Long-stay patients in the pediatric intensive care unit

OBJECTIVE: Length of stay in the pediatric intensive care unit (PICU) is a reflection of patient severity of illness and health status, as well as PICU quality and performance. We determined the clinical profiles and relative resource use of long-stay patients (LSPs) and developed a prediction model to identify LSPs for early quality and cost saving interventions. DESIGN: Nonconcurrent cohort study. SETTING: A total of 16 randomly selected PICUs and 16 volunteer PICUs. PATIENTS: A total of 11,165 consecutive admissions to the 32 PICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: LSPs were defined as patients having a length of stay greater than the 95th percentile (>12 days). Logistic regression analysis was used to determine which clinical characteristics, available within the first 24 hrs after admission, were associated with LSPs and to create a predictive algorithm. Overall, LSPs were 4.7% of the population but represented 36.1% of the days of care. Multivariate analysis indicated that the following factors are predictive of long stays: age <12 months, previous ICU admission, emergency admission, no CPR before admission, admission from another ICU or intermediate care unit, chronic care requirements (total parenteral nutrition and tracheostomy), specific diagnoses including acquired cardiac disease, pneumonia, and other respiratory disorders, having never been discharged from the hospital, need for ventilatory support or an intracranial catheter, and a Pediatric Risk of Mortality III score between 10 and 33. The performance of the prediction algorithm in both the training and validation samples for identifying LSPs was good for both discrimination (area under the receiver operating characteristics curve of 0.83 and 0.85, respectively), and calibration (goodness of fit, p = .33 and p = .16, respectively). LSPs comprised from 2.1% to 8.1% of individual ICU patients and occupied from 15.2% to 57.8% of individual ICU bed days. CONCLUSIONS: LSPs have less favorable outcomes and use more resources than non-LSPs. The clinical profile of LSPs includes those who are younger and those that require chronic care devices. A predictive algorithm could help identify patients at high risk of prolonged stays appropriate for specific interventions.     

Isolated metastases of cervical cancer to the abdominal wall--a case report

We described an unusual case of skin metastases of the uterine cervix in 63 year old woman. Previously, she was found having a Stage IIa squamous carcinoma of the cervix. She underwent bilateral salpingo-oophorectomy, total abdominal hysterectomy and pelvic node dissection. Then the patient was treated by external and intracavitary radiation. Within the next six months she was readmitted to the hospital because of abdominal pain and urinary stress incontinence after irradiation. The examination revealed three firm, freely-movable, solid subcutaneous nodules on the abdominal wall, umbilical site and urinary fistula. No other significant physical phenomena were noted. Radical excision of all the lesions was conducted and followed by four courses of adjuvant chemotherapy. Histopathological examination of the excised nodules revealed nests of squamous cell carcinoma, which were histologically identical to the previous carcinoma of the cervix. After successful treatment, the patient was continued for three months now, without any clinical evidence of recrudescence, and with good results from the urinary fistula treatment. Moreover, in these case-report we presented a review of current literature about new techniques and treatment methods of the cervical carcinomas.     

Estimation of DNA methylation level in nonendometrial uterus malignancies

OBJECTIVES: Rebuilding of genome structure leads to many pathological states including neoplastic malignancies. Rebuilding often occurs as a process caused by disturbances in gene silencing mechanism. DNA methylation pattern is one of the most important mechanisms connected to gene's silencing. Estimation of DNA methylation level in nonendometrial uterine neoplastic tissues compared to normal endometrial samples was the aim of this study. DESIGN: It was to be shown, that changes in methylation rate in promotory regions could lead to carcinogenesis in particular cell. Authors describe an analysis of DNA methylation level in nonendometrial neoplastic uterine tissues compared to DNA methylation level in normal endometrium. MATERIALS AND METHODS: Tissue samples from 9 women with tumor mixtus mesodermalis were collected. 12 samples were normal endometrium-control group. DNA was isolated from tissues and than we performed an estimation of DNA methylation levels. Than we performed a statistical analysis of results. RESULTS: The median DNA methylation level was significantly higher in neoplastic tissues than in normal endometrium. CONCLUSIONS: Authors conclude, that DNA methylation level is higher in neoplastic tissues, but does not correlate with clinical stage of the disease.     

