Primary malignant mixed Müllerian tumor arising from the mesorectum with a synchronous ovarian cancer: a case report and review of the literature.

INTRODUCTION: Extragenital malignant mixed Müllerian tumor is an extremely rare presentation of malignant mixed Müllerian tumor, especially when combined with a synchronous ovarian cancer. CASE PRESENTATION: We report the clinical course and pathologic findings of a case of mesorectal malignant mixed Müllerian tumor with synchronous ovarian cancer, in a 50-year-old, gravida 0, para 0, Han Chinese woman with regular menstruation. This is the sixteenth case in the English literature of extragenital malignant mixed Müllerian tumor combined with synchronous or metachronous malignancy reported. CONCLUSION: Although extragenital malignant mixed Müllerian tumor is very rare and has a poor prognososis, a longer survival time might be achieved with treatment by cytoreductive surgery, radiotherapy and chemotherapy.

Gastric glomus tumor: a case report and review of the literature.

Glomus tumors are usually thought of as benign tumors although some malignant cases have been reported. These tumors arise from the glomus body and are commonly observed in the dermis or subcutis, but rarely in visceral organs. Here, we report a 37-year-old female who initially presented with epigastric discomfort. The preoperative diagnosis was a gastrointestinal stromal tumor. A minilaparotomy was done with an incision length of 4 cm followed by wedge resection. The final pathologic diagnosis was a gastric glomus tumor. We have reviewed the only five cases of gastric glomus tumors that have been reported to date in Taiwan, including the present case, and compare these cases with those reported in other countries. The age of onset ranged from 35 to 69 years (median, 41 years) with female dominance (4 females and 1 male). Two of the five cases presented with gastrointestinal bleeding with an ulcerative tumor, and the others only had epigastric discomfort. The tumors were located around the prepyloric antrum of the stomach. No definite diagnosis was reached before surgery in any of the five cases, and all of the tumors were considered likely to be benign lesions. Clinicians who treat such patients should be aware of this problem because of the difficulty in accurate preoperative diagnosis.

ICU discharge APACHE II scores help to predict post-ICU death.

BACKGROUND: The mortality rate after discharge from the intensive care unit (ICU) (so called post-ICU mortality) has remained high (8.6-23.6%) during the past 15 years. The object of this study was to examine the effects of the severity of illness at ICU discharge assessed using the Acute Physiology and Chronic Health Evaluation (APACHE) on the post-ICU mortality rate. METHODS: A 6-month prospective observational study was conducted in the medical ICU of a university affiliated tertiary care hospital. RESULTS: A total of 203 patients were discharged from the ICU to general wards from December 1998 through June 1999, and 39 (19.2%) of the 203 discharged ICU patients subsequently died at hospital. Logistic regression analysis identified two independent risk factors for post-ICU mortality rate: discharge APACHE II score (Odds Ratio 1.17, 95% IC 1.10-1.25, p < 0.0001) and male gender (OR 3.24, 95% CI 1.26-8.33, p = 0.015). Patients discharged from the ICU with discharge APACHE II scores of 17 or greater had the mortality rate of 37.3% compared with 9.4% for those with discharge APACHE II scores of less than 17. The former group were significantly older (p < 0.0001) and had higher proportion of requiring tracheostomy or hemodialysis during ICU admission (p < 0.0001) than the latter group. CONCLUSION: In our study, a higher APACHE II score calculated at ICU discharge and male gender were independent risk factors for post-ICU death. Identifying patients with discharge APACHE II scores of 17 or greater helps to predict post-ICU death.