Life-Threatening Massive Thromboembolism After Laparoscopic Splenectomy in an Idiopathic Thrombocytopenic Patient

A life-threatening massive thromboembolism is reported that developed after laparoscopic splenectomy in a 57-year-old female with idiopathic thrombocytopenic purpura (ITP). Although asymptomatic, she underwent splenectomy because of poor response to steroids and intravenous (IV) gamma globulin. Thirteen days after splenectomy, she suffered portal and mesenteric emboli, followed by pulmoner emboli and left popliteal thrombophlebitis. Extensive workup for hypercoagulable states was negative. Low molecular weight heparin (LMWH) was initiated at a suboptimal dose because of thrombocytopenia. During follow-up, her platelet count increased gradually. Whenever the platelet count had remained stable at > 50 x 109/L, she received full dose of LMWH treatment. Over the next 38 days, her pain resolved, she tolerated a full diet, and sent home. Follow-up imaging studies demonstrated a recanalized portal vein and totally resolved pulmonary arteries. We thought that, consumption of platelets in the massive thromboembolism sites including portal, mesenteric and pulmoner vascular beds had resulted in deep thrombocytopenia, which improved gradually with anticoagulant therapy

Serum paraoxonase and arylesterase activities in patients with lung cancer in a Turkish population

BACKGROUND: Lung cancer (LC) is the leading cause of cancer-related deaths. Oxidative DNA damage may contribute to the cancer risk. The antioxidant paraoxonase (PON1) is an endogenous free radical scavenger in the human body. The aim of this study was to determine serum PON1 and arylesterase (ARE) activities in patients with newly diagnosed LC. METHODS: This case control study involved a total of 39 patients with newly diagnosed LC (untreated) and same number of age- and sex-matched healthy individuals. Serum PON1 and ARE activities in addition to lipid parameters were measured in both groups. RESULTS: Serum PON1 and ARE activities were found to be lower in patients with LC compared to the controls (p = 0.001 and p = 0.018, respectively). The ratio of PON1/high density lipoprotein (HDL) was significantly lower in the LC group compared to the control one (p = 0.009). There were positive correlations between the serum levels of HDL and PON1 in both the control (r = 0.415, p = 0.009) and the LC groups (r = 0.496, p = 0.001), respectively. PON1 enzyme activity was calculated as three different phenotypes in both groups. In regard to lipid parameters, total cholesterol levels were significantly lower (p = 0.014) in the LC group whereas the other lipid parameters such as HDL, LDL, and triglyceride levels were not significantly different among groups. CONCLUSION: Serum PON1 activity is significantly low in the LC group compared with the healthy controls. Metastasis status and cigarette smoking do not affect serum PON1 activity in the LC patients

Comparison of total, salivary and calculated free cortisol levels in patients with severe sepsis

BACKGROUND: The purposes of the study were to compare serum total cortisol (STC), salivary cortisol (SaC) and calculated free cortisol (cFC) levels at baseline and after the adrenocorticotrophic hormone (ACTH) stimulation test in patients with severe sepsis (SS) and determine the suitability of use of SaC and cFC levels instead of STC for the diagnosis of adrenal insufficiency (AI) in patients with SS. And secondary aims of this study were to compare these parameters in patients with SS with healthy controls and check their effects on survival status of the patients. METHODS: Thirty patients with SS (15 men and 15 women) were compared with 16 healthy controls. Low-dose (1 μg) ACTH stimulation test was performed to the patients on the first, seventh and 28th days of diagnosis of SS, but in control group, 1 μg ACTH stimulation test was performed only once. STC, SaC and cFC levels were measured during ACTH stimulation test. RESULTS: Patients were categorized as having low or high baseline STC according to a cut-off level of 10 μg/dL. In high STC group, baseline and peak SaC levels were found to be 2.3 (0.2–9.0) and 3.4 (0.5–17.8) μg/dL on D1 and 1.1 (0.8–4.6) and 2.6 (1.3–2.9) μg/dL on D7, respectively. In the control group, baseline and peak SaC levels were 0.4 (0.1–1.4) and 1.1 (0.4–2.5) μg/dL, respectively. Baseline and peak SaC levels after ACTH stimulation were found to be higher in high STC group than in controls, but they were found to be similar in low STC and control groups. In high STC group, cFC levels were 0.3 (0.1–0.3) and 0.4 (0.3–0.7) μg/dL on D1 and 0.2 (0.1–0.3) and 0.4 (0.1–0.7) μg/dL on D7, respectively. In the control group, baseline and peak cFC levels were 1.7 (0.4–1.9) and 1.8 (1.0–6.6) μg/dL, respectively. cFC levels were found to be lower in patients with SS subgroups than in the control group. Baseline and stimulated STC, SaC and cFC levels did not differ according to the survival status. SaC, cFC and STC levels were found to be correlated with each other. CONCLUSIONS: SS is associated with increased SaC, but decreased cFC levels when baseline STC is assumed to be sufficient. When STC level is assumed to be insufficient, SaC levels remain unchanged, but cFC levels are decreased. Lower STC levels is not associated with increased mortality in patients with SS. More data are needed in order to suggest the use of SaC and cFC instead of STC. TRIAL REGISTRATION: ClinicalTrials.gov No: NCT0258943

