BACKGROUND: Identifying early markers of septic complications can aid in the diagnosis and therapeutic management of hospitalized patients. In this study, the utility of procalcitonin (PCT) vs. C-reactive protein (CRP) as early markers of sepsis was compared. METHODS: A series of 2,697 consecutive blood samples was collected from hospitalized patients and serum PCT and CRP levels were measured. Patients were categorized by PCT level as follows: < 0.05 ng/ml, 0.05-0.49 ng/ml, 0.5-1.99 ng/ml, 2-9.99 ng/ml, and > 10 ng/ml. Diagnostic utility was analyzed by receiver operating characteristic (ROC) curves. RESULTS: Mean CRP levels varied among the five PCT categories at 0.31 ± 2.87, 5.65 ± 6.26, 13.78 ± 8.01, 12.15 ± 10.16, and 17.77 ± 10.59, respectively (P < 0.05). PCT and CRP differed between positive and negative blood culture groups (PCT: 15.9 vs. 4.78 mg/dl; CRP: 11.5 ng/ml vs. 9.57 ng/ml; P < 0.05). The areas under the ROC curves (PCT, 95% confidence interval [CI]: 0.743, range: 0.698-0.789 at a threshold of 0.5 ng/ml; CRP, 95% CI: 0.540, range: 0.478-0.602 at a threshold of 8 mg/l) differed for PCT and CRP (P < 0.05). CONCLUSIONS: Therefore, PCT is a reliable marker for sepsis diagnosis and is more relevant than CRP in patients with a positive blood culture. These findings can be useful for the treatment of critically ill sepsis patients.
C-Reactive Protein ; Critical Illness* ; Diagnosis ; Humans ; ROC Curve ; Sepsis*

BACKGROUND: Identifying early markers of septic complications can aid in the diagnosis and therapeutic management of hospitalized patients. In this study, the utility of procalcitonin (PCT) vs. C-reactive protein (CRP) as early markers of sepsis was compared. METHODS: A series of 2,697 consecutive blood samples was collected from hospitalized patients and serum PCT and CRP levels were measured. Patients were categorized by PCT level as follows: < 0.05 ng/ml, 0.05-0.49 ng/ml, 0.5-1.99 ng/ml, 2-9.99 ng/ml, and > 10 ng/ml. Diagnostic utility was analyzed by receiver operating characteristic (ROC) curves. RESULTS: Mean CRP levels varied among the five PCT categories at 0.31 ± 2.87, 5.65 ± 6.26, 13.78 ± 8.01, 12.15 ± 10.16, and 17.77 ± 10.59, respectively (P < 0.05). PCT and CRP differed between positive and negative blood culture groups (PCT: 15.9 vs. 4.78 mg/dl; CRP: 11.5 ng/ml vs. 9.57 ng/ml; P < 0.05). The areas under the ROC curves (PCT, 95% confidence interval [CI]: 0.743, range: 0.698-0.789 at a threshold of 0.5 ng/ml; CRP, 95% CI: 0.540, range: 0.478-0.602 at a threshold of 8 mg/l) differed for PCT and CRP (P < 0.05). CONCLUSIONS: Therefore, PCT is a reliable marker for sepsis diagnosis and is more relevant than CRP in patients with a positive blood culture. These findings can be useful for the treatment of critically ill sepsis patients.
C-Reactive Protein ; Critical Illness* ; Diagnosis ; Humans ; ROC Curve ; Sepsis*

OBJECTIVES: Balloon cells and dysplastic neurons are histopathological hallmarks of the cortical tubers of tuberous sclerosis complex (TSC) and focal cortical dysplasia (FCD) of the Taylor type. They are believed to be the epileptogenic substrate and cause therapeutic drug resistant epilepsy in man. P-glycoprotein (P-gp) is the product of multidrug resistance gene (MDR1), and it maintains intracellular drug concentration at a relatively low level. The authors investigated expression of P-gp in balloon cells and dysplastic neurons of cortical tubers in patients with TSC. METHODS: An immunohistochemical study using the primary antibody for P-gp, as an indicative of drug resistance, was performed in the cortical tuber tissues in two patients of surgical resection for epilepsy and six autopsy cases. RESULTS: Balloon cells of each lesion showed different intensity and number in P-gp immunopositivity. P-gp immunopositivity in balloon cells were 28.2%, and dysplastic neurons were 22.7%. These immunoreactivities were more prominent in balloon cells distributed in the subpial region than deeper region of the cortical tubers. Capillary endothelial cells within the cortical tubers also showed P-gp immunopositivity. CONCLUSION: In this study, the drug resistance protein P-glycoprotein in balloon cells and dysplastic neurons might explain medically refractory epilepsy in TSC.
Autopsy ; Drug Resistance* ; Drug Resistance, Multiple ; Endothelial Cells ; Epilepsy ; Genes, MDR ; Humans ; Malformations of Cortical Development ; Neurons ; P-Glycoprotein ; Tuberous Sclerosis* ; Up-Regulation*

Hiccup can be regarded as a failure of the usual alternating excitation-inhibition between glottis closure and inspiration. The coordinating center is located in the brain-stem reticular formation. A wide variety of pathological conditions can cause intractable hiccup: myocardial infarction, brain tumor, renal failure, prostate cancer, abdominal surgery, etc. Stroke is an unusual cause of intractable hiccup. Intractable hiccup is rare but disabling condition which can induce depression, weight loss, sleep deprivation, and even death. Etiological treatment is not always available and intractable hiccup treatment has classically relied on metoclopramide and chlorpromazine. We experienced a case of intractable hiccup induced by multiple cerebral infarct, and we present this rare case with the review of literature.
Brain Neoplasms ; Chlorpromazine ; Depression ; Glottis ; Hiccup* ; Metoclopramide ; Myocardial Infarction ; Prostatic Neoplasms ; Renal Insufficiency ; Reticular Formation ; Sleep Deprivation ; Stroke ; Weight Loss