Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis

A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days later, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobilia) and a focal lesion with mixed echotexture in segment III (hepatic hematoma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures. Received: 14 January 1999; Revised: 21 May 1999; Accepted: 9 June 1999     

Comparative efficacy of ceftriaxone versus ceftazidime in the treatment of nosocomial lower respiratory tract infections.

Seventy-two hospitalized patients with pneumonia or bacteremia were randomly allocated to receive ceftriaxone 2 g once daily i.v. or ceftazidime 2 g twice a day i.v. At the end of the study 60 patients were evaluable, 31 in the ceftazidime group and 29 in the ceftriaxone group. Thirty-four patients (ceftazidime = 15, ceftriaxone = 19) yielded one or more pathogens, of which 64% were gram-negative bacilli. Clinical cure or improvement was observed in 90% of patients in both groups. All 3 cases of bacteremia were cured. Three patients in each group failed to respond to the administered drug. Eradication of the pathogen(s) was observed in 82% of the ceftazidime group and in 86% of the ceftriaxone group. Two episodes of superinfection due to Pseudomonas aeruginosa were recorded in the ceftriaxone group, while Candida spp. was isolated from the sputum in 2 patients in the ceftazidime group. Three strains of P. aeruginosa (2 in the ceftazidime group, 1 in the ceftriaxone group) persisted despite the treatment. No side effects were seen except for skin rash in 2 patients receiving ceftazidime. Compliance was good in both groups, particularly with the once daily administration of ceftriaxone. Overall ceftriaxone and ceftazidime appear to be equally effective in the treatment of nosocomial pneumonia, with the exception of P. aeruginosa infection.     

Megakaryocytic blast crisis as first presentation of chronic myeloid leukemia

We describe an extremely rare case of megakaryocytic blast crisis as first presentation of chronic myeloid leukemia. The patient had a very high platelet count and developed an ischemic stroke with seizures. She was treated with hydroxyurea, platelet apheresis, ARA-C, and idarubicin in order to obtain a prompt reduction of thrombocytosis and then with imatinib 600 mg/die PO. The therapy induced a complete hematological remission with a resolution of neurological signs within 4 weeks.     

Emergence of linezolid resistance in the vancomycin-resistant Enterococcus faecium multilocus sequence typing C1 epidemic lineage

A relatively high rate of vancomycin-resistant Enterococcus faecium not susceptible to linezolid was observed in intensive care unit patients. Linezolid-resistant isolates carried the G2576T mutation in the 23S rRNA gene, belonged to different clones, and shared the same allelic profile, which clusters in the C1 multilocus sequence typing epidemic lineage.     

Therapeutic induced hypothermia does not improve the prognosis of out-of-hospital cardiac arrest patients

Unconscious patients admitted to critical care units after out-of-hospital cardiac arrest are at high risk for death, and neurologic deficits are common among those who survive. The target temperature management (TTM), 33 vs. 36 °C, after out-of-hospital cardiac arrest trial was conducted to assess the benefits and harms of two targeted temperature regimens after out-of-hospital cardiac arrest of presumed cardiac cause. The study randomized 950 unconscious survivors of out-of-hospital cardiac arrest with presumed cardiac cause to a target temperature of 33 vs. 36 °C following return of spontaneous circulation (ROSC), irrespective of the initial rhythm. At the end of the trial, 50 % of the patients in the 33 °C group (235 of 473 patients) had died, as compared to 48 % of the patients in the 36 °C group (225 of 466 patients) [hazard ratio with a temperature of 33 °C 1.06; 95 % confidence interval (CI) 0.89–1.28; p = 0.51]. In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33 °C does not confer a survival benefit as compared to a targeted temperature of 36 °C.     

Colchicine is safe and effective for secondary prevention of recurrent pericarditis

The CORP (COlchicine for Recurrent Pericarditis) trial [7]is a prospective, randomized, double-blind, placebo controlled, multicenter trial to evaluate the efficacy and safety of colchicine (1.0–2.0 mg on the first day, followed by a maintenance dose of 0.5–1.0 mg/day for 6 months) in association with conventional anti-inflammatory therapy for the secondary prevention of recurrence in patients with a first relapse of pericarditis. Patients were excluded if they were having their first episode of acute pericarditis, or their second or subsequent recurrence, or had pericarditis with tuberculous, purulent, or neoplastic causes. The primary study end point was the recurrence rate at 18 months. Secondary end points were symptom persistence after 72 h, remission rate at 1 week, number of recurrences, time to first recurrence, disease-related hospitalizations,cardiac tamponade, and constrictive pericarditis rates.120 patients (60 in the colchicine and 60 in the placebo group) were included in the analysis. The recurrence rate is 24 % in the colchicine group and 55 % in the placebo group (absolute risk reduction 0.31 [95 % CI 0.13–0.46];relative risk reduction 0.56 [0.27–0.73]; number needed to treat 3 [2–7]). Colchicine improves the persistence of symptoms at 72 h (absolute risk reduction 0.30 [95 % IC,0.13–0.45]; relative risk reduction 0.56 [0.27–0.74]). It also reduces the mean number of recurrences, increases the remission rate at 1 week and prolongs the time to subsequent recurrence. Colchicine and placebo groups have similar rates of side effects (7 %) and drug withdrawal (8 vs. 5 %, P = 0.89);no severe side effects occurred in any of the groups. Gastrointestinal intolerance was the main side effect during the study.