Systematic Review and Meta-Analysis of Randomized Clinical Trials in the Treatment of Human Brucellosis

BACKGROUND: Brucellosis is a persistent health problem in many developing countries throughout the world, and the search for simple and effective treatment continues to be of great importance. METHODS AND FINDINGS: A search was conducted in MEDLINE and in the Cochrane Central Register of Controlled Trials (CENTRAL). Clinical trials published from 1985 to present that assess different antimicrobial regimens in cases of documented acute uncomplicated human brucellosis were included. The primary outcomes were relapse, therapeutic failure, combined variable of relapse and therapeutic failure, and adverse effect rates. A meta-analysis with a fixed effect model was performed and odds ratio with 95% confidence intervals were calculated. A random effect model was used when significant heterogeneity between studies was verified. Comparison of combined doxycycline and rifampicin with a combination of doxycycline and streptomycin favors the latter regimen (OR = 3.17; CI95% = 2.05-4.91). There were no significant differences between combined doxycycline-streptomycin and combined doxycycline-gentamicin (OR = 1.89; CI95% = 0.81-4.39). Treatment with rifampicin and quinolones was similar to combined doxycycline-rifampicin (OR = 1.23; CI95% = 0.63-2.40). Only one study assessed triple therapy with aminoglycoside-doxycycline-rifampicin and only included patients with uncomplicated brucellosis. Thus this approach cannot be considered the therapy of choice until further studies have been performed. Combined doxycycline/co-trimoxazole or doxycycline monotherapy could represent a cost-effective alternative in certain patient groups, and further studies are needed in the future. CONCLUSIONS: Although the preferred treatment in uncomplicated human brucellosis is doxycycline-aminoglycoside combination, other treatments based on oral regimens or monotherapy should not be rejected until they are better studied. Triple therapy should not be considered the current treatment of choice

An unusual manifestation of brucellosis: A case with multisystemic involvement and adult respiratory distress syndrome

A rare complication of brucellosis is presented. A 23-year old man was admitted to the hospital with fever, chills, fatigue, dyspnea, and rash. The patient was diagnosed as brucellosis by the isolation Brucelia melitensis (B. melitensis) from blood and cerebrospinal fluid cultures. Multisystemic involvement; pneumonia, meningitis, hepatitis, endocarditis, cutaneous lesions and hematological abnormalities were observed. Adult respiratory distress syndrome (ARDS) developed. The patient treated with a combination of ceftriaxone, doxycycline and rifampicin, was operated for mitral valve replacement. Relapse has not been observed

Prostatitis and hepatitis due to Brucella melitensis: a case report

A case is reported of a 43-year-old man who presented prostatitis and hepatitis due to Brucella melitensis. His symptoms were icterus, weakness, anorexia, fever, and urinary discomfort, Physical examination revealed icterus and hepatosplenomegaly, Lymphomonocytosis, elevated erythrocyte sedimentation rate and abnormal liver functions had been detected in laboratory tests, Brucella melitensis was isolated from prostatic fluid and blood cultures