Thoracic ultrasound for the detection of rib metastases of non-small cell lung cancer

Transthoracic ultrasound has lately emerged as a useful diagnostic tool for respiratory physicians in the diagnosis of diverse pulmonarydiseases, usually including pleural effusion and pneumothorax. However, the use of chest ultrasound may be also critical in the evaluationof chest wall diseases. Therefore, we present an interesting case of a patient with metastases of lung cancer to the rib, detected duringthe chest wall ultrasound examination. By representing a non-invasive, surface-imaging technique with several advantages, chest ultrasoundmay evolve to a valid, bed-side diagnostic tool for the diagnosis and follow up of lung cancer with metastases in the chest wall

Ultrasonografia klatki piersiowej w wykrywaniu przerzutów niedrobnokomórkowego raka płuca do żeber

Ultrasonografia transtorakalna staje się coraz bardziej użytecznym narzędziem diagnostycznym w pulmonologii. Jest ona stosowana w diagnostyce różnorodnych chorób płuc, najczęściej odmy oraz płynu w jamie opłucnowej. Ultrasonografia klatki piersiowej może mieć jednak także istotne znaczenie w ocenie chorób ściany klatki piersiowej. W pracy przedstawiono przypadek pacjenta z przerzutami raka płuca do żebra, wykrytymi w trakcie badania ultrasonograficznego ściany klatki piersiowej. Ultrasonografia klatki piersiowej, jako posiadająca wiele zalet, nieinwazyjna technika obrazowania powierzchni, może rozwinąć się w ważne, przyłóżkowe narzędzie diagnostyki i obserwacji raka płuca z przerzutami do ściany klatki piersiowej.Ultrasonografia transtorakalna staje się coraz bardziej użytecznym narzędziem diagnostycznym w pulmonologii. Jest ona stosowana w diagnostyce różnorodnych chorób płuc, najczęściej odmy oraz płynu w jamie opłucnowej. Ultrasonografia klatki piersiowej może mieć jednak także istotne znaczenie w ocenie chorób ściany klatki piersiowej. W pracy przedstawiono przypadek pacjenta z przerzutami raka płuca do żebra, wykrytymi w trakcie badania ultrasonograficznego ściany klatki piersiowej. Ultrasonografia klatki piersiowej, jako posiadająca wiele zalet, nieinwazyjna technika obrazowania powierzchni, może rozwinąć się w ważne, przyłóżkowe narzędzie diagnostyki i obserwacji raka płuca z przerzutami do ściany klatki piersiowej

Effect of the Novel Influenza A (H1N1) Virus in the Human Immune System

BACKGROUND: The pandemic by the novel H1N1 virus has created the need to study any probable effects of that infection in the immune system of the host. METHODOLOGY/PRINCIPAL FINDINGS: Blood was sampled within the first two days of the presentation of signs of infection from 10 healthy volunteers; from 18 cases of flu-like syndrome; and from 31 cases of infection by H1N1 confirmed by reverse RT-PCR. Absolute counts of subtypes of monocytes and of lymphocytes were determined after staining with monoclonal antibodies and analysis by flow cytometry. Peripheral blood mononuclear cells (PBMCs) were isolated from patients and stimulated with various bacterial stimuli. Concentrations of tumour necrosis factor-alpha, interleukin (IL)-1beta, IL-6, IL-18, interferon (FN)-alpha and of IFN-gamma were estimated in supernatants by an enzyme immunoassay. Infection by H1N1 was accompanied by an increase of monocytes. PBMCs of patients evoked strong cytokine production after stimulation with most of bacterial stimuli. Defective cytokine responses were shown in response to stimulation with phytohemagglutin and with heat-killed Streptococcus pneumoniae. Adaptive immune responses of H1N1-infected patients were characterized by decreases of CD4-lymphocytes and of B-lymphocytes and by increase of T-regulatory lymphocytes (Tregs). CONCLUSIONS/SIGNIFICANCE: Infection by the H1N1 virus is accompanied by a characteristic impairment of the innate immune responses characterized by defective cytokine responses to S.pneumoniae. Alterations of the adaptive immune responses are predominated by increase of Tregs. These findings signify a predisposition for pneumococcal infections after infection by H1N1 influenza

Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay

<p>Abstract</p> <p>Background</p> <p>Procalcitonin (PCT) has been proposed as a diagnostic and prognostic sepsis marker, but has never been validated in febrile patients with prolonged ICU stay.</p> <p>Methods</p> <p>Patients were included in the study provided they were hospitalised in the ICU for > 10 days, were free of infection and presented a new episode of SIRS, with fever >38°C being obligatory. Fifty patients fulfilled the above criteria. PCT was measured daily during the ICU stay. The primary outcome was proven infection.</p> <p>Results</p> <p>Twenty-seven out of 50 patients were diagnosed with infection. Median PCT on the day of fever was 1.18 and 0.17 ng/ml for patients with and without proven infections (p < 0.001). The area under the curve for PCT was 0.85 (95% CI; 0.71-0.93), for CRP 0.65 (0.46-0.78) and for WBC 0.68 (0.49-0.81). A PCT level of 1 ng/mL yielded a negative predictive value of 72% for the presence of infection, while a PCT of 1.16 had a specificity of 100%. A two-fold increase of PCT between fever onset and the previous day was associated with proven infection (p 0.001) (OR = 8.55; 2.4-31.1), whereas a four-fold increase of PCT of any of the 6 preceding days was associated with a positive predictive value exceeding 69.65%. A PCT value less than 0.5 ng/ml on the third day after the advent of fever was associated with favorable survival (p 0.01).</p> <p>Conclusion</p> <p>The reported data support that serial serum PCT may be a valuable diagnostic and prognostic marker in febrile chronic critically ill patients.</p

