Gastric tonometry versus cardiac index as resuscitation goals in septic shock: a multicenter, randomized, controlled trial

Introduction  

Resuscitation goals for septic shock remain controversial. Despite the normalization of systemic hemodynamic variables, tissue hypoperfusion can still persist. Indeed, lactate or oxygen venous saturation may be difficult to interpret. Our hypothesis was that a gastric intramucosal pH-guided resuscitation protocol might improve the outcome of septic shock compared with a standard approach aimed at normalizing systemic parameters such as cardiac index (CI).     

Reconstruction of complex facial defects after radical resection of advanced skin cancers

Management of patients with extensive facial skin cancers is a challenge. We present a series of nine patients with extensive facial skin cancers and our experience with managing these patients.     

The two faces of presbyacusis: hearing impairment and psychosocial consequences

A study of hearing disability and handicap was performed in a sample of elderly persons living in an urban area of G?teborg, Sweden. The aim was to describe the psychosocial consequences of presbyacusis. For this purpose, elderly persons with fairly uncontaminated presbyacusis were chosen. The study group consisted of 154 persons (59 men and 95 women) between the ages of 70 and 91 with a median age of 78 years. The methods used included a self-assessed hearing instrument, pure-tone audiometry, and registration of desired services regarding rehabilitative audiology. The questionnaire included 26 items, 20 of them within four areas: assessment of normality, communication, quality of life and environment/orientation. The results showed that the assessment, whether the hearing was normal or not, was correlated with audiometrically measured hearing. Many of the participants expressed concern that their hearing had deteriorated. Communication situations with background noise were troublesome for many of the participants, but they had only minor problems when performing daily activities like shopping. The quality of life in general was only mildly affected by hearing loss. Items regarding environment and orientation showed varying results. Some everyday aspects of listening were related to hearing ability, but directional hearing was not correlated with measured hearing. In spite of the participants' worry about hearing deterioration, only 8% requested hearing aids as a result of the examination.     

Adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct: a case report

OBJECTIVES: To present the clinical presentation, workup, surgical approach, and pathological findings of the first case report of a patient with adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct. STUDY DESIGN: Retrospective review of the records of a case of adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct. METHODS: The clinical presentation, workup, surgical approach, and pathological findings were reviewed. RESULTS: A 51-year-old man presented with a 10-year history of recurrent epiphora of the right eye. At dacryocystorhinostomy a small lesion was visualized within the lumen of the lacrimal sac. A biopsy specimen was consistent with adenocarcinoma. En bloc resection was accomplished using a lateral rhinotomy and medial maxillectomy. The final specimen showed adenocarcinoma ex-pleomorphic adenoma. The patient was given postoperative radiation therapy. He was free of disease 16 months after treatment. CONCLUSIONS: Lacrimal sac tumors should be considered in the differential diagnosis of chronic epiphora. Management of nasolacrimal adenocarcinoma requires complete surgical resection. Radiation treatment in and of itself is not curative but may be useful as adjuvant therapy. Carcinoma ex-pleomorphic adenoma can develop in the lacrimal sac and nasolacrimal duct.     

Cutaneous metastatic lung cancer: literature review and report of a tumor on the nose from a large cell undifferentiated carcinoma

Cutaneous metastatic disease is a prognostically important diagnosis. We report the case of a 64-year-old man who had an uncommon histologic type of lung cancer--a large cell undifferentiated carcinoma, which was metastatic to the skin of the nose. The relative frequency of cutaneous metastasis is similar to that of primary cancers. Cutaneous disease as the first sign of metastasis is most often seen in cancer of the lung. However, its appearance as a large tumor on the nose, which was observed in this case, is unusual.