Acta Clin Belg
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Camurati-Engelmann disease is an uncommon condition, radiologically characterized by symmetric diaphyseal sclerosis involving the tubular bones. Clinical features include limb pain, muscle weakness, waddling gait and sometimes deafness. The evaluation is made by conjunction of radiographic and scintigraphic data. ⋯ The evolution is unpredictable. The history of a 23 year old male with such a disorder is presented hereafter. His clinical course shows a very good response to the administration of corticosteroids, whereas no improvement is observed as far as the radiographic and isotopic features are concerned.
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The case of a 75-year-old women with probable tracheal laceration and tension pneumomediastinum after intubation is reported. A dramatic reduction of tracheal caliber was observed during fiberoptic bronchoscopy. Despite severe dyspnea, the patient healed with conservative measures. We conclude that aggressive surgical treatment for tracheal laceration is not always necessary.
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The incidence of peri-operative pulmonary complications varies, depending on surgery and patient related determinants. Risk factors include upper abdominal or thoracic surgery, duration of anaesthesia, age, obesity, smoking history and underlying respiratory diseases such as COPD. The preoperative evaluation of patients undergoing general surgery is predominantly based on medical history and physical examination. ⋯ If in this latter group, the preoperative lung function is severely compromised, a quantitative perfusion scan and exercise testing may be useful for the assessment of the operative risk. Prevention of postoperative pulmonary complications should begin with discontinuation of smoking at least 8 weeks prior to surgery. In high risk patients preoperative chest physiotherapy, including incentive spirometry, is clearly beneficial.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomised study comparing the efficacy of talc slurry and bleomycin in the treatment of malignant pleural effusions.
In comparative studies with other agents, insufflated talc has been shown to be the most effective agent in achieving chemical pleurodesis in patients with malignant pleural effusions. