Pseudoartrosis atrófica con defecto óseo en secuelas de fracturas de la diáfisis humeral: tratamiento con placa en onda más colocación de autoinjertos óseos / Atrophic ununited diaphyseal fractures of the humerus with a bony defect: treatment using a wave-plate

Entre 1993 y 2000 fueron tratados en el Departamento de Ortopedia y Traumatología del Hospital Clínica San Rafael y en la practica privada del co-autor, 22 pacientes con pseudoartrosis atrófica de húmero con defecto óseo, utilizando placa en puente con moldeo en onda y autoinjerto de hueso córtico-esponjoso. En tres casos se agregó un autoinjerto estructural de peroné. La longitud promedio del defecto óseo fue de 2,2 cm (1-7 cm). En 18 pacientes (81 por ciento) se logró un seguimiento clínico y radiológico de 10 meses (5-36 meses); con este único procedimiento consolidaron 16 casos (89 por ciento) y 2 casos (11 por ciento) requirieron una revisión con nueva colocación de injertos y osteosíntesis. Los resultados sugieren que en presencia de un adecuado cubrimiento muscular, la aplicación de una placa en onda con injertos óseos autólogos, representa una buena alternativa para el tratamiento de la pseudoartrosis atrófica compleja de húmero

Rothia dentocariosa endocarditis complicated by multiple intracranial hemorrhages.

Rothia dentocariosa is a gram-positive rod found commonly as part of the normal flora of the mouth. It rarely causes clinical disease. Subacute infective endocarditis has been the most commonly reported R dentocariosa infection, and extracardiac complications occur frequently. Solitary intracranial hemorrhages have been reported in two cases. We describe the first case of infective endocarditis complicated by the sequential and unusually prolonged development of multiple new intracranial hemorrhages.

Chloramphenicol treatment for vancomycin-resistant Enterococcus faecium bacteremia.

OBJECTIVE: To evaluate the results of treating vancomycin-resistant Enterococcus faecium (VREF) bacteremia with chloramphenicol. METHODS: We retrospectively reviewed the charts of all adult patients with VREF bacteremia treated with chloramphenicol during the calendar year 1998 at a 522-bed tertiary referral center in New York City. Patients were identified by reviewing microbiology laboratory records. Patients with clinically significant VREF bacteremia who received chloramphenicol for at least 48 h were included in the study. Clinical and microbiological outcomes were determined. Microbiological and molecular tests were performed on a small representative sample of isolates to identify the presence of resistance mechanisms and to look for similarity among the isolates. RESULTS: Seven episodes of significant VREF bacteremia occurred in six patients. Mean age was 54 years. All patients had cancer and three had severe neutropenia. Five of seven episodes were associated with chronic indwelling devices, but in only one of these cases was the device removed. All isolates were susceptible to chloramphenicol in vitro. All six microbiologically evaluable episodes had a favorable response to chloramphenicol treatment, and four of seven (57%) clinically evaluable episodes had favorable outcomes. Only one death may have been due to VREF bacteremia, so the maximal attributable mortality was 14%. The three representative samples that were tested further were indistinguishable from one another and they displayed no evidence of resistance mechanisms. CONCLUSIONS: In a cohort of severely ill cancer patients, chloramphenicol was effective in treating VREF bacteremia. The use of chloramphenicol should be considered in treating infections with this highly resistant organism, where therapeutic options are limited.

Lung cancer in HIV-infected patients: a one-year experience.

The relative incidence and rate of lung cancer in HIV-infected patients compared with the general US population has been a source of controversy. We sought to establish these parameters in a cohort of 2616 HIV-infected patients. Tumour type, stage of disease, patient demographics and immune parameters including viral loads were ascertained. An annual rate of 191 cases/100,000 population was found, which is 3.01 times greater (95% confidence interval [CI]=1.3-7.0) when compared with the general US population and 7.4 times the rate in US males between ages 35 and 54 (95% CI=3.1-17.8). Three patients had CD4 counts greater than 200 cells/mm3 at diagnosis and 2 had undetectable viral loads. The mean age was 44 years and all had advanced disease and short survival. In conclusion, the incidence of primary lung cancer was increased in this cohort of HIV-infected patients and occurred over a wide range of immunosuppression and viral replication.