Intensive care unit-acquired blood stream infections: a 5-year retrospective analysis of a single tertiary care hospital in Korea.

PURPOSE: Bloodstream infections (BSIs) are serious complications with high mortality and morbidity in patients with critical illness. This study was conducted to analyze the clinical and microbiological characteristics as well as outcomes in patients with intensive care unit (ICU)-acquired BSIs. METHODS: Data from 1,545 patients admitted to the ICU were retrospectively collected from January 2005 to December 2010. ICU-acquired BSI was defined as a positive blood culture for a clinically significant bacterial or fungal pathogen obtained >72 h after admission to the ICU. Data on clinical and demographic characteristics, comorbid illness, causes of infections, causative pathogens, and clinical outcomes were analyzed. RESULTS: Among the 1,545 ICU patients analyzed, 129 ICU-acquired BSIs occurred in 124 patients. Catheter-related BSIs (CR-BSIs) and ventilator-associated pneumonia (VAP) were the most common causes (29.4 and 20.9%, respectively). The most common isolates were Staphylococcus aureus in 35 (25.7%) and Candida species in 32 (24.8%) cases. Ninety-eight patients died (overall hospital mortality rate, 75.9%). ICU-acquired BSI-related mortality occurred in 23 (63.8%) and 7 (19.4%) of the VAP and CR-BSIs cases, respectively. The most commonly isolated microorganisms from these fatalities were S. aureus (12, 25.7%) and Acinetobacter species (12, 25.7%). In 99 ICU-acquired BSI cases, patients did not receive adequate empirical antimicrobial treatment at the onset of BSIs, whereas the patients in 30 cases did. CONCLUSION: ICU-acquired BSIs may be associated with high mortality in patients with critical illness. Meticulous infection control and adequate treatment may reduce ICU-acquired BSI-related mortality.

MR traceable delivery of p53 tumor suppressor gene by PEI-functionalized superparamagnetic iron oxide nanoparticles.

Cancer gene therapy involves the replacement of missing or altered genes with healthy ones. In this paper, we have proposed tumor suppressor gene-carrying superparamagnetic iron oxide nanoparticles (SPIONs) for anti-cancer gene therapy. Thermally crosslinked SPIONs (TCL-SPIONs) were conjugated with branched polyethylenimine (PEI 1800 Da) by EDC-NHS chemistry for p53 plasmid DNA delivery. The morphology of the bPEI conjugated TCL-SPIONs (bPEI-TCL-SPION) and pDNA-loaded bPEI-TCL-SPION nanoparticles was measured using transmission electron microscopy (TEM). The particle sizes of the pDNA-loaded bPEI-TCL-SPION nanoparticles were also confirmed by dynamic light scattering, and ranged from 100 to 130 nm, depending on the molar charge ratio. The fluorescently labeled pDNA was complexed with bPEI-TCL-SPION and its intracellular internalization was investigated using confocal microscopy. The p53 plasmid-loaded bPEI-TCL-SPION nanoparticles achieved significantly higher p53 tumor suppressor gene expression and cellular viability compared to positive controls. The expressed wild-type p53 protein suppressed tumor cell proliferation as compared to the mutant control. When transgene expression of the p53 tumor suppressor gene was evaluated at the mRNA level and quantified using real-time PCR, the results were highly dependent on the molar charge ratio (N/P) as well as the cancer cell type. SPIONs internalized within cancer cells were tracked by magnetic resonance (MR) imaging. It was concluded that bPEI-TCL-SPION could be used as efficient gene delivery carriers that can be tracked by MR imaging.

Prognostic value of preoperative radiological staging assessed by computed tomography in patients with nonmetastatic colon cancer.

PURPOSE: This study evaluated the prognostic value of preoperative locoregional staging in patients with colon cancer and who underwent curative resection. METHODS: A total of 536 consecutive patients who underwent curative resection for colon cancer from February 1999 to November 2007 were prospectively enrolled. The clinicopathological variables, including the radiological staging using computed tomography, were analyzed for the prognostic significance. RESULTS: The 5-year overall survival rates of the patients with radiological T1, T2, T3, and T4 were 96%, 89%, 75%, and 79%, respectively (P = 0.028). The 5-year overall survival rates were 83%, 76%, and 54%, respectively, for patients with radiological N0, N1, and N2 disease (P < 0.001). The 5-year overall survival rates of the patients with radiological TNM (tumor-node-metastasis) stages I, II, and III were 90%, 81%, and 70%, respectively (P < 0.001) and the 5-year overall survival rates of the patients with pathological TNM stages I, II, and III were 93%, 80%, and 70%, respectively (P = 0.001). On multivariate analysis, the radiological T and N categories remained independent prognostic factors for both overall survival and disease-free survival. CONCLUSION: Radiological staging is an independent predictor of long-term survival in the preoperative setting.

Unusual manifestation of endometrioid adenocarcinoma arising from subserosal cystic adenomyosis of the uterus: emphasis on MRI and positron emission tomography CT findings.

