Leiomyoma of the uterus is the most common benign uterine tumor affecting 40-50% of women older than 40 years of age. The pathogenesis of uterine leiomyoma is unknown, but several studies have suggested that each leiomyoma arises from a single neoplastic cell within the smooth muscle of the myometrium. Uterine leiomyoma can be extended outside the uterus growing into the pelvic veins, and in exceptional cases, even into the right side of the heart. Since this was first recognized more than 90 years ago, more than 25 cases of tumor extending into the vessel has been reported, but the pathogenesis and treatment of intravenous leiomyomatosis was not still established. We experienced a case of intravenous leiomyomatosis and report with a brief review of literatures.

Intra-hospital transport (IHT) of critically ill patients is associated with morbidity and mortality. Mass transfer of patients, as happens with unit relocation, is poorly described. We outline the process and adverse events associated with the relocation of a critical care unit.

A prospective multicentre observational study was carried out to assess the extent to which critical care teams manage patients in hospital who are cared for outside the critical care unit. The Health Service Executive (HSE) in Ireland is in the process of implementing a national Early Warning Score (EWS) and, at an EWS of 7 or above, a referral to critical care is recommended. This study recorded the EWS of patients referred to the critical care team and describes the subsequent interventions made by the critical care team and patient outcomes.

Objective: Diagnosis of acute kidney injury (AKI) relies on measurement of serum creatinine concentration and urine flow, which change slowly and have low specificity and sensitivity. We investigated the potential of urinary levels of a-glutathione S-transferase (alpha-GST) and pi-GST - markers of proximal and distal renal tubule damage, respectively - to provide an earlier and more accurate indication of AKI in patients in the intensive care unit.Design, setting and participants: Urine samples were collected over the 48 hours after ICU admission from 40 consecutive patients who were admitted with a diagnosis of sepsis between October 2007 and May 2008. AKI was diagnosed during the 48 h after ICU admission with the criteria of the Acute Kidney Injury Network (AKIN). Urinary alpha-GST and pi-GST levels were measured with commercially available enzyme-linked immunosorbent assay (ELISA) kits. Serum creatinine concentration was also measured. Haemodynamic and resuscitation parameters were recorded, but managed independently by the ICU team.Results: Urine samples were analysed from 38 patients (21 men, 17 women) with a median age of 54 years (interquartile range [IQR], 41-69 years), median APACHE II score of 13.3 (IQR, 8-17), and median ICU length of stay of 9 days (IQR, 3-19 days). Hospital mortality was 24%, and ICU mortality was 13%. Nineteen patients (50%) developed AKI, all within 24h of ICU admission. Urinary alpha-GST level was not increased in patients who developed AKI versus non-AKI patients. Median (IQR) urinary pi-GST level (mu g/L) at ICU admission was 10.8 (4.7-22.65) in the non-AKI group, 19.3 (2.88-44) in those who developed Stage 1 AKI, and 27.4 (14.8-43.8) in those who developed Stage 3 AKI. Median urinary pi-GST level at ICU admission was higher in all groups than in healthy control subjects. The area under the receiver operating characteristics curve for urinary pi-GST level indicated that it was not a good predictor of AKI.Conclusions: Urinary pi-GST is elevated early in all patients with sepsis syndrome, but is not predictive of AKI as defined by AKIN. This may indicate sensitive detection of an earlier phase of kidney injury, and suggests that sepsis-related renal injury affects the distal tubules, giving new insights into the pathophysiology of AKI in sepsis.

ICU admission post cardiac arrest accounts for 6% of admissions to the ICU [1]. ICU survival post cardiac arrest ranges from 25% to 35% [2]. We reviewed the records of both out-of-hospital and inhospital cardiac arrest admissions to our ICU to audit their outcomes, the primary outcome variable being survival to ICU and hospital discharge. Secondary objectives were to determine the length of stay in the ICU and hospital of both survivors and nonsurvivors.

Patients who have overdosed on drugs commonly present to emergency departments, with only the most severe cases requiring intensive care unit (ICU) admission. Such patients typically survive hospitalisation. We studied their longer term functional outcomes and recovery patterns which have not been well described. All patients admitted to the 18-bed ICU of a university-affiliated teaching hospital following drug overdoses between 1 January 2004 and 31 December 2006 were identified. With ethical approval, we evaluated the functional outcome and recovery patterns of the surviving patients 31 months after presentation, by telephone or personal interview. These were recorded as Glasgow outcome score, Karnofsky performance index and present work status. During the three years studied, 43 patients were identified as being admitted to our ICU because of an overdose. The average age was 34 years, 72% were male and the mean APACHE II score was 16.7. Of these, 32 were discharged from hospital alive. Follow-up data was attained on all of them. At a median of 31 months follow-up, a further eight had died. Of the 24 surviving there were 13 unemployed, seven employed and four in custody. The median Glasgow outcome score of survivors was 4.5, their Karnofsky score 80. Admission to ICU for treatment of overdose is associated with a very high risk of death in both the short- and long-term. While excellent functional recovery is achievable, 16% of survivors were held in custody and 54% unemployed.

Cocaine misuse is increasing and it is evidently considered a relatively safe drug of abuse in Ireland. To address this perception, we reviewed the database of an 18-bed Dublin intensive care unit, covering all admissions from 2003 to 2007. We identified cocaine-related cases, measuring hospital mortality and long-term survival in early 2009. Cocaine-related admissions increased from around one annually in 2003-05 to 10 in 2007. Their median (IQR [range]) age was 25 (21-35 [17-47]) years and 78% were male. The median (IQR [range]) APACHE II score was 16 (11-27 [5-36]) and length of intensive care stay was 5 (3-9 [1-16]) days. Ten patients died during their hospital stay. A further five had died by the time of follow-up, a median of 24 months later. One was untraceable. Cocaine toxicity necessitating intensive care is increasingly common in Dublin. Hospital mortality in this series was 52%. These findings may help to inform public attitudes to cocaine.