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A retrospective study was designed to ascertain the main clinical features of 30 patients admitted for brain abscess between 1989 and 2005. A contiguous source of infection was identified in 40% of cases, direct inoculation secondary to trauma or neurosurgery in 23,3%, and a distant source in 23,3%. Fever, headache and sensorial involvement were the main clinical manifestations. Temporal and frontal lesions were predominant. Microbiological information was available in only half of cases, prevailing polymicrobial and gram-positive bacterial infections. Most patients underwent surgical procedures (66.7%) and the rest received only medical therapy. During antimicrobial treatment, 6 patients (20%) suffered a serious adverse event that prompted discontinuation or change of therapy. Failure of treatment was observed in 40%, including 3 deaths (10%), non-programmed surgical drainage or reintervention (16.7%) and changes of the antimicrobial regimen (13.3%). Eight patients were discharged with sequels (26.7%), and during follow-up, 21% presented major events (death or brain abscess-related readmission).

Se diseñó un estudio para conocer las principales características clínicas en 30 pacientes atendidos por absceso cerebral entre 1989 y 2005. La puerta de entrada predominante fue por contigüidad (40%) y luego inoculación directa por neurocirugía-trauma o diseminación hematógena (23,3%). La fiebre, cefalea y el compromiso de conciencia fueron las manifestaciones cardinales y la localización predominante fue temporal o frontal. Se observó un predominio de infecciones polimicrobianas y por cocáceas gram positivas. La mayor parte fue sometida a tratamiento quirúrgico (66,7%) y el resto a tratamiento médico solamente. Durante el tratamiento antimicrobiano, 6 pacientes (20%) presentaron una reacción adversa que obligó a su suspensión o a cambio. Se observó fracaso del tratamiento médico-quirúrgico en 40% de los casos, incluyendo 3 decesos (10% letalidad), drenaje quirúrgico no programado o reintervenciones (16,7%) o ajustes de esquema (13,3%). Ocho pacientes presentaron secuelas al alta (26,7%) y durante el seguimiento, 21% presentó rehospitalizaciones relacionadas o falleció A retrospective study was designed to ascertain the main clinical features of 30 patients admitted for brain abscess between 1989 and 2005. A contiguous source of infection was identified in 40% of cases, direct inoculation secondary to trauma or neurosurgery in 23,3%, and a distant source in 23,3%. Fever, headache and sensorial involvement were the main clinical manifestations. Temporal and frontal lesions were predominant. Microbiological information was available in only half of cases, prevailing polymicrobial and grampositive bacterial infections. Most patients underwent surgical procedures (66.7%) and the rest received only medical therapy. During antimicrobial treatment, 6 patients (20%) suffered a serious adverse event that prompted discontinuation or change of therapy. Failure of treatment was observed in 40%, including 3 deaths (10%), non-programmed surgical drainage or reintervention (16.7%) and changes of the antimicrobial regimen (13.3%). Eight patients were discharged with sequels (26.7%), and during follow-up, 21% presented major events (death or brain abscess-related readmission)

A retrospective study was designed to ascertain the main clinical features of 30 patients admitted for brain abscess between 1989 and 2005. A contiguous source of infection was identified in 40% of cases, direct inoculation secondary to trauma or neurosurgery in 23,3%, and a distant source in 23,3%. Fever, headache and sensorial involvement were the main clinical manifestations. Temporal and frontal lesions were predominant. Microbiological information was available in only half of cases, prevailing polymicrobial and gram-positive bacterial infections. Most patients underwent surgical procedures (66.7%) and the rest received only medical therapy. During antimicrobial treatment, 6 patients (20%) suffered a serious adverse event that prompted discontinuation or change of therapy. Failure of treatment was observed in 40%, including 3 deaths (10%), non-programmed surgical drainage or reintervention (16.7%) and changes of the antimicrobial regimen (13.3%). Eight patients were discharged with sequels (26.7%), and during follow-up, 21% presented major events (death or brain abscess-related readmission).

Uno de los principales problemas en los hospitales de Latinoamérica han sido los microorganismos productores de β-lactamasas de espectro extendido (BLEE) multirresistentes. Ob-jetivo. Establecer el perfi l deresistencia fenotípica de Klebsiella pneumoniae (KP)y Escherichia coli (EC) causantes de infección nosocomial en el hospital San Jerónimo de Montería (Colombia) y comparar cuatro métodos para la detección de BLEE. Metodolo-gía. Se analizaron 60 aislamientos, 30KP y 30 EC provenientes de pacientes intrahospitalarios del HSJ, se emplearon los métodos de difusión de disco del National Committee for Clinical Laboratory Standards (NCCLS) y los métodos confi rmatorios para la detec-ción de BLEE el de disco combinado, la prueba Etest® ESBL y MicroScan® ESBL. Resultados. 14 de 60 (23.3%) aislamientos producían BLEE, 11 de 30 KP (36.6%) y 3 de 30 EC (10%). Los métodos difusión de disco del NCCLS, MicroScan® ESBL y Etest®ESBL fueron concordantes en los resultados para confi rmación de la producción de BLEE, pero el método de disco combinado mostró diferencias en los resultados con respecto a los anteriores ya que determinó la producción de BLEE en 9 de 30 (30%)KP y 2 de 30 (6.6%)EC (p