There are several reports of adenocarcinoma developing within adenomyosis of the uterus, but imaging features of MRI, including diffusion-weighted imaging (DWI) and positron emission tomography (PET)-CT, have not been published. Herein we report a rare case of endometrioid adenocarcinoma arising from subserosal cystic adenomyosis to emphasise the unusual growth features, as well as the imaging findings of the tumour on MRI and PET-CT.

Association of nodular regenerative hyperplasia of the liver with porto-pulmonary hypertension in a patient with systemic lupus erythematosus.

A 37-year old woman with systemic lupus erythematosus (SLE) complicated by pulmonary hypertension (PHT) was admitted to evaluate abnormal liver function. Radiological imaging study, including ultrasonography, computed tomography and magnetic resonance imaging and upper gastrointestinal endoscopy, revealed multiple hepatic nodules, hepatosplenomegaly and esophageal varices. Percutaneous needle liver biopsy showed non-cirrhotic hepatic nodules with hyperplastic hepatocytes surrounded by atrophic hepatocytes, confirming the diagnosis of nodular regenerative hyperplasia (NRH) associated with non-cirrhotic portal hypertension (PT). NRH of the liver is known to be a very rare hepatic manifestation in rheumatic diseases. This case shows the association of NRH with porto-pulmonary hypertension in SLE.

Acute gastrointestinal bleeding: contrast-enhanced MDCT.

With the introduction of multidetector row computed tomography (MDCT), CT is being considered a potential diagnostic method for patients with acute gastrointestinal (GI) bleeding. On arterial phase MDCT images, active GI bleeding is typically identified as a focal area of high attenuation within the bowel lumen, which represents a collection of contrast material that has been extravasated in association with arterial bleeding. Additional CT findings suggestive of acute GI bleeding are focal dilatation of fluid-filled bowel segment noted on contrast-enhanced CT and acute hematoma on unenhanced CT. In addition to detection of active bleeding, an advantage of contrast-enhanced MDCT is the ability to demonstrate morphologic changes in the GI tract, which could suggest specific conditions that cause acute GI bleeding such as intestinal tumors. Arterial phase contrast-enhanced MDCT is rapid, noninvasive, and accurate in detecting and localizing sites of bleeding in patients with acute GI bleeding. Contrast-enhanced MDCT may be a promising diagnostic option in patients with acute GI bleeding.

Mesenteric inflammatory myofibroblastic tumor mimicking a necrotized malignant mass in an adult: case report with MR findings.

Inflammatory myofibroblastic tumors are lesions that usually affect young adults and children. Numerous extrapulmonary sites of these tumors have been found, but the mesentery is a very unusual location for an inflammatory myofibroblastic tumor and it is extremely rare in an older patient. Inflammatory myofibroblastic tumor of the mesentery is often demonstrated as a large and infiltrative lesion with heterogeneous enhancement. Its diagnosis is recognized as difficult and it often mimics malignant tumor. We report a case of mesenteric inflammatory myofibroblastic tumor mimicking a necrotized malignant mass in a 55-year-old man who was examined with magnetic resonance imaging. To our knowledge, this is the first report of magnetic resonance imaging of mesenteric inflammatory myofibroblastic tumor with extensive central necrosis in an older patient.

Hepatocellular carcinoma after systemic chemotherapy: gadolinium-enhanced mr measurement of necrosis by volume histogram.

As a preliminary study, we measured the necrosis of advanced hepatocellular carcinoma (HCC) by volume histogram after systemic chemotherapy and correlated it with clinical data. Five patients with advanced HCC secondary to chronic hepatitis and cirrhosis underwent pretreatment and posttreatment MR examination on a 1.5 T MR scanner following systemic chemotherapy. MR sequences included dynamic enhanced fast spoiled gradient echo 3D images. Clinical response to chemotherapy, as determined by MR images, was measured as changes of both the total tumor volume and the percent of tumor necrosis by volume histogram algorithm. Four of five patients had clinical improvement. Three of these patients had no or minimal change of tumor volume; however, there was an increase in tumor necrosis in follow-up MR image. One patient of five with no change in tumor necrosis had no response and died at 3 months. Serial MR images showed increased irregular necrosis of advanced HCC after systemic chemotherapy, but stable volume, in patients who responded clinically to systemic chemotherapy.

Liver lesion conspicuity: T2-weighted breath-hold fast spin-echo MR imaging before and after gadolinium enhancement--initial experience.

PURPOSE: To evaluate the effect of a gadolinium chelate on T2-weighted breath-hold fast spin-echo magnetic resonance images of focal hepatic lesions. MATERIALS AND METHODS: In 21 patients with focal hepatic lesions, identical T2-weighted breath-hold fast spin-echo images were obtained before and after gadolinium enhancement and were compared regarding lesion-to-liver contrast-to-noise ratio, signal-to-noise ratio, lesion conspicuity, and vascular pulsation artifact. Image review was performed independently, in random order, by two experienced radiologists. RESULTS: For solid lesions, the lesion-to-liver contrast-to-noise ratio on enhanced images was significantly higher (P <.05) than that on nonenhanced images. For nonsolid lesions, however, there was no significant difference (P =.07). For both readers, lesion conspicuity for solid lesions on enhanced images was significantly higher than on nonenhanced images (P <.05). Severity of vascular pulsation artifact was not significantly different. CONCLUSION: Solid-lesion contrast on T2-weighted breath-hold fast spin-echo images improves after administration of a gadolinium chelate. These images should be obtained after, rather than before, gadolinium enhancement.

