphate kinase inhibitors. RESULTS: The amount and activity of nucleoside diphosphate kinase in sarcolemmal membranes from failing hearts (n=13) were increased 3- to 4-fold compared to levels in membranes from non-failing myocardium (n=5). This increase in sarcolemmal nucleoside diphosphate kinase activity resulted in a 50% inhibition of adenylyl cyclase activity over a range of GDP and ATP concentrations. CONCLUSION: The amount and activity of nucleoside diphosphate kinase are increased in sarcolemmal membranes of failing human myocardium, resulting in a substantial receptor-independent inhibition of adenylyl cyclase activity.

Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices.

OBJECTIVE: The purpose of the study was to assess the effectiveness of cerebral protection devices during carotid artery angioplasty and stent placement. METHODS: Between September 1998 and September 1999, carotid angioplasty and stenting were performed in 46 patients with symptomatic (39.1%) or asymptomatic (60.9%) severe carotid artery stenosis. Wallstents were used in all patients with selective predilatation. Cerebral protection devices were used in 25 of these patients. Primary end points were perioperative neurologic complications and mortality. Data were collected prospectively. RESULTS: The overall combined end point of all neurologic deficits and death rate was 4.34%. Two neurologic events (one transient ischemic attack and one minor stroke) occurred in the unprotected group (9.53%) versus none in the group with cerebral protection. This difference is not statistically significant. The mortality rate was 0% for both groups. On an intention to treat basis, the overall technical success rate for carotid angioplasty was 97.8%, and for placement of cerebral protection devices it was 100%. An important number of particles of different sizes were captured in all cases in which cerebral protection devices were used. CONCLUSION: Experience has shown that cerebral protection during carotid angioplasty and stenting is technically feasible and appears to be effective in preventing procedure-related neurologic complications. Further investigation is warranted.

Bloodstream infections in children with cancer: a multicentre surveillance study of the Italian Association of Paediatric Haematology and Oncology. Supportive Therapy Group-Infectious Diseases Section.

A one-year prospective, multicentre surveillance study on aetiology, main clinical features and outcome of bloodstream infections in children with cancer was conducted in 18 paediatric haematology centres belonging to the Italian Association for Paediatric Haematology and Oncology. A total of 191 bloodstream infections were reported during the study period. Of them, 123 (64%) occurred in neutropenic and 68 (36%) in non-neutropenic patients. Gram-positive cocci caused 45% (85/191) of the episodes, gram-negative rods 41% (78/191), and fungi 9% (18/191). The remaining 5% (10/191) of the episodes were poly-microbial infections. A total of 204 pathogens were isolated (46% gram-positive cocci; 44% gram-negative rods; and 10% fungi). The aetiologic distribution was similar among neutropenic and non-neutropenic patients. A correlation between the infection and the presence of an indwelling central venous catheter was found in 20% (23/114) of the episodes among neutropenic patients and in 55% (23/62) among non-neutropenic patients. Gram-negative micro-organisms were isolated in an unusually high proportion of catheter-related infections (48%). The overall mortality rate from any cause within 30 days from the first positive blood culture was 11%, and was higher among patients who were neutropenic at the onset of the infection than among those who were not neutropenic (15 versus 4%, P = 0.03). In addition, the mortality was significantly higher in recipients of bone marrow transplantation than in patients with acute leukaemia or solid tumour (21, 11 and 6%, respectively) and was also higher in fungaemias and poly-microbial infections (22 and 30%) than in single gram-positive and gram-negative bacteraemias (11 and 6%).