Staphylococcal toxic shock syndrome associated with disseminated intravascular coagulopathy leading to compartment syndrome of the lower extremity

We report a case of a 56-year old multimorbid male patient who was transferred to our specialized burn center with a combination of extensive blistering with underlying deep tissue necrosis, disseminated intravascular coagulation and compartment syndrome to the left lower extremity. He was treated with high doses of intravenous antibiotics, above the knee amputation and multiple necrosectomy but died after 51 days due to multi organ failure.We believe that a rare combination of infection causing severe toxic shock syndrome leading to disseminated intravascular coagulation that then caused atraumatic compartment syndrome was responsible for this condition. Keywords: Staphylococcal toxic shock syndrome, Disseminated intravascular coagulopathy, Compartment syndrom

Determination of calcitonin levels in C-cell disease: Clinical interest and potential pitfalls

An elevated serum calcitonin level is a highly sensitive marker for medullary thyroid carcinoma (MTC) that can be used for screening, differential diagnosis, prognostic assessment, follow-up monitoring, and assessment of treatment response. Nevertheless, additional data are required to definitively support routine measurement of calcitonin levels in the initial work-up of patients with thyroid nodules, mainly because there is no convincing evidence that such testing actually reduces MTC-related mortality. By contrast, the prognostic value of measuring calcitonin levels preoperatively, postoperatively, and during follow-up of patients with MTC is widely acknowledged. Furthermore, determination of calcitonin levels is also used to evaluate the response of MTC to novel forms of systemic treatment, such as tyrosine kinase inhibitors. In this Review, we discuss the key issues surrounding the use of this laboratory test in the clinical management of patients with MTC. © 2009 Macmillan Publishers Limited. All rights reserved