Bacteremic pneumococcal pneumonia: clinical outcomes and preliminary results of inflammatory response.

PURPOSE: Further examination of clinical outcomes and inflammatory response of bacteremic pneumococcal community-acquired pneumonia (CAP) is of great interest to enhance the care of patients with pneumococcal CAP. METHODS: This is a secondary analysis of the Community Acquired Pneumonia Organization (CAPO) to compare the time to clinical stability (TCS), length of hospital stay (LOS), and in-hospital mortality of hospitalized pneumococcal CAP patients with and without bacteremia. To measure the effect of bacteremia in pneumococcal CAP patients on outcomes, we modeled all-cause in-hospital mortality using a Poisson regression model, and TCS and LOS using Cox proportional hazards models. Adjusted multivariate regression models were also used to predict the probability of occurrence of each of the study outcomes. To investigate the inflammatory response, we measured the plasma levels of pro- and anti-inflammatory cytokines [tumor necrosis factor (TNF)-α, interleukin (IL)-1rα, IL-6, IL-8, IL-10], inflammatory biomarkers [C-reactive protein (CRP), pro-calcitonin (PCT), and B-type natriuretic peptide (BNP)], and peripheral blood neutrophil responses in 10 patients, 4 bacteremic and 6 non-bacteremic pneumococcal CAP, upon admission and every other day during the first 6 days of hospitalization. Functional data were presented as median and standard error of the median (SEM); due to small number of samples no statistical comparisons were performed between groups. RESULTS: From 833 pneumococcal CAP patients, 394 patients (47 %) were bacteremic. Bacteremic pneumococcal CAP were less likely to reach TCS with an adjusted hazard ratio (AHR) of 0.82 (95 % CI 0.69-0.97; p = 0.02) and had higher in-hospital mortality with an AHR of 1.63 (95 % CI 1.06-2.50, p = 0.026). Bacteremic pneumococcal CAP patients had a longer LOS than non-bacteremic pneumococcal CAP (p < 0.003). Higher plasma levels of CRP, PCT, and BNP were found in bacteremic than in non-bacteremic patients. The bacteremic group had consistently higher plasma levels of both pro- and anti-inflammatory cytokines. The blood neutrophil functional responses were similar in both groups of patients. CONCLUSIONS: Bacteremic pneumococcal CAP patients were significantly associated with higher in-hospital mortality, lower TCS, and longer LOS. HIV-infected patients showed a greater mortality which was not statistically significant. Bacteremic pneumococcal CAP patients had higher levels of biomarkers and systemic cytokines.

Nitrofurantoin retains antimicrobial activity against multidrug-resistant urinary Escherichia coli from US outpatients.

OBJECTIVES: To examine the prevalence of multidrug-resistant (MDR) urinary Escherichia coli among US outpatients and to assess the antimicrobial activity of oral antibiotics commonly used to treat urinary tract infections (UTIs) against MDR isolates. METHODS: Antimicrobial susceptibility testing data from outpatient urine cultures in The Surveillance Network (TSN) Database USA were analysed. Six antimicrobial agents from six separate drug classes were included: ampicillin, cefalotin, ciprofloxacin, nitrofurantoin, trimethoprim/sulfamethoxazole and amoxicillin/clavulanate. Isolates were categorized as resistant to one, two, three, four, five and six agents and compared for the years 2001 and 2010. Phenotypes of MDR isolates were assessed to determine antimicrobial activity of recommended therapy for UTIs. RESULTS: Prevalence of MDR E. coli increased from 9.1% in 2001 (n = 29,198) to 17.0% in 2010 (n = 32,742) (P < 0.0001). In isolates that demonstrated resistance to three, four or five antimicrobial agents in 2010, resistance to nitrofurantoin was observed in only 2.1%, 7.5% and 24.1% of isolates, respectively. Conversely, widespread resistance was observed for trimethoprim/sulfamethoxazole (62.6%, 88.6% and 97.9% for isolates resistant to three, four and five agents, respectively) and ciprofloxacin (48.9%, 84.3% and 98.2% for isolates resistant to three, four and five agents, respectively). CONCLUSIONS: Because of its consistent antimicrobial activity against MDR E. coli, nitrofurantoin remains a reliable first-line agent for the empirical treatment of acute uncomplicated cystitis.

