Surviving meningococcal septic shock in childhood: long-term overall outcome and the effect on health-related quality of life

Introduction  

The purpose of this study was to evaluate associations between long-term physical and psychological outcome variables in patients who survived meningococcal septic shock (MSS) in childhood.     

Analysis of NF-κB Nuclear Translocation in PMN-neutrophils of Major Trauma Patients in the Early Post-traumatic Period: A Pilot Study

Background Post-traumatic inflammation is connected to polymorphonuclear neutrophil (PMN)-dysfunction characterized by reduced nuclear translocation of NF-κB during the post-traumatic period. However, the dynamic of NF-κB translocation in PMN of major trauma patients remains unclear. Hence, the aim of this pilot study was to analyze NF-κB in PMN from multiply injured patients immediately after trauma. Patients and Methods Blood samples of major trauma patients (ISS > 16) were drawn on admission within 90 minutes after trauma and at 6, 12, 24, 48, and 72 hours after trauma. Neutrophilic NF-κB-translocation was analyzed by EMSA and quantified by densitometry as (arbitrary units). In addition, PMN of healthy volunteers were analyzed either in their native state (–control) or after LPS stimulation (+control). Results Twelve patients (NISS: 34 ± 10 [mean ± SEM]) were enrolled. NF-κB translocation was significantly increased in trauma patients on admission and after 6 hours. Interestingly, a second activity peak was present after 24 hours. In patients who later died, NF-κB activity was significantly elevated initially, to be rapidly diminished after 6 hours, while it increased in the survivors group. After 24 hours NF-κB activity increased significantly in the survivors group, to become reduced in both groups at a later time. Conclusions Within this pilot study, the dynamic of NF-κB translocation in PMN of multiply injured patients immmediately after trauma was analyzed for the first time. Enabled by closely matched sequential blood sampling strictly standardized to the traumatic event, an essential biphasic increase of neutrophilic signal transduction could be investigated in the very early post-traumatic period, which preceded the downregulation of the innate immune system.     

Bladder cancer: staging with CT and MR imaging

Magnetic resonance (MR) imaging and computed tomography (CT) were compared in 30 patients with histologically proved bladder cancer. MR imaging was accurate in depicting the presence or absence of extravesical spread in 22 patients (accuracy, 73%; sensitivity, 82%; specificity, 62%), and CT was accurate in 24 patients (accuracy, 80%; sensitivity, 94%; specificity, 62%). The MR examinations of two patients were of undiagnostic quality and therefore considered to be technical failures. Each technique resulted in five false-positive and one false-negative examination for the diagnosis of extravesical tumor spread. In 28 patients the integrity of the bladder wall was assessed with MR imaging. In 22 patients the bladder wall was disrupted, and 18 of these patients had deep muscle invasion. In six patients the bladder wall was intact, and none of these patients had evidence of deep muscle invasion at pathologic examination. In this study MR imaging was slightly inferior to CT in the delineation of invasive tumors beyond the bladder wall. However, if one excludes from analysis the two patients with undiagnostic studies, there is no significant difference in accuracy between the two techniques.     

Hepatic malignancies: improved treatment with intraarterial Y-90

An improved treatment method for hepatic malignancies with yttrium-90 incorporated into the matrix of glass microspheres was evaluated prospectively. Fifteen patients with 12 metastatic colorectal cancers, one carcinoid, one islet cell tumor, and one hepatoma were treated with three dose levels: 5,000 cGy (5,000 rad), ten patients; 7,500 cGy (7,500 rad), three patients; and 10,000 cGy (10,000 rad), two patients. Mean follow-up was 7 months (range, 2-12 months). Stable disease in the liver was seen in ten patients, four of whom had concurrent progression of extrahepatic disease, which resulted in two deaths. Two additional deaths were not directly related to the malignant process. Progression of liver disease was found in five patients, with three deaths occurring at 7-8 months. No procedural, hematologic, or pulmonary complications occurred. Late gastroduodenal ulceration occurred at 6-8 weeks in three patients who had histories of chronic alcohol abuse. This method of therapy seems to be feasible and efficient. Caution is necessary with high doses or with patients with a history of or predisposition to gastroduodenal ulcers.     

Calcified transitional cell carcinoma of the renal pelvis

Six patients with calcified transitional cell carcinoma of the renal pelvis were encountered over a 10-year period, and the radiographic features in these cases are presented. Radiographically discernible calcification is one of the less common manifestations of this lesion, and the pattern of calcification may be variable. However, the combination of a coarse, punctate pattern with a mucosal lesion on excretory or retrograde urography should suggest the diagnosis and prompt further investigation.     

Neck neoplasms: MR imaging. Part II. Posttreatment evaluation

Thirty-three patients who had undergone prior surgery and/or radiation therapy for malignant neoplasms of the neck were studied with magnetic resonance (MR) imaging. Twenty-seven of these patients were also evaluated with computed tomography (CT). Ten patients were healthy posttreatment volunteers, and 23 had documented tumor recurrence. MR images better demonstrated normal muscular landmarks, especially in patients with obliterated fat planes. Areas of posttreatment fibrosis or scarring were low in signal intensity with all MR pulse sequences. However, in three patients, high signal intensity from postradiation edema of the supraglottic area mimicked neoplasm. In patients with recurrent tumor, MR imaging was superior to CT in defining the relationship of tumor and muscle and in demonstrating vascular anatomy when no intravenous contrast material was given during the CT examination. In two patients tumor and fibrosis were separated on MR images because of signal intensity differences. CT scans, however, showed adjacent bone and cartilage anatomy better. Our data indicate that an MR examination may be helpful in patients in whom CT is indeterminate either because of anatomical distortion or suboptimal demonstration of vascular anatomy.