The influence of submics of new antibiotics on th aderense of E. coli on uroepithelial cells of healthy women

The adherence of seventeen E. coli strains isolated from the urine of patients with pyelonephritis on epithelial cells obtained from the urine of healthy adult women under the influence of subMICs of five newer antibiotics (meropenem, ceftibuten, FCE N° 22891, cefpirome, cefatrizine and fleroxacin) was studied. Post log phase cultures of E. coli in concentration of 10⁷ organisms/ml, after exposure to less than 1/4 of the MIC of the studied antibiotics were incubated with a suspension of epithelial cells in concentration of 10⁵ cells/ml under continuous stirring for an hour in 37°C. Subsequently the number of adhered organisms on 50 intact epithelial cells was counted by phase-contrast microscopy and compared with the controls. The non parametric methods Kruskal-Wallis and Mann Whitney were employed for statistical analysis. A statistically significant decrease of E. coli adherence under the influence of all studied antibiotics was observed compared with the controls. On the other hand no difference was observed among them in their ability to decrease E. coli adherence on epithelial cells.Μελετήθηκε η προσκολλητικότης δέκα επτά στελεχών E. coli τα οποία απομονώθησαν από ασθενείς με πυελονεφρίτιδα, σε επιθηλιακά κύτταρα τα οποία ελαμβάνοντο από ουρά υγιών ενηλίκων γυναικών υπό την επίδραση υπανασταλτικών πυκνοτήτων πέντε νεωτέρων αντιβιοτικών μερσπενέμης, κεφτιμπουτένης, FCE πενέμης Ν° 22891, κεφπιρόμης, κεφατριζίνης και φλεροξασίνης. Καλλιέργειες κολοβακτηριδίων σε λογαριθμική φάση αναπτύξεως και σε συγκεντρώσεις μικροβιακών στελεχών 10⁷/ml μετά έκθεση σε υπετετραπλάσιες της MIC πυκνότητες των υπό εξέταση αντιβιοτικών, επωάζοντο με εναιώρημα επιθηλιακών κυττάρων πυκνότητος 10⁵/ml υπό συνεχή ανάδευση στους 37°C επί μία ώρα. Ακολουθούσε μέτρηση των προσκολληθέντων μικροβιακών στελεχών σε 50 άθικτα επιθηλιακά κύτταρα με μικροσκόπιο αντιθέσεως φάσεως και γινόταν σύγκριση με τον μάρτυρα. Η στατιστική ανάλυση έγινε με τις μη παραμετρικές μεθόδους Kruskal Wallis και Mann Whitney. Παρατηρήθηκε στατιστικά σημαντική μείωση της προσκολλητικότητας των κολοβακτηριδίων στα επιθηλιακά κύτταρα υπό την επίδραση υπαναταλτικών πυκνοτήτων όλων των μελετηθέντων αντιβιοτικών, ενώ δεν υπήρχε στατιστικά σημαντική διαφορά μεταξύ των όσον αφορά την προκαλούμενη μείωση της προσκολλητικότητας

Peritoneal tuberculosis in pregnancy mimicking advanced ovarian cancer: a plea to avoid hasty, radical and irreversible surgical decisions

Tuberculous peritonitis is rare in most Western counties, and can cause significant diagnostic and therapeutic problems. A 28-year-old pregnant female presented with nausea and vomiting, right lower quadrant abdominal pain, fever and intra-abdominal fluid. During surgery for presumed complicated acute appendicitis, many small masses (considered to be ‘implants’) were found within the peritoneal cavity, with a larger mass in the pelvis, mainly on the right. The clinical intra-operative diagnosis was advanced ovarian cancer and multiple biopsies were taken. The histological diagnosis was peritoneal tuberculosis. The patient was successfully treated conservatively. Hasty decisions to undertake radical and irreversible surgery should be avoided; this type of surgery should be performed only after histological confirmation. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved

Spontaneous peritonitis caused by Leminorella grimontii

A case of spontaneous peritonitis caused by Leminorella grimontii in a 63-year-old man with cirrhosis is reported. To our knowledge, L. grimontii has never been reported as a cause of spontaneous bacterial peritonitis. The patient responded to antimicrobial therapy. Clinical and therapeutic implications are discussed. (c) 2006 Elsevier Inc. All rights reserved

Quetiapine and Clarithromycin-Induced Neuroleptic Malignant Syndrome

We report a case of neuroleptic malignant syndrome possibly caused by the combined administration of quetiapine and clarithromycin in a 75-year-old male patient. He was receiving quetiapine regularly. Two days before his admission to the hospital, he had been feverish and started receiving clarithromycin without consulting a doctor. Clarithromycin administration was interrupted 3 days after his admission because it was ineffective and because his clinical state was deteriorating. The patient presented altered level of consciousness and excessive muscular rigidity on his limbs, while he remained feverish (38.7 degrees C). Laboratory abnormalities included elevated serum creatine phosphokinase level (5.387 U/L), leukocytosis, and low serum iron. The patient was diagnosed with neuroleptic malignant syndrome, and quetiapine was immediately discontinued. After the following days, his muscle rigidity and mental status ameliorated, his fever withdrew, and his laboratory findings improved. The various features of the case are discussed in view of the fact that the concomitant administration of cytochrome 3A4 inhibitors, such as clarithromycin, is suggested to cause an increase of plasma concentrations of quetiapine. Thus, physicians should have a high index of suspicion of the interactions of commonly administered medications