A Contemporary Review of Blood Transfusion in Critically Ill Patients.

Blood transfusion is a common therapeutic intervention in hospitalized patients. There are numerous indications for transfusion, including anemia and coagulopathy with deficiency of single or multiple coagulation components such as platelets or coagulation factors. Nevertheless, the practice of transfusion in critically ill patients has been controversial mainly due to a lack of evidence and the need to consider the appropriate clinical context for transfusion. Further, transfusion carries many risk factors that must be balanced with benefits. Therefore, transfusion practice in ICU patients has constantly evolved, and we endeavor to present a contemporary review of transfusion practices in this population guided by clinical trials and expert guidelines.

An Adrenocortical Carcinoma Evolving After Nine Years of Latency From a Small Adrenal Incidentaloma.

Adrenal incidentalomas (AIs) are common incidental findings in medical practice with clinical significance. Although most AIs are nonsecretory and nonmalignant, they require a short course of follow-up over one to two years to rule out malignancy or hormonal secretion according to clinical practice guidelines. However, this can result in some adrenocortical carcinomas (ACCs) being missed if they transform at a later stage or evolve slowly. Here, we report one such case of an AI, which although remained indolent, eventually transformed into an ACC many years after the initial detection.

Meningitis retention syndrome.

A 50-year-old Caucasian woman presented with signs and symptoms of meningitis preceded by a 3 day history of flu-like symptoms and progressive difficulty with urination. Cerebrospinal Fluid (CSF) analysis was consistent with aseptic meningitis. She was found to have a significant urinary retention secondary to atonic bladder. MRI of the brain and spine were normal and CSF-PCR (polymerase chain reaction) was positive for HSV-2. Urinary retention in the context of meningitis and CSF pleocytosis is known as Meningitis Retention Syndrome (MRS). MRS is a rare but important complication of meningitis most commonly associated with HSV-2. Involvement of central pathways may have a role in the pathogenesis of MRS but this is poorly documented. MRS is different from Elsberg syndrome wherein patients display features of lumbosacral polyradiculitis or radiculomyelitis. Early treatment with antiviral therapy was associated with a favorable outcome in our patient.

Organ trafficking for live donor kidney transplantation in Indoasians resident in the west midlands: high activity and poor outcomes.

INTRODUCTION: Some Indoasian (IA) patients with established renal failure travel abroad for commercial kidney transplantation. We compared the 1-year outcomes of IA patients from one UK region who received overseas transplants with IA patients receiving local living donor (LD) kidney transplantation, deceased donor (DD) transplantation, and dialysis. METHODS: Between 1996 and 2006, 40 adults were transplanted overseas; 38 were IA, and follow-up data were available on 36 patients. Forty IA patients received LD transplants, and 156 patients received DD transplants locally. A cohort of 120 prospective dialysis patients was also used as a comparator group. RESULTS: In the overseas cohort, 20 patients (56%) were not active in the UK transplant waiting list at the time of kidney transplantation overseas. One-year graft survival was 87%, and 1-year patient survival was 83%. Composite graft and patient survival was 69.5% at 1 year. In the local LD transplant recipients, patient survival was 97.5% (39 of 40; P=0.03), and graft survival was 97.5% (39 of 40; P=0.06). Composite graft and patient survival was 95% (P=0.003). In the overseas group, 42% had major infections compared with 15% in the local group (P=0.02). One-year graft survival for DD transplant was 84.6% (132 of 156), and 1-year patient survival was 93% (145 of 156; P=NS and P=0.06, respectively). In the dialysis group, 1-year patient survival was 96.7% (116 of 120; P=0.001). CONCLUSION: IA patients who choose to travel overseas for kidney transplantation have poor clinical outcomes and should be counseled accordingly.