Magnetic resonance imaging findings in pre-clinical Creutzfeldt-Jakob disease.

The diagnosis of probable Creutzfeldt-Jakob disease (CJD) requires compatible clinical manifestations, typical electroencephalographical findings, and 14.3.3 protein positive in cerebrospinal fluid. Actually, MRI findings are not necessary, but they may support this diagnosis. The authors report a patient with definitive diagnosis of CJD who showed in a first MRI study performed two years before the clinical onset of the disease the same hyperintensities in caudate nuclei that were found in the last MRI. The authors think that these findings could be useful in detecting asymptomatic patients who need more extensive study and following.

[Enterobacter amnigenus. An unusual human pathogen]. / Enterobacter amnigenus. Un patógeno humano inusual.

BACKGROUND: Enterobacter amnigenus is a bacteria with doubtful pathogenicity. The observation of a patient with a well-documented E. amnigenus infection has prompted us to review the pathology caused by this microorganism. METHODS: Retrospective evaluation of the clinical charts of patients with any isolate positive for E. amnigenus over a period of 46 months. Based on the clinical data, presence or absence of other causal microorganisms and/or alternative diagnosis, E. amnigenus was classified as definitive, probable, or improbable cause of infection. RESULTS: We analyzed 15 E. amnigenus isolates, representing 0.97 of 10,000, the total bacterial isolates in our laboratory for this period, and 0.52% of those corresponding to Enterobacter sp. We were able to clinically evaluate E. amnigenus in 7 patients, in whom infection by this microorganism was classified as definitive in 4, probable in 1, and improbable in 2. Antibiotic susceptibility studies showed a resistance level of 83% to ampicillin, 75% to cefazoline and cefoxitine, and 33% to amoxicillin-clavulanic acid. All isolates were susceptible to third-generation cephalosporins, aztreonam, ciprofloxacin, cotrimoxazole and aminoglycosides. CONCLUSIONS: E. amnigenus cause well-documented bacterial infection in man. Thus, isolation of this microorganism should not be considered as a contaminant or simple colonizer. The clinical behavior and antimicrobial susceptibility of E. amnigenus is similar to that of E. cloacae, a taxonomically-related species.

[Thrombocytopenia onset in acute episodes of pancreatitis]. / Aparición de trombocitopenia en los episodios agudos de pancreatitis.

BACKGROUND: The objective of this study was to determine the prevalence of thrombocytopenia in acute pancreatitis and its value as a prognostic marker for complications. METHODS: The records of all patients admitted to our institution between January and June 1993 were reviewed. After exclusion of other possible causes of thrombocytopenia, 104 patients were evaluated. The prognostic value of thrombocytopenia was determined by evaluation of the length of hospital stay, radiologic severity, complications, need for ICU care, need for surgery and mortality. RESULTS: The etiology of pancreatitis was as follows: gallstone-induced in 49 patients, alcoholic in 35, idiopathic in 12 and due to other causes in the remaining 8 cases. Thrombocytopenia developed early, within the first 48 hours and was moderate (106 +/- 27 x 10(9)/l). Alcoholic pancreatitis was associated to a higher probability to develop thrombocytopenia (43% vs 36% in gallstone-induced pancreatitis and 4% in idiopathic pancreatitis, p = 0.02). Thrombocytopenic patients had a greater radiologic severity (Balthazar's scores D or E 78% vs 49%, p = 0.04), a higher number of acute complications (28% vs 10%, p = 0.05) and a more frequent need for ICU care (25% vs 7%, p = 0.01). No differences were seen in length of hospital stay, need for surgery and mortality between the two groups of patients. CONCLUSIONS: Thrombocytopenia is frequent in acute pancreatitis, especially in cases of alcoholic origin. Its presence suggests a higher risk to develop complications.