Cytokines and neutrophils responses in influenza pneumonia.

This case report shows a striking correlation of remarkable brief high levels of pro- and anti-inflammatory cytokines coupled with increased neutrophil activation, followed by a sharp decrease in cytokine levels and increased neutrophil apoptosis associated with the favorable clinical outcomes of a patient with severe influenza infection. The host response examined in our case is not complete, given it did not assess the full spectrum of host response. The brief neutrophil and cytokine response seen in our case in the absence of antiviral therapy and in the presence of methotrexate immunosuppressive therapy rise the question as to whether the latter optimally modulated the macrophage function, resulting in a favorable outcome of severe influenza viral infection.

Imaging diagnosis of vertebral metastasis. / Diagnóstico por imagen de las metástasis vertebrales.

The spine is the third most frequent location for metastatic disease, after the lung and liver. On the other hand, the most frequent bone tumors are metastases and the spine is the main location. A review of the different imaging techniques available, both radiological and nuclear medicine, and the morphological appearance of spinal metastases in each of them is performed. Magnetic resonance imaging is the best imaging modality for detection of spinal metastases. It is important to make the differential diagnosis between vertebral fracture of osteoporotic and pathological cause. Spinal cord compression is a serious complication of metastatic disease and its assessment by imaging through objective scales is decisive for estimating spinal stability and therefore establishing treatment. Lastly, percutaneous intervention techniques are briefly discussed.

[Translated article] Imaging diagnosis of vertebral metastasis.

The spine is the third most frequent location for metastatic disease, after the lung and liver. On the other hand, the most frequent bone tumours are metastases and the spine is the main location. A review of the different imaging techniques available, both radiological and nuclear medicine, and the morphological appearance of spinal metastases in each of them is performed. Magnetic resonance imaging is the best imaging modality for detection of spinal metastases. It is important to make the differential diagnosis between vertebral fracture of osteoporotic and pathological cause. Spinal cord compression is a serious complication of metastatic disease and its assessment by imaging through objective scales is decisive for estimating spinal stability and therefore establishing treatment. Lastly, percutaneous intervention techniques are briefly discussed.

How Does Ball Possession Affect the Physical Demands in Spanish LaLiga? A Multilevel Approach.

Purpose: Using a multilevel approach, this study analyzed the relationship between ball possession and distance covered at different speed sections: total distance (TD), distance covered between 14.1-21 km·h-1 (MIRD), 21.1-24 km·h-1 (HIRD), and > 24.1 km·h-1 (VHIRD). Methods: The sample included 1,520 matches played by 80 Spanish professional soccer teams across four consecutive LaLiga seasons (from 2015/2016 to 2018/2019). Two observations were collected per match, one from each team, resulting in a total of 2,950 records (760 per season). Data were collected using Mediacoach®. Results: At match level (i.e., grand-mean centered), ball possession negatively predicted all distances covered. At team level (i.e., group-mean centered), ball possession negatively predicted total distance covered and distance covered between 14.1-21 km·h-1. Furthermore, cross-level interactions (Match X Team) in ball possession negatively predicted all distances covered at speeds above 14.1 km·h-1. Specifically, in high-possession teams, the negative relationship between match ball possession and distances traveled at all speed ranges above 14.1 km·h-1 was stronger than in teams with medium or low possession. Conversely, match ball possession was positively related todistance covered at low intensities, and negatively related at high intensities in low-possession teams. Conclusion: These findings show practitioners and researchers that the distances covered at different speed ranges depend on technical-tactical parameters such as ball possession.

