Acral necrosis by Stenotrophomonas maltophilia

Keywords:necrosis;skin and soft tissue infection;Stenotrophomonas maltophilia Abstract Background Stenotrophomonas maltophilia (SM) has been considered a nosocomial pathogen. Nevertheless, community acquired infection may occur more frequently than usually recognized. Case We describe distal necrosis of the fingers by SM in a farmer, contracted in the community and successfully treated with a combination of cotrimoxazole and ciprofloxacin. The patient was diagnosed with chronic lymphocytic leukaemia 6 months later. Conclusions This unusual presentation shows that infection with SM should be included in the differential diagnosis of the skin and soft tissue infection, even in apparently healthy patients

A warfarin induction regimen for out-patient anticoagulation in patients with atrial fibrillation

Currently available protocols for induction of warfarin anticoagulation employ initial doses of 10 mg and are best suited to in‐patient use. However, with the increasing number of elderly patients with atrial fibrillation requiring anticoagulation, there is a need for a less intense regimen which could be used for out‐patients. We have established such a regimen and report on its prospective evaluation in 37 patients referred for out‐patient initiation of warfarin, and a non‐randomized comparison with 37 in‐patients, with similar diagnoses, commenced on a traditional warfarin protocol. After exclusion of five patients on amiodarone, all of whom experienced supratherapeutic International Normalized Ratio (INR) results, the new out‐patient regimen, employing an initial 5 mg dose, resulted in a lower maximum INR during the first 21 d therapy (median 2.9 v 4.0; P = 0.0001) and fewer INRs > 4.5 (2/36 v 9/33) compared to the traditional 10 mg regimen. Time to reach stable anticoagulation was similar with each regimen; however, the 5 mg regimen gave a more accurate prediction of maintenance dose (correlation coefficient for predicted versus actual maintenance dose, r = 0.985). In comparison to a traditional 10 mg protocol, the proposed 5 mg warfarin induction regimen proved both safer and more reliable for initiation of prophylactic anticoagulation in patients with atrial fibrillation

Stenotrophomonas maltophilia: an increasing problem in patients with acute leukaemia

Stenotrophomonas maltophilia (previously Pseudomonas maltophilia and Xanthomonas maltophilia) is an increasing problem as an opportunistic pathogen in immunocompromised patients such as those with acute leukaemia. Infection is difficult to treat and eradicate due to its inherent and quickly acquired resistance to many antibiotics. Presentation with unusual cutaneous lesions is not uncommon and can present diagnostic difficulties. We present two cases which highlight the classical features of this infection in leukaemic patients, and discuss the need for early antibiotic treatment with regimens including cotrimoxazole, and the consideration of prompt central venous catheter removal

Antithrombin concentrate alone may not prevent venous thromboembolism following neurosurgery

No abstract available

Los conceptos que inspiran el trabajo de los psicoanalistas de pareja y familia: Estudio preliminar del análisis cuantitativo en el contenido de una encuesta

The author's purpose in the present paper is to explore core psychoanalytic concepts that lend support to clinical practice for the members of the International Association of Psychoanalysis of Couple and Family (AIPPF). To achieve this goal the authors have developed a tool that allows to collect information (self-administered questionnaire), briefly presented. The questionnaire requests each member to sort out important concepts in the five following areas: individual psychoanalysis, intersubjective psychoanalysis, group psychoanalysis, family psychoanalysis, couple psychoanalysis, as well as to outline these concepts on three levels: theory, clinic, practice and technique. The sample obtained corresponds to 22 responses which the authors discuss and analyze in detail. In their conclusions, the authors draw attention to the fact that different theoretical orientations are present in couple and family therapy and that the responses to the questionnaire were pondered and on occasion are original and manifest current notions. It can also be observed that current change in family configurations has marked the standpoint concerning certain clinical aspects and links. The authors conclude by highlighting the value of this work to develop new research on more specific aspects, among which several subjected to a more refined approach in recent studies in the institution are mentioned.En este trabajo los autores se proponen explorar qué conceptos psicoanalíticos centrales que hacen de soporte de la práctica clínica para los miembros de la Asociación Internacional de Psicoanálisis de Pareja y Familia (AIPPF). Para ello los autores han desarrollado un instrumento que permite recolectar la información (cuestionario autoadministrado), que exponen brevemente. En el cuestionario se le solicita a cada miembro que mencione los conceptos de importancia en cinco terrenos: psicoanálisis individual, psicoanálisis intersubjetivo, psicoanálisis de grupo, psicoanálisis de familia, psicoanálisis de pareja, y que especifique dichos conceptos en tres niveles: el de la teoría, el de la clínica, el de la práctica y técnica. La muestra obtenida corresponde a 22 respuestas, que los autores comentan y analizan en detalle. En sus conclusiones, los autores destacan que, respecto de la terapia de pareja y familia, están presentes diferentes orientaciones teóricas, que las respuestas al cuestionario han sido meditadas, y que en ocasiones resultan originales y con un aire de modernidad. También se observa que el cambio en las configuraciones familiares en la actualidad ha dejado una marca en los modos de pensar algunos aspectos de la clínica y de los vínculos. Los autores terminan el trabajo destacando la utilidad de este trabajo para desarrollar nuevas investigaciones sobre aspectos más puntuales, entre los cuales mencionan varios que están siendo objeto de un enfoque más refinado en estudios recientes en la institución