Elevated Levels of Procalcitonin and Interleukin-6 are Linked with Postoperative Complications in Cardiac Surgery.

BACKGROUND: Cardiac surgery-associated acute kidney injury is a frequent and serious postoperative complication of cardiac surgery and is associated with an increased risk of morbidity, mortality, and length stay. In this study, we hypothesized that persistent elevation in inflammation in the first 48 h might be a powerful predictor of clinical outcome. Our aim was to elucidate the usefulness of interleukin-6 and procalcitonin postoperative levels in predicting mortality and renal complications in cardiac surgery patients. METHODS: A total of 122 cardiac surgery patients were enrolled. Procalcitonin and interleukin-6 concentrations were measured on the second postoperative day, and their levels were evaluated versus a number of conditions and endpoints. RESULTS: Procalcitonin has a good predictive value for adverse renal outcome (p < 0.05). Interleukin-6 has a good predictive value for 30 days and overall mortality in cardiac surgery population (p < 0.05). We did not observe a significant difference in procalcitonin and interleukin-6 levels among patients with different types of surgery and different extracorporeal circulation time, but the levels of both the molecules increase significantly depending on number of transfusions received by patients (p < 0.01). CONCLUSION: We speculated that procalcitonin and interleukin-6 could be two effective biomarkers. There is a possibility of having a combined inflammatory multi-biomarker panel, with procalcitonin for predicting renal outcome and interleukin-6 for predicting mortality.

Ectopic prolactinoma in the clivus: a case report.

We report the case of an ectopic pituitary adenoma in a 65-year-old man with an empty sella who initially presented with right ptosis and eyelid edema and headache. Neuroimaging studies revealed a large tumoral process at the height of the clivus, with partial destruction of surrounding bone structure. He underwent transphenoidal surgery and histopathologic examination, including immunohistochemical studies, revealed a prolactin-producing pituitary adenoma. A careful review of the literature was done.

Diagnostic and therapeutic management of diabetic mastopathy: a case report.

Sclerosing lymphocytic lobulitis (SLL) is a benign breast lesion, better known as diabetic mastopathy (DMP), since it tipically occurs in diabetic patients. This very uncommon condition is strongly associated with type I diabetes mellitus. We report a case of a 61-year-old woman, with type II insulin-dependent diabetes mellitus, who presented mammography and ultrasonography images suspicious for breast carcinoma. As histopathology surprisingly demonstrated SLL and breast MRI showed benign characteristics, unnecessary surgery was avoided. The aim of this report is to underline that DMP is an uncommon clinicopathological entity which can clinically and radiologically mimic breast cancer but also that breast carcinoma may be hidden within these dense fibrotic lesions. In the light of cases reported in literature, breast MRI can be considered an essential tool in the diagnostic and therapeutic management of DMP.

Clinical and laboratory markers of autosomal dominant polycystic kidney disease (ADPKD) progression: an overview.

Autosomal dominant polycystic kidney (ADPKD) is the most common inherited renal cystic disease and it occurs in all races, the reported prevalence is between 1:400 and 1:1000. It is characterized by development of cysts in both kidneys and progressive renal function loss. Among most Autosomal Dominant Polycystic Kidney patients, renal function remains intact until the fourth decade of life. It is very important to identify early markers of disease progression to recognize patients with a worse prognosis. The aim of this study is to review the clinical and laboratory markers of ADPKD progression. The early clinical parameters evaluated seem to be directly correlated with the volume of the cysts that determine the kidney volume. From a clinical point of view, total kidney volume (TKV) appears to be the best marker of early ADPKD progression. This review evaluated several ADPKD progression markers comparing the early consolidated clinical and the new promising laboratory indicators. From a laboratory point of view, copeptin has a potential role between the serum biomarkers of ADPKD progression. However, further studies are necessary to validate the potential predictive value of its serum level and to adopt it for routine use. The combination of biomarkers could probably predict ADPKD progression with more accuracy than the use of a single biomarker.

Breast core biopsy of a rare case of unknown primary large cell neuroendocrine carcinoma metastatic to the breast.

Metastases to the breast from extramammary neoplasms are very rare. Correct diagnosis of breast malignancy is important for establishing appropriate management. Here we report a 57-year old male patient with breast metastasis from large cell neuroendocrine carcinoma (LCNEC) which was diagnosed with ultrasonography-guided-core-biopsy.

MR imaging of a bilateral ovarian clear cell borderline adenofibromatous tumor.

