Prognostic factors in emergency patients aged 90 years and older.

AIM: We evaluated the relation between general status on arrival and prognosis in patients aged 90 years and older who were admitted to our department through the emergency room, with the aim of assisting the development of a treatment policy for elderly people. METHODS: We retrospectively analyzed patients aged 90 years and older who were admitted to our department from January 2006 to September 2013. Patients were divided into two groups, patients who were discharged from our hospital or transferred to another hospital, and patients who died in our hospital. Comparisons of the patients' general status and the results of blood examinations were carried out between the two groups. Independent parameters to predict prognosis were also evaluated. RESULTS: Fifty-eight patients were enrolled in this study. The mean age was 93.2 ± 3.4 years (range, 90-106 years). Forty-five patients (77.6%) were discharged from our hospital (group A), and 13 patients (22.4%) died (group B). The percentage of patients with the inability to walk independently was significantly higher in group B. Mean arterial pressure, Glasgow Coma Scale (GCS), PaO2/FiO2 ratio, and serum albumin level on arrival were significantly better in group A. Multivariate logistic regression analysis indicated that the inability to walk independently (odds ratio, 22.4; 95% confidence interval, 4.4-113.1; P < 0.0001) and GCS (odds ratio, 7.0; 95% confidence interval, 1.8-27.7; P = 0.003) were the parameters to predict prognosis. CONCLUSION: The inability to walk independently and GCS (consciousness status) are the most sensitive predictors of prognosis in emergency patients aged 90 years and older.

Usefulness of fibrin degradation products and d-dimer levels as biomarkers that reflect the severity of trauma.

PURPOSE: To evaluate the usefulness of the levels of fibrin degradation products (FDPs) and d-dimer (DD) in blood for reflecting the severity of trauma. PATIENTS AND METHODS: We reviewed medical records of trauma patients who were transferred to the emergency department of Gunma University Hospital between January 2010 and December 2010. The relationships among Injury Severity Score, mean blood pressure, heart rate, hemoglobin, hematocrit, platelet count, fibrinogen, international normalized ratio of prothrombin time, activated partial thromboplastin time, FDP, and DD on arrival were examined in those patients. RESULTS: A total of 122 patients were included in this study. The coefficients of correlation of FDP (r = 0.710) and DD (r = 0.636) with Injury Severity Score were higher than those of other parameters. In addition, the areas under the receiver operating characteristic curve of FDP and DD were larger than those of other parameters (0.757 and 0.756, respectively). The cutoff value of FDP from the Youden index was 4.70 µg/mL, and the sensitivity and specificity values were 75.9% and 68.4%, respectively. The cutoff value of DD from the Youden index was 2.55 µg/mL, and the sensitivity and specificity values were 75.9% and 73.7%, respectively. There were four patients requiring more than 10 U of red blood cell transfusion within 24 hours after trauma (a unit of red blood cell transfusion is made from 200 mL of whole blood in Japan). In those four patients, the mean values of FDP and DD were 90.8 µg/mL (range, 5.7-160 µg/mL) and 45.3 µg/mL (range, 3.2-66.4 µg/mL), respectively, and those data were much higher than the mean of all patients. The mean values of FDP and DD in four patients who died were 244.6 µg/mL (range, 158.4-420 µg/mL) and 102.8 µg/mL (range, 32.8-240 µg/mL), respectively. Both FDP and DD in patients who died were remarkably elevated immediately after trauma. CONCLUSION: FDP and DD levels may be useful parameters for initial evaluation of the severity of trauma, massive blood transfusion, and mortality.

Hepatocellular Carcinoma Mimicking Liver Abscesses in a Cirrhotic Patient with Severe Septic Shock as a Result of Salmonella O9 HG Infection.

We describe a case of severe Salmonella O9 HG sepsis with a mass in the liver, which was diagnosed as hepatocellular carcinoma (HCC) by autopsy of the liver. The patient was a 67-year-old man with chronic high blood pressure. In addition, he was an alcoholic and had been drinking every day for many years. He had had a dinner of 'sukiyaki' with a raw egg two days before admission. The next morning, he had developed vomiting, diarrhea, and abdominal pain. Salmonella O9 HG was found in the blood and stool cultures. In the computed tomography (CT) finding of the liver, there was a 2 cm early-enhanced mass with a multilocular structure, with ringed enhancement and daughter nodes. Since we thought that the mass was a liver abscess, we performed needle aspiration from the liver mass and were able to withdraw blood. Despite adequate antibiotic treatment, the patient died as a result of complications on the 55th day after admission. After the patient's death, we conducted an autopsy. There were two HCC masses, a moderately-differentiated and a well-differentiated mass, as a result of alcoholic cirrhosis of the liver. As the HCC had multilocular cyst-like structures, which were fiber- and necrosis-rich, CT images of the liver masses resembled abscesses.

Tissue characterization of uterine myometrium using the ultrasound gray-level histogram width.

PURPOSE: The purpose of this study was to clarify the usefulness of the gray-level histogram width for tissue characterization of the uterine myometrium. METHODS: Thirty-five patients with uterine fibroids, 5 patients with adenomyosis, and 9 patients with extensive myometrial invasion by endometrial carcinoma were studied. The gray-level histogram width was determined by transvaginal ultrasonography. The Mann-Whitney U test was used for statistical analysis. Receiver operating characteristic curves were generated for use in tissue characterization. RESULTS: Significant differences in the gray-level histogram width were found between normal myometrium (54.2% ± 4.2%) and carcinoma (58.2% ± 3.9%), normal myometrium and fibroid (64.3% ± 5.2%), and carcinoma and fibroid. However, it was difficult to identify adenomyosis. The cutoff values to distinguish normal myometrium from carcinoma, normal myometrium from fibroid, and carcinoma from fibroid are 56, 58, and 64, respectively. CONCLUSION: The gray-level histogram width is useful for tissue characterization of the uterine myometrium.

Hydrotubation for diagnosing carcinoma in situ of the fallopian tube. A case report.

BACKGROUND: Primary adenocarcinoma of the fallopian tube is rare and not diagnosed until at an advanced stage. We present a case of carcinoma in situ of the fallopian tube in which cytologic examination obtained by hydrotubation facilitated the diagnosis. CASE: A 55-year-old woman presented to Yamaguchi Red Cross Hospital for uterine cancer screening. Endometrial brush cytology revealed adenocarcinoma cells, but endometrial curettage showed no abnormal findings. We performed hydrotubation, collecting abdominal fluid by culdocentesis for cytology. The smear test showed adenocarcinoma with cells similar to those obtained by endometrial brush cytology. Laparotomy showed no abnormalities in the abdominal cavity, and pelvic washing cytology was negative. Based on the positive cytology found by hydrotubation, we performed a hysterectomy and bilateral salpingo-oophorectomy. Postsurgical histology revealed adenocarcinoma in situ of the fallopian tube. CONCLUSION: The present case suggests that cytologic examination obtained by hydrotubation may be useful in diagnosing early tubal cancer.