The relationship between running distance and coaches' perception of team performance in professional soccer player during multiple seasons.

This study analyzed how the physical movement profile of soccer matches evolved throughout a season by assessing the variability of different metrics depending on the season phase. In addition, the evolution of running distances was investigated in the relation to the team performance based on the coaches' perception. Games from four consecutives Spanish LaLiga seasons (n = 1520) were recorded using an optical tracking system (i.e., ChyronHego). Total distance (TD), distance covered between 14 and 21 km h-1 (MIRD), 21-24 km h-1 (HIRD), and > 24 km h-1 (VHIRD) were analyzed, as well as the number of efforts between 21 and 24 km h-1 (Sp21) and > 24 km h-1 (Sp24). Seasons were divided into four phases (P): P1 (matches 1-10), P2 (11-19), P3 (20-29), and P4 (30-38). Linear mixed models revealed that soccer players covered significantly greater distances and completed a higher number of sprints in P2 and P3. Also, team performance evaluated by soccer coaches was positively related to TD, HIRD, VHIRD and Sp21 in P1. A negative relationship was observed between team performance and distance covered at speeds below 21 km h-1 in P2 and P3. Team performance was negatively related to TD, MIRD, and HIRD, and Sp21 in P4. As conclusion, the team performance perceived by coaches is related to the movement profile throughout a season, and it significantly influences the evolution of soccer players' movement profiles. Specifically, it seems that the players of the best teams have the best physical performance at the beginning of the season with respect to the rest of the phases.

Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary disease: incidence, epidemiology and outcomes.

OBJECTIVES: Community-acquired pneumonia (CAP) is an important complication in patients with chronic obstructive pulmonary disease (COPD). This study aimed to define incidence, and outcomes of COPD patients hospitalized with pneumonia in the city of Louisville, and to estimate the burden of disease in the US population. METHODS: This was a secondary analysis of a prospective population-based cohort study of residents in Louisville, Kentucky, 40 years old and older, from 1 June 2014 to 31 May 2016. All adults hospitalized with CAP were enrolled. The annual incidence of pneumonia in COPD patients in Louisville was calculated and the total number of adults with COPD hospitalized in the United States was estimated. Clinical outcomes included time to clinical stability (TCS), length of hospital stay (LOS) and mortality. RESULTS: From a Louisville population of 18 246 patients with COPD, 3419 pneumonia hospitalizations were documented during the 2-year study. The annual incidence was 9369 patients with pneumonia per 100 000 COPD population, corresponding to an estimated 506 953 adults with COPD hospitalized due to pneumonia in the United States. The incidence of CAP in patients without COPD was 509 (95% CI 485-533) per 100 000. COPD patients had a median (interquartile range) TCS and LOS of 2 (1-4) and 5 (3-9) days respectively. The mortality of COPD patients during hospitalization, at 30 days, 6 months and 1 year was 193 of 3419 (5.6%), 400 of 3374 (11.9%), 816 of 3363 (24.3%) and 1104 of 3349 (33.0%), respectively. CONCLUSIONS: There was an annual incidence of 9369 cases of hospitalized CAP per 100 000 COPD patients in the city of Louisville. This was an approximately 18-fold greater incidence of CAP in COPD patients than in those without COPD.

Diagnóstico por imagen de las metástasis vertebrales / Imaging diagnosis of vertebral metastasis

La columna vertebral es la tercera ubicación más frecuente para la enfermedad metastásica, después del pulmón y el hígado. Por otra parte, los tumores óseos más recurrentes son las metástasis, siendo la columna su principal lugar de localización. En este trabajo se realiza una revisión de las diferentes técnicas de imagen disponibles, tanto radiológicas como de medicina nuclear, y de la apariencia morfológica de las metástasis de columna en cada una de ellas. La resonancia magnética (RM) es la mejor modalidad de imagen para la detección de metástasis en la columna. Es importante efectuar el diagnóstico diferencial entre fractura vertebral de causa osteoporótica y patológica. La compresión medular es una complicación grave de la enfermedad metastásica y su valoración mediante imagen a través de escalas objetivas es determinante para la estimación de la estabilidad de la columna y, por consiguiente, para establecer el tratamiento. Por último, se comentan brevemente las técnicas de intervencionismo percutáneo.(AU)