Estimation of DNA methylation level in endometrial cancer tissues

OBJECTIVES: A level of DNA methylation plays an important role in regulation of cellular gene's expression. Estimation of DNA methylation level in endometrial neoplastic tissues compared to normal endometrial samples was the aim of this study. DESIGN: It was to be shown, that changes in methylation rate in promotory regions could lead to carcinogenesis in particular cell. Authors describe an analysis of DNA methylation level in endometrial cancer tissues compared to DNA methylation level in normal or hyperplastic endometrium. MATERIAL AND METHODS: Endometrial samples from 88 women were collected. 56 of them were classified as adenocarcinoma, 20 as hyperplastic changes, 12 as normal endometrium-control group. DNA was isolated from tissues and than prepared to pm5dC and pdC. Than we performed a statistical analysis of results. RESULTS: The median DNA methylation level was significantly higher in neoplastic tissues than in normal endometrium. There was no difference between DNA methylation level between normal endometrium and hyperplastic changes. CONCLUSIONS: Authors conclude that neoplastic endometrial tissues show high DNA methylation rate compared to normal or hyperplastic endometrium.     

Wegener's granulomatosis--a disease of many faces

We describe a case of Wegener's granulomatosis. The first symptoms included severe headache subsiding only after administration of dexamethasone. Despite a great number of diagnostic tests involving CT and MR of the head, the cause of the headache remained unknown. Because a chest x-ray revealed a nodule in the right lung, the patient was sent to our Clinic. Reevaluation of CT and MR pointed to a massive ethmoid sinusitis. 7-days' course of antibiotics and corticosteroids induced remission of the lung nodule. Several diagnoses were made: neoplasm, bacterial ethmoid sinusitis, trigeminal neuritis, thrombotic cavernous sinusitis and tuberculosis. Results of the ethmoid sinus biopsy together with a high c-ANCA concentration gave the correct diagnosis.     

Physiological responses to a natural antioxidant flavonoid mixture,silymarin, in BALB/c mice: II. alterations in thymic differentiation correlate with changes in c-myc gene expression

Silymarin is a mixture of bioactive flavonoids isolated from the seeds and fruits of Milk Thistle [ Silybum marianum (L.) Gaertner]. We tested the hypothesis that exposure to silymarin will modulate differentiation and cell selection in the thymus via alterations in gene expression. Male BALB/c mice were treated intraperitoneally once daily for five days with 0, 10, 50 or 250 mg/kg of silymarin. Flow cytometric examination of thymic lymphocyte populations showed that the absolute numbers of CD4 + and CD8 + positive T-lymphocytes were increased by silymarin. The c- myc proto-oncogene is important in controlling differentiation and functions of thymocytes. Treatment with silymarin resulted in increased c- myc expression in the thymus. In contrast, the expressions of IL-2 and IL-4 were decreased by silymarin, while MHC II expression did not change. These results indicate that in vivo exposure to silymarin influences phenotypic selection processes in the thymus at doses that may be encountered in natural medicinal use. Further studies investigating the effects of silymarin on the immune system are warranted.     

Anterior Pituitary Corticotropes of Adrenalectomized,Leptin-Administered Rats

Leptin (LEP), the product of the ob gene is an adipose-tissue secreted hormone that acts to decrease caloric intake and increase energy expenditure. Some observations suggest the mutual relationship between leptin and blood ACTH levels. In the rat acute LEP administration enhances blood ACTH levels while prolonged treatment lowers blood corticotropin concentrations. Since the pituitary-derived ACTH is an important element in functioning of that loop, studies were undertaken to investigate the effect of prolonged LEP administration on anterior pituitary ACTH cells of adrenalectomized rats.Studies were performed on bilaterally adrenalectomized adult female rats. They were administered for 3 or 6 days with 2.7 nmol/rat/day LEP (recombinant human leptin) or with the vehicle (0.9% NaCl). LEP administration did not affect the body weight of bilaterally adrenalectomized rats. During the whole experiment the average increase in body weight was 3.9–4.3 g/day. LEP administration into adrenalectomized rats had no effect on anterior pituitary weight. This treatment resulted in a significant increase in pituitary ACTH concentration and content, and these changes were accompanied by a potent decrease in blood corticotropin level. LEP administration into adrenalectomized rats only insignificantly lowered the quantity of anterior pituitary ACTH-immunoreactive cells and their average area. On the opposite, the average volume of pituitary corticotropes of LEP-treated rats was notably lower than that in adrenalectomized-vehicle administered ones.Results of performed experiments clearly demonstrate that prolonged LEP administration results in a notable inhibition of the growth and secretory activity of anterior pituitary corticotropes of the adrenalectomized rats.     

Utilizing IL-12, IL-15 and IL-7 as Mucosal Vaccine Adjuvants

In this paper we review and discuss three of the most exciting and promising cytokines for therapeutic intervention and immunomodulation of immune responses including those on mucosal surfaces. The main properties of IL-12, IL-15 and IL-7 are described and the studies utilizing these cytokines as immunomodulators and vaccine adjuvants discussed.