A Delayed Fatal Metastatic Hürthle Cell Carcinoma

Hürthle (oxyphilic or oncocytic) cell carcinoma is a variant of follicular cell carcinoma of thyroid. Although this entity of thyroid cancer is well known, its occurrence in young patients has scarcely been reported. We report a case of a 26 year-old male patient, at the time of diagnosis, of Turkish origin, who developed a tracheal, pulmonary and mediastinal metastatic Hürthle cell carcinoma with bilateral cervical and mediastinal lymphadenopathies. This case illustrates an aggressive and metastatic cancer at the time of diagnosis and resistant to all treatment options including surgery, chemotherapy and radioactive iodine

A study to determine the correlation between clinical, fiber-optic endoscopic evaluation of swallowing and videofluoroscopic evaluations of swallowing after prolonged intubation

Background: Clinical evaluation of swallowing disorders postextubation is often neglected. Videofluoroscopy is the gold standard with fiber-optic endoscopic evaluation of swallowing (FEES) having a high sensitivity. The aim of this study was to analyze the correlations between clinical, FEES, and videofluoroscopic evaluations in the intensive care unit. Methods: Twenty-one patients extubated after prolonged intubation were subjected to a clinical evaluation of swallowing and FEES within 24 hours. This was repeated at 48 hours with a videofluoroscopic evaluation with identical swallowing-namely, boluses of liquid and thickened water. The patients were scored from 0 (normal) to 3 (worst). Results: There was no correlation between the oral phase (bedside evaluation) and FEES. The correlation between pharyngeal phase (palatal and laryngeal elevation, pharyngeal rales, and gag reflex) before and after swallowing at 24 and 48 hours was statistically significant (liquid water P =.025 [24 hours] vs P <.001 [48 hours]; thickened water P <.001 [24 and 48 hours]). Clinical assessment, although not statistically significant, failed to detect silent aspiration (P =.58). There was a good correlation between FEES and videofluoroscopy as opposed to clinical assessment and videofluoroscopy (P <.001 vs P =.762). Conclusion: Cough is a reliable sign of swallowing disorder but does not exclude silent aspiration and contraindicates oral feeding. Cough induced by liquid water should lead to modification of diet in terms of consistency and viscosity with cough reassessment. © 2011 American Society for Parenteral and Enteral Nutrition.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Is There a Correlation Between Circulating Levels of Citrulline and Intestinal Dysfunction in the Critically Ill?

Objective: The aim of this study was to assess the correlation between plasma citrulline and Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, survival, inflammation (C-reactive protein [CRP]), inotrope use, serum levels of prealbumin and albumin, and renal failure in the critically ill patient. Methods: This prospective observational singlecenter controlled study included 91 adult patients over a 2-year period. Inclusion criteria were patients staying in the intensive care unit for >48 hours. Patients renal status was categorized as those with a glomerular filtration rate (GFR) >60 mL/min without renal support, a GFR >60 mL/min with renal support, a GFR 36 ?mol/L). The relationship between the recorded parameters and these different cut-off values of plasma citrulline concentrations was analyzed. Results: Ninety-one patients (34% female and 66% male) with a mean (SD) age of 69.3 (11.9) years, a mean (SD) body mass index of 24.8 (5.34) kg/m2, a mean (SD) APACHE II score of 22.4 (7.92), a mean (SD) SOFA score of 8 (4.4), and a mean (SD) plasma citrulline of 21.7 (13.1) μmol/L were enrolled. Only patients with intestinal dysfunction had low plasma citrulline level <15 μmol/L (P = .014). No correlations between serum levels of CRP, albumin, or prealbumin; renal failure; inotrope use; SOFA score; and APACHE II score were found with plasma citrulline level. Conclusion: Low plasma citrulline levels in patients correlate well with intestinal dysfunction. (Nutr Clin Pract. 2012;27:527-532) © 2012 American Society for Parenteral and Enteral Nutrition.SCOPUS: ar.jinfo:eu-repo/semantics/publishe