Lactate as a Predictor of 30-Day Mortality in Cardiogenic Shock

Background/Objectives: This study sought to evaluate the efficacy of various lactate measurements within the first 24 h post-intensive care unit (ICU) admission for predicting 30-day mortality in cardiogenic shock patients. It compared initial lactate levels, 24 h levels, peak levels, and 24 h clearance, alongside the Simplified Acute Physiology Score 3 (SAPS3) score, to enhance early treatment decision-making. Methods: A retrospective analysis of 64 patients assessed the prognostic performance of lactate levels and SAPS3 scores using logistic regression and AUROC calculations. Results: Of the baseline parameters, only the SAPS3 score predicted survival independently. The lactate level after 24 h (LL) was the most accurate predictor of mortality, outperforming initial levels, peak levels, and 24 h-clearance, and showing a significant AUROC. LL greater than 3.1 mmol/L accurately predicted mortality with high specificity and moderate sensitivity. Conclusions: Among lactate measurements for predicting 30-day mortality in cardiogenic shock, the 24 h lactate level was the most effective one, suggesting its superiority for early prognostication over initial or peak levels and lactate clearance.

Identification and characterization of MTR1, a novel gene with homology to melastatin (MLSN1) and the trp gene family located in the BWS-WT2 critical region on chromosome 11p15.5 and showing allele-specific expression

Alterations within human chromosomal region 11p15.5 are associated with the Beckwith-Wiedemann syndrome (BWS) and predisposition to a variety of neoplasias, including Wilms' tumors (WTs), rhabdoid tumors and rhabdomyosarcomas. To identify candidate genes for 11p15. 5-related diseases we compared human genomic sequence with expressed sequence tag and protein databases from different organisms to discover evolutionarily conserved sequences. Herein we describe the identification and characterization of a novel human transcript related to a putative Caenorhabditis elegans protein and the trp (transient receptor potential) gene. The highest homologies are observed with the human TRPC7 and with melastatin 1 ( MLSN1 ), whose transcript is downregulated in metastatic melanomas. Other genes related to and interacting with the trp family include the Grc gene, which codes for a growth factor-regulated channel protein, and PKD1/PKD2, involved in polycystic kidney disease. The novel gene presented here (named MTR1 for MLSN1 - and TRP -related gene 1) resides between TSSC4 and KvLQT1. MTR1 is expressed as a 4.5 kb transcript in a variety of fetal and adult tissues. The putative open reading frame is encoded in 24 exons, one of which is alternatively spliced leading to two possible proteins of 872 or 1165 amino acids with several predicted membrane-spanning domains in both versions. MTR1 transcripts are present in a large proportion of WTs and rhabdomyosarcomas. RT-PCR analysis of somatic cell hybrids harboring a single human chromosome 11 demonstrated exclusive expression of MTR1 in cell lines carrying a paternal chromosome 11, indicating allele-specific inactivation of the maternal copy by genomic imprinting.

Novel WT1 mutation, 11p LOH, and t(7;12) (p22;q22) chromosomal translocation identified in a Wilms' tumor case

About 5-10% of sporadic Wilms' tumors (WT) are associated with mutations in the Wilms' tumor 1 gene (WT1). More than 90% of patients with Denys-Drash syndrome (DDS; characterized by renal nephropathy, gonadal anomaly, and predisposition to WT) show constitutional intragenic WT1 mutations. We describe a novel WT1 stop-mutation in exon 2. This heterozygous germline mutation was detected in a one-year-old girl who was bilaterally affected with Wilms' tumor but without any other clinical manifestations of DDS. The C-to-A transversion is predicted to result in a polypeptide comprising only the first 165 amino acids of the WT1 protein. Loss of heterozygosity (LOH) studies comparing tumor DNA with lymphocyte DNA revealed LOH for the entire short arm of chromosome 11 in tumor tissue. In addition to the chromosome 11 lesions, the tumor showed a seemingly balanced chromosomal translocation t(7;12) (p22;q22) as the only visible cytogenetic aberration.

