ABDOMINAL MYCOBACTERIAL INFECTION MIMICKING ACUTE APPENDICITIS IN AN AIDS PATIENT

A case of abdominal mycobacterial infection mimicking acute appendicitis in a human immunodeficiency virus (HIV) infected patient is reported. The case illustrates the unusual aetiology of an acute abdomen in this population and the report reviews the aetiology of surgical abdominal pain in HIV infection and discusses the management of abdominal mycobacterial infections.     

The microbiology and outcome of sepsis in Victoria, Australia

We analysed data from 33741 patients with ICD-10-AM-defined sepsis from an Australian hospital morbidity dataset to investigate the relationships between specific types of organisms, potential risk factors for infection, organ dysfunction, ICU utilization and hospital mortality. A total of 24% of patients received some of their care in an intensive care unit, and the overall hospital mortality rate was 18%. Gram-positive bacteria were isolated in 27% of cases and Gram-negative bacteria in 20%. Sepsis due to Staphylococcus aureus was associated with vascular and joint devices whereas Pseudomonas aeruginosa and Gram-negative rods were more common with genitourinary devices and lymphoproliferative disease. Sepsis-associated organ dysfunction most commonly involved the respiratory system, followed by the renal and circulatory systems. These patterns may provide useful clues to the pathogenesis and therapy of this often fatal syndrome which is a major ongoing problem for hospitalized patients.     

Chemoradiation is a tolerable therapy for older adults with esophageal cancer

INTRODUCTION: Esophageal adenocarcinoma (EC) is increasing in incidence. Chemoradiation (CRT) is regarded as an acceptable alternative to surgery for the management of locally advanced EC. Ten-20% of EC patients are over the age of 75 years. There are limited data regarding efficacy and tolerability of CRT for the treatment of EC in the elderly. PATIENTS AND METHODS: We retrospectively reviewed EC cases > or = 70 years of age treated with CRT at a single institution. Clinical data, regarding therapy administered and outcome, were obtained from records. Clinical prognostic variables were analyzed against survival in a univariate model using the log rank test and in a multivariate model using Cox proportional hazards analysis. RESULTS: Thirty consecutive patient records were identified. Commonly used chemotherapy agents included 5-fluorouracil, cisplatin, paclitaxel and oxaliplatin. There was no significant correlation between age and survival. The dose of chemotherapy or radiation was unrelated to any of the toxicities (p-values > 0.16). The most common grade 3 or 4 toxicities were dehydration, hypotension, mucositis and pneumonitis. On multivariate analysis, adenocarcinoma histology (p = 0.0094) and higher radiation dose (p = 0.0158) were associated with improved survival. The median survival of the patients was 10 months. CONCLUSION: CRT was tolerable for older patients with EC. Close monitoring for dehydration, nutritional compromise and pulmonary toxicity is required.     

A Phase II Study of Gemcitabine and Capecitabine in Advanced Cholangiocarcinoma and Carcinoma of the Gallbladder: A Single-Institution Prospective Study

Aim To determine the clinical benefit response (CBR), time to tumor progression (TTP), overall survival, and effect on quality of life (QOL) of gemcitabine and capecitabine in patients with advanced biliary cancer. Methods Gemcitabine (1000 mg/m² IV over 30 minutes on days 1 and 8) and capecitabine (650 mg/m² orally twice daily for 14 days) were administered and repeated every 21 days. All patients completed the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire and Pancreatic Cancer Module (EORTC QLQ-C30-PAN 26) questionnaire on day 1 of each cycle. Cumulative QOL scores were calculated. The two-stage design required 17 patients to evaluate the confirmed response at nine weeks. Results Twelve patients with a median age of 54 years were enrolled. A median of eight cycles per patient were completed. With a median follow-up of 18.2 months, the CBR (two partial response and five stable disease) was 58% [95% confidence interval (CI) 28–85%]. Four out of seven patients with CBR had no decline in QOL with chemotherapy. The probability of survival at one year was 0.58. Median TTP and overall survival were 9.0 and 14.0 months, respectively. Nine patients had grade 3 or 4 toxicities. There were no treatment-related deaths. Conclusions Gemcitabine and capecitabine at this dose and schedule are well tolerated and effective and may offer clinical benefit and maintain QOL in patients with advanced biliary cancer. This regimen merits further investigation in the neoadjuvant setting.     

An unusual toxic cause of hemolytic-uremic syndrome

Hemolytic uremic syndrome (HUS) has been associated with a variety of infective as well as non-infective causes. HUS as a toxic manifestation of exposure to herbicides/pesticides has not been reported so far in literature. We report a subject who presented with clinical features of features of HUS after intentional suicidal ingestion of the herbicidal agent monochloroacetic acid (MCA). A 55-year-old farmer was admitted with a history of consumption of monochloroacetic acid with vomiting, hematochezia and oligo-anuria. Our investigations revealed severe renal failure, metabolic acidosis, anemia, and thrombocytopenia with evidence of intravascular hemolysis. He was treated for HUS with plasma transfusions and haemodialysis in view of renal failure. During the course of hospital admission he developed acute antero-septal myocardial infarction and subsequently succumbed to the disease. MCA is used as an herbicidal agent and also a bleaching agent for silkworm cocoons. The toxicity of MCA has included metabolic acidosis, rhabdomyolysis and renal failure; however HUS has not been described in the literature. Extra -renal manifestations of HUS such as cardiomyopathy have also been infrequently described. This case is presented to highlight an as yet unknown toxicity of MCA.     

Reduced expression of toll-like receptor 2 on peripheral monocytes in patients with chronic hepatitis B

Persistent infection with hepatitis B virus (HBV) likely depends on viral inhibition of host defenses. We report that chronic hepatitis B e antigen-positive HBV infection is associated with a significant reduction in peripheral blood monocyte expression of Toll-like receptor 2, a key component of innate immunity, thereby providing a mechanism by which wild-type HBV may establish persistent infection.     

The Bethesda System for Reporting Thyroid Cytopathology: Interpretation and Guidelines in Surgical Treatment

Objectives: (1) The aim of this study is to assess the efficacy of The Bethesda System for Reporting Thyroid Cytology (TBSRTC) in accurate prediction of thyroid lesions on fine needle aspiration (FNA). (2) To appraise the surgeon with guidelines for adequacy of samples, and interpretation of FNA reports with TBSRTC and hence aiding them in surgical decision making. Five hundred and sixty four FNAs were done on patients with thyroid swellings in the department of Pathology and reported using TBSRTC guidelines. In cases where surgery was done, histopathological report was correlated. Using TBSRTC the commonest cytological diagnosis was benign-Hashimotos thyroiditis followed by benign follicular nodule. TBSTRC reduces inter-observer variability in reporting thyroid FNAs and provides good communication between the surgeon and pathologist. It also implicates guidelines for cancer risk and clinical management to the surgeons, thus avoiding unnecessary surgery.