9 research outputs found

    Primary right atrium angiosarcoma mimicking pericarditis

    Get PDF
    <p>Abstract</p> <p>Background</p> <p>Primary cardiac neoplasms occur rarely and most of them are benign. Malignant tumors including angiosarcoma are extremely rare and have a non specific clinical presentation and a poor prognosis.</p> <p>Case presentation</p> <p>We present a case of a young male who was transferred to our hospital because of shock and multiple organ failure after a complicated pericardial biopsy. During the previous seven months he presented with recurrent episodes of pericardial effusions and tamponade. Chest computed tomography revealed a mass in the right atrium, infiltrating the myocardium and pericardium. During emergency surgery that followed, the patient died because of uncontrolled hemorrhage. Autopsy revealed the mass of the right atrium, which was identified on histological examination as primary cardiac angiosarcoma.</p> <p>Conclusion</p> <p>This case highlights the difficulties both in early diagnosis and in the management of patients with cardiac angiosarcoma.</p

    Kinetics of progenitor hemopoetic stem cells in sepsis: Correlation with patients survival?

    Get PDF
    BACKGROUND: Current theories underline the crucial role of pro-inflammatory mediators produced by monocytes for the pathogenesis of sepsis. Since monocytes derive from progenitor hemopoetic cells, the kinetics of stem cells was studied in peripheral blood of patients with sepsis. METHODS: Blood was sampled from 44 patients with septic syndrome due to ventilator-associated pneumonia on days 1, 3, 5 and 7 upon initiation of symptoms. Concentrations of tumour necrosis factor-alpha (TNFα), interleukin (IL)-6, IL-8 and G-CSF were estimated by ELISA. CD34/CD45 cells were determined after incubation with anti-CD45 FITC and anti-CD34 PE monocloncal antibodies and flow cytometric analysis. Samples from eight healthy volunteers served as controls. RESULTS: Median of CD34/CD45 absolute count of controls was 1.0/μl. Respective values of the total study population were 123.4, 112.4, 121.5 and 120.9/μl on days 1, 3, 5 and 7 (p < 0.0001 compared to controls). Positive correlations were found between the absolute CD34/CD45 count and the absolute monocyte count on days 1, 5 and 7. Survival was prolonged among patients with less than 310/μl CD34/CD45 cells on day 1 compared to those with more than 310/μl of CD34/CD45 cells (p: 0.022). Hazard ratio for death due to sepsis was 5.47 (p: 0.039) for CD34/CD45 cells more than 310/μl. Median IL-6 on day 1 was 56.78 and 233.85 pg/ml respectively for patients with less than 310/μl and more than 310/μl CD34/CD45 cells (p: 0.021). CONCLUSION: Stem cells are increased in peripheral blood over all days of follow-up compared to healthy volunteers. Patients with counts on day 1 less than 310/μl are accompanied by increased survival compared to patients with more than 310/μl

    Exercise tolerance and dyspnea in patients with chronic obstructive pulmonary disease (COPD)