The spine is the third most frequent location for metastatic disease, after the lung and liver. On the other hand, the most frequent bone tumors are metastases and the spine is the main location. A review of the different imaging techniques available, both radiological and nuclear medicine, and the morphological appearance of spinal metastases in each of them is performed. Magnetic resonance imaging is the best imaging modality for detection of spinal metastases. It is important to make the differential diagnosis between vertebral fracture of osteoporotic and pathological cause. Spinal cord compression is a serious complication of metastatic disease and its assessment by imaging through objective scales is decisive for estimating spinal stability and therefore establishing treatment. Lastly, percutaneous intervention techniques are briefly discussed.(AU)

[Translated article] Imaging diagnosis of vertebral metastasis / Diagnóstico por imagen de las metástasis vertebrales

La columna vertebral es la tercera ubicación más frecuente para la enfermedad metastásica, después del pulmón y el hígado. Por otra parte, los tumores óseos más recurrentes son las metástasis, siendo la columna su principal lugar de localización. En este trabajo se realiza una revisión de las diferentes técnicas de imagen disponibles, tanto radiológicas como de medicina nuclear, y de la apariencia morfológica de las metástasis de columna en cada una de ellas. La resonancia magnética (RM) es la mejor modalidad de imagen para la detección de metástasis en la columna. Es importante efectuar el diagnóstico diferencial entre fractura vertebral de causa osteoporótica y patológica. La compresión medular es una complicación grave de la enfermedad metastásica y su valoración mediante imagen a través de escalas objetivas es determinante para la estimación de la estabilidad de la columna y, por consiguiente, para establecer el tratamiento. Por último, se comentan brevemente las técnicas de intervencionismo percutáneo.(AU)

The spine is the third most frequent location for metastatic disease, after the lung and liver. On the other hand, the most frequent bone tumors are metastases and the spine is the main location. A review of the different imaging techniques available, both radiological and nuclear medicine, and the morphological appearance of spinal metastases in each of them is performed. Magnetic resonance imaging is the best imaging modality for detection of spinal metastases. It is important to make the differential diagnosis between vertebral fracture of osteoporotic and pathological cause. Spinal cord compression is a serious complication of metastatic disease and its assessment by imaging through objective scales is decisive for estimating spinal stability and therefore establishing treatment. Lastly, percutaneous intervention techniques are briefly discussed.(AU)

Early switch from intravenous to oral antibiotics in hospitalized patients with bacteremic community-acquired Streptococcus pneumoniae pneumonia.

BACKGROUND: The identification of Streptococcus pneumoniae bacteremia in hospitalized patients with community-acquired pneumonia is considered by some investigators to be an exclusion criterion for early switch from intravenous to oral therapy. OBJECTIVE: To determine whether the switch from intravenous to oral therapy in such patients, once the bx;1patient reaches clinical stability, is associated with poor clinical outcome. METHODS: The medical records of 400 patients with community-acquired pneumonia hospitalized at the Veterans Affairs Medical Center of Louisville (Louisville, Ky) were reviewed to identify patients with bacteremic S pneumoniae. Four criteria were used to define when a patient reached clinical stability and should be considered a candidate for switch therapy: (1) cough and shortness of breath are improving, (2) patient is afebrile for at least 8 hours, (3) white blood cell count is normalizing, and (4) oral intake and gastrointestinal tract absorption are adequate. RESULTS: A total of 36 bacteremic patients were identified. No clinical failures occurred in 18 patients who reached clinical stability and were switched to oral therapy or in 7 patients who reached clinical stability and continued intravenous therapy. Clinical failures (5 deaths) occurred in the group of 11 patients who did not reach clinical stability. CONCLUSION: Once a hospitalized patient with community-acquired pneumonia reaches clinical stability, it is safe to switch from intravenous to oral antibiotics even if bacteremia caused by S pneumoniae was initially documented.

