Cardiac tamponade from a giant thymoma: case report

Thymoma, the most common neoplasm of the anterior mediastinum especially in adults, accounts for 20-25% of all mediastinal tumors and 50% of anterior mediastinal masses. These tumors are routinely asymptomatic for prolonged periods of time. Pericardial tamponade is a very rare initial manifestation of a thymoma. This report presents a patient who had hemorrhagic pericardial tamponade that likely resulted from the largest symptomatic mixed type (type AB) thymoma described in the literature

The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe

Comparison of arterial and, venous blood gas values in conscious dogs and dogs under anaesthesia induced by ketamine

The aim of the present study was to determine whether venous blood samples can be used as an alternative to arterial samples in conscious and in anaesthetised dogs. Blood gas parameters (blood pH, PCO2, HCO3act-, BEecf, ctCO(2)) were measured in the femoral artery and in the cephalic vein of 12 dogs before (conscious dogs) and during profound anaesthesia induced by ketamine (15 mg/kg IM) after sedation with xylazine (2 mg/kg IM). Anaesthesia induced significant increases of all arterial values of gas parameters except for pH values which have significantly decreased. Similarly venous values were also significantly modified except for BEecf and HCO3act-. Arterial pH values were significantly higher than venous values whereas all the other parameters were significantly lower in arterial blood in conscious and in anaesthetised dogs. High positive correlations were evidenced between arterial and venous values of a given parameter in conscious dogs (the correlation coefficients were comprised between 0.861 and 0.947) as well as in anaesthetised dogs although they were less intense (the correlation coefficients ranged from 0.824 to 0.895). During anaesthesia, the highest correlation rate (r(2)> 80%) was obtained between arterial and venous pH values. In conclusion, venous blood gas values can predict arterial values in healthy dogs with sufficient accuracy whereas only venous pH values may be used during ketamine anaesthesia

C-Reactive Protein and Hemogram Parameters for the Non-Sepsis Systemic Inflammatory Response Syndrome and Sepsis: What Do They Mean?

<div><p>Objectives</p><p>Sepsis is one of the most common reasons of increased mortality and morbidity in the intensive care unit. The changes in CRP levels and hemogram parameters and their combinations may help to distinguish sepsis from non-sepsis SIRS. The aim of this study is to investigate the CRP and hemogram parameters as an indicator of sepsis.</p><p>Methods</p><p>A total of 2777 patients admitted to the ICU of two centers between 2006–2013 were evaluated retrospectively. The patients were diagnosed as SIRS (-), non-sepsis SIRS and sepsis. The patients who were under 18 years old, re-admitted, diagnosed with hematological disease, on corticosteroid and immunosuppressive therapy, SIRS (-), culture negative, undocumented laboratory values and outcomes were excluded. 1257 patients were divided into 2 groups as non-sepsis SIRS and sepsis. The patients’ demographic data, CRP levels, hemogram parameters, length of ICU stay and mortality were recorded.</p><p>Results</p><p>1257 patients were categorized as non-sepsis SIRS (816, 64.9%) and sepsis (441, 35.1%). In the multivariate analysis, the likelihood of sepsis was increased 3.2 (2.2–4.6), 1.7 (1.2–2.4), 1.6 (1.2–2.1), 2.3 (1.4–3.8), 1.5 (1.1–2.1) times by the APACHE II≥13, SOFA score≥4, CRP≥4.0, Lym_C<0.45 and PLT_C<150 respectively (p<0.001 p = 0.007 p = 0.004 p<0.001 p = 0.027). The likelihood of sepsis was increased 18.1 (8.4–38.7) times by the combination of CRP≥4.0, lym_C<0.45 and PLT_C<150 (P<0.001).</p><p>Conclusions</p><p>While WBC_C, Neu_C, Neu%, NLCR and Eo_C are far from being the indicators to distinguish sepsis from non-sepsis SIRS, the combinations of CRP, Lym_C and PLT_C can be used to determine the likelihood of sepsis.</p></div

Determination of Total Cell Protein Profiles of Streptomyces Species

Present study has been conducted for finding out the total protein profile of bacterial strain Streptomyces sps by sodium dodecyl sulphate polyacrylamide gel electrophoresis. Total 139 isolates of Streptomyces have been isolated from the soil. Amongst all isolated strain, total 20 isolates were used for getting protein profile by SDS PAGE. Amongst all isolates, 20 isolates were selected for protein profiling and these were divided in two groups. Two strains of Streptomyces i.e. S. violaceus and S. albidoflavus were selected as a reference strain for both groups. Band profile were analyzed and assessed by computer added program BioRad Quantity with the use of Unweighted Pair Group Method of Analysis (UPGMA). As a result of this computer assisted numeric analysis study, approximately 40 different types of protein bands were reported between 10 or 100 kD molecular weight. Analysis of acquired dendogram on the basis of similarities ratios, all 40 proteins can be divided in to 7 groups. In addition, the isolates A4B3G, D145B, S5036.6 and reference isolate S. violaceus were available in the same group, while 805A, C804B, F1705 isolates and reference sample S. albidoflavus were detected in the same group. The test organisms which were similar to each other in terms of morphological and biochemical characters delivered the same protein bands. SDS-PAGE method is an effective method in terms of determining taxonomical relations between the various species of genus Streptomyces

Combinations of CRP and hemogram parameters for likelihood of sepsis.

<p>Abbreviations: CRP, c-reactive protein; Eo_C, eosinophil count; PLT_C, platelet count. ^#, p<0.001.</p

Comparison of survivor and non-survivor patients.

<p>Abbreviations: APACHE II, Acute Physiology And Chronic Health Evaluation; CRP, c-reactive protein; Eo_C, eosinophil count; PLT_C, platelet count; SOFA, Sequential Organ Failure Assessment.</p

Study flowchart.

<p>Abbreviations: APACHE II, Acute Physiology And Chronic Health Evaluation; SIRS, systemic inflammatory response syndrome; SOFA, Sequential Organ Failure Assessment.</p