13 research outputs found
Burkitt lymphoma of the ovaries mimicking sepsis: a case report and review of the literature
Abstract Background It is not unusual for systemic diseases to mimic sepsis and, in any case, the clinician should thoroughly investigate this possibility. Case presentation We present the case of a 21-year-old Greek woman who presented to the Intensive Care Unit of our hospital with severe septic shock – multiple organ failure as a result of a suspected gynecological infection of the ovaries. An immediate improvement of her clinical condition in combination with strong clinical suspicion and negative cultures led to the differential diagnosis of diseases other than sepsis. Based on the results of the biopsies that were obtained by research laparotomy, our patient suffered from primary Burkitt ovarian lymphoma. Her clinical condition improved with supportive treatment and chemotherapy. Chemotherapy is the dominant treatment for Burkitt’s lymphoma, while surgery or radiotherapy has no place. Conclusions All intensivists should be aware of clinical conditions that mimic sepsis as early diagnosis can lead to appropriate therapy and avoid unnecessary diagnostic tests and antibiotic abuse
Increased apoptosis in the alveolar microenvironment of the healthy human lung
Background. Apoptosis represents a physiological clearance mechanism in
human tissues. The role of apoptosis has not been examined in normal
lung cell populations, such as alveolar macrophages and
polymorphonuclear cells. What is the percentage, as well as the role, of
apoptosis in the alveolar microenvironment of the healthy human lung?
Patients and methods. Bronchoalveolar lavage was obtained from 21
volunteers without lung disease. The specimens were analyzed using:
Annexin V binding, DNA laddering, light microscopy and
immunohistochemistry for bcl-2 expression.
Results. Apoptosis of the total bronchoalveolar lavage cell population
was 51.2%. Both alveolar macrophages and polymorphonuclear cells had a
high apoptotic rate (62.1% and 48.3%, respectively) as determined by
Annexin V binding. These findings were further confirmed using
morphological criteria for apoptosis and gel electrophoresis for DNA
fragmentation. In the majority of the individuals examined, (8 out of
21), the bcl-2 gene was expressed in the lymphocyte population mainly.
Conclusions. The percentage of apoptosis in lung cells of healthy humans
is high. Apoptosis plays a key role in normal lung cell death. It
appears to be the mechanism that opposes cell proliferation by
eliminating, aged or damaged cells thus facilitating the process of lung
remodeling. (C) 2008 Elsevier Inc. All rights reserved
Prognostic Usefulness of Serial C-Reactive Protein Measurements in ST-Elevation Acute Myocardial Infarction
It has been reported that increased levels of C-reactive protein are
related to adverse long-term prognosis in the setting of ST-segment
elevation acute myocardial infarction (MI). In previous studies, the
timing of C-reactive protein determination has varied widely. In the
present study, serial high-sensitivity C-reactive protein (hsCRP)
measurements were performed to investigate if any of the measurements is
superior regarding long-term prognosis. A total of 861 consecutive
patients admitted for ST-segment elevation MI and treated with
intravenous thrombolysis within the first 6 hours from the index pain
were included. HsCRP levels were determined at presentation and at 24,
48, and 72 hours. The median follow-up time was 3.5 years. New nonfatal
MI and cardiac death were the study end points. By the end of follow-up,
cardiac death was observed in 22.4% and nonfatal MI in 16.1% of the
patients. HsCRP levels were found to be increasing during the first 72
hours. Multivariate Cox regression analysis demonstrated that hsCRP
levels a presentation were an independent predictor of the 2 end points
(relative risk [RR] 2.8, p = 0.002, and RR 2.1, p = 0.03, for MI and
cardiac death, respectively), while hsCRP levels at 24 hours did not
yield statistically significant results (RR 1.4, p = 0.40, and RR 1.1, p
= 0.80, for MI and cardiac death, respectively). The corresponding RRs
at 48 hours were 1.2 (p = 0.5) for MI and 3.2 (p = 0.007) for cardiac
death and at 72 hours were 1.6 (p = 0.30) for MI and 3.9 (p <0.001) for
cardiac death. In conclusion, hsCRP levels at presentation represent an
independent predictor for fatal and nonfatal events during long-term
follow-up. HsCRP levels at 48 and 72 hours, which are close to peak
hsCRP levels, independently predict only cardiac death. (c) 2013
Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:26-30
Burkitt lymphoma of the ovaries mimicking sepsis: a case report and review of the literature
Prosafe: a european endeavor to improve quality of critical care medicine in seven countries
BACKGROUND: long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present ProsaFe, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. the project involved 343 icUs in seven countries. all patients admitted to the icU were eligible for data collection. MetHoDs: the ProsaFe network collected data using the same electronic case report form translated into the corresponding languages. a complex, multidimensional validation system was implemented to ensure maximum data quality. individual and aggregate reports by country, region, and icU type were prepared annually. a web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database. RESULTS: The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. conversely, icU equipment differed, and patient outcomes showed wide variations among countries. coNclUsioNs: ProsaFe is a permanent, stable, open access, multilingual database for clinical benchmarking, icU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor
Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project
PURPOSE: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). METHODS: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. RESULTS: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. CONCLUSION: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.status: publishe