Preoperative predictors of the need for allogeneic blood transfusion in lung cancer surgery.

BACKGROUND: The use of blood-saving techniques in elective surgery can produce a favorable cost-benefit ratio only when there is a reasonable likelihood that transfusion will be required. To apply a targeted blood-sparing technique in lung cancer surgery, the patient's preoperative characteristics that predict the use of allogeneic blood transfusion (ABT) in this practice were investigated. STUDY DESIGN AND METHODS: One hundred seventy-three consecutive patients who underwent primary lung cancer surgery were included in this retrospective study. Clinical and epidemiologic variables, lung tumor extension (TNM staging), and surgery type were analyzed by logistic regression to discover the preoperative predictors of ABT. RESULTS: Thirty patients, 17.3 percent of all who underwent surgery and 19.9 percent of those who underwent resolvent surgery, received ABT. Excluding a patient who needed 18 units of RBCs, the number of ABT units required by transfused patients was 1. 93 +/- 0.88 (mean +/- SD). Extensive surgery, patient's age (< or =64 years), and elevated erythrocyte sedimentation rate (>45 mm/hour) were the preoperative variables that influenced the need for ABT. The definitive predictive model was able to recognize 82.3 percent of patients who received ABT and 95.6 percent of those who did not. CONCLUSION: A predictive model can preoperatively identify patients at risk for needing ABT in lung cancer surgery. The model could be utilized to tailor blood-sparing intervention programs.

[MALT lymphoma of the left lacrimal and mammary glands, liver cirrhosis caused by HCV and type II cryoglobulinemia]. / Linfoma MALT delle ghiandole lacrimale e mammaria di sinistra, cirrosi epatica da HCV e crioglobulinemia di tipo II.

We describe a case of MALT (mucosa-associated lymphoid tissue) lymphoma associated to post-hepatitis C liver cirrhosis, type II cryoglobulinaemia, gastrointestinal bleedings and thromboses. HCV infection justified the association between the first three pathologies, while gastrointestinal bleedings and thromboses were respectively attributed to portal hypertension secondary to liver cirrhosis and to some thrombophilic conditions. Among the latter there was also an antithrombin III deficiency. The singularity of the case and some difficulties met in its treatment, justify the report.

Non-Hodgkin's lymphoma with rheumatism-like presentation and multiple cystic and nodular lesions in the liver.

We report the case of a non-Hodgkin's lymphoma in an isolated and not previously diagnosed "adult polycystic liver disease". In this case, a rheumatism-like presentation was associated with the discovery of multiple nodular and cystic lesions in the liver. Of these, the former were related to lymphoma involvement, the latter to pre-existent liver disease. The singularity of the case, not previously reported, and some difficulties met in diagnosing the two pathologies, justify the report.

[The erroneous diagnosis of posttraumatic splenic rupture and cardiorespiratory arrest following laparotomy in a subject occupationally exposed to low environmental temperatures]. / Erronea diagnosi di rottura post-traumatica di milza e arresto cardiorespiratorio successivo a laparotomia in soggetto professionalmente esposto a basse temperature ambientali.

We describe the case of a worker professionally exposed to low environmental temperatures who presented anaemia with abdominal pain in apparent succession to a thoraco-abdominal trauma following a car accident. A laparotomy, carried out because of suspected post-traumatic spleen rupture, was complicated by a transitory cardiorespiratory arrest. Subsequently, the patient resulted to be suffering from acute cold agglutinin disease secondary to Mycoplasma pneumoniae infection and from a precedently undiagnosed hypertrophic cardiomyopathy. The temporary removal of the patient from his job contributed to the favourable evolution of the haemolytic disease. Together with the case description, we provide an explanation of the various manifestations observed.

Misdiagnosis of post-traumatic splenic rupture in a patient with acute cold agglutinin disease due to Mycoplasma infection.

