Procalcitonin as a marker for the diagnosis of sepsis

Background: Quick diagnosis of sepsis in intensive care unit patients is challenging for physicians.Methods: The prospective study was conducted at our hospital. We studied the efficacy of procalcitonin as a marker of sepsis in 87 adults admitted to our intensive care unit with symptoms of systemic infection. The study samples included all patients aged above 18 years with acute sepsis. Statistical analyses were done using SPSS. PCT and various other relevant factors were measured in all study subjects. PCT levels of less than 0.1 ng/ml were considered negative; all other levels were considered positive.Results: PCT proved to be an excellent indicator of sepsis. Serum PCT levels predicts mortality in the present study.Conclusions: PCT is among the most promising sepsis markers capable of completing clinical signs and routine lab parameters suggestive of severe infection

Transanal rectopexy for external rectal prolapse

Purpose The surgical management of patients with full-thickness rectal prolapse (FTRP) continues to remain a challenge in the laparoscopic era. This study retrospectively assesses a cohort of patients undergoing a transanal suture sacro rectopexy supported by sclerosant injection into the presacral space under ultrasound guidance. Methods Patients with FTRP underwent a sutured transrectal presacral fixation of 2/3 of the circumference of the rectum from the third sacral vertebra to the sacrococcygeal junction through a side-viewing operating proctoscope. The procedure was supplemented by ultrasound-guided injection into the retrorectal space of a 2 mL solution of sodium tetradecyl sulfate/polidocanol mixed with air. Patients were functionally assessed before and 6 months after surgery with the Agachan constipation score and the Pescatori incontinence score. Results There were 36 adult patients (26 males; the range of age, 23–92 years). The mean operative time was 27 minutes (range, 23–50 minutes) with no recorded perioperative morbidity. The median follow-up was 66 months (range, 48–84 months) with 1 (2.8%) recurrence presenting 18 months after surgery. There were 19 patients (52.8%) who presented with incontinence before surgery with 17 out of 19 (89.5%) reporting improvement in their Pescatori score (P<0.001). No patient had worsening incontinence and there were no de novo incontinence cases. Constipation scores improved in 23 out of 36 patients (63.9%) with a mean score reduction difference of 7.91 (P=0.001). Conclusion Transanal sutured sacral rectopexy with supplemental presacral sclerosant injection is safe and effective in the management of FTRP with sustained improvement in bowel function

Procalcitonin as a marker for the diagnosis of sepsis

Background: Quick diagnosis of sepsis in intensive care unit patients is challenging for physicians.Methods: The prospective study was conducted at our hospital. We studied the efficacy of procalcitonin as a marker of sepsis in 87 adults admitted to our intensive care unit with symptoms of systemic infection. The study samples included all patients aged above 18 years with acute sepsis. Statistical analyses were done using SPSS. PCT and various other relevant factors were measured in all study subjects. PCT levels of less than 0.1 ng/ml were considered negative; all other levels were considered positive.Results: PCT proved to be an excellent indicator of sepsis. Serum PCT levels predicts mortality in the present study.Conclusions: PCT is among the most promising sepsis markers capable of completing clinical signs and routine lab parameters suggestive of severe infection

Percutaneous repair of iatrogenic subclavian artery injury by suture-mediated closure device

Central venous catheterization through internal jugular vein is done routinely in intensive care units. It is generally safe, more so when the procedure is performed under ultrasound guidance. However, there could be inadvertent puncture of other vessels in the neck when the procedure is not performed under real-time sonographic guidance. Closure of this vessel opening can pose a challenge if it is an artery, in a location difficult to compress, and is further complicated by deranged coagulation profile. Here, we discuss the removal of an inadvertently placed catheter from subclavian artery with closure of arteriotomy percutaneously using arterial suture-mediated closure device

Early outcomes of radiofrequency ablation in unresectable metastatic colorectal cancer from a tertiary cancer hospital in India

Aims: The study was carried out to evaluate the early outcomes using Radiofrequency Ablation (RFA) for unresectable liver metastases in the management of metastatic colorectal cancer (mCRC) from an area of low endemicity. Material and Methods: 60 Patients with unresectable colorectal liver metastases had undergone 88 sessions of RFA from January 2007 till December 2013. The results were retrospectively analysed to evaluate the outcomes in terms of efficacy and survival rates. Results: The median follow up of patients in our series was 24.8months. 35/52 (67.3%) patients had complete response at 3 months while 8 patients were lost to follow up. Of the 17 patients who had recurrence, 4 (23.5%) were at the ablated site while 13 patients (76.4%) progressed elsewhere. Abdominal pain was commonest post procedural symptom (20%). There was no procedure related mortality or any major complications. Mean disease free interval and Progression free survival was 6.7 and 13.1 months. Estimated median survival in patients with liver limited disease and those with small lesion (&lt;3cm) was 3.79 years and 3.45 years respectively. Median survival in patients with lesion size 3–5 cms was 1.5 years. Annual survival rates would be 94.5%, 55.2% and 26.2% for 1, 3 and 5 years. Conclusion: Radiofrequency ablation of unresectable liver metastases is effective in treatment of mCRC. Estimated survival rates and Annual survival rates at our institute from the low endemic region also follow the global trend. Size of the lesion was an important predictor of efficacy of RFA. Presence of extrahepatic disease and lesion size &gt;3 cm was associated with decreased survival