[Oral levofloxacin versus intravenous ceftriaxone and amoxicillin/clavulanic acid in the treatment of community-acquired pneumonia that requires hospitalization]. / Levofloxacino oral frente a ceftriaxona y a amoxicilina/ácido clavulánico intravenosos en el tratamiento de la neumonía adquirida en la comunidad que requiere hospitalización.

BACKGROUND: Levofloxacin, an antibiotic from the quinolone family, which is used with success in the ambulatory treatment of patients with community-acquired pneumonia, has been recently introduced to the pharmaceutical market. The purpose of this study was to compare the effectiveness and tolerance of oral (v.o.) levofloxacin (LVF) versus intravenous (i.v.) amoxicillin/clavulanate (AMX/CL) and ceftriaxone (CTX) in the treatment of the community-acquired pneumonia that require hospitalization (CAPH). PATIENTS AND METHOD: In this prospective and randomized study 84 patients were included, 28 per group, from both sex with CAPH. The patients were assigned randomly to receive one of the next treatments: AMX/CL, 1.02 g i.v. every 8 h, CTX, 1 g i.v. every 12 h or LVF, 500 mg v.o. every 24 h. At the beginning clinical, biochemical and radiological characteristics were recorded from each case and at the 72 h the effect of treatment was evaluated using the evolution of the thermal curve and radiological images. The quantitative variables were analyzed with ANOVA, the qualitatives parameters with *2 test and Yates correction. The level of signification was * = 0.05. RESULTS: Age, sex, clinical presentation, biochemical measurements and radiological images in the 3 groups were similar and no adverse effects were recorded in any of them. Number of patients with favorable outcome in the groups AMX/CL, CTX and LVF was 25 (89%), 25 (89%) and 26 (93%); p = 0,870. CONCLUSIONS: Levofloxacin can be a simple, effective and safe therapeutic option for patients with CAPH.

[Intestinal infarct caused by giant cell arteritis]. / Infarto intestinal causado por arteritis de células gigantes.

Arteritis of giant cells compromising extracranial and particularly intestinal tissues is not frequent. Therefore, it is common practice to make the diagnosis retrospectively after analyzing the surgical sample. A case is presented of an 83 year old woman admitted to the Clinical Department with a clinical course of 3 days of evolution characterized by fever and pain in the left hemiabdomen. Her personal medical history included multiple diverticulosis of colon, collecistectomy and appendicectomy. Laboratory tests showed that uremia was 0.75 g/L (N.L to 0.45 g/L), V.E.S. 90 mm at the first hour, and the rest of the determinations were normal. The chest and abdomen rays as well as the abdomen and pelvis ecographies were normal. A diagnosis was reached as acute diverticulitis and the patient was treated with 400 mgr of ciprofloxacina and 2,000 mgr a day of metronidazol. She continued in a feverish state and with abdominal pain, so that an anexial tomography of abdomen was taken. It showed a widening of peritoneal fascias with scarce liquid in the left parietocolic dripping and Douglas septum. After 96 hours, surgery exploration was done and injuries in the left colon revealed compatibility with an infarct of the colon which had to be extirpated. Pathological examination revealed an infarct of colon due to a secondary arterial thrombosis characteristic of giant cell arteritis. After the diagnosis, immunological studies and biopsy of the left temporal artery were performed and reported as normal. The patient was treated with 40 mgr of prednisone a day improving rapidly.

Infarto intestinal causado por arteritis de células gigantes. / [Intestinal infarct caused by giant cell arteritis]

Arteritis of giant cells compromising extracranial and particularly intestinal tissues is not frequent. Therefore, it is common practice to make the diagnosis retrospectively after analyzing the surgical sample. A case is presented of an 83 year old woman admitted to the Clinical Department with a clinical course of 3 days of evolution characterized by fever and pain in the left hemiabdomen. Her personal medical history included multiple diverticulosis of colon, collecistectomy and appendicectomy. Laboratory tests showed that uremia was 0.75 g/L (N.L to 0.45 g/L), V.E.S. 90 mm at the first hour, and the rest of the determinations were normal. The chest and abdomen rays as well as the abdomen and pelvis ecographies were normal. A diagnosis was reached as acute diverticulitis and the patient was treated with 400 mgr of ciprofloxacina and 2,000 mgr a day of metronidazol. She continued in a feverish state and with abdominal pain, so that an anexial tomography of abdomen was taken. It showed a widening of peritoneal fascias with scarce liquid in the left parietocolic dripping and Douglas septum. After 96 hours, surgery exploration was done and injuries in the left colon revealed compatibility with an infarct of the colon which had to be extirpated. Pathological examination revealed an infarct of colon due to a secondary arterial thrombosis characteristic of giant cell arteritis. After the diagnosis, immunological studies and biopsy of the left temporal artery were performed and reported as normal. The patient was treated with 40 mgr of prednisone a day improving rapidly.