Elevated S100B levels do not correlate with the severity of encephalopathy during sepsis

Background: Sepsis-associated encephalopathy (SAE) is defined as a diffusecerebral dysfunction induced by the systemic response to infectionwithout any clinical or laboratory evidence of direct infectiousinvolvement of the central nervous system. The astroglial proteinS100B has been used as a marker of severity of brain injuryand as a prognostic index in trauma patients and cardiac arrestsurvivors. We measured S100B serum levels in patients with severesepsis to investigate if the severity of SAE correlated withan increase in S100B levels. Methods: Twenty-one patients, with a diagnosis of severe sepsis, wereincluded in this study. S100B levels were measured at intensivecare unit (ICU) admission, 72 h and 7 days after admission.Their association with markers of brain dysfunction such asGlasgow coma scale (GCS), and EEG, and with sepsis-related organfailure assessment score (SOFA) and ICU mortality was investigated. Results: Fourteen patients had elevated S100B levels. The levels didnot correlate with GCS at admission, EEG pattern, or SOFA scores.Also, S100B levels did not differ between patients who recoveredneurologically and those who did not (P = 0.62). Conclusions: In severe sepsis, an increase in S100B does not allow the physiciansto distinguish patients with severe impairment of consciousnessfrom those with milder derangements or to prognosticate neurologicalrecovery.     

Coffee and tea consumption and risk of hepatocellular carcinoma in Italy

The role of coffee in the aetiology of hepatocellular carcinoma has raised great interest. In Italy, coffee consumption is high, thus allowing the investigation of the topic over a broad range of consumption. A hospital-based case-control study was conducted in Italy in 1999-2002, including 185 incidents, histologically confirmed cases of hepatocellular carcinoma aged 43-84 years. Controls were 412 subjects admitted to the same hospitals' networks for acute, non-neoplastic diseases unrelated to diet. Coffee and tea consumption were assessed using a validated food-frequency questionnaire. Odds ratios (ORs) and corresponding the 95% confidence intervals (CI) were computed using unconditional multiple logistic regression, adjusting for hepatitis viruses seropositivity, alcohol intake, smoking habits and other potential confounding factors. Compared to people who drunk <14 cups/week of coffee, the risk of hepatocellular carcinoma decreased for increasing levels of consumption (OR=0.4, 95% CI: 0.2-1.1 for >or=28 cups/week, p for trend = 0.02). In the present study, inverse relations were observed across strata of hepatitis C and, B virus infections and alcohol drinking. No significant association emerged with consumption of decaffeinated coffee (OR=0.7, 95% CI=0.2-2.5) or tea (OR=1.4, 95% CI=0.8-2.7). The present study supports the hypothesis of a favourable effect of coffee, though not decaffeinated coffee and tea, on the risk on hepatocellular carcinoma.     

Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European prospective investigation into cancer and nutrition (EPIC)

Alcohol consumption may be associated with risk of colorectal cancer (CRC), but the epidemiological evidence for an association with specific anatomical subsites, types of alcoholic beverages and current vs. lifetime alcohol intake is inconsistent. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), 478,732 study subjects free of cancer at enrolment between 1992 and 2000 were followed up for an average of 6.2 years, during which 1,833 CRC cases were observed. Detailed information on consumption of alcoholic beverages at baseline (all cases) and during lifetime (1,447 CRC cases, 69% of the cohort) was collected from questionnaires. Cox proportional hazard models were used to examine the alcohol-CRC association. After adjustment for potential confounding factors, lifetime alcohol intake was significantly positively associated to CRC risk (hazard ratio, HR=1.08, 95%CI=1.04-1.12 for 15 g/day increase), with higher cancer risks observed in the rectum (HR=1.12, 95%CI=1.06-1.18) than distal colon (HR=1.08, 95%CI=1.01-1.16), and proximal colon (HR=1.02, 95%CI=0.92-1.12). Similar results were observed for baseline alcohol intake. When assessed by alcoholic beverages at baseline, the CRC risk for beer (HR=1.38, 95%CI=1.08-1.77 for 20-39.9 vs. 0.1-2.9 g/day) was higher than wine (HR=1.21, 95%CI=1.02-1.44), although the two risk estimates were not significantly different from each other. Higher HRs for baseline alcohol were observed for low levels of folate intake (1.13, 95%CI=1.06-1.20 for 15 g/day increase) compared to high folate intake (1.03, 95%CI=0.98-1.09). In this large European cohort, both lifetime and baseline alcohol consumption increase colon and rectum cancer risk, with more apparent risk increases for alcohol intakes greater than 30 g/day.     

Neutropenic enterocolitis: is there a right timing for surgery? Assessment of a clinical case

Neutropenic enterocolitis is a severe and potentially life-threatening complication that may affect patients undergoing chemotherapy for acute leukemia or lymphoma. These patients may develop systemic sepsis through bacterial or fungal translocation across the intestinal wall. In many cases neutropenic enterocolitis is confined to the cecum, but the entire colon is sometimes involved. Most patients are treated conservatively because an improvement occurs when the absolute neutrophil count rises. However, a surgical approach consisting of resection of the colon may sometimes be necessary, even in patients with complete aplasia and a high risk of complications. The right time to perform surgery is hard to define. Intestinal wall thickness, evaluated by ultrasound, is an important prognostic factor which could act as a guide to surgical indication. We analyze a case of neutropenic enterocolitis which occurred in a patient with acute myeloid leukemia during chemotherapy and we suggest that, as well as intestinal wall thickness, hemodynamic worsening should be considered an indication for surgery.     

Synchronous bilateral breast cancer in men: a case report and review of the literature

Breast carcinoma is a rare disease in men, and bilateral cases are extremely uncommon. The rarity of male breast carcinoma and the small number of large studies on this topic have made it necessary to extrapolate treatment standards and outcomes from those established for women. Between 1997 and 2007, 75 men with breast cancer were referred to our institute, and the bilateral case we present here was the only one we have observed since 1994. The goal of our work was to contribute to the available literature with this extremely unusual presentation of the disease.     

Preoperative angiography of the iliofemoral vessels in hip revision surgery of massive acetabular bone defects

Hip arthroplasty, and particularly revision surgery, may be complicated by injury to the large vessels on rare occasions, and this can be responsible for severe sequelae. The potential for vascular damage is increased when acetabular osteolysis is followed by medial dislocation of the socket. We report preliminary experience in performing preoperative arteriography of the iliofemoral vessels in 15 patients affected with endopelvic protrusion of the acetabular component. Digital angiography was helpful in defining the precise relationship between the arteries and the prosthesis. When the cup revealed a close proximity to the major vascular structures (10 cases), revision hip surgery was preceded by a laparotomic approach to isolating pelvic vessels, thus permitting an immediate control of the potentially massive bleeding. Received: 3 June 2000/Accepted: 26 June 2000