Peritonitis secundaria a una perforación por infestación con «Ascaris lumbricoides» / Intestinal perforation with secondary peritonitis caused by Ascaris lumbricoides

La perforación intestinal y la peritonitis secundaria causada por Ascaris lumbricoides, aunque es rara en nuestro medio, debe tenerse en cuenta en los pacientes con clínica compatible procedentes de áreas endémicas. Presentamos el caso de una niña rumana con un cuadro clínico de fiebre, vómitos y dolor abdominal de 15 días de evolución, con colecciones abdominales observadas en las pruebas de imagen, en las que se aprecia una infestación por A. lumbricoides tras la cirugía laparoscópica (AU)

Intestinal perforation with secondary peritonitis caused by Ascaris lumbricoides is rare in our environment. This entity should be taken into consideration in patients who come from endemic areas, and who have suggestive clinical manifestations. We report a case of a Rumanian girl with 15 days of fever, stomach pains and vomiting. Imaging studies evidenced abdominal collections in which Ascaris lumbricoides infestation was found through laparoscopic surgery (AU)

Brote intrafamiliar de gastroenteritis por Shigella flexneri en Madrid / Intrafamilial outbreak of Shigella flexneri gastroenteritis in Madrid

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Time course of total and distrectual weight gain after refeeding in anorexia nervosa.

Anorectic patients who achieve complete recovery from the eating disorder can obtain a favorable psychosocial outcome but the long-term nutritional outcome is ill-defined. We investigated the time course of total and distrectual body composition during and after refeeding in 32 female patients with anorexia nervosa. Patients were enrolled at their lowest weight (T0) and re-examinated after a 15% weight gain (at a mean of 3 months, T1; n=17) and after 3 years of stable weight recovery (T2; n=8). At T2 patients were compared to a control group of 8 healthy females matched for age and body mass index. All subjects underwent dual X-ray absorptiometry and anthropometry at each visit. At T0, the 32 subjects were at 61%+/-8% of ideal body weight (IBW) with severe reductions in fat mass (FM; 7.1%+/-4.5%), fat free mass (FFM) and bone mineral content (BMC). At T2, the 8 subjects had gained 40% of initial weight, but remained at 85.1%+/-7.7% of IBW ( p<0.01 vs. controls), with a percent FM comparable to that of controls and an absolute FFM still deficient. BMC did not improve at T2 and remained 79% of that in controls. FM depletion was more severe in the limbs than in the trunk and at T2 the trunk/limb FM ratio remained greater than that in controls. These data strongly suggest that continued nutritional surveillance and support is necessary throughout these patients' lives, even after correction of the psychiatric illness and of severe underweight.

Artritis sépticas causadas por Streptococcus pneumoniae / Septic arthritis due to Streptococcus pneumoniae

Antecedentes: Streptococcus pneumoniae es una causa poco documentada de artritis infecciosa. El objetivo de este trabajo es describir nuestra experiencia con 5 casos de artritis neumocócica a lo largo de 14 años. Métodos: Se revisaron de manera retrospectiva las historias clínicas correspondientes a artritis de etiología infecciosa recogidas en nuestro centro entre enero de 1986 y diciembre de 2000, excluyendo el período neonatal y los pacientes con postoperatorio inmediato, analizando los casos de etiología neumocócica. Resultados: De las 39 artritis sépticas documentadas microbiológicamente, cinco (12,8 por ciento) correspondieron a infección neumocócica. Cuatro de los pacientes eran menores de 15 meses. En cuatro existió fiebre sin focalidad como antecedente y en uno de ellos otitis media como enfermedad asociada a bacteriemia. La localización más frecuente fue la cadera en 4 casos y en uno resultó afectada la rodilla. La radiología simple no mostraba alteraciones en tres de los casos, en tanto que la ecografía resultó patológica en cuatro de ellos. El diagnóstico etiológico se estableció en 1 caso mediante aislamiento en el hemocultivo y líquido sinovial, en 1 caso mediante hemocultivo, en dos se demostró la presencia de neumococo en el líquido articular y en 1 caso mediante la detección de antígeno de neumococo en orina. De los cultivos positivos, 2 casos tenían susceptibilidad disminuida a penicilina (concentración mínima inhibitoria [CMI], 0,125-1 mg/l) y todos resultaron sensibles a cefotaxima. Se realizó drenaje quirúrgico en todos los casos de afectación de la cadera. En ningún caso la enfermedad evolucionó con secuelas. Conclusiones: En nuestra experiencia, el neumococo es una causa que debe tenerse en cuenta de artritis séptica, que afecta principalmente a niños menores de 15 meses y con localización frecuente en la cadera. El cultivo del líquido fue el método con mayor rentabilidad diagnóstica. Un alto porcentaje de cepas tienen susceptibilidad disminuida a penicilina. El diagnóstico y el tratamiento precoces se acompañan de un buen pronóstico articular (AU)

[Septic arthritis due to Streptococcus pneumoniae]. / Artritis sépticas causadas por Streptococcus pneumoniae.

