[Subglottic pleomorphic adenoma]. / Adenoma pleomorfo subglótico.

Pleomorphic adenoma is the most common tumor of major salivary glands, but it is unusual into the larynx. The AA. expose a case of a 74-year-old man who consulted for dysphonia and diagnosed as having a subglottic pleomorphic adenoma. The patient needed an urgent tracheotomy owing to the dyspnoea. Removal of the tumor was made through direct laryngoscopy. Literature on pleomorphic laryngeal adenoma is reviewed.

[Imipenem combined with teicoplanin or vancomycin in the initial empirical treatment of febrile neutropenia. Analysis of the primary response and of a global sequential strategy in 126 episodes]. / Imipenem combinado con teicoplanina o vancomicina en el tratamiento empírico inicial de la neutropenia febril. Análisis de la respuesta primaria y de una estrategia secuencial global en 126 episodios.

The results of empiric antibiotic therapy in 126 episodes of febrile neutropenia in patients with hematologic neoplasms postchemotherapy and bone marrow transplantation are presented. The main objective of this work was the study of the initial control of infection comparing two glycopeptidic antibiotics: vancomycin and teicoplanin combined with imipenem in first line of empiric therapy. The secondary objective was to analyze the overall control of infection during the complete episode of neutropenia using a sequential empiric antibiotic therapy course which included the addition of amikacin followed by intravenous amphotericin B when fever persisted or recurred without microbiological documentation. Both initial courses (no guidelines), imipenem + vancomycin (arm A) and imipenem + teicoplanin (arm B) resulted in a similar percentage of response at 72 hours, both in episodes of fever of unknown origin (FUO) (55% and 68%, respectively; p = NS) and in those microbiologically documented (54% and 34.5%, p = NS); 58% and 79% of these episodes, respectively, were caused by gram-positive organisms. About 60% of patients in both arm ultimately required the empiric addition of amikacin, with or without amphotericin B, because of persistence or recurrence of fever; the percentage of overall responses in both arm did not differ significantly, both in FUO (70% and 86%, p = NS) and in microbiologically documented episodes (71% and 45%, p = NS). The overall infectious mortality for the whole group was 1.58%. In conclusion, no significant differences were observed in the clinical response or in toxicity between the combination of imipenem with any of the two glycopeptides: vancomycin or teicoplanin, for the initial empiric therapy of febrile neutropenia. The sequential empiric use of amikacin followed by amphotericin B assured an adequate overall control of infection in a group of patients with prolonged severe neutropenia.

[Transient bacteremia caused by Corynebacterium urealyticum: apropos of 2 cases]. / Bacteriemia transitoria por Corynebacterium urealyticum: a propósito de 2 casos.

BACKGROUND: Corynebacterium urealyticum is a pathogen mainly isolated from the urinary tract and seldom from the blood. We present two cases of bacteremia caused by multiresistant C. urealyticum isolated in two and three blood cultures respectively. PATIENTS AND METHODS: The two cases were studied. C. urealyticum was isolated from blood cultures and clinical charts were reviewed retrospectively. No history of prior antibiotic therapy was observed in either patient. Blood cultures were processed using BACTEC NC 730 system (Becton Dickinson). The API Coryne system (BioMérieux) was used to identify both strains. RESULTS: Despite both patients having not received any antibiotic treatment, they improved clinically and microbiologically. Therefore, the episodes were considered as transitory bacteremias. CONCLUSION: Although C. urealyticum is not common, we believe that it is necessary to identify any diphtheromorphic microorganism in blood, when they are clinically significant.

Nosocomial septicemia caused by Serratia plymuthica.

We report a case of nosocomial septicemia in a 79-year-old patient caused by Serratia plymuthica with no evident focus of infection. The patient was treated with gentamicin (40 mg every 8 h) during 10 days; clinical resolution of the infection was obtained after the 10-day treatment period.