We describe a case of cold agglutinin disease, secondary to Mycoplasma pneumoniae infection, which presented with anaemia and abdominal pains in apparent succession to a thoraco-abdominal trauma. An exploratory laparotomy, carried out because of suspected post-traumatic rupture of the spleen, was complicated by a transitory cardiorespiratory arrest. The subsequent and correct diagnosis of the mycoplasmal infection and the cold agglutinins led to specific and successful therapy. The previously unknown hypertrophic cardiomyopathy was a contributing factor to the cardiorespiratory arrest.

Prognostic value of some laboratory parameters in a group of intravenous drug users in the early stages of HIV infection.

During a 5 year follow-up we found significantly reduced survival for non-accidental deaths in 37 intravenous drug users (IVUDs) in the early stages of HIV infection when compared with 32 HIV-negative IVUDs (p = 0.017). Moreover, in HIV-positive subjects, survival was significantly reduced for those groups which at the beginning of the follow-up showed the following values: circulating CD4+ lymphocytes <250/mmc (p = 0.007), CD4+/CD8+ ratio < 0.5 (p = 0.027), serum albumin < 4.13 g/dl (p = 0.045), IgA > or = 2.5 g/l (p = 0.043), IgM < 1.8 g/L (p = 0.041) and platelet count < 130 x 1,000/mmc (p = 0.038). In HIV positive patients, the value of 250 units/mmc for the circulating CD4+ lymphocytes still remained the most predictive parameter of increased mortality for disease at 5 years, even following investigations conducted with other cut-offs. Relationships existing at the beginning of the follow-up between circulating CD4+ lymphocytes and other prognostic parameters suggest that IgA (r = -0.34; p = 0.04), serum albumin (r = 0.33; p = 0.05), and CD4+/CD8+ ratio (r = 0.72; p = 0.0001), but not IgM (r = 0.25; N.S.) and platelets (r = 0.07; N.S.), are dependent variables of shortened survival.

Modification of phlogosis indices in pneumonia during antibiotic therapy.

50 consecutive cases of pneumonia were treated using a standardized diagnostic-therapeutic protocol. The variations of the more common phlogosis indices (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], leucocytes) during the antibiotic therapy were evaluated, together with clinical progress. Comparative evaluations of the phlogosis indices were taken as well as the X-ray picture. The data analysed, according to the literature, showed a significantly faster and more widespread response to the therapy by the CRP, in respect to ESR and the leucocytes number. This data has been substantially confirmed even in individual groups into which the case study was subdivided. In the "compromised" (according to the British Thoracic Society) patients, the fall in the CRP level was not so early as in the "uncompromised" group. There did not seem to be however different behaviour of ESR and leucocytes between these two groups. Modifications in these two tests over time were rarely significant. An age equal to or greater than 70 appears the element which best defines the state of "compromised host". A comparison of the clinical progress with the variations of the tests of phlogosis and the radiographic tests confirms the usefulness of CRP as an early index of the clinical evolution and the lateness of X-ray tests.

Serum albumin and others parameters in intravenous drug users HIV-infected.

In 37 intravenous drug users (IVDUs) in the first stages of HIV-infection (17 in stage II and 20 in stage III according to CDC), compared with 32 IVDUs HIV-negatives, we found a significant decrease in circulating leucocytes (p less than 0.01), lymphocytes (p less than 0.005), platelets (p less than 0.005), serum albumin (p less than 0.005), and C3 (p less than 0.02) and significant increase in serum gammaglobulins (p less than 0.0005) and IgG (p less than 0.0005). On the other hand no difference was observed in hemoglobin and in IgA levels; nevertheless an inverse relationship between serum IgA and CD4+ lymphocytes was present in HIV-positive (HIV+) patients (r = -0.34; p = 0.04). This observation agrees with that is observed in the advanced stages of HIV-infection, which presents an increase in IgA serum levels. In these stages this fact could be due to a decrease of secretory IgA, with a deficient barrier effect; the consequent recirculation of intestinal antigens should enhance the antibody production, as well as serum IgA. In the IVDUs HIV-infected a reverse correlation between albumin serum levels and the length of HIV-positivity (r = -0.44; p = 0.008) and a direct correlation between albumin serum levels and circulating CD4+ lymphocytes (r = 0.37; p = 0.05) were present. There was no direct linear relationship between albumin serum levels and creatinine, on the contrary to what was observed in the control group. The decrease of albumin levels could have a prognostic value as in other clinical conditions, in which it is associated with a higher mortality risk. Many factors could act to decrease albumin levels, but the most important one is perhaps the malnutrition of HIV-infected patients that can also be present in the first stages of infection, negatively influencing the associated immunodeficiency.