Histiocytic necrotizing lymphadenitis, Kikuchi-Fujimoto's disease, associated with systemic lupus erythemotosus.

Histiocytic necrotizing lymphadenitis, Kikuchi-Fujimoto's Disease (KFD), is a condition rarely associated with systemic lupus erythematosus (SLE). The diagnosis of KFD can precede, postdate or coincide with the diagnosis of SLE. Lymphadenopathy is a common clinical presentation of KFD and SLE, and is histologically indistinguishable in both conditions. We describe two cases of KFD associated with SLE. The diagnosis of KFD in one case was made several years before the diagnosis of SLE, and the other was simultaneous. Both showed large lymphadenopathy, but neither fever nor neutropenia. Lymph-node biopsy showed necrosis, with proliferation of histiocytes and immunoblasts, paucity of neutrophils and absence of hemathoxilin bodies. Both patients responded favourably to steroid treatment. Patients with KFD should be assessed for SLE and have long-term follow-up checking for development of SLE. KFD should be ruled out in SLE flare-up accompanied by lymphadenopathy.

Pneumothorax in active pulmonary tuberculosis: resurgence of an old complication?

With the recent resurgence of tuberculosis (TB) in western countries, the incidence of complicating secondary pneumothorax has also increased. The work-up and management of this complication differs from that in other types of secondary spontaneous pneumothorax (SSP). Our objective was to assess clinical features and therapeutic modalities of SSP in patients with and without active pulmonary tuberculosis (APTB). All patients diagnosed with SSP seen at the Hospital Xeral of Vigo from January 1990 to June 1995 were candidates for this study. Full clinical, radiological and examinations were performed in all patients. Invasive procedures (thoracic catheter aspiration, thoracoscopy and thoracotomy) and mean hospital stay were compared in patients with and without APTB. Forty-eight patients with SSP were enrolled. Eleven patients (10 males and one female, mean age 30 +/- 11 years) had APTB; and 37 patients (31 males and six females, mean age 49 +/- 20 years) had conditions other than APTB. Chest pain, cough and fever were more frequent in patients with APTB (90% vs 59%; 45% vs 13.5%; 36% vs 5%, respectively). Catheter aspiration was successful in three of 10 (30%) of patients with APTB and in 15/23 (60.86%) of those without APTB. Catheter aspiration time was longer in the former group (25 +/- 22 days vs 13 +/- 11 days, P = 0.17). As initial treatment, thoracoscopy was performed in seven of 37 (18.91%) of those without APTB and in one of 10 (10%) patients with APTB. For patients with unsuccessful catheter aspiration, thoracoscopy was performed in eight of nine (89%) patients without APTB and in none of the patients with APTB. Thoracotomy was performed in only one of nine (11%) without APTB and in four of seven (57%) patients with APTB. Patients with APTB had a longer hospitalization (41 vs 18 days, P < 0.001). We concluded that SSP and APTB was a frequent association in our study. Patients with APTB showed a lesser and slower response to catheter aspiration. Despite severe clinical presentation and demand for more invasive procedures, patients with APTB showed a favourable response.

Skin cross-reactivity between Dermatophagoides pteronyssinus and storage mites in atopic children.

