Background: Critically ill patients are at high risk for pulmonary embolism (PE). Specific PE prediction rules have not been validated in this population. The present study assessed the Wells and revised Geneva scoring systems as predictors of PE in critically ill patients. Methods: Pulmonary computed tomographic angiograms (CTAs) performed for suspected PE in critically ill adult patients were retrospectively identified. Wells and revised Geneva scores were calculated based on information from medical records. The reliability of both scores as predictors of PE was determined using receiver operating characteristic (ROC) curve analysis. Results: Of 138 patients, 42 (30.4%) were positive for PE based on pulmonary CTA. Mean Wells score was 4.3 (3.5) in patients with PE versus 2.7 (1.9) in patients without PE ( P < .001). Revised Geneva score was 5.8 (3.3) versus 5.1 (2.5) in patients with versus without PE ( P = .194). According to the Wells and revised Geneva scores, 56 (40.6%) patients and 49 (35.5%) patients, respectively, were considered as low probability for PE. Of those considered as low risk by the Wells score, 15 (26.8%) had filling defects on CTA, including 2 patients with main pulmonary artery embolism. The area under the ROC curve was 0.634 for the Wells score and 0.546 for the revised Geneva score. Wells score >4 had a sensitivity of 40%, specificity of 87%, positive predictive value of 59%, and negative predictive value of 77% to predict risk of PE. Conclusions: In this population of critically ill patients, Wells and revised Geneva scores were not reliable predictors of PE.
Summary:We describe an atypical case of subacute thyroiditis affecting a 50 year old patient with long lasting fever, weight loss, malaise and a high erythrocyte sedimentation rate. Cytological examination of the thyroid gland showed the classic granulomas with giant cells. However, the patient had neither painful enlargement of the gland nor thyrotoxicosis.This case, as well as others previously described, probably represents a new subtype of subacute thyroiditis, painless giant cell thyroiditis. The presence of painless giant cell thyroiditis should be considered in any patient with undiagnosed pyrexia, weight loss and elevated ESR.
Solitary fibrous tumor is a rare neoplasm. Few cases have been described in the head and neck area, and less than 11 were located in the larynx. We described two new cases of solitary fibrous tumor of the larynx. A man, 64-year-old, and a woman, 77-year-old, both with submucosal and nodular supraglottic lesions, were submitted to surgical treatment and both showed CD-34 and bcl-2 immunoreactivity and S-100 and smooth-muscle actin negativity. After 24 and 22 months of postoperative follow-up, respectively, they did not show signs of active disease.
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