Efficacy of rifampin, in monotherapy and in combinations, in an experimental murine pneumonia model caused by panresistant Acinetobacter baumannii strains.

The objective of this work was to evaluate the efficacy of rifampin, and its combinations with imipenem or sulbactam, in an experimental pneumonia model caused by two panresistant Acinetobacter baumannii strains (HUVR99 and HUVR113). Minimum inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs) (µg/ml) of the strains were rifampin 128/>128 for both strains, imipenem 128/>256 and 256/>256 for HUVR99 and HUVR113, respectively, and sulbactam >256/>256 for both strains. In time-kill studies, at MICs, rifampin was bactericidal for both strains and sulbactam against the HUVR99 strain. Rifampin plus imipenem or sulbactam, at the MIC or mice C (max), were synergistic. In vivo, against HUVR99 and HUVR113, rifampin (73% and 40%) and its combinations improved the survival with respect to the control group (20% and 0%, p < 0.05), respectively. Rifampin (87% and 46%) and its combinations improved the sterilization of blood cultures with respect to the control groups (0%, p < 0.05). In regard to the bacterial clearance from lungs, rifampin (2.57 ± 2.47 and 5.35 ± 3.03 log(10) cfu/g) and its combinations with imipenem or sulbactam diminished the bacterial lung concentration with respect to the control group (10.89 ± 3.00 and 11.86 ± 0.49, p < 0.05) with both strains. In conclusion, rifampin alone or associated to imipenem or sulbactam were effective for the treatment of murine pneumonia caused by selected panresistant A. baumannii strains.

Angiosarcoma de mama. A propósito de un caso / Breast angiosarcoma. A case report

El angiosarcoma es una neoplasia infrecuente enla mama si bien constituye uno de los sarcomas másfrecuentes en esta localización existiendo en grannúmero de casos una estrecha relación entre su aparicióny el antecedente de radioterapia a nivel torácico.Aunque los datos clínicos y las pruebas deimagen pueden orientar el diagnóstico, será necesarioel estudio histológico e inmunohistoquímico paradeterminar el mismo. El pronóstico está determinadopor el grado histológico, constituyendo las lesionesde alto grado un grupo con muy mal pronóstico.Presentamos un caso de angiosarcoma de mamano relacionado con radioterapia previa y de crecimientoinsidioso que histológicamente mostrabapatrones de bajo, moderado y alto grado

Angiosarcoma of the breast is a rare neoplasmbut one of the most common sarcomas in thislocation, frequently associated with thoracicradiotherapy. Clinical data and imaging techniquesmay help the diagnosis, but histological andimmunohistochemical studies become necessary inmost cases. The prognosis depends on thehistological grade, neoplasms of high grade havinga worse prognosis. We report the case of a slowgrowth and variegate histological grade breastangiosarcoma having no relationship withradiotherapy

Pharmacokinetic/pharmacodynamic assessment of the in-vivo efficacy of imipenem alone or in combination with amikacin for the treatment of experimental multiresistant Acinetobacter baumannii pneumonia.

A guinea-pig pneumonia model involving imipenem-susceptible and imipenem-resistant strains of Acinetobacter baumannii was developed to assess the in-vitro and in-vivo activities of imipenem, alone or in combination with amikacin, and the pharmacokinetic and pharmacodynamic parameters. Serum levels were measured by bioassay (imipenem) or immunoassay (amikacin), followed by calculation of pharmacokinetic and pharmacodynamic parameters (Cmax, AUC, t1/2, Cmax/MIC, AUC/MIC, and Deltat/MIC). In-vivo efficacy was evaluated by comparing bacterial counts in the lungs of treatment groups with end-of-therapy controls by anova and post-hoc tests. Decreases in the Cmax (13.4%), AUC (13%), t1/2 (25%) and Deltat/MIC (11.8-32.2%) of imipenem were observed when it was administered with amikacin, compared with administration of imipenem alone. Similarly, decreases in the Cmax (34.5%), AUC (11.6%), Cmax/MIC (34.5%) and AUC/MIC (11.7%) of amikacin were observed when it was administered with imipenem. Bacterial counts in lungs were reduced by imipenem (p 0.004) with the imipenem-susceptible strain, and by amikacin (p 0.001) with the imipenem-resistant strain. The combination of imipenem plus amikacin was inferior to imipenem alone with the imipenem-susceptible strain (p 0.01), despite their in-vitro synergy, and was inferior to amikacin alone with the imipenem-resistant strain (p < 0.0001). In summary, combined use of imipenem with amikacin was less efficacious than monotherapy, probably because of a drug-drug interaction that resulted in decreased pharmacokinetic and pharmacodynamic parameters for both antimicrobial agents.

