The Netherlands journal of medicine
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Case Reports
"Spontaneous" catheter fracture and embolization of a totally implanted venous access port.
A case of "spontaneous" fracture of the catheter of a totally implanted venous access device is reported. The distal part of the catheter migrated into a pulmonary artery branch and could not be retrieved. The cause and consequences of this rare complication are discussed. It is emphasized that the integrity of a totally implanted venous access device should be ascertained before cytostatic agents are administered.
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Two patients with sporadic Legionella pneumonia complicated by adult respiratory distress syndrome (ARDS) are described. Details about the clinical course and follow-up of their chest films are provided. The outcome in both patients was favourable. Literature concerning Legionella pneumonia complicated by ARDS is reviewed.
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The clinical diagnosis of extrinsic allergic alveolitis can be supported by a positive provocation test. Twenty-eight common mushroom (Agaricus bisporus) workers, 4 oyster mushroom (Pleurotus ostreatus) workers and 6 Shii Take mushroom (Lentinus edodes) workers, whose medical history indicated a possible extrinsic allergic alveolitis, were examined. The provocation test consisted of a control day, an exposure day, and half a day of follow-up observation. ⋯ The chest X-ray and arterial blood gas sample were taken once. The exposure consisted of a 1-h presence on the common mushroom farm in spawning conditions or inhaling a suspension of spores of Pleurotus or Shii-Take in the laboratory. Eighteen of the 28 people employed on the common mushroom farm, all 4 Pleurotus workers and 4 of the 6 Shii-Take workers were diagnosed as having extrinsic allergic alveolitis, according to the following criteria: a positive history and 2 or more of the following findings: increase in leucocyte count, rise in temperature and decrease in inspiratory vital capacity (IVC) and total lung capacity (TLC).
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A new system is described for cooling the scalp with cold air in order to prevent chemotherapy-induced alopecia. Compressed air was cooled by means of a vortex tube built into a hair-drier cap. This system reduced the blood flow in the scalp to 35%, the surface temperature to 14.2 degrees C and the intradermal temperature at hair follicle level to 29.2 degrees C. ⋯ However, patients treated with epirubicin at 75 mg/m2 all showed grade 3 hair loss in spite of air cooling. In view of the possibility of achieving and maintaining low scalp temperatures, the cold air system is to be preferred to cryogel packs. Whether better clinical results may be obtained with cooling for longer periods and/or to lower temperatures remains to be determined.