In our environment, some children with allergic respiratory pathology do not have as favorable an evolution as expected after three years of immunotherapy with D. pteronyssinus extracts. We believe this is due to the existence of other mites whose antigenic determinants are not present in D. pteronyssinus. The purpose of the present study was to evaluate skin cross-reactivity between Dermatophagoides and storage mites in children with bronchial asthma. Fifty patients were chosen, with a mean age of 7.78 +/- 2.98 years and a range of 3-14 years. There were 38 boys (76%) and 12 girls (24%) with rhinitis and bronchial asthma. All patients had skin tests and prick tests with the following extracts performed on them: house dust (HD), Dermatophagoides farinae (DFA), Dermatophagoides pteronyssinus (DPT), Acarus siro (AS), Glycyphagus domesticus (GD), Lepidoglyphus destructor (LD), Tyrophagus putrescentiae (TP), with negative and positive controls. The areas of the papulae were evaluated in crosses, according to the size of the histamine and using computerized papulometry, using the Kurta series one graphic tablet with one resolution of 200 points per inch. The data were processed with the "Image-pro" analysis image program. The following conclusions were obtained from our study: 1) No case of skin sensitization to storage mites was found in any of our 50 patients, without house dust and/or Dermatophagoides mites also being present. 2) The greatest skin response with regard to histamine was found for DFA (52%), DPT (44%), HD (22%), GD (10%), AS (4%) and GF (2%).(ABSTRACT TRUNCATED AT 250 WORDS)

Infectious disease concerns and possible complications in the dental patient.

Several questions and concerns often arise in the management of patients with infectious complications. This article explores the difficult issues surrounding the treatment of patients with infectious diseases: infectivity of the present conditions, medication side effects, and potential complications secondary to the dental treatment are questions to be considered in the evaluation of these patients. Dentists should be aware of the management of oral complications of these conditions and are important members of the health care team involved in the follow-up care of these patients.

[Cryptococcosis of the central nervous system and infection by HIV. Clinical-evolutive characteristics in 13 cases]. / Criptococosis del sistema nervioso central e infección por VIH. Características clínico-evolutivas de 13 casos.

Cryptococcosis is the fourth cause of infection of the Central Nervous System in patients with infection by HIV. Despite this fact, the series published in our country are referred to a limited number of cases. We describe the most relevant characteristics of 13 patients with meningitis by Cryptococcus neoformans. We used as inclusion criteria a positive culture of the Cephalorhachidian Fluid (CRF). We observed a significant reduction in the levels of CD4 lymphocytes in all patients, the absence of meningitic syndrome in more than 50% cases (8/13) and a normal CRF cytobiochemistry in three patients. The thoracic radiography was normal in all cases but two, although the cryptococcus was cultured in a transbronchial biopsia of a patient with normal thoracic radiography. The Computerized Axial Tomography showed frequent alterations (5/13). Eight patients were treated with amphotericin B (0.5 mg/kg/d) and five with fluconazol (400 mg/day). Despite following a maintenance therapy with fluconazol (200 mg/d), we had two cases of recurrence in the group previously treated with fluconazol. The level of leukocytes in the CRF was the only prognosis factor (p < 0.05). Five patients died during their first hospitalization due to causes related to the infection by cryptococcus. New therapeutical guidelines are needed in order to improve the prognosis of these patients.

[Cerebral abscesses. The clinical and evolutionary aspects of 17 cases treated surgically]. / Abscesos cerebrales. Aspectos clínicos y evolutivos de 17 casos intervenidos quirúrgicamente.

Seventeen cases of cerebral abscesses undergoing surgery were reviewed, underlying the characteristics of predisposing factors, infectious sources, microbiological and radiological studies, as well as clinical and evolutive aspects. The average age of the patients was 34 years, with a higher incidence in the second (35%) and sixth (22%) decades. The young patients (< 40 years) showed a greater frequency of adjacent infectious sources (83%) and the older patients (> 40 years), distant infectious sources (75%). The average time gap between the onset of symptoms and the diagnosis was 7 +/- 13 days. CAT showed in all the patients typical hypodense images with a peripheral ring; three patients had multiple abscesses and the remainder, single abscesses. In 12 patients (70.5%), microbiological cultures were positive, 3 (25%) for aerobe germs, 7 (50.3%) for anaerobe germs, 1 (8.33%) for multiple germs and 1 (8.33%) for fungi. Eleven patients underwent surgical drainage, four of which required latter exeresis. Six other patients underwent exeresis as the only surgical treatment. One patient died and the remainder showed a positive evolution. The hospital length of stay was 42.3 +/- 52.3 days. The most frequent sequela was the epilepsia present in 23.5% of the patients. Our findings are similar to the results of recent works, although in our series, there is a higher frequency of anaerobe germs. No differences were observed between the surgical techniques used nor between the past and current antibiotherapy patterns.

