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Pfister R.,University of Cologne | Kochanek M.,University of Cologne | Leygeber T.,University of Cologne | Brun-Buisson C.,University Paris Est Creteil | And 8 more authors.
Critical Care

Introduction: Procalcitonin (PCT) is helpful for diagnosing bacterial infections. The diagnostic utility of PCT has not been examined thoroughly in critically ill patients with suspected H1N1 influenza.Methods: Clinical characteristics and PCT were prospectively assessed in 46 patients with pneumonia admitted to medical ICUs during the 2009 and 2010 influenza seasons. An individual patient data meta-analysis was performed by combining our data with data from five other studies on the diagnostic utility of PCT in ICU patients with suspected 2009 pandemic influenza A(H1N1) virus infection identified by performing a systematic literature search.Results: PCT levels, measured within 24 hours of ICU admission, were significantly elevated in patients with bacterial pneumonia (isolated or coinfection with H1N1; n = 77) (median = 6.2 μg/L, interquartile range (IQR) = 0.9 to 20) than in patients with isolated H1N1 influenza pneumonia (n = 84; median = 0.56 μg/L, IQR = 0.18 to 3.33). The area under the curve of the receiver operating characteristic curve of PCT was 0.72 (95% confidence interval (CI) = 0.64 to 0.80; P < 0.0001) for diagnosis of bacterial pneumonia, but increased to 0.76 (95% CI = 0.68 to 0.85; P < 0.0001) when patients with hospital-acquired pneumonia and immune-compromising disorders were excluded. PCT at a cut-off of 0.5 μg/L had a sensitivity (95% CI) and a negative predictive value of 80.5% (69.9 to 88.7) and 73.2% (59.7 to 84.2) for diagnosis of bacterial pneumonia, respectively, which increased to 85.5% (73.3 to 93.5) and 82.2% (68.0 to 92.0) in patients without hospital acquired pneumonia or immune-compromising disorder.Conclusions: In critically ill patients with pneumonia during the influenza season, PCT is a reasonably accurate marker for detection of bacterial pneumonia, particularly in patients with community-acquired disease and without immune-compromising disorders, but it might not be sufficient as a stand-alone marker for withholding antibiotic treatment. © 2014 Pfister et al.; licensee BioMed Central Ltd. Source

Rami-Porta R.,Hospital Universitari Mutua Terrassa | Bolejack V.,Cancer Research and Biostatistics | Goldstraw P.,Imperial College London
Seminars in Respiratory and Critical Care Medicine

The seventh edition of the tumor, node, and metastasis (TNM) classification is based on the proposals of the Staging Project of the International Association for the Study of Lung Cancer (IASLC). The analyses of the IASLC international database of 81,015 patients diagnosed with lung cancer between 1990 and 2000 were used to validate the TNM descriptors. The changes include: the subclassification of T1 and T2 tumors into T1a (≤2 cm) and T1b (>2 and ≤3 cm), and T2a (>3 and ≤5 cm) and T2b (>5 and ≤7 cm), respectively; the reclassification of T2 tumors >7 cm as T3; the reclassification of T4 tumors by additional nodules in the same lobe of the primary tumor as T3; the reclassification of M1 tumors by additional nodules in another ipsilateral lobe as T4; the reclassification of pleural and pericardial dissemination, and contralateral M1 nodules as M1a; and the separation of intrathoracic (M1a) and extrathoracic (M1b) metastases. Other innovations include the emphasis on the use of the TNM classification for small cell carcinoma, the inclusion of bronchopulmonary carcinoids into this staging system, the proposal of a new lymph node map, and the adoption of a new, internationally agreed definition of visceral pleura invasion. All these changes improve the separation of tumors with significantly different prognosis. © Georg Thieme Verlag KG Stuttgart. New York. Source

