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Nosocomial pneumonia (NP) is associated with high morbimortality, representing the second cause of nosocomial infection after urinary tract infection. The objective of this work was to become acquainted with the etiology of NP and to evaluate the antimicrobial resistance profile of the isolated microorganisms from adult patients with and without previous antimicrobial treatment admitted in the intensive care unit (ICU). From 2000 to 2005, 430 bronchoalveolar lavages from 430 adult patients diagnosed with pneumonia admitted in the ICU were analyzed. Seventy-four percent (199/ 269) of the patients with previous treatment had positive cultures, whereas in the group without previous treatment the percentage was 83% (134/161) (p = 0,03). The main agents in both groups of patients were: Acinetobacter spp. (37.9% vs 36.1%), Staphylococcus aureus (21.3% vs 26.6% ) and Pseudomonas aeruginosa (20.9% vs 17.7%), respectively (p > 0,05). The antimicrobial resistance in Acinetobacter spp., P. aeruginosa and S. aureus from previously treated patients was higher than that from patients without previous antimicrobial treatment (p < 0,05), except in the case of trimethoprim-sulfamethoxazole in S. aureus (p = 0,29). In conclusion, previous antimicrobial treatment did not modify the etiology of NP, but caused an increase in overall antimicrobial resistance and a lower percentage of positive cultures.

In this case report, a 56 year old patient with tuberculous destruction of the right sacroiliac joint is presented. Diagnosis was delayed because of unspecific signs of lumbalgia, which were interpreted as the consequence of nerve root compression. There was a specific infiltration into the surrounding intra- and extrapelvic muscles. Therapy is surgical, followed by a combination drug therapy for at least one year.

Objective: The purpose was to evaluate the levels of maternal serum human chorionic gonadotropin, alpha-fetoprotein, and unconjugated estriol in trisomy 18 pregnancies compared with normal singleton pregnancies., Study Design: Sera from 14 trisomy 18 pregnancies (13 retrospectively and one prospectively ascertained) were analyzed for human chorionic gonadotropin, alpha-fetoprotein, and unconjugated estriol., Results: The alpha-fetoprotein levels in the 10 trisomy 18 pregnancies without open neural tube or ventral wall defect had a median of 0.65 multiple of the median, although two had alpha-fetoprotein levels above 2.5 multiples of the median. The human chorionic gonadotropin levels had a median of 0.32 multiple of the median and the unconjugated estriol levels had a median of 0.56 multiple of the median. Although most women with trisomy 18 pregnancies had serum human chorionic gonadotropin levels that were less than 1.0 multiple of the median, three had markedly elevated human chorionic gonadotropin levels (greater than 5.0 multiples of the median)., Conclusion: Our data are partially consistent with those previously published but suggest the possibility of a bimodal distribution of alpha-fetoprotein and human chorionic gonadotropin levels in trisomy 18-affected pregnancies, unrelated to a neural tube or abdominal wall defect. The efficiency of screening for trisomy 18 prospectively, using the three serum markers, requires further evaluation.

Low levels of maternal serum alpha-fetoprotein are currently being used to screen for Down's syndrome in midpregnancy. Because of the possibility that gestational age may affect the detection rate of Down's syndrome, we analyzed maternal serum AFP levels and gestational age in 51 Down's syndrome pregnancies that had been confirmed by amniocentesis or at birth, and we compared these pregnancies with 3239 screened singleton pregnancies with known normal outcomes. The highest yield of a low risk for Down's syndrome associated with maternal serum alpha-fetoprotein occurred at 16.5 to 17.5 weeks' gestation. Our data suggest that maternal serum alpha-fetoprotein screening for Down's syndrome should be done between 16 and 18 weeks' gestation, which is the gestational age currently recommended for neural tube defect screening.

Two-hundred-eighty-six patients with acute transmural myocardial infarction underwent thrombolytic treatment (Streptokinase) between 1980 and 1986. In the earlier years patients were treated by thrombolysis only (n = 158) and in more recent years by thrombolysis followed by immediate percutaneous transluminal coronary angioplasty (n = 128). Age, sex, incidence of previous infarction and incidence of multivessel disease were comparable between groups. Patency of the infarct vessel (TIMI 3) was higher after thrombolysis combined with angioplasty than after thrombolysis alone (87% vs. 70%, p less than 0.001), and the residual stenosis of the infarct vessel was lower (46% vs. 84%, p less than 0.05). Hospital mortality (thrombolysis combined with angioplasty vs. thrombolysis alone) was 6% vs. 13%; one-year mortality was 8% vs. 21%, and five-year mortality was 18% vs. 31% (p less than 0.02). We conclude that treatment of patients with acute transmural myocardial infarction by thrombolysis combined with angioplasty is followed by a better long-term prognosis than treatment by thrombolysis only.