[Cryofibrinogenemia: apropos of a case]. / Criofibrinogenemia: a propósito de un caso.

We describe the case of a 70-years-old woman with ischemic-hemorrhagic lesions in the cutaneous surface of both feet and analytical data of disseminated intravascular coagulation, in which the studies conducted were negative except for the presence of cryofibrinogen in plasma. We also review the clinical manifestations and the diseases associated to cryofibrinogenemia previously described in the literature.

[Intestinal tuberculosis in patients with and without HIV infection]. / Tuberculosis intestinal en pacientes con y sin infección por VIH.

GOAL: To Study the main characteristics of intestinal tuberculosis (ITB), comparing patients with and without infection by HIV (HIV and non-HIV, respectively). PATIENTS AND METHODS: The clinical records of patients diagnosed of this disease in the past five years in our center, were retrospectively reviewed. We used as inclusion criteria the histological and/or microbiological corroboration of the intestinal anatomical piece or the bacteriological and/or histological corroboration of tuberculosis at any other location with clinical and radiological signs compatible with intestinal affection. Two groups were established according to the serological results for HIV: HIV and non-HIV. RESULTS: We studied seven cases, three of them infected by the HIV. The mean age of HIV patients was 23 years, whereas the mean age of non-HIV patients was 49 years. Three non-HIV patients referred pulmonary tuberculosis when they were young. The interval between the onset of symptoms and the diagnosis in HIV patients was 45 days, ranging in the non-HIV patients between one month and four years. All the patients had abdominal pain. Six patients, including three HIV, had fever and constitutional syndrome. Thoracal radiography showed tuberculosis activity, bacteriologically demonstrated, in a HIV patient and in a non-HIV patient. Except one HIV-patient, the remainder were laparotomized. In all the HIV patients, intestinal tuberculosis was suspected upon admission, but this was not the case in the four non-HIV patients. CAT was the most useful of all the supplementary explorations conducted. Retrospectively, only four laparotomies were justified, although before this procedure, four patients were incorrectly oriented, one of them infected by the HIV. All the patients showed a good response to an specific treatment. CONCLUSIONS: Laparotomy is still a frequent diagnostic method. The characteristics of the HIV patients are similar to the ones of the non-HIV patients. The main differences are: younger ages and shorter time of evolution until diagnosis in the HIV group, and evidence of former or current pulmonary tuberculosis in the non-HIV group.

[Kikuchi's disease. A clinicopathological study of 3 cases]. / Enfermedad de Kikuchi. Un estudio clinicopatológico de tres casos.

We had reviewed all the patients with Histiocytic Necrotizing Lymphadenitis (Kikuchi's disease) seen in a General Hospital during two years. Three of the six cases were young females who showed the same clinical symptoms: Fever and unilateral painful, lymphadenopathy, usually at the latero-cervical region. All patients have mild neutropenia and high levels of serum transaminases. The lymph node biopsy yielded the proper diagnostic in all cases. The course of disease was good, and all patients healed without treatment one to two month after the symptom started. To date, we have not recorded any relapse. Our finding are quite similar to the other cases published in the medical literature. The benign course of this disease, and the need for biopsy to get a correct diagnosis, can explain why this disease may be unrecognized in clinical practice.