As the radiation received in conventional cystography is about 20 times higher than radionuclide cystography and the sensitivity of the last is higher in order to diagnose vesicoureteral reflux, we consider the use of radionuclide cystography in early detection of reflux in patients with prenatally detected hydronephrosis. Between 2003 and 2009, a study of neonates with prenatal history of hydronephrosis was performed in order to rule out reflux. Our protocol was as follows: The diagnosis was confirmed by postnatal ultrasound at 1 week (in this case patient initiate antibiotic prophylaxis). A new ultrasound was repeated at 6 weeks, if the dilatation was larger than 8 mm at this time, direct radionuclide scintigraphy was performed. The patients were placed on prophylactic antibiotics until the screenining results were known. Conventional cystography was performed if a male infant showed severe dilatation, or in general in cases with parenchymatous atrophy or if a duplex system was suspected. In 13 (20%) of the 65 cases (18 kidneys) reflux was detected (3 minor, 8 moderate and 7 severe). In most cases, follow up was performed with radionuclide cystography. None of the patients with reflux placed on prophylactic antibiotics developed a febrile urinary tract infection during the first year of life. Direct radionuclide cystography is a useful diagnostic method in early detection of vesicoureteral reflux in patients with prenatal hydronephrosis with higher sensitivity than conventional cystography, and with an important advantage concerning radiation of the patient. Patients screened and placed on prophylactic antibiotics are probably going to present less episodes of pielonephrytis. Source

Garcia-Domingo M.I.,Hospital Universitari Mutua Terrassa | Pares D.,Hospital Del Mar | Espin-Basany E.,Hospital de la Vall DHebron | Biondo S.,Hospital de Bellvitge | And 3 more authors.
Archives of Surgery

Objectives: To assess the prevalence of surgical site infection (SSI) after elective operations for colon and rectal cancer after the application of evidence-based preventive measures and to identify risk factors for SSI. Design: Prospective, observational, multicenter. Setting: Tertiary and community public hospitals in Catalonia, Spain. Patients: Consecutive patients undergoing elective surgical resections for colon and rectal cancer during a 9-month period. Main Outcome Measures: The prevalence of SSI within 30 days after the operations and risk factors for SSI. Results: Data from 611 patients were documented: 383 patients underwent operations for colon cancer and 228 underwent operations for rectal cancer. Surgical site infection was observed in 89 (23.2%) colon cancer patients (superficial, 12.8%; deep, 2.1%; and organ/space, 8.4%) and in 63 (27.6%) rectal cancer patients (superficial, 13.6%; deep, 5.7%; and organ/space, 8.3%). For colon procedures, the following independent predictive factors were identified: for incisional SSI, open procedure vs laparoscopy; for organ/space SSI, hyperglycemia at 48 hours postoperatively (serum glucose level, >200 mg/dL), ostomy, and National Nosocomial Infection System index of 1 ormore. In rectal procedures, no risk factors were identified for incisional SSI; hyperglycemia at 48 hours postoperatively (serum glucose level,>200 mg/dL) and temperature lower than 36°C at the time of surgical incision were associated with organ/space SSI. Conclusion: The prevalence of SSI in elective colon and rectal operations remains high despite the application of evidence-based preventive measures. ©2011 American Medical Association. All rights reserved. Source

Eberhardt W.E.E.,University of Duisburg - Essen | Mitchell A.,Cancer Research and Biostatistics | Crowley J.,Cancer Research and Biostatistics | Kondo H.,Kyorin University | And 5 more authors.
Journal of Thoracic Oncology

Introduction: The aim of this study is to analyze all metastatic (M) categories of the current tumor, node, and metastasis (TNM) classification of lung cancer with the objective of providing suggestions for modifications of the M component in the next edition of the TNM classification for lung cancer. Methods: The new International Association for the Study of Lung Cancer lung cancer database was created from 94,708 patients diagnosed as having lung cancer between 1999 and 2010. Including further patients submitted through the electronic data capture system to Cancer Research and Biostatistics until 2012, all together 1059 non-small-cell lung cancer cases were available for a detailed analysis of the clinical M categories. Overall survival was calculated using the Kaplan-Meier method, and prognosis was assessed using a Cox proportional hazards regression analysis. Results: No significant differences were found among the M1a (metastases within the chest cavity) descriptors. However, when M1b (distant metastases outside the chest cavity) were assessed according to the number of metastases, tumors with a single metastasis in a single organ had significantly better prognosis than those with multiple metastases in one or several organs. Conclusions: In this revision of the TNM classification, cases with pleural/pericardial effusions, contralateral/bilateral lung nodules, contralateral/bilateral pleural nodules, or a combination of multiple of these parameters should continue to be grouped as M1a category. Single metastatic lesions in a single distant organ should be newly designated to the M1b category. Multiple lesions in a single organ or multiple lesions in multiple organs should be reclassified as M1c category. This new division can serve as a first step into providing rational definitions for an oligometastatic disease stage in non-small-cell lung cancer in the future. © 2015 by the International Association for the Study of Lung Cancer. Source

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