INTRODUCTION: There are few reports of Streptococcus pneumoniae as a cause of septic arthritis. The aim of this study was to describe our experience with five documented cases of pneumococcal arthritis over 14 years. METHODS: The medical histories of infectious septic arthritis in our center between January 1986 and December 2000 were retrospectively reviewed. Cases of pneumococcal etiology were analyzed while those occurring in the neonatal and immediate postoperative periods were excluded. RESULTS: Among the 39 documented cases of septic arthritis, 5 (12.8 %) were caused by Streptococcus pneumoniae. Four of the patients were younger than 15 months old. Fever without localizing signs as an antecedent was present in four patients; of these, one patient had concurrent otitis media. The most common localization was the hip (four patients) and the knee (one patient). In three patients simple radiology showed no abnormalities while in four ultrasonography showed abnormalities. Etiologic diagnosis was established by isolation of S. pneumoniae from blood culture and synovial fluid (one patient), from blood culture (one patient), from synovial fluid (two patients), and by detection of pneumococcal antigen in urine (one patient). Of the germs isolated, two showed reduced susceptibility to penicillin (CMI 0.125-1 mg/l) and all were susceptible to cefotaxime. Open drainage was performed in all patients with hip involvement. None of the patients presented sequelae. CONCLUSIONS: In our experience, S. pneumoniae should be taken into account as a cause of septic arthritis that mainly affects children younger than 15 months. The hip was the most frequently involved joint. Joint fluid culture was the method providing the best diagnostic yield. A high proportion of strains are not susceptible to penicillin. Early diagnosis and management lead to a good prognosis.

The "Non-Oxidative" pummerer reaction: conclusive evidence for S(N)2-type stereoselectivity, mechanistic insight, and synthesis of enantiopure L-alpha-trifluoromethylthreoninate and D-alpha-trifluoromethyl-allo-threoninate(1)

Enantiopure methyl D-alpha-trifluoromethyl-allo-threoninate 18 and L-alpha-trifluoromethylthreoninate 19 were synthesized using (R)-ethyl p-tolylsulfoxide as chiral alpha-hydroxyethyl anion equivalent. The key step was the S(N)2-type replacement of the sulfinyl auxiliary with a hydroxy group, via trifluoroacetic anhydride promoted "non-oxidative" Pummerer reaction (NOPR) of the diastereomeric intermediate beta-sulfinyl amines 14 and 15, obtained by condensation of (R)-ethyl p-tolylsulfoxide 13 with the N-Cbz imine of methyl trifluoropyruvate 12. The conclusive evidence for S(N)2-type stereoselectivity of the NOPR was achieved by X-ray diffraction of both the starting diastereomer 14 and the p-bromobenzoate 25, obtained from the threoninate 19. NMR monitoring of the NOPR performed on 15 allowed the detection of a transient intermediate, which was identified as the four membered cyclic sigma-sulfurane 27. This intermediate spontaneously rearranged (40 min, rt) into the corresponding sulfenamide 17, probably via an intramolecular displacement of the sulfinyl by a trifluoroacetoxy group, with inversion of configuration at the carbon stereocenter. The same process occurred for the diastereomeric beta-sulfinyl amine 14, but the sulfenamide 16 was formed at a very fast rate, thus precluding NMR detection of the corresponding sigma-sulfurane intermediate 26. One-pot treatment of the diastereomeric sulfenamides 16 and 17 with NaBH(4) afforded very good yields of the corresponding threoninates 18 and 19.

Pericarditis purulenta en paciente inmunocompetente con CIA / Purulent pericarditis in immunocompetent patient with interauricular communication

Paciente inmunocompetente quien presenta taponamiento cardíaco por pericarditis purulenta primaria asociado a CIA tipo ostium secundum. El ecocardiograma transesofágico y los hemocultivos fueron negativos para el diagnóstico de endocarditis. Queremos remarcar la utilidad del acceso quirúrgico subxifoideo, para el drenaje pericárdico

Pericarditis purulenta en paciente inmunocompetente con CIA / Purulent pericarditis in immunocompetent patient with interauricular communication

Paciente inmunocompetente quien presenta taponamiento cardíaco por pericarditis purulenta primaria asociado a CIA tipo ostium secundum. El ecocardiograma transesofágico y los hemocultivos fueron negativos para el diagnóstico de endocarditis. Queremos remarcar la utilidad del acceso quirúrgico subxifoideo, para el drenaje pericárdico (AU)

Q fever in children.

OBJECTIVE: To describe clinical profiles of Q fever in children. DESIGN: Retrospective study. SETTING: Tertiary teaching hospital. PARTICIPANTS: Thirteen children aged 2 to 14 years, with a mean +/- SD age of 9.6 +/- 3.6 years. SELECTION PROCEDURES: Review of the medical records of all children with Q fever admitted from 1986 to 1990. The diagnosis was made by detection of phase II antibodies to Coxiella burnetii by the complement fixation test. MEASUREMENTS/MAIN RESULTS: Clinical profiles consisted of a self-limited illness characterized by high fever (mean +/- SD, 39.9 degrees C +/- 0.66 degrees C) of 5 to 10 days' duration (mean +/- SD, 7.4 +/- 1.6 days), constitutional symptoms, and mild liver dysfunction. Eleven patients had gastrointestinal manifestations (vomiting and/or abdominal pain). Respiratory symptoms were not prominent. Most patients had normal or low white blood cell counts, and seven showed a relative increase of band forms. Their erythrocyte sedimentation rates ranged from 8 to 23 mm/h. All patients did well without specific therapy for C burnetii. CONCLUSION: In children with the symptoms described above, tests to detect antibodies to C burnetii should be performed.