Imipenem, doxycycline and amikacin in monotherapy and in combination in Acinetobacter baumannii experimental pneumonia.

Acinetobacter baumannii is a common cause of nosocomial pneumonia and other nosocomial infections. Multiresistant A. baumannii has also a high prevalence, which can make effective treatment difficult. We designed a new model of A. baumannii experimental pneumonia using C57BL/6 immunocompetent mice. This model was used to compare the efficacy of imipenem, doxycycline and amikacin in monotherapy, and the combination of imipenem plus amikacin and doxycycline plus amikacin. Doxycycline plus amikacin were synergic in vitro after 24 h incubation, whereas imipenem plus amikacin showed no in vitro synergy. The number of sterile lungs and the lung clearance of A. baumannii were greater in the group treated with imipenem than in those treated with amikacin or doxycycline in monotherapy (P < 0.05). The combination of imipenem plus amikacin and doxycycline plus amikacin was no more effective than imipenem alone in the clearance of organisms from lungs (2.42 +/- 1.46 cfu/g versus 2.7 +/- 1.5 cfu/g versus 1.23 +/- 1.02 cfu/g). These results suggest that the addition of amikacin does not improve the results obtained by imipenem monotherapy. Doxycycline plus amikacin is an alternative to imipenem in the therapy of A. baumannii pneumonia.

[Unilateral neonatal cystic disease of the kidney as first manifestation of tuberous sclerosis]. / Enfermedad quística renal neonatal unilateral como primera manifestación de esclerosis tuberosa.

OBJECTIVE: To report a case of unilateral cystic disease in a neonatal kidney as the first manifestation of tuberous sclerosis, with special reference to the diagnostic difficulties. METHODS: The pathological and clinical features of unilateral cystic kidney disease, which was basically segmental, are described. This condition had been detected in a newborn at physical examination. RESULTS: The pathological findings of the kidney cysts were characteristic of tuberous sclerosis, which allowed us to rule out a renal tumor. The clinical course confirmed the histological diagnosis. CONCLUSIONS: The reported cases of bilateral cystic kidney disease as the first manifestation of tuberous sclerosis are few and only one case with unilateral involvement has been reported in the English literature. In the case described herein, biopsy proved to be very useful in the diagnosis of the disease since the kidney cysts had specific histological features.

[Multicenter study of tuberculosis in clinical autopsies in Andalucia, in the 1973-1988 period]. / Estudio multicéntrico de la tuberculosis en autopsias clínicas en Andalucía, en el período 1973-88.

We revised 6,863 protocols of clinical autopsies in four hospitals of the Andalusian Health Service, from 1973 to 1988, out of which 2,814 were valid, and finding 81 active tuberculosis cases (TBC) (2.87%), in 53 males and 28 females, with mean age of 54.41 years. Milliar forms (44 cases) predominated over non-milliar (37), with a premortem diagnosis in 32 cases. TBC was considered as the principal disease in 65.43%, it directed contributed to death in 59.26% of cases, and was associated to other diseases in 79.01% of cases. The most frequent localizations were lung (80.25%), lymph nodes (43.20%) and liver (37.04%). We compared two similar periods of time: 1978-80 and 1986-88, observing an increase in TBC in the latter, 14:22, which can be attributed to HIV infection, since 6 of the 22 cases were associated to this pathology.