EN OCTUBRE DE 2002 se llevó a cabo un estudio descriptivo de corte con el propósito de investigar sobre el conocimiento y la aplicación del Derecho Internacional Humanitario (DIH) y la Misión Médica (MM), en los servicios de urgencias localizados en municipios del oriente del departamento de Antioquia, región que sufre desde hace varios años las consecuencias del conflicto armado colombiano y que refleja la problemática general del país. El estudio se hizo encuestando a los directores de esos servicios de urgencias para averiguar qué formación habían tenido sobre DIH y MM y qué pautas había en las instituciones que representaban para la aplicación de estas normas. Los directores encuestados manifestaron tener muy poca información acerca del DIH y la MM. Durante su formación académica de pregrado y posgrado no recibieron educación formal al respecto. Estuvieron de acuerdo en la importancia del tema, la necesidad de capacitarse y la posibilidad de aplicarlo. Por otra parte, en las instituciones de salud que cuentan con servicios de urgencias en el oriente antioqueño se carece de protocolos o manuales sobre el DIH y la MM así como de actividades de formación continua que permitan al personal sanitario actuar a la luz de estas normas; además, el conocimiento previo de estos aspectos no es requisito para laborar en las instituciones de salud que cuentan con servicios de urgencias en la región. IN OCTOBER 2002 a descriptive study was made to find out the grade of knowledge in the Emergency Services of the East region of Antioquia of the International Human Right, (IHR) and the Medical Mission (MM). This region has been suffering since many years the consequences of the war that show what has been happening in the entire country. A questionnaire was filled by the directors of the hospitals in this region about both items. They agree on the importance of the items but said they have little knowledge about them and they have received few instructions regarding those items. In their hospitals there are neither guides nor education programs for the personnel in this regard. To be posted in a hospital, a person needs not show proficiency in IHR or MM

Background: Spondylodiscitis is a rare but prolonged inflammation of two adjacent vertebral bodies and the disk in between. Aim: To report the clinical features of a series of patients with spondylodiscitis. Material and methods: A retrospective analysis of medical records of patients with spondylitis, identified between 1989 and 2002. Results: A total of 25 cases were identified, 15 female, aged 49.8 years as a mean. Their mean evolution before admission was 4.3 months. Main complaints were back or radicular pain. Mild anemia was present in most patients. Mean erythrocyte sedimentation rate and C reactive protein values were 66 mm/h and 60 mg/L, respectively. Forty four percent of patients had neurological complications. Vertebral computed tomography and scintigraphic studies were done in 72% of patients, but magnetic resonance imaging was done only in 4 (16%). In 18 patients, a tissue sample for pathological and microbiological analysis, was obtained by imaging guiding or surgically. Tuberculosis, diagnosed on pathology, was the leading cause of spondylitis in nine cases (36%), followed by Staphylococcus aureus infection in five (20%). Other agents found were E coli and group D Streptococcus (one each). Age, symptoms, evolution time and different laboratory parameters did not differ between patients with tuberculosis and patients with other causes. A microbiological cause was not established in 36% of cases. Most patients evolved satisfactorily and recovered from neurological complications (88%). One patient with tuberculosis did not improve after prolonged treatment and 2 patients infected with S aureus died (8%). Conclusions: Spondylodiscitis is associated to a diversity of microbial agents and in most cases has a favorable prognosis (Rev Méd Chile 2003; 131: 473-82).

The clinical features of eight patients, four females, aged 4 to 15 years under chronic hemodialysis for terminal renal failure (creatinine clearance 10 ml.min.1,73 m2 or less) are reported. Initial diseases were Alport syndrome, systemic lupus erythematosus, chronic glomerulonephritis (n = 2), bilateral polycystic kidney, prune belly syndrome and reflux nephropathy (n = 2). Distal vascular approach by means of arteriovenous fistulas was preferred for these patients and the kinetic urea model was used to evaluate the performance of the procedure. Patients required nine to twelve hours of hemodialysis per week for optimal results. Mean weight decreases of 1 to 3 kg and reductions in blood urea nitrogen and serum potassium of 40 mg.dl and 2,5 mEq.1, respectively, were observed. The main complications of hemodialysis were the disequilibrium syndrome, infections at the site of insertion of the arteriovenous fistulae and congestive heart failure. Three patients were submitted to renal transplantation with live donors homografts: one died and the other two remain alive but under chronic hemodialysis. Five children are attending school regularly, and two of them are waiting a kidney donor for transplantation. Despite encouraging results chronic hemodialysis in children constitutes only primary supportive therapy prior to renal transplantation.