Commonly Used Severity Scores Are Not Good Predictors of Mortality in Sepsis from Severe Leptospirosis: A Series of Ten Patients

Introduction. Severe leptospirosis, also known as Weil's disease, can cause multiorgan failure with high mortality. Scoring systems for disease severity have not been validated for leptospirosis, and there is no documented method to predict mortality. Methods. This is a case series on 10 patients admitted to ICU for multiorgan failure from severe leptospirosis. Data were collected retrospectively, with approval from the Institution Ethics Committee. Results. Ten patients with severe leptospirosis were admitted in the Patras University Hospital ICU in a four-year period. Although, based on SOFA scores, predicted mortality was over 80%, seven of 10 patients survived and were discharged from the hospital in good condition. There was no association between SAPS II or SOFA scores and mortality, but survivors had significantly lower APACHE II scores compared to nonsurvivors. Conclusion. Commonly used severity scores do not seem to be useful in predicting mortality in severe leptospirosis. Early ICU admission and resuscitation based on a goal-directed therapy protocol are recommended and may reduce mortality. However, this study is limited by retrospective data collection and small sample size. Data from large prospective studies are needed to validate our findings

Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy): a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Injury of the gallbladder after blunt abdominal trauma is an unusual finding; the reported incidence is less than 2%. Three groups of injuries are described: simple contusion, laceration, and avulsion, the last of which can be partial, complete, or total traumatic cholecystectomy.</p> <p>Case presentation</p> <p>A case of isolated complete avulsion of the gallbladder (near traumatic cholecystectomy) from its hepatic bed in a 46-year-old Caucasian man without any other sign of injury is presented. The avulsion was due to blunt abdominal trauma after a car accident. The rarity of this injury and the stable condition of our patient at the initial presentation warrant a description. The diagnosis was made incidentally after a computed tomography scan, and our patient was treated successfully with ligation of the cystic duct and artery, removal of the gallbladder, coagulation of the bleeding points, and placement of a drain.</p> <p>Conclusions</p> <p>Early diagnosis of such injuries is quite difficult because abdominal signs are poor, non-specific, or even absent. Therefore, a computed tomography scan should be performed when the mechanism of injury is indicated.</p

Gastrointestinal stromal tumors (gist)

With the opportunity of five patients we treated in our department we discuss the diagnostic and therapeutic problems that can occur with the management of stromal tumors.Materials and methods: In the time period 2001-2005 we treated 5 patients with GIST, three females and two males, with median age 58,2 years. The patients presented with non-specific dull abdominal pain (2 patients), epigastric pain, gastric distention/dyspepsia (1 patient), and lower gastrointestinal hemorrhage/anaemia (2 patients). The imaging techniques that we used as an aid for the diagnosis were: computed tomography in all patients, barium radiography of the small intestine in one patient, scintigraphy of the abdomen with Technetium 99m-labeled RBCs in one patient, endoscopy of the upper GI tract in 2 patients and colonoscopy in 2 patients. The tumors were located in the small intestine (ileum) in three patients, the stomach in one patient and the mesocolon in one patient. We performed three enterectomies with end to end anastomosis, one subtotal gastrectomy and one removal of the transverse colon and mesocolon. Three of the tumors were mainly spindle cell type, one epithelioid cell type and one mixed spindle and epithelioid cell type. 4 of the patients were CD117 and CD34 positive and one patient negative for both andibodies. One patient deceased 16 days after the operation. Two patients with tumors of the small intestine are alive at the present time 5 and 4 years respectively but we have no records of postoperative follow up. One patient 3,5 years later has no indication of tumor recurrence of the small intestine on CT. The patient with the tumor of the stomach is the only patient that received Imatinib Mesylate and continues to be diseasefree after 9 months of treatment.Conclusion: Through the review of the literature we observe that the use of imatinib represents an effective, revolutionary, target therapy for GIST. Stromal tumors is a simple form of cancer with limited genetic abnormalities and mutations and it still remains to be seen if this type of therapeutic procedure can be used in more complex and common tumors, such as the cancer of the colon and others. Also, further clinical investigation must determine the ideal dose and duration of imatinib treatment and the combination with surgical treatment and other new target therapies

Parathyroid involvement in thyroid cancer: an unforeseen event

<p>Abstract</p> <p>Background</p> <p>Parathyroid metastatic disease from thyroid cancer has not been studied extensively, mainly due to the need for parathyroid preservation during thyroid surgery.</p> <p>Methods</p> <p>We reviewed files from 1,770 patients with thyroid cancer followed up in our department and 10 patients with parathyroid metastases (0.5%) were identified. Patient and tumor characteristics were recorded.</p> <p>Results</p> <p>Six out of ten patients had metastases from papillary thyroid cancer, three from follicular thyroid cancer and one from anaplastic thyroid cancer. In nine patients parathyroid infiltration from thyroid cancer was found in direct contact with the thyroid cancer, and in one patient metastatic foci were observed not in continuity with the thyroid cancer.</p> <p>Conclusions</p> <p>Parathyroid involvement, although infrequent, may occur in thyroid cancer independently of patient age and tumor size. The clinical significance of such event is not clear. The influence on disease outcome remains to be elucidated.</p