    No full text
    We investigated whether maximal exercise work rate (WR max) is related to the degree of chronic dyspnea and resting respiratory function in 35 patients with stable COPD. All patients underwent a maximum symptom limited incremental bicycle exercise test to obtain WR max. The severity of chronic dyspnea was assessed using the modified MRC scale. A standard visual HRCT score for emphysema was used in a subgroup of 31 patients. The 35 COPD patients were aged 62±9 yr (mean±SD). Resting lung function data was: FVC%pred=81±23, FEV1%pred= 47±22, FEV1/FVC%=45±13. The main findings are: 1) WR max, %pred correlates best with the MRC dyspnea score (r=-0.91, ρ<0.001); 2) there is also a good correlation of WR max, %pred to FEV1/FVC, %pred (r=0.75 ρ<0.001) and to FEV1/FVC % (r =0.74, ρ<0.001).) 3) HRCT score correlates better to FEV1% pred,( r = -0.66, ρ<0.001) than WRmax % pred and mMRC score (r=-0.59 both). We conclude that in stable COPD patients exercise capacity, chronic dyspnea, and FEV1/FVC are closely related indices of severity of COPD. In contrast, the HRCT scale for emphysema does not reflect closely severity of COPD.Σκοπός της παρούσας μελέτης είναι να προσδιορίσει τη σχέση του μέγιστου έργου κατά η διάρκεια της άσκησης (WRmax), το βαθμό της χρόνιας δύσπνοιας και τις παραμέτρους των λειτουργικών δοκιμασιών του αναπνευστικού συστήματος σε 35 ασθενείς με σταθερή ΧΑΠ. Όλοι οι ασθενείς υπεβλήθησαν σε εργοσπιρομετρική μελέτη η οποία ήταν μέγιστη, περιοριζόμενη από συμπτώματα άσκηση με βαθμιαία αυξανόμενο έργο σε εργομετρικό ποδήλατο. Ο βαθμός της δύσπνοιας αξιολογήθηκε βάσει της MRC κλίμακας. Σταθερή απεικονιστική κλίμακα χρησμοποιήθηκε για την βαθμονόμηση του πνευμονικού εμφυσήματος σε υποομάδα 31 ασθενών. Οι 35 ασθενείς με ΧΑΠ ήταν ηλικίας 62±9 ετών. Οι σπιρομετρικοί παράγοντες σε ηρεμία είναι: FVC % pred = 81±23, FEV1 % pred = 47±22, FEV1/ FVC % = 45±13. Τα κύρια ευρήματα της παρούσας μελέτης είναι τα παρακάτω: 1. το WRmax % pred συσχετίζεται στατιστικώς σημαντικά με τη mMRC κλίμακα (r =-0.91, ρ<0.001). 2. παρατηρείται επίσης καλή συσχέτιση του WRmax % pred με το FEV1/FVC % pred, (r=0.75, ρ<0.001) και το FEV1/FVC % (r =0.74, ρ<0.001). 3. η βαθμονόμηση του πνευμονικού εμφυσήματος βάσει αξονικής τομογραφίας θώρακος (HRCT score) συσχετίζεται καλύτερα με τη FEV1% pred, ( r = -0.66, ρ<0.001), ενώ πτωχή συσχέτιση παρατηρείται με το WRmax % pred και την mMRC κλίμακα (r=-0.59, και για τις δύο παραμέτρους ). Με βάσει τα παραπάνω, καταλήγουμε στο συμπέρασμα ότι σε ασθενείς με σταθερή ΧΑΠ, η ικανότητα για άσκηση, η χρόνια δύσπνοια και ο λόγος FEV1/FVC συνδέονται σημαντικά με τη βαρύτητα της νόσου. Αντίθετα η κλίμακα HRCT για την βαθμονόμηση του πνευμονικού εμφυσήματος δεν συνδέεται στατιστικά σημαντικά με τη βαρύτητα της ΧΑΠ

    Fatal post-traumatic zygomycosis in an immunocompetent young patient

    No full text
    Zygomycosis, a relatively uncommon infection, usually occurs among immunocompromised individuals. It has been reported only rarely in trauma patients. A fatal case is reported of pulmonary and rapidly progressive cutaneous zygomycosis in a young, otherwise healthy farmer, with multiple bone fractures, wounds and soft tissue injuries after an accident with an agricultural machine in the field. Rhizopus spp. was isolated from both cultures of bronchial washings and wound samples. The diagnosis was confirmed by histopathological examination of tissue specimens from a large wound. Despite systemic antifungal therapy and surgical debridement, the patient’s condition deteriorated and he died from refractory septic shock

    Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: A lethal cause of pneumonia in an adult immunocompetent patient

    No full text
    Necrotizing pneumonia and fatal septic shock were caused by Panton-Valentine leukocidin-positive, community-acquired, methicillin-resistant Staphylococcus aureus (CA-MRSA) in a previously healthy, 61-y-old female. This patient did not belong to any high-risk group (e.g. homosexuals, military recruits, sports team members, etc.). CA-MRSA infection should be suspected in any adult with severe pneumonia/sepsis

    Exercise testing and exercise-limiting factors in patients with bilateral bronchiectasis

