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Biomedical subjects

R Pallarés

Publications and source records attributed to R Pallarés.

35 records · Page 2Linked to original sources
PubMed1986

Gangrenous cholecystitis and acute cholangitis associated with anaerobic bacteria in bile.

The incidence of anaerobic bacteria in bile, and the relationship between bacterial species isolated from the bile and the clinical characteristics of disease in these patients was studied. One hundred and twenty-five bile specimens obtained during surgery from the same number of patients were cultured aerobically and anaerobically. Seventy patients (56%) had positive cultures and in 30% of the patients with positive cultures anaerobic bacteria were recovered, usually together with aerobic bacteria. Members of the Bacteroides fragilis group were the most frequently isolated anaerobic organisms. There was a high rate of isolation of anaerobic bacteria from bile in patients with gangrenous cholecystitis (72%) or acute cholangitis (50%). Administration of antibiotics effective against anaerobic bacteria should be considered when treating these diseases.

Acute Disease↗
PubMed1986

Comparative clinical evaluation of aztreonam versus aminoglycosides in gram-negative septicaemia.

We have conducted an open randomized comparison of aztreonam versus an aminoglycoside in 100 adult, non-granulocytopenic patients with suspected or proven aerobic Gram-negative septicaemia. Forty-three patients with negative blood cultures, with blood isolates resistant to the antibiotic used, or who died within the first 24 h were excluded. Of the 57 evaluable patients, 31 received aztreonam and 26 aminoglycoside (13 gentamicin and 13 tobramycin). Patients in both groups were comparable with respect to age, sex, underlying diseases, sites of local infection and risk factors. There were 39 blood isolates in the aztreonam group and 28 in the aminoglycoside group. The overall cure rate was 83.8% in aztreonam-treated patients and 76.9% in aminoglycoside-treated patients. There were five failures (2 aztreonam, 3 aminoglycoside) and in six patients only clinical improvement could be achieved (3 aztreonam, 3 aminoglycoside). Both antibiotics were well tolerated. Nephrotoxicity was found in seven patients of the aminoglycoside group (P = 0.004), whereas enterococcal superinfections occurred in six of the aztreonam group (P = 0.0124). The results of our study suggest that aztreonam is at least as effective as gentamicin or tobramycin in patients with septicaemic infections due to susceptible bacteria. Aztreonam-treated patients are free of nephrotoxicity but are at risk of enterococcal superinfections.

Adult↗
PubMed1986

Etiological agent and primary source of infection in 42 cases of focal intracranial suppuration.

The microbiological findings for 42 patients with focal intracranial suppuration were analyzed and correlated with the different sources of primary infection. Streptococcus spp. were identified in focal intracranial suppuration of all origins except postcraniotomy. Microaerophilic streptococci were important in cases secondary to respiratory tract infection and in those of unknown origin. Streptococcus faecalis, Proteus spp., and Bacteroides fragilis were the organisms most commonly found in polymicrobial otogenic abscesses. Clostridium sp. was the main microorganism implicated in postcraniotomy suppurations.

Adolescent↗
PubMed1985

Comparative trial of rifampin-doxycycline versus tetracycline-streptomycin in the therapy of human brucellosis.

In an attempt to compare the efficacy of rifampin-doxycycline with tetracycline-streptomycin for the treatment of human brucellosis, we administered both combinations for a 30-day period, similar to the period recommended by the World Health Organization in a prospective, randomized trial. Forty-six patients were included in the final study (36 men and 10 women); 41 had blood cultures positive for Brucella melitensis. The 28 patients in group A received tetracycline hydrochloride at doses of 0.5 g every 6 h or doxycycline at 100 mg every 12 h for 30 days plus 1 g of streptomycin a day for 21 days. The 18 patients in group B received rifampin at 15 mg/kg per day in a single morning dose plus 100 mg of doxycycline every 12 h for 30 days. For patients with focal disease from both groups, therapy was prolonged to 45 days. All patients underwent rigorous clinical and bacteriological long-term follow-up. There were no therapeutic failures in either group, and the defervescence period was similar for both groups (3.1 days for group A, 2.6 days for group B). Two patients (7.1%) from group A had relapses, as did seven (38.8%) from group B (P = 0.024), and blood cultures again became positive for B. melitensis in all of them. In both groups treatment was generally well tolerated. The results strongly suggest that the rifampin-doxycycline combination is a less efficacious mode of therapy for brucellosis to prevent relapses than is the classical tetracycline-streptomycin combination when both are administered for 30 days. A more prolonged period of administration of the rifampin-doxycycline combination may be required to obtain the same low relapse rate as that achieved with the classical tetracycline-streptomycin treatment.

