Clinical response to ertapenem in severe community-acquired pneumonia: a retrospective series in an elderly population.

To evaluate in routine hospital practice the clinical response to ertapenem in comparison with other parenteral antibiotics in the treatment of community-acquired pneumonia (CAP), clinical records from patients with severe CAP treated with ertapenem from July 2002 to June 2006 in seven Spanish hospitals were retrospectively reviewed. Patients were classified according to the Pneumonia Severity Index (PSI). Each ertapenem-treated patient was matched with two patients in the same hospital treated with other antibiotics, according to age (difference 76 years). Comorbidities were present in 193 patients (95.5%). No differences were found in median hospital stay (7 days for ertapenem vs. 10 days for comparators, p 0.066). A slightly higher clinical response rate was obtained for ertapenem vs. comparators (88.7% vs. 77.1%; p 0.0465; OR 2.25; 95% CI 0.99-5.12), with significant differences in clinical response in patients coming from nursing homes (95.8% ertapenem vs. 63.8% comparators; p 0.0034) but not in non-institutionalized patients (85.4% ertapenem vs. 84.5% comparators; p 0.929). The higher clinical response to ertapenem vs. comparators in severe CAP was due to its significantly higher efficacy in healthcare-associated CAP in patients coming from nursing homes.

[Eosinophilic gastroenteritis, apropos a new case]. / Gastoenteritis eosinofílica, a propósito de un nuevo caso.

Eosinophilic gastroenteritis is an uncommon disorder, characterised by eosinophilic infiltration of gut wall, with variable clinical features, depending affected layer of the wall and digestive area, but usually consisting in abdominal pain, diarrhoea, and vomiting. Etiopathogenesis is unknown, with a frequent allergic condition and good response to corticosteroids therapy. Although the existence of eosinophilic gastroenteritis may be suggested by abdominal manifestations, an allergic history with laboratory date and ESR normal, only the antral or intestinal biopsy might to confirm the diagnostic. We report a case of a patient with eosinophilic gastroenteritis and history of bronchial asthma, without evidence of intestinal parasitosis, and a spectacular response to corticosteroids therapy.

[Occult bladder cancer in incarcerated inguinal hernia. Report of a case and review of the literature]. / Cáncer de vejiga oculto en hernia inguinal incarcerada. Aportación de un caso y revisión de la literatura.

OBJECTIVE: To describe a case of incarcerated inguinal hernia containing bladder carcinoma. METHODS/RESULTS: A case of urothelial bladder neoplasm presenting with perforation and scrotal abscess is described. The clinical features, incidence and diagnostic aspects are discussed and the literature briefly reviewed. CONCLUSION: The association of malignant tumor and hernia of the abdominal wall is uncommon, particularly those involving the inguinal zone. To our knowledge, only 8 cases have been reported from 1965 to 1995, accounting for 5.3% of all hernia sac-associated tumors. The location of this type of tumor delays diagnosis and the outcome is generally poor.

Idiopathic granulomatous vasculitis: response to immunosuppressive therapy.

A case of idiopathic granulomatous vasculitis (disseminated visceral giant cell arteritis) is described in an old woman, the seventh case of this rare disorder reported to date. The main organ affected was the liver and, to our knowledge, this is the first patient to be diagnosed while still alive and the only case to have received medical treatment. It is also the first time that muscular involvement has been documented in this condition. Cyclophosphamide treatment resulted in disappearance of symptoms and increase in weight. The patient died of an unrelated condition.

[Langerhans cell granulomatosis with unifocal bone disease and asymptomatic pulmonary infiltration]. / Granulomatosis de células de Langerhans con afectación ósea unifocal e infiltrado pulmonar asintomático.

Langerhans' cell granulomatosis is a usually benign disease, characterized by the proliferation of Langerhans' cell containing S-100 protein. Disease is related with the smoking habit and immunological alterations, and is able to affect any organ in isolated or multisystem form. Diagnosis is provided by biopsy of the lesion and bronchoalveolar lavage if the lung is injured. We present a case of a smoker man with lytic lesion in the skull, which biopsy was diagnostic, and with an asymptomatic interstitial infiltrates lungs, with a restrictive spirometry. Remission was achieved with prednisone (0.75 mg x kg) and stop smoking.