Enterobacter bacteremia. An analysis of 50 episodes.

During a six-year period, 147 patients had Enterobacter bacteremia (3.8% of the episodes of bacteremia), with an incidence of 1.25 per 1,000 admitted patients. We chose a random group of 50 cases for analysis. The disease was community acquired in 24% of the cases and nosocomially acquired in the remaining 76%. The bacteremia was unimicrobial in 70% and part of a polymicrobial bacteremia in 30%. The species most commonly causing bacteremia was Enterobacter cloacae. Portals of entry, in decreasing order of frequency, were unknown, surgical wound, respiratory tract, and urinary tract. The most common clinical finding was fever (92%). Shock occurred in 30% of the patients, and only two patients had evidence of disseminated intravascular coagulation. Of the Enterobacter isolates, 12% were resistant to gentamicin. Overall mortality was 42%; factors associated with a poor prognosis were inadequacy of antimicrobial chemotherapy, septic shock, type of underlying disease, clinical condition, and requirement of intensive care.

Serratia bacteremia.

During a 6-yr period, 146 patients at our institution had Serratia bacteremia (3.8% of the total number of episodes of bacteremia), with an incidence of 1.24/1000 admitted patients. We chose a random group of 50 cases for clinical analysis in the present study. The disease was community-acquired in 8% of the cases and nosocomially-acquired in the remaining 92%. The bacteremia was unimicrobial in 84% and part of a polymicrobial bacteremia in 16% of the episodes. The most frequently isolated species of the Serratia genus was S. marcescens. Portals of entry, in decreasing order of frequency, were: urinary, unknown, respiratory, and surgical wound infections. Clinically, the most frequent finding was fever (100%). Shock occurred in 28% of the patients, and none of our cases showed evidence of disseminated intravascular coagulation. We found 62% of Serratia isolates resistant to gentamicin. Overall mortality was 38% and factors associated with a poor prognosis were: severity of the underlying disease, critical clinical situation at onset of bacteremia, presence in the intensive care unit (I.C.U.), occurrence of shock or polymicrobial bacteremia, portal of entry in the respiratory tract, and inadequate treatment.

1-Chloro-1,1-difluoro-N-(4-methoxyphenyl)-3-(pyrrolidin-2-ylidene)propan-2-imine.

In the title compound, C(14)H(15)ClF(2)N(2)O, the Z configuration has been confirmed. The molecular structure shows an intramolecular N-H.N hydrogen bond [H.N 2.04 (6), N.N 2.709 (6) A and N-H.N 124 (5) degrees ]. This interaction could be responsible for the Z configuration.

[A decade of laparoscopic varicocelectomy: costs and learning stages]. / Una década en la varicocelectomía laparoscópica: costes y fases de aprendizaje.

OBJECTIVE: To present the results of a retrospective study on laparoscopic varicocelectomy, with special reference to the changes in the operating time observed throughout the training period. METHODS: We have reviewed the laparoscopic varicocelectomy procedures performed from 1987 to 1997. The operating times were graphically represented and compared, and the modifications and complications observed over the ten-year period were analyzed. RESULTS/CONCLUSIONS: The operating times decreased as the number of procedures increased and its duration further decreased as the interval between operations became shorter. In our case, the average operating time after the training period has been completed is 44 minutes. The cost of laparoscopic varicocelectomy and laparoscopic surgery in general is comparable to that of open surgery if nondisposable material is utilized.

Klebsiella bacteremia: an analysis of 100 episodes.

During a five-year period, 204 patients had klebsiella bacteremia at this institution; these cases constituted 6.6% of the total episodes of bacteremia. The incidence was 2.3 cases per 1,000 admitted patients. A random group of 100 cases was chosen for analysis in the present study. The disease was community acquired in 23%, nosocomially acquired in 77%, unimicrobial in 88%, or part of a polymicrobial bacteremia in 12% of episodes. Three-quarters of the episodes were caused by Klebsiella pneumoniae and the remaining one-quarter, by Klebsiella oxytoca. Portals of entry, in decreasing order of frequency, were urinary, respiratory, and biliary tracts. Twenty-four percent of the Klebsiella isolates were resistant to gentamicin. The most frequent clinical finding (in 96% of the cases) was fever. Shock occurred in 22% and pyogenic metastatic foci, in 5% of the patients. None of the patients had evidence of disseminated intravascular coagulation. Overall mortality was 25%, and factors associated with poor prognosis were inadequacy of antimicrobial chemotherapy, septic shock, type of underlying disease, and clinical condition of the patients.

Retrospective analysis of two hundred and twelve cases of bacteremia due to anaerobic microorganisms.

Cases of bacteremia caused by anaerobic microorganisms and occurring during a four year period in a non-selected patient group in a Spanish general hospital were analysed retrospectively. Microbiological data was collected on 212 patients and clinical data on 103 patients. Cases of anaerobic bacteremia represented 8.6% of the total number of cases of bacteremia. Of the 232 anaerobic microorganisms causing bacteremia, gram-negative bacilli were responsible in 113 cases (48.7%), gram-positive bacilli in 92 cases (39.6%), gram-positive cocci in 25 cases (10.7%), and Veillonella spp. in two cases (0.8%). The most important clinical features were fever (64%), anemia (56%), septic shock (22%) and metastatic abscesses (21%). Patients with anaerobic bacteremia were hospitalized for an average of 51.7 days. The overall mortality was 32% and factors associated with poor prognosis were severe underlying disease, nosocomial acquisition, presence of shock, presence of metastatic foci of infection, and absence of adequate surgical drainage. The mortality rate of patients who received adequate antimicrobial therapy was 30% and that of patients who received inadequate treatment or none was 29%. It is concluded that anaerobic bacteremia has a significant rate of morbidity and mortality and that underlying disease and surgical debridement and/or drainage have greater prognostic significance than the use of antimicrobial agents.