[Splenic rupture in infectious mononucleosis]

A 22 year old male with infectious mononucleosis, who stated a history of trauma to his left thoracic wall, developed an acute abdomen with symptoms of shock. A ruptured spleen was suspected. This working diagnosis, which was supported by ultrasound led to a splenectomy the initial diagnosis. The case report of this rare complication--due to the increased vulnerability of the spleen capsula in infectious mononucleosis--is highlighting the possible danger of splenic rupture. As of today, emergency splenectomy without any compromise ist still the safest state of the art therapy.

[Experimental peritoneal calcinosis--glucocorticoid as inhibitor]

Peritoneal disturbances in the course of continuous ambulatory peritoneal dialysis (CAPD) are therapeutical relevant. Even calcifications are described in rarely cases. Concerning these cases an experimental model is known being created by Selye and belonging to the calciphylactic concept. In 8 female Wistar rats (weighing 140 to 180 g) this experiment was reproduced and in a similar series an inhibition was achieved by intraperitoneal application of a glucocorticoid. Experiments in this kind give a pathogenetic contribution for peritoneal disturbances and also possible therapeutic hints.

[Intrathoracic hemorrhage of the intra-abdominal organs following diaphragmatic rupture. A rare cause of hemothorax]

After posttraumatic diaphragm ruptures in some cases life threatening haemorrhages from intraabdominal organs (especially from the spleen) into the thorax were found. In general, the diagnosis cannot be established by peritoneal lavage or abdominal sonography. And in case of emergency, there is often not enough time to obtain a computed tomography. It is therefore extremely important for the patient's prognosis that the surgeon initially performing treatment be aware of this cause of bleeding. Correct interpretation of the chest x-ray, for instance in the case of stomach air in a left basal shadow above the diaphragm, can confirm the suspicion, and the urgently required operation can be performed in time.

[Ultrasound-controlled percutaneous puncture of pancreatic pseudocysts]

The puncture of pancreatic pseudocysts with the help of ultrasound is an attempt of treatment without putting too much strain on the patient. In a number of cases a definitive emptying of cysts is successful so that a surgical intervention with application of an interior drainage can be avoided. Of 4 male patients of medium age treated 2 were successfully to be treated. The casuistics of one of the patients is reported. Under the point of view that a sonographically assisted intervention increases the security of the puncture therapy the complex of problems is outlined.

[Adult celiac disease with secondary hyperparathyroidism]

After a pregnancy the 26-year-old patient complained of pain in several joints. Waddling gait and light-grey excrements were conspicuous. Radiologically signs of calcium salt reduction with hank-like bone structures in both forearms. Hypocalcaemia, hyperphosphataemia, parthormone in the serum increased. Villi could not be proved by aspiration biopsy in the small intestine. The bone biopsy spoke for a secondary hyperparathyroidism. By glutene-free nutrition the patient was without pain after several months and was able to go without hindrance after one year.

[Coumarin necrosis in Klinefelter's syndrome]

A coumarin necrosis of the buttocks skin occurred in a patient with a Klinefelter's syndrome. In the acute stage of the complication the oestrogen activity was increased which is decreased in other persons with this arrangement of chromosomes. It is proposed to analyze the oestrogenes in urine of male patients or of females in the postclimacteric period with coumarine necroses before a treatment with sexual hormones.

[Pancreas carcinoma in the rat (attempts at implantation)]

It is reported on the technique of transplantation of a carcinoma on the pancreas of the rat. As to the origin the malignoma used is a tumour induced by Methyl-Yellow and known as solid form of the Zajdela-hepatoma. Out of 50 transplantation experiments 48 were successful (96%). After continuous growth regional formations of metastases were observed. Death took place in the 3rd week after transgression of the borders of the organs under the picture of cachexia.