Imaging evaluation of ovarian masses.

Adnexal masses present a special diagnostic challenge, in part because benign adnexal masses greatly outnumber malignant ones. Determination of a degree of suspicion for malignancy is critical and is based largely on imaging appearance. Endovaginal ultrasonography (US) is the most practical modality for assessment of ovarian tumors because it is readily available and has a high negative predictive value. Morphologic analysis of adnexal masses is accurate for identifying masses as either low risk or high risk. The most important morphologic features are non-fatty solid (vascularized) tissue, thick septations, and papillary projections. Color Doppler US helps identify solid, vascularized components in a mass. Spectral Doppler waveform characteristics (eg, resistive index, pulsatility index) correlate well with malignancy but generally add little information to morphologic considerations. Computed tomography can help assess the extent of disease in patients before and after primary cytoreductive surgery. Magnetic resonance (MR) imaging is better reserved for problem solving when US findings are nondiagnostic or equivocal because, although it is more accurate for diagnosis, it is also more expensive. The signal intensity characteristics of ovarian masses make possible a systematic approach to diagnosis. Mature cystic teratomas, cysts, endometriomas, leiomyomas, fibromas, and other lesions can be accurately diagnosed on the basis of T1-weighted, T2-weighted, and fat-saturated T1-weighted MR imaging findings.

Postoperative pelvic lymphocele: treatment with simple percutaneous catheter drainage.

PURPOSE: To evaluate the effectiveness of simple percutaneous catheter drainage in the treatment of postoperative lymphocele. MATERIALS AND METHODS: Percutaneous catheter drainage of 23 symptomatic lymphoceles was performed with ultrasonographic (US) guidance in 20 patients who had undergone radical pelvic lymphadenectomy because of uterine malignancy. All lymphoceles were diagnosed on the basis of biochemical and cytologic findings in aspirated fluid. The drainage catheter was removed when the amount of daily drainage was less than 10 mL per day and when the lymphocele was seen at imaging to have resolved. Follow-up US was performed at 1, 3, and 6 months after catheter removal. The results were classified as success, partial success, or failure. RESULTS: Lymphoceles ranged in size from 5 x 4 x 3 to 25 x 10 x 10 cm. Mean total drainage volume was 2,012 mL (range, 300-17,240 mL). Fluid from 10 lymphoceles (43%) was positive at Gram staining and bacteriologic culture; fluid from 13 (57%) was sterile. Duration of catheter drainage was 3-49 days (mean, 22 days). Twenty (87%) lymphoceles resolved completely; three (13%) recurred. Two recurrent lymphoceles were again treated with percutaneous catheter drainage; the third resolved spontaneously 5 months after catheter removal. Successful treatment was ultimately achieved in all patients. Postprocedural complications occurred in four patients. One had a secondary infection of lymphocele; one, catheter dislodgment; and two, skin infection at the site of catheter insertion. CONCLUSION: Percutaneous catheter drainage is safe and effective for treatment of symptomatic postoperative lymphoceles.

Portal, mesenteric, and splenic vein thromboses after splenectomy in a patient with chronic myeloid leukemia variant with thrombocythemic onset.

Portal, mesenteric, or splenic vein thrombosis is a very uncommon complication with significant mortality in the patients undergoing splenectomy for hematologic disorders. We report a 49-year-old woman who developed portal, superior mesenteric, and splenic vein thromboses after splenectomy. Four years before the event, she presented with a marked thrombocytosis and was diagnosed to have chronic myeloid leukemia variant with thrombocythemic onset as evidence by Philadelphia (Ph1) chromosome and a b3a2 BCR/ABL transcript. Six weeks after splenectomy, she developed severe epigastric pain. The diagnosis of thromboses of portal, mesenteric, and splenic veins was made by computed tomography scan and Doppler sonogram. She was successfully treated with antegrade intraarterial urokinase therapy via superior mesenteric artery and long-term anticoagulant therapies. To our knowledge, our patient is the first case of portal, mesenteric, and splenic vein thromboses after splenectomy in a patient with CML variant with thrombocythemic onset successfully treated with antegrade intraarterial thrombolytic therapy followed by anticoagulant therapies.

A case of adrenal cavernous hemangioma.

Adrenal hemangiomas are rare tumor. Only 29 surgical cases have been reported. Although rare, adrenal hemangiomas should be included in the differential diagnosis of adrenal neoplasms. We report an additional case of adrenal hemangioma that was removed surgically, and the pertinent literature is reviewed.