[Evaluation of ciprofloxacin for the treatment of severe bacterial infections]. / Evaluación de la ciprofloxacina en el tratamiento de infecciones bacterianas graves.

The results of efficacy and safety of ciprofloxacin administered by parenteral and oral route in the treatment of severe infections-particularly, osteomyelitis and bacteremia-due to gram-negative bacilli are studied in the present work. The group consisted of 34 patients, there were 25 men and 9 women, whose age ranged from 5 to 84 years. Two patients were excluded from the study and did not enter in the efficacy analysis, although they accounted for the evaluation of incidence of side effects. Ten patients presented osteomyelitis, 16 patients had bacteremia (one of them, with endocarditis), and six patients suffered from other types of infection (one of them had meningitis). All patients recovered or presented clinical improvement with the treatment, except three of them, which accounted for a response rate of 90.6%. In 28 of the 32 evaluable cases, microbiologic eradication was achieved (eradication rate, 87.5%). Infection due to Pseudomonas aeruginosa persisted or recurred in three patients with chronic osteomyelitis; in two of them, the strain become resistant to ciprofloxacin, and in the third patient, the results of cultures persisted positive along the whole course, thus, the eradication of the microorganism was not achieved. One woman presented bacteremia due to Acinetobacter which persisted despite antibiotic therapy. Side effects were mild and obliged to withdraw the treatment in two cases (dizziness). Ciprofloxacin is a new fluoroquinolone that is easily administered by parenteral and oral route. In the present study, it has revealed as safe and highly efficacious, even in particularly severe or resistant bacterial infections.

Brucellar meningitis.

Neurobrucellosis develops in less than 5% of cases of systemic brucellosis; however, most patients with neurobrucellosis have meningeal involvement. Seven new cases of brucellar meningitis and 17 cases from the Spanish- and English-language medical literature are analyzed in terms of epidemiologic data, clinical manifestations, laboratory results for cerebrospinal fluid and serum, treatment, and course of the disease. Brucellar meningitis mimics other neurologic and non-neurologic conditions, and its diagnosis is only suggested in the presence of adequate epidemiologic information. Isolation of Brucella from the cerebrospinal fluid is uncommon. Treatment is accomplished with the combination of tetracycline or doxycycline and streptomycin, rifampin, or both. Mean length of therapy in the seven new cases was 8.5 months. Brucellar meningitis has a better prognosis than other forms of chronic meningitis, and mortality is low for reasons that are not clear; however, the incidence of minor sequelae is high.

[Chronic adrenal failure secondary to an isolated deficiency of ACTH. Presentation of 2 new cases]. / Fracaso adrenal crónico secundario a deficiencia aislada de ACTH. Presentación de dos nuevos casos.

Chronic adrenal failure due to hypothalamic-hypophyseal disorders is rarely encountered. This can be due to hormonal deficiencies generally related to the presence of a brain tumor or an infiltrating process and sometimes to an isolated deficiency of ACTH. We report on two patients with adrenal failure with low basal cortisol levels and a poor response to short cortisol stimulation test with ACTH. Long cortisol stimulation test with ACTH was normal and ACTH was not stimulated with corticotropin releasing factor. However, other specific dynamic pituitary hormonal tests were normal. The uncommon clinical presentation of the disease, such as severe hypoglycemic crisis and fever of unknown origin (FUO), is underscored.

Evaluation of aztreonam in the treatment of severe bacterial infections.

We investigated the clinical efficacy and safety of aztreonam in the treatment of 50 episodes of infection in 46 adult patients. The clinical condition of patients at the beginning of treatment was critical or poor in 28 of the episodes of infection. Episodes treated were 39 urinary tract infections (12 of them with concomitant bacteremia), 2 soft tissue infections, 8 patients with osteomyelitis (1 with concomitant bacteremia), and one episode of pneumonia. Significant isolated microorganisms were aerobic or facultative gram-negative rods and were responsible for the following episodes of infection (number of episodes): members of the family Enterobacteriaceae (49), Pseudomonas aeruginosa (5), and Haemophilus influenzae (1). The overall rate of clinical response to aztreonam was 94% of the treated episodes. Colonization or superinfection or both occurred in 29 episodes, but only 8 episodes required antimicrobial therapy. Aztreonam seems to be an effective single agent therapy for many bacterial infections. Colonization and superinfection by Candida sp., Streptococcus faecalis or Staphylococcus aureus must be monitored.

Terapia hormonal sustitutiva y enfermedad de Alzheimer / Hormonal substitute therapy and Alzheimer´s disease

El objetivo del presente artículo es el de establecer la relación del tratamiento hormonal sustitutivo y la enfermedad de Alzheimer. Estudios previos avalaron que el uso de la terapia hormonal sustitutiva podría prevenir o disminuir la aparición de síntomas de Alzehimer, al combatir la deprivación estrogénica que se insinuó como un factor de riesgo. En el presente trabajo se revisa la bibliografía y se definen las nuevas consideraciones existentes en la actualidad sobre el tema

The aim of the present article is, of establishing the relation of the hormonal substitute treatment and Alzheimer’s disease. Previous studies supported, that the use of the hormonal substitute therapy might anticipate or diminish the appearance of Alzehimer’s symptoms, when the deprivation attacks estrogénica that was insinuated as a factor of risk. In the present work the bibliography is checked and the new existing considerations are defined at present on the topic