Comparative study of bacteremias caused by Enterococcus spp. with and without high-level resistance to gentamicin. The Grupo Andaluz para el estudio de las Enfermedades Infecciosas.

A prospective, multicenter study was carried out over a period of 10 months. All patients with clinically significant bacteremia caused by Enterococcus spp. were included. The epidemiological, microbiological, clinical, and prognostic features and the relationship of these features to the presence of high-level resistance to gentamicin (HLRG) were studied. Ninety-three patients with enterococcal bacteremia were included, and 31 of these cases were caused by HLRG (33%). The multivariate analysis selected chronic renal failure, intensive care unit stay, previous use of antimicrobial agents, and Enterococcus faecalis species as the independent risk factors that influenced the development of HLRG. The strains with HLRG showed lower levels of susceptibility to penicillin and ciprofloxacin. Clinical features (except for chronic renal failure) were similar in both groups of patients. HLRG did not influence the prognosis for patients with enterococcal bacteremia in terms of either the crude mortality rate (29% for patients with bacteremia caused by enterococci with HLRG and 28% for patients not infected with strains with HLRG) or the hospital stay after the acquisition of enterococcal bacteremia. Hemodynamic compromise, inappropriate antimicrobial therapy, and mechanical ventilation were revealed in the multivariate analysis to be the independent risk factors for mortality. Prolonged hospitalization was associated with the nosocomial acquisition of bacteremia and polymicrobial infections.

Influence of the conjoint administration of insulin and glucagon upon hepatic regeneration.

In noneviscerated rats, the influence of the conjoint administration of insulin and glucagon in the regenerative response triggered by 70 per cent hepatectomy using the incorporation of tritiated thymidine by nuclear deoxyribonucleic acid as a parameter has been demonstrated. The response was earlier and more intense in relation to animals not hormonally stimulated and stimulated only with glucagon (previously reported by us). Such a response has been comparatively greater both in the nonparenchymal cells and in the hepatocytes, especially in the latter, which are the main cause of the early peak of thymidine incorporation in the periportal zones indicating a greater regenerative activity than in the intermediate and centrolobular zones. In our opinion, this indicates the importance of certain extrahepatic humoral agents in the manifestation of the regenerative process. Therefore, the results of our study ascertain the determining role and synergistic action of the pancreatic hormones--insulin and glucagon--in hepatic regeneration.

Popliteal artery entrapment syndrome.

Three cases of popliteal artery entrapment syndrome, one of them bilateral, are presented with a review of the literature, with special reference to the embryological development of the popliteal space and the diagnostic and therapeutic problems presented by this syndrome.