    No full text
    SUMMARY. Introduction: Exercise capacity is reduced in many patients with bronchiectasis, but there is little information available regarding exercise responses in these patients. Objectives: The aim of this study was to investigate exercise capacity and exercise responses in patients with bilateral bronchiectasis in order to identify possible exercise-limiting factors. Population and Methods: Fifteen patients with bronchiectasis aged 50±16 years underwent lung function testing, including assessment of tidal expiratory flow limitation (EFL), and performed a maximum incremental (20 watts/min) symptom-limited bicycle exercise test. Results: Exercise performance was reduced in 7 of the 15 patients, particularly in those with a greater degree of impairment of lung function, and specifically lower FEV1 (p<0.001) and FVC (p<0.001). EFL was detected in 5 of the 7 patients with exercise limitation and absent in all with normal exercise capacity. Patients with reduced exercise capacity exhibited significantly lower maximal ventilation (V.Emax %pred; p<0.001), maximal tidal volume (VTmax; p= 0.03), breathing reserve (higher V.Emax/MVV; p<0.001), peak-exercise oxygen saturation measured by pulse oximetry (SpO2, p<0.001), O2-pulse (p<0.001) and anaerobic threshold (AT, p<0.001) and perceived a higher degree of dyspnoea (Borg score; p=0.007). The best correlate of maximal work rate (WRmax, %pred) was the AT (r= 0.90, r2 = 0.81, p<0.001), while for peak oxygen uptake (V.O2max, %pred) the most significant correlation was the peak-exercise SpO2 (r=0.83, r2 = 0.69, p<0.001). Conclusions: Patients with bronchiectasis who have tidal EFL and a low FEV1 exhibit a reduction in exercise capacity. Ventilatory limitation, desaturation and impaired O2-transport/utilization to the periphery appear to be the principal factors limiting exercise. V.O2max can be predicted accurately from parameters obtained by simple means, such as peak-exercise SpO2 obtained by pulse oximetry. Pneumon 2009, 22(4):296-314

    A 6-mRNA host response classifier in whole blood predicts outcomes in COVID-19 and other acute viral infections

    No full text
    Predicting the severity of COVID-19 remains an unmet medical need. Our objective was to develop a blood-based host-gene-expression classifier for the severity of viral infections and validate it in independent data, including COVID-19. We developed a logistic regression-based classifier for the severity of viral infections and validated it in multiple viral infection settings including COVID-19. We used training data (N = 705) from 21 retrospective transcriptomic clinical studies of influenza and other viral illnesses looking at a preselected panel of host immune response messenger RNAs. We selected 6 host RNAs and trained logistic regression classifier with a cross-validation area under curve of 0.90 for predicting 30-day mortality in viral illnesses. Next, in 1417 samples across 21 independent retrospective cohorts the locked 6-RNA classifier had an area under curve of 0.94 for discriminating patients with severe vs. non-severe infection. Next, in independent cohorts of prospectively (N = 97) and retrospectively (N = 100) enrolled patients with confirmed COVID-19, the classifier had an area under curve of 0.89 and 0.87, respectively, for identifying patients with severe respiratory failure or 30-day mortality. Finally, we developed a loop-mediated isothermal gene expression assay for the 6-messenger-RNA panel to facilitate implementation as a rapid assay. With further study, the classifier could assist in the risk assessment of COVID-19 and other acute viral infections patients to determine severity and level of care, thereby improving patient management and reducing healthcare burden

    A 6-mRNA host response classifier in whole blood predicts outcomes in COVID-19 and other acute viral infections

    No full text
    Predicting the severity of COVID-19 remains an unmet medical need. Our objective was to develop a blood-based host-gene-expression classifier for the severity of viral infections and validate it in independent data, including COVID-19. We developed a logistic regression-based classifier for the severity of viral infections and validated it in multiple viral infection settings including COVID-19. We used training data (N_=_705) from 21 retrospective transcriptomic clinical studies of influenza and other viral illnesses looking at a preselected panel of host immune response messenger RNAs. We selected 6 host RNAs and trained logistic regression classifier with a cross-validation area under curve of 0.90 for predicting 30-day mortality in viral illnesses. Next, in 1417 samples across 21 independent retrospective cohorts the locked 6-RNA classifier had an area under curve of 0.94 for discriminating patients with severe vs. non-severe infection. Next, in independent cohorts of prospectively (N_=_97) and retrospectively (N_=_100) enrolled patients with confirmed COVID-19, the classifier had an area under curve of 0.89 and 0.87, respectively, for identifying patients with severe respiratory failure or 30-day mortality. Finally, we developed a loop-mediated isothermal gene expression assay for the 6-messenger-RNA panel to facilitate implementation as a rapid assay. With further study, the classifier could assist in the risk assessment of COVID-19 and other acute viral infections patients to determine severity and level of care, thereby improving patient management and reducing healthcare burden
    corecore