Parathyroid apoplexy, the explanation of spontaneous remission of primary hyperparathyroidism: a case report

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Peptic Ulcer Perforation as the First Manifestation of Previously Unknown Primary Hyperparathyroidism

A patient admitted for acute abdomen was incidentally found with elevated serum calcium level. In surgery, under conservative treatment of the hypercalcemia, a perforated duodenal ulcer was found and simple closure was performed. Postoperatively, calcium level continued to rise, parathyroid hormone was elevated and ultrasonographic examination showed a lesion in the right anterior neck, while serum gastrin level was normal, thus documenting the diagnosis of primary hyperparathyroidism. Conservative treatment had no effect on calcium level and the patient was subjected to emergency neck exploration, where a large parathyroid adenoma was removed. After surgery, calcium and PTH levels were normalized and the patient was discharged on the 5th postoperative day. Peptic ulcer and its complications are usual manifestations of primary hyperparathyroidism, with or without increased gastrin level. On the other hand, cases of a perforation of peptic ulcer as the first clinical manifestation of primary hyperparathyroidism are extremely rare

Monads for (n)omads

Από την πρώτη στιγμή της εμφάνισης της ζωής στη γη, η κινητικότητα αποτέλεσε φαινόμενο άμεσα συνδεδεμένο με αυτή. Ο άνθρωπος στη διάρκεια των χρόνων κινείται συνεχώς για λόγους επιβίωσης, ιμπεριαλιστικούς, για λόγους εμπορίου, κλπ. Σήμερα μετακινείται, πέρα από τους παραπάνω λόγους, και προκειμένου να πραγματοποιήσει τις επαγγελματικές του υποχρεώσεις. Με αφορμή το φαινόμενο αυτό, στα πλαίσια της διπλωματικής μας, ασχοληθήκαμε με τη δημιουργία μιας ‘κοινότητας’, μιας δομής που φέρει μονάδες κατοίκησης προκειμένου να φιλοξενήσει ομάδες ανθρώπων που μπορεί να μετακινούνται για διάφορους λόγους. Η κοινότητα αποτελείται από 2 τμήματα, ένα σταθερό και ένα μεταβλητό. Το μεταβλητό αποτελεί μια μεταλλική κατασκευή που έρχεται να τοποθετηθεί όπου αυτό είναι απαραίτητο. Μπορεί να προσαρμόζεται στο εκάστωτε περιβάλλον προκειμένου να ενσωματωθεί στον τόπο της προσωρινής διαμονής. Το σταθερό αποτελούν το πλήθος των μονάδων που φέρει η μεταλλική κατασκευή, μονάδες κατοίκησης, που όμως εσωτερικά έχουν τη δυνατότητα να μεταβάλλονται προκειμένου να εξυπηρετήσουν τις ανάγκες του εκάστωτε χρήστη. Σε κάθε περίπτωση όμως, κάθε ένα από αυτά τα δύο τμήματα μπορεί να λειτουργήσει και μόνο του, είτε η μεταλλική κατασκευή σαν προέκταση του δημόσιου χώρου, πχ εκθεσιακός χώρος, είτε η κάθε μονάδα σαν ανεξάρτητη μεταφερόμενη μονάδα κατοίκησης.From the very first moment of the emergence of life on earth, mobility was a phenomenon directly connected with it. Human, over the years, was constantly moving in order to survive, for imperialist reasons, for trade, etc. Today, besides the above reasons, he keeps moving in order to carry out his professional obligations. Because of all these, in our thesis, we dealt with the creation of a 'community', a structure bearing units of habitation to accommodate groups of people that can be moving for various reasons. The community consists of 2 parts, one stable and one transformable. The transformable is a metal construction placed where necessary. It can be adapted to every environment in order to be incorporated in the site of the temporary residence. The stable is a number of units on the metal construction, units of living that have the ability to change internally to accommodate the needs of each user. In any case, both of these two parts can be handled alone either the metal construction as an extension of public space, eg in case of an exhibition, either each unit as an independent transported unit of living.Γεωργούλα Β. ΚωνσταντίναΕλένη ΑνδρέουΕυδοξία Παπαγεωργίο

Identification of Very Low-Risk Subgroups of Patients with Primary Mediastinal Large B-Cell Lymphoma Treated with R-CHOP

Background R-CHOP can cure approximately 75% of patients with primary mediastinal large B-cell lymphoma (PMLBCL), but prognostic factors have not been sufficiently evaluated yet. R-da- EPOCH is potentially more effective but also more toxic than R-CHOP. Reliable prognostic classification is needed to guide treatment decisions. Materials and Methods We analyzed the impact of clinical prognostic factors on the outcome of 332 PMLBCL patients <= 65 years treated with R-CHOP +/- radiotherapy in a multicenter setting in Greece and Cyprus. Results With a median follow-up of 69 months, 5-year freedom from progression (FFP) was 78% and 5-year lymphoma specific survival (LSS) was 89%. On multivariate analysis, extranodal involvement (E/IV) and lactate dehydrogenase (LDH) >= 2 times upper limit of normal (model A) were significantly associated with FFP; E/IV and bulky disease (model B) were associated with LSS. Both models performed better than the International Prognostic Index (IPI) and the age-adjusted IPI by Harrel’s C rank parameter and Akaike information criterion. Both models A and B defined high-risk subgroups (13%-27% of patients [pts]) with approximately 19%-23% lymphoma-related mortality. They also defined subgroups composing approximately one-fourth or one-half of the patients, with 11% risk of failure and only 1% or 4% 5-year lymphoma-related mortality. Conclusion The combination of E/IV with either bulky disease or LDH >= 2 times upper limit of normal defined high-risk but not very-high-risk subgroups. More importantly, their absence defined subgroups comprising approximately one-fourth or one-half of the pts, with 11% risk of failure and minimal lymphoma-related mortality, who may not need more intensive treatment such as R-da-EPOCH. Implications for Practice By analyzing the impact of baseline clinical characteristics on outcomes of a large cohort of patients with primary mediastinal large B-cell lymphoma homogeneously treated with R-CHOP with or without radiotherapy, we developed novel prognostic indices which can aid in deciding which patients can be adequately treated with R-CHOP and do not need more intensive regimens such as R-da-EPOCH. The new indices consist of objectively determined characteristics (extranodal disease or stage IV, bulky disease, and markedly elevated serum lactate dehydrogenase), which are readily available from standard initial staging procedures and offer better discrimination compared with established risk scores (International Prognostic Index [IPI] and age-adjusted IPI)

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project

PURPOSE: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). METHODS: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. RESULTS: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. CONCLUSION: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.status: publishe