Performance status (PS): a simple predictor of short-term outcome of cancer patients with solid tumors admitted to the intensive care unit (ICU).

BACKGROUND: Admission of cancer patients with serious medical complications to the Intensive Care Unit (ICU) remains controversial. The aim of this study was to examine the 30-day all-cause mortality in cancer patients with solid tumors admitted to the ICU and to identify factors predicting 30-day mortality. PATIENTS AND METHODS: A retrospective study was conducted in 69 consecutive cancer patients with solid tumors admitted to the ICU of a 400-bed general hospital in Greece, between October 2001 and October 2005. Demographics, ECOG performance status (PS) prior to hospitalization, stage of cancer, metastases, number of metastatic sites, prior chemotherapy, primary site of tumor, APACHE II score on ICU admission, development of ICU acquired infection, sepsis, multiple organ failure (MOF), need for mechanical ventilation (MV), length of ICU stay, hospital stay and 30-day mortality were examined. RESULTS: The observed 30-day hospital mortality rate was 66.6% (n=46) with most deaths (n=32) occurring in the ICU. Univariate negative predictors of 30-day mortality were PS 3-4 (p=0.03), APACHE II score (p=0.001), MOF (p=0.001) and need for MV (p=0.001). Only PS 3-4 was an independent predictor in multivariate analysis (p=0.02). CONCLUSION: ECOG PS 3-4 prior to hospitalization was found to be a simple negative predictor of short-term outcome of cancer patients with solid tumors admitted to the ICU.

Venous pressure measurements in the superior and inferior vena cava: the influence of intra-abdominal pressure.

BACKGROUND/AIMS: To investigate the relationship of pressure in the inferior vena cava (Pivc) with a) pressure in the superior vena cava (Psvc), b) intra-abdominal pressure as measured in the urinary bladder (Pcyst). METHODOLOGY: A prospective study of 38 mechanically ventilated patients. Simultaneous measurements of Psvc, Pivc and Pcyst (151 sets of measurements) were performed. Measurements were divided in: Group A (Pcyst < 10 mmHg), group B (10 mmHg < or = Pcyst < 15 mmHg), group C (Pcyst > or = 15 mmHg). Statistical analysis was performed with paired t-test, Pearson correlation. Results are expressed in mean +/- SEM. RESULTS: In Groups A and B, Psvc and Pivc were not significantly different and they were highly correlated (10.8+/-0.5 mmHg vs. 10.9+/-0.5 mmHg, r=0.93 for Group A and 14.4+/-0.7 mmHg vs. 14.7+/-0.6 mmHg, r=0.87 for Group B). Pcyst was significantly lower than Pivc in both groups. In Group C, Pivc was significantly higher than Psvc (18.9+/-0.7 mmHg vs. 16.4+/-0.7 mmHg). There was no significant difference between Pivc and Pcyst (19.2+/-0.6 mmHg). Pivc significantly correlated with Pcyst (r=0.78) and Psvc (r=0.7). A. When Pcyst > Psvc, Pivc was higher than Psvc (p<0.01). With Pcyst < 15 mmHg, no significant difference was found between Pcyst and Pivc and they were correlated (r=0.766, p<0.05). Pressures in the superior and inferior vena cava were also correlated (r=0.764, p<0.05). With Pcyst > or = 15 mmHg, Pivc was lower than Pcyst (p<0.01). It correlated highly with Pcyst (r=0.85, p<0.01) and less strongly with Psvc (r=0.701, p<0.01). B. When Pcyst < or = Psvc, no difference between Pivc and Psvc was observed. With Pcyst < 15 mmHg, Pivc was higher than Pcyst (p<0.01) and highly correlated with Psvc (r=0.932, p<0.01). Pivc also correlated with Pcyst (r=0.69, p<0.01). With Pcyst > or = 15 mmHg, Pivc was higher than Pcyst (p<0.01) and correlated with Psvc (r=0.74, p<0.01) and Pcyst (r=0.789, p<0.01). CONCLUSIONS: Although Psvc and Pivc are interchangeable in the absence of an increased Pcyst, when Pcyst is high, measurements of Pivc are misleading. A Pcyst > Psvc results in a "waterfall" effect, and Pivc does not accurately reflect Psvc any more.

Möbius syndrome with dental involvement: a case report and literature review.

The clinicopathological findings on a 17-year-old female with the Möbius/Moebius syndrome are reported. The signs and symptoms of this neuromuscular condition include congenital bilateral or unilateral palsies of the facial and abducens cranial nerves and a broad scope of multisystem abnormalities. A case of unilateral deficiencies of cranial nerves VI and VII, congenital ectrodactyly of toes, and multiple congenitally missing primary and permanent teeth is reported. A review of the literature reveals various ideas regarding the diversity of symptoms and the etiology of the syndrome. The purpose of this article is to report oral manifestations, such as congenitally missing teeth, associated with Möbius syndrome.

The quantitative and qualitative analysis of the craniofacial skeleton of mice lacking the IGF-I gene.

Insulin-like growth factors are mediators of growth hormone and are believed to also stimulate growth independently. Insulin-like growth factor I (IGF-I) null mutant mice exhibit a lower rate of skeletal growth compared with their wild-type (control) littermates. Although their general body dimensions seem proportionate, their heads appear shortened with a blunt nose compared with the controls. The aim of this project was threefold: 1) to investigate whether differences in shape/form exist between the craniofacial skeleton of the IGF-I null mutant mice and their control littermates by using three techniques; 2) to determine whether the three techniques yield similar, different, or complementary information regarding the size and shape of specimens; and 3) to investigate whether the histological sections obtained from the craniofacial skeleton exhibit any differences between the two groups. Thirty adult male mice, 12 mutant and 18 wild type, obtained from 11 litters were examined. Lateral and superio-inferior radiographs of their head were analyzed by the procrustes, the macroelement, and the traditional cephalometric techniques. Later, the animals were processed for routine histological examination. The IGF null mutant mice demonstrated a generalized decrease of craniofacial size (43-64% of the normal adult size) and a non-allometric change of shape when compared with their wild-type littermates. While the mandible did not exhibit any shape changes, the facial and cranial areas demonstrated prominent changes. Examination of histological sections did not reveal any structural difference between the two groups at the adult stage. Furthermore, procrustes and macroelement techniques offer a more complete, detailed, and comprehensive description of the specimens compared.

Usual interstitial pneumonia associated with cytomegalovirus infection after percutaneous transluminal coronary angioplasty.

An unusual case of cytomegalovirus (CMV) pneumonia in a diabetic patient is presented. The diagnosis was based on typical histopathological findings including intranuclear inclusion bodies combined with molecular identification of CMV in tissue specimens. The possibility of CMV reactivation associated with a previous cardiac procedure, which led to the development of usual interstitial pneumonia, is discussed. Clinicians should be aware of CMV-associated severe bilateral pneumonia developing after cardiac procedures even in non-transplant patients. The correct diagnosis depends on clinical awareness in the appropriate setting along with proof of viral infection.