Adolescent↗
PubMed1983

Polymicrobial anaerobic septicemia due to lateral sinus thrombophlebitis.

Continuous polymicrobial anaerobic septicemia was the main manifestation of a lateral sinus thrombophlebitis (LST) in a patient who had a history of chronic otitis media. Five different anaerobic microorganisms were isolated in blood cultures. Three of them were also present in ear cultures. The diagnosis was confirmed at surgery and the patient was successfully treated with moxalactam disodium therapy. This case emphasizes that LST should be considered before polymicrobial anaerobic septicemia, especially if there is a history of chronic otitis media.

Adult↗
PubMed1983

Biliary tract infections caused by Haemophilus influenzae type b.

Four cases of women with biliary infection caused by Haemophilus influenzae type b are reported. The patients had underlying benign or malignant disease of the biliary tract. Haemophilus influenzae was isolated in pure culture from bile in all cases and also from blood cultures in three cases. The clinical condition of three patients was not severe, two of them recovering after surgery without antibiotic therapy. The fourth patient died of septic shock which occurred after liver biopsy. The frequency of biliary infections caused by Haemophilus influenzae has probably been underestimated because of the special nutritional requirements of this microorganism. The route by which Haemophilus influenzae reaches the biliary tract is not fully understood.

Aged↗
PubMed1983

Isolation of Pseudomonas putrefaciens in intra-abdominal sepsis.

We report the isolation of Pseudomonas putrefaciens from an intra-abdominal abscess in a patient with colonic carcinoma and from bile in two patients with biliary tract disease. In all three cases, P. putrefaciens was isolated in mixed culture with enteric bacteria.

Abscess↗
PubMedDate not supplied

Brucellar spondylitis: a detailed analysis based on current findings.

Three hundred thirty-one cases of brucellosis included in a 10-year prospective protocol were reviewed to identify and follow up patients with spondylitis. Of 20 patients (17 male and three female; mean age, 54 years), spondylitis was diagnosed soon after onset of the brucellosis in 15, there were significant systemic symptoms in 17, and blood cultures were positive for Brucella melitensis in 14. The main symptom was vertebral pain. The commonest radiographic changes were narrowing of the disk and epiphysitis. The discrete character of radiographic alterations and negative uptake on bone scanning caused diagnostic delays in three patients. 99mTc bone scans finally became abnormal in all patients, but were not useful for follow-up because low uptake persisted after the clinical status stabilized. Three patients had paravertebral abscesses; in two of them fever and pain persisted despite antibiotic therapy until diagnosis and surgical drainage. Finally, all patients were cured, ten with sequelae. Brucellar spondylitis often had an acute clinical course with bacteremia. Because neither clinical nor radiographic changes one year after onset were significant, long-term follow-up is not considered necessary except when paravertebral abscess is suspected.

Abscess↗
PubMedDate not supplied

Successful diagnosis and treatment of cardiac perforation due to subclavian catheter during total parenteral nutrition.

A case of atrial perforation by a subclavian vein catheter, which was inserted for total parenteral nutrition (TPN) is reported. Acute thoracic symptoms developed 3 days after the infusion was started. The diagnosis was correctly made by demonstrating contrast medium within the pericardial sac. The catheter was withdrawn and the patient recovered satisfactorily. The clinical picture and the differential diagnosis of this complication are discussed.

Adult↗