pulmonary edemaSerial portable chest roentgenograms are used to evaluate patients with pulmonary edema. The ability of portable chest roentgenograms to demonstrate and monitor changes in pulmonary edema in supine critically ill patients has never been fully evaluated. A modification of the double-indicator dilution technique has made it possible to make serial determinations of extravascular lung water. By using the thermal-dye technique to measure extravascular lung water and comparing the results with interpretation of portable chest roentgenograms, we sought to evaluate (1) the ability of portable chest roentgenograms to define extravascular lung water in critically ill supine adults, and (2) the utility of portable chest roentgenograms as a monitor for quantifying changes in lung water under these circumstances.

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respiratory protective deviceCase 1

A 53-year-old chemical worker had an accidental exposure to

uranium hexafluoride gas at work in a chemical plant on Nov 12, 1968. He was not wearing a respiratory protective device and breathed uranium hexafluoride vapors for about 15 minutes. He immediately developed shortness of breath and cough and was subsequently taken to an emergency room where because of severe respiratory distress, an emergency tracheotomy was performed. He was discharged from the hospital after four days, but noted persistent dyspnea and increased airway excitability after exposure to nonspecific irritants or stimuli such as marked temperature change, dusts, and a variety of fumes and vapors. He was evaluated at UC Medical Center approximately 140 months after his accident on July 8, 1980.

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 pulmonary functionThe detrimental effects of smoking on adult pulmonary function has led to concern that passive smoking (the exposure to smoke from others cigarettes) may be harmful, especially to young children. The major studies that have examined the relation between parental smoking and childhood symptoms and pulmonary function are summarized in Table 3. Of these studies, all but four are cross-sectional analytic surveys. In such studies, childrens’ symptoms and/or pulmonary function are examined at a single point in time and related to parental smoking habits. Inference from cross-sectional analytic surveys is limited by the fact that predisposition to decreased pulmonary function may have preceded the exposure to smoke. It is known, for example, that smokers have smaller babies (not only because of smoking, but probably because of other factors associated with smoking). It is possible that lung development, or predisposition to pulmonary infection, may differ in these smaller babies. In addition, analytic surveys tell us about symptoms only over a relatively short period of time. Thus, while cough or respiratory infections might not be different in ten-year-olds depending on parental smoking, differences may have been apparent earlier in life, or develop later.

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placeboThe maximum obtainable monitoring time was 4,320 hours (20 patients, each patient monitored nine times 24 hours). Three hundred and forty-eight hours were not recorded. Another 360 hours were excluded as they contained less than 50 minutes of unambiguous ECG-recording. Thus, our results are based on 3,612 of3,972 recorded hours, 1,190 with placebo, 1,227 with theophylline!, and 1,195 with enprofylline.

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Hodgkin's diseaseSince the early 1920s the medical literature has been replete with reports of changes induced in normal and diseased tissues following radiation therapy for various malignancies. This is particularly so in Hodgkins disease of the thorax. The case presented here describes the development of dense calcifications in previously normal prestemal soft tissues following radiotherapy in a patient with Hodgkin’s disease of the mediastinum. To the authors knowledge, such radiation-induced changes have not been reported previously.

Case Report

A 32-year-old white woman was diagnosed at the age of 18 as having nodular sclerosing Hodgkins disease of the mediastinum, stage IIA. Following staging laparotomy and splenectomy, she underwent radiotherapy with 4,000 rads to the upper mantle and “in verted-Y” fields, along with splenic pedicle radiation. She also received six courses of MOPP chemotherapy (nitrogen mustard, Oncovin, procarbazine and prednisone). She tolerated therapy well and achieved complete remission; however, within six months she developed postradiation pericarditis. This was successfully treated with a partial pericardectomy via a left posterior thoracotomy. To get aquanted with such a notion as thoracotomy you may just make one step namely to check out Canadian health care mall official LiveJournal.

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intragastric balloonThe intragastric balloon was successfully positioned in all patients. However, in one patient the balloon was removed a few days after placement because of gastric intolerance. Therefore, a total of 17 patients successfully completed the 6-month treatment protocol with the intragastric balloon. No significant complications were observed.

The clinical characteristics of the 17 morbidly obese patients before insertion of the intragastric balloon and after its removal are reported in Table 1. At baseline, all subjects were morbidly obese patients (BMI range, 46.0 to 82.0 kg/m2) with a substantial amount of visceral fat accumulation, as evidenced by the high values of the waist circumference and the sagittal abdominal diameter. Pulmonary function testing revealed restrictive ventilatory impairment with further significant reductions in oxygen saturation in the clinostatic position (p 20 events/h in all patients, and > 50 events/h in 13 of 17 patients (76.5%).

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Of 347 endomyocardial biopsies performed on 49 patients, 47 specimens demonstrated histologic evidence of acute rejection. In this study, acute rejection was characterized by the presence of interstitial edema with pyrinophilic lymphocytes, with or without myonecrosis. Simultaneous immune activation of peripheral blood lymphocytes occurred with 33 biopsy specimens positive for acute rejection (Table 1). Thus, the morphologic evaluation of lymphocytes demonstrated a 70 percent sensitivity in detecting an episode of acute cardiac rejection. The predictive value of a positive test (positive immune activation of lymphocytes) was 39 percent. Significant differences in absolute numbers of total lymphocytes, T-cell subsets (helper cells, cytotoxic-suppressor cells, cytotoxic cells, resetting T cells, mitogenic T cells) and helper/suppressor ratios analyzed via a Students t test revealed no consistent, statistically significant differences in absolute numbers of the above-described cell populations. During acute cardiac rejection, the helper/ suppressor ratio was variable, with high, low, and normal values noted. Read the rest of this entry »

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.


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