Hyperosmolar hyperglycemic nonketotic coma in Waldenström's macroglobulinemia associated with type II diabetes and complicated by pulmonary tuberculosis.

In this paper we describe a successfully treated case of hyperosmolar hyperglycemic non ketotic coma (HHNC). The HHNC was observed in a patient affected by Waldenström's macroglobulinemia, associated with type II diabetes and complicated by pulmonary tuberculosis. Hyperosmolar hyperglycemic nonketotic coma is a clinical condition with a high mortality rate associated with a severe increase in blood viscosity. This increase in blood viscosity justifies several clinical manifestations of the HHNC. We believe that an increase in the blood viscosity produced by the simultaneous presence of the single diseases mentioned above may have encouraged the development of hyperosmolar coma in the case reported.

[Vitiligo appearing after contact with mud containing solvents: an occupational cause?]. / Vitiligine comparsa dopo contatto con fango a base di solventi: sua origine professionale?

The authors describe one case of Vitiligo in a worker employed in a firm for the exploitation of underground energetic products. The disease occurred after contact with the mud used for the drilling containing aromatic, aliphatic and chlorinated hydrocarbons. The possible occupational cause of the disease, as more solvents in the mud have the structure of aromatic hydrocarbons is discussed.

[Serum levels of IgE in liver cirrhosis]. / Livelli sierici di IgE in corso di cirrosi epatica.

In a study of 18 subjects with liver cirrhosis, mainly of alcoholic origin, the Authors found an average increase in the serum levels of IgE, IgG, IgA, and IgM, with respect to control subjects (p less than 0.001). Nonetheless, no correlation was found in either of the cirrhotic or control groups, between serum levels of IgE and other immunoglobulins. Also, in 11 of the 18 patients with cirrhosis, a linear and direct correlation between the amount of decreased phagocytic activity in the liver (studied by hepatic scanning, using Technetium Tc 99m sulfur colloid), and the increase in serum levels of IgG (p less than 0.001) and of IgA (p less than 0.05), but not of IgE, was observed. In respect to the controls, patients with cirrhosis also showed a significant decrease in circulating T-lymphocytes OKT8+ (p less than 0.05), and a significant increase in the OKT4+/OKT8+ ratio (p less than 0.01), but no significant modification of the eosinophils and circulating T-lymphocytes OKT3+ and OKT4+. A significant correlation was present in the patients with cirrhosis, but not in the controls, between the serum levels of IgE and circulating eosinophils (p less than 0.05), and between the levels of IgM and the OKT4+/OKT8+ ratio (p less than 0.05). In the healthy control subjects, a linear, inverse correlation was present between serum IgE and circulating OKT8+ (p less than 0.05) and a direct, linear correlation was found between IgE and the OKT4+/OKT8+ ratio (p less than 0.05); both, on the other hand, were absent in the patients with cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lymphocyte subpopulations in patients with liver cirrhosis]. / Sottopopolazioni linfocitarie in pazienti con cirrosi epatica.

We have characterized some subset of T-lymphocytes by monoclonal antibodies in 30 patients affected by hepatic cirrhosis. The OKT3 cells was significantly decreased so as OKT8. The OKT4/OKT8 ratio was significantly raised. The reduction of OKT3 was similar to that observed by other Authors. Our other results have a correlation with the alcoholic etiology of the observed disease.