Bronchoscopic findings in post-obstructive pulmonary oedema

Purpose

To present the first photographed bronchoscopic findings associated with negative pressure pulmonary oedema (NPPE).

Clinical features

A previously healthy patient underwent anterior C₃–C₄ disc removal and arthrodesis. Following tracheal extubation he developed acute respiratory distress manifested as stridor, tachypnoea, restlessness, and desaturation. Once the trachea was reintubated, he displayed the classic findings of pulmonary oedema. Bronchoscopy was performed to confirm tracheal tube position and to rule out tracheal injury secondary to surgical manipulation. Diffuse punctate haemorrhages were noted throughout the visualised tracheobronchial tree.

Conclusion

We believe that these haemorrhages represent disruption of the bronchial vasculature and may contribute to the clinical presentation of NPPE.     

Keyless data capture: emerging technologies in health information processing

As middle managers, medical record practitioners will be involved in justification of auto ID technology to upper management. To prepare a good justification, one must have a thorough knowledge of the technology and its advantages and disadvantages. One must also be familiar with the payback period and the installation process. This article has attempted to introduce the reader to some emerging technologies in health care, and answer some of the questions that are key to justifying their acquisition. By most estimates, these technologies are finding their way into health care, however slowly, and hold much promise for improvement in productivity and accuracy in data collection.     

Anaesthetic management of acute blunt thoracic trauma

Sunnybrook Health Science Centre is an adult regional trauma unit serving metropolitan Toronto and environs. We undertook a nvo-year retrospective review of patients admitted to our institution with blunt thoracic trauma. Three hundred and thirty-three patients with blunt trauma and an injury severity score (ISS) greater than 17 required emergency surgery. Of these, 208 had blunt thoracic injuries while 125 did not have chest injuries. Both groups were similar with respect to age but patients with thoracic trauma had a greater ISS. (P < 0.05) and greater intraoperative mortality (P < 0.01). The aetiology of the intraoperative deaths with one exception was exsanguination. Emergency thoracotomy or sternotomy indicated a poor prognosis with a mortality rate of 80%. The most common intraoperative problem was an elevated airway pressure. Awake intubation was undertaken in 77.5% of patients requiring anaesthesia and surgery because of the potentially compromised airways and difficult intubations due to the nature of the associated injuries. Finally, 74% of patients undergoing urgent surgery required mechanical postoperative ventilation. The presence of blunt chest trauma should be considered a marker of the severity of injury sustained by the patient.     

Insulin antibodies: methodology and clinical implications

Anti-insulin antibodies detection is based on the demonstration of a specific and saturable binding to insulin either radiolabelled with 125 I (Radiobinding assay or RBA) or coated on a solid phase (Enzyme linked immunosorbent assay or EIA). The 2 assays are remarkably different by their sensitivity to the affinity of the antigen antibody reaction. In addition, RBA may be biased by the presence of the iodine atom on the radioiodinated insulin whereas, at least on theoretical grounds. EIA could be biased because of denaturation or non availability of some epitopes when insulin is coated. Anti-insulin antibodies may be induced by insulin therapy. When they "spontaneously" appear, they are called autoantibodies. Insulin autoantibodies may be detected in the normal population, in type 1 diabetic patients before any administration of exogenous insulin and in patients suffering from the autoimmune hypoglycemic syndrome. In some patients, this syndrome may be associated with administration of a thiol containing drug. In some cases, insulin antibodies may appear several years after a transient insulin therapy, possibly as a consequence of a disturbance of the immunologic memory. The properties of antibodies and autoantibodies (concentration, affinity, number and nature of epitopes, heavy and light chain composition and ability to form aggregates) are relatively characteristic of the disease with which they are associated and determine their potential effects on insulin bioavailability and plasma glucose homeostasis.     

Predictive value of plasma CEA in patients with colorectal carcinoma

Two years follow-up of 46 patients with colorectal carcinoma resected "for cure" shows that of the nine patients with an elevated (less than 5 ng/ml) CEA plasma titer one to six months after surgery, only one, or 11%, had remained disease free. Of the 38 patients with normal (less than 5 ng/ml) plasma CEA, 27, or 71%, were free of disease two years after surgery. In another 85 patients presenting six months to ten years after resection "for cure" of their colorectal carcinoma, normal CEA levels were found in 73, and only five, or 6.4%, of these presented with disease progression when followed for two years; of the 12 patients that presented with CEA values less than 5 ng/ml, disease progression was evident in eight or 67%; in eight patients with CEA levels of greater than 10 ng/ml, the proportion of patients with disease progression increased to 87.5% (7/8). When a patient with a history of colorectal cancer, but seemingly free of disease, presents with levels not only repeatedly above normal (greater than 5 ng/ml) but above the levels found in some nonmalignant conditions (greater than 10 ng/ml), thorough re-examination of the patient to locate the site of possible disease progression is indicated. In 14 such patients further diagnostic methods showed local recurrences in four, metastasis limited to the liver in six, and other metastasis in four. In conclusion, in patients with colorectal carcinoma postoperative elevated CEA plasma levels are a sign of poor prognosis. Consistently elevated CEA levels (greater than 10 ng/ml) are a strong indication of disease progression.     

Wertigkeit der CT und MRT in der Diagnostik von Lebermalignomen

Prim?re und sekund?re Lebermalignome z?hlen weltweit zu den h?ufigsten Tumoren. Metastasen kommen hierbei etwa 30-mal h?ufiger vor als hepatozellul?re Karzinome [4]. Die H?ufigkeit metastatischer Tumorabsiedlungen erkl?rt sich aus der topographisch-funktionellen Lage der Leber als Bindeglied zwischen dem portalen und kavalen Kreislaufsystem. Abh?ngig von der Art des Prim?rtumors liegen die Angaben über das Auftreten einer Lebermetastasierung zwischen 30 und 80%[4, 16]. Die Therapie von Lebertumoren hat sich entscheidend weiterentwickelt. In den letzten 20 Jahren etablierte sich mit der Verbesserung der Operationstechniken – verbunden mit einer Senkung der Operationsletalit?t – eine zunehmend aggressive chirurgische Therapie mit potenziell kurativer Zielsetzung in der Behandlung von Lebertumoren.Auch die chemotherapeutischen Verfahren und in den letzten Jahren insbesondere die interventionellen Therapiem?glichkeiten der Lebertumoren wurden weiterentwickelt. Insofern ist eine genaue Bild gebende Diagnostik zur ad?quaten Therapieplanung von gro?er Bedeutung. Priv.-Doz.Dr. G.Jung Institut für Diagnostische Radiologie, Heinrich-Heine-Universit?t Düsseldorf, Moorenstra?e 5, 40225 Düsseldorf, E-Mail: Jung@med.uni-duesseldorf.de