Borderline clear cell adenofibromatous tumors of the ovary are extremely rare with less than 50 cases reported in the English literature. We report one case of ovarian borderline clear cell adenofibromatous tumor in a 58-year-old woman. The diagnosis, suspected at the MRI, was confirmed histologically. The patient was submitted to hysterosalpingo-oophorectomy. After a period of 12 months, no recurrence had occurred.

Salvage treatment with ganciclovir in a splenectomized, polytransfused patient affected by systemic inflammatory response syndrome.

A 23-year-old man was admitted to hospital with a 12-day history of daily fever. A clinical history revealed that 10 months previously, the patient had been splenectomized and polytransfused for a severe blunt trauma. On admission, laboratory data revealed significant leukocytosis (33,230/ul). The patient's general clinical conditions rapidly worsened into a severe systemic inflammatory response syndrome in four days. After 10 days of broad-spectrum antibiotic treatment, the temperature curve was unmodified and severe leukocytosis persisted (44,300 ul) with absolute lymphocytosis. Laboratory tests ruled out hematological diseases, pneumonia, abscesses and endocarditis. In the light of IgM positivity for CMV (unconfirmed by PCR) and with the support of a PubMed search, we commenced a salvage treatment with intravenous ganciclovir, suspecting a viral infection or reactivation. After two days of therapy, an immediate defervescence was observed with a remarkable clinical improvement. After 10 days, the clinical syndrome had been completely resolved and the patient was discharged in good, general clinical health.

Obesity and iron deficiency anemia as risk factors for asymptomatic bacteriuria.

BACKGROUND: Few studies examined the risk factors of asymptomatic bacteriuria, showing contradictory results. Our study aimed to examine the association between different clinical and laboratory parameters and asymptomatic bacteriuria in internal medicine patients. MATERIALS AND METHODS: 330 consecutive hospitalized subjects, asymptomatic for urinary tract infections (UTIs), underwent to microscopic examination of urine specimens. 100 subjects were positive for microscopic bacteriuria and were recruited into the study. At the quantitative urine culture 31 subjects of study population were positive while 69 subjects were negative for bacteriuria. RESULTS: The analysis of clinical characteristics showed that the two groups of subjects (positive and negative urine culture for bacteriuria) were significant different (p<0.05) about obesity (76.7% vs 42% respectively), metabolic syndrome (80.6% vs 44,9%), cholelithiasis (35.5% vs 13,2%) and iron deficiency anemia (80.6% vs 53,6%). The univariate analysis showed that only obesity, cholelithiasis and iron deficiency anemia were positively associated with positive urine culture for bacteriuria (Odds Ratios [OR]=3.79, p=0.0003; OR=2,65, p=0.0091; OR=2.63, p=0.0097; respectively). However, the multivariate analysis by logistic regression showed that only obesity and iron deficiency anemia, independently associated with positive urine culture for bacteriuria (OR=3.9695, p=0.0075; OR=3.1569, p=0.03420 respectively). CONCLUSIONS: This study shows that obesity and iron deficiency anemia are independent risk factors for asymptomatic bacteriuria.

Emphysematous cholecystitis: Imaging findings.

We report a case of emphysematous cholecystitis. We also offer a review of the literature, emphasizing the clinical features, pathogenesis, imaging features and treatment of this surgical condition. Early recognition and surgical consultation are vital in these patients. The significance of plain abdominal radiographs, ultrasonography, CT and RM studies is discussed. Diagnostic problems are mentioned to help understand this rare clinical condition.

Clinical features of hemorrhoidal disease in renal transplant recipients.

Hemorrhoidal disease is a frequent cause of morbidity among the general population with a reported incidence of 4.4%, but little is known about its incidence and clinical features in kidney transplant recipients. Among 116 patients who had undergone kidney transplantation and were evaluated for hemorrhoidal disease, 82 had no hemorrhoids (70.6%), 28 (24%) had grade I hemorrhoids, and 6 (5.4%) had grade II hemorrhoids at the pretransplantation evaluation. Twenty-seven out of 116 recipients (22.4%) developed grade III or IV hemorrhoids after transplantation and underwent surgery. Hemorrhoidal disease was more frequent in patients with a pretransplantation history of hemorrhoids, with a rapid weight increase in the posttransplantation period, or who were aged between 30 and 50 years. Immunosuppressive therapy may play an important role in the worsening of hemorrhoidal disease among kidney transplant recipients. A prompt diagnosis and surgical treatment, whenever necessary, is mandatory for patients with clinical signs of worsening of hemorrhoids.

Clinical pattern of adult polycystic kidney disease in a northeastern region of Italy.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic renal disorder, with a prevalence of 1 : 500 to 1 : 1,000. ADPKD is genetically heterogeneous: the genes involved are PKD1 and PKD2. ADPKD occurs worldwide and in all ethnic groups and is an important cause of CKD Stage 5. Prevalence of ADPKD on renal replacement therapy (RRT) in Italy has been reported to be 8.2%. In the dialysis population of Vicenza, a province in Northeastern Italy, it accounts for 13.4%. The study aims to investigate reasons for the high prevalence of ADPKD in our region and to describe the clinical profile and genetics of these patients. METHODS: Since April 2007, ADPKD patients have been enrolled. Patients from families not native to Vicenza have been excluded. The diagnosis of ADPKD is defined by ultrasound criteria. Complete clinical details have been recorded, including family history. We have used linkage analysis to identify the gene involved in each family. RESULTS: We describe the first 100 patients recruited from a total of 42 families. 29 patients were in ESRD at the time of enrollment. Renal stones and hepatic cysts were present in 24% and 40%, respectively. The majority of the ADPKD patients (61%) were diagnosed either incidentally or by screening. Positive family history was recorded in 86 patients. The involved gene was PKD1 in 83.7% and PKD2 in 16.3% of the studied patients. PKD2 patients presented the common haplotype. CONCLUSIONS: It is the first epidemiological study from Northeastern Italy reporting clinical profile and genetic analysis of ADPKD patients. The clinical profile of the patients is similar to previous reports, but there is a high prevalence of ADPKD in our region. The presence of a common haplotype is in accordance with our hypothesis of a founder effect in our province, suggesting that a strong lineage-specific gene is present. If the sequence analysis confirms the same mutation, this might suggest a common ancestral origin and a segregation of a specific mutation.

[Aneurysm of the pancreatico-duodenal artery]. / Anévrisme des artères pancréatico-duodénales.

The mean age is 50. Symptoms include acute abdominal pain, hypotensive shock, GI bleeding, biliary colic, jaundice, and/or acute anemia. Less often, pancreatico-duodenal aneurysms may be fortuitously diagnosed by abdominal imaging. Rupture of a PDAA is a grave complication with high mortality and demands urgent intervention. Arterial embolization is the treatment of choice; surgical intervention should be reserved for failures of embolization. We report a case of PDAA successfully treated by arterial embolization but which posed problems in both diagnosis and treatment.

[The importance of using the cerebral function monitor (CFM) in the neurological prognosis of neonates in intensive care]. / Importanza dell'uso del Cerebral Function Monitor (CFM) nella prognosi neurologica dei neonati ricoverati in Terapia Intensiva.

Cerebral function monitor (CFM), unlike traditional EEG, allows a long-term evaluation of electric brain activity, without interfering with the nursing of the newborn in the intensive care unit. Our aim was to evaluate the prognostic value of CFM for neurological outcome. We studied 102 newborns (gestational age 34.5 +/- 4.36 weeks; weight 1980 +/- 720 grams) by Multitrace CFM (Lectromed) 5 hours daily in the first week following admission. The patients also underwent cerebral echography, EEG and neurological follow-up to the 24th month. CFM was found to correlate well with the EEG recorded 3 months later. The persistence for at least one week of an I.C. tracing or the normalization of initial tracing have a good prognostic value (positive predictive value 95.23%), a persistently pathologic registration has a negative prognostic value (negative predictive value 85.18%), that even increases if cerebral echographic alterations are demonstrated (98.57%). The association of CFM and ultrasound abnormalities determines a relative risk for neurological motor impairment of 69.14, whereas CFM alone gives a relative risk of 6.4.

[Incidence of ROP (Retinopathy of Prematurity) in hypoxemic neonates: case contribution]. / Incidenza della ROP nei neonati ipossiemici: contributo casistico.

In this retrospective study the Authors correlated the hypoxia with the severity of retinopathy of prematurity (ROP) in a population of 683 outborn preterm infants (bw < 2500 g and gestational age < 38 weeks). They excluded all cases with specific pathological conditions. Among neonates with the same gestational age the incidence of ROP was higher (p < .05) in those with hypoxia (pH < 7.25, tcPO2 < 50 mmHg). These data suggest that hypoxia plays a role in the pathogenesis of ROP.