Lipomas intraóseos del calcáneo / Intraosseous lipomas of the calcaneus

El lipoma intraóseo es considerado uno de los tumores primarios benignos óseos más raros. Se presentan 8 casos de lipomas intraóseos del calcáneo. La edad media de los pacientes fue de 35 años (rango: entre 16 y 62 años).La resonancia magnética con secuencias de sustracción grasa tiene un importante valor en el diagnóstico de este tipo de tumores. En todos los casos se procedió al tratamiento quirúrgico mediante curetaje de la lesión y aporte de injerto óseo, con el objetivo de prevenir las fracturas patológicas y los cambios degenerativos. No existió ningún caso de recidiva (AU)

Meningitis caused by Mycobacterium fortuitum.

A previously healthy 16-yr-old Caucasian male developed a relapsing purulent meningitis shortly after a motor accident in Venezuela, in which he received a small wound with a retained foreign body in the sacral region. Repeated initial physical examinations, radiographs of lumbar and sacral regions, and contrast myelography failed to demonstrate a cerebrospinal fluid leak or bone involvement, and Mycobacterium fortuitum was repeatedly isolated from the cerebrospinal fluid. Finally, from the originally "cured" lumbar wound a purulent material was obtained from which M. fortuitum was also isolated. A retained foreign body was removed, and an abscess and fistulous tract were incised and drained. The patient responded dramatically to the combination of isoniazid plus co-trimoxazole and surgery.

Evaluation of ceftazidime in the treatment of severe bacterial infection.

We investigated the clinical efficiency and safety of ceftazidime for treatment of 33 episodes of infection in 30 patients (17 males and 13 females), whose ages ranged from 9 to 92 years (mean 52.5). Fourteen patients had ultimately fatal disease and the remaining 16 had non-fatal diseases. The clinical condition of patients at the beginning of treatment was critical or poor in 16 cases. Episodes of infection treated were: 24 urinary tract infections (eight of them with concomitant bacteraemia), seven wound infections (one with concomitant bacteraemia and three with osteomyelitis), and two episodes of pneumonia. Twenty-nine episodes of infection were monomicrobial and the four remaining ones were polymicrobial. Significant organisms isolated were all aerobic or facultatively anaerobic Gram-negative rods and were responsible for the following episodes of infection: Escherichia coli (14), Pseudomonas aeruginosa (12), Pseudomonas cepacia (1), Proteus mirabilis (5), Serratia marcescens (2), Klebsiella (2), Enterobacter aerogenes (1) and Haemophilus influenzae (1). Total dosage of ceftazidime ranged from 28 to 240 g (mean 82.4 g), and mean duration of therapy was 17 days (range 8 to 44 days). The overall rate of clinical response to ceftazidime was 91%. Local and general tolerance to the drug was excellent. Enterococcal and/or candida colonization occurred in 12 episodes (36%) and superinfections by the same micro-organisms occurred in three episodes. Ceftazidime seems to be an effective and safe single agent for therapy of many bacterial infections, including those caused by Ps. aeruginosa.

[Endocarditis due to Pseudomonas aeruginosa (author's transl)]. / Endocarditis por Pseudomonas aeruginosa.

A case of pseudomonas endocarditis of biliary origin with impairment of the mitral and tricuspid heart valves is reported. Former history of the patient did not reveal narcotic addiction or previous open-heart surgery. Osteomyelitis is an uncommon complication of pseudomonas endocarditis. Echocardiography was a useful diagnostic method in the present case, showing the vegetation on the tricuspid valve. The poor prognosis of cases with left valvular heart disease which are resistant to medical treatment is emphasized. Differential count of the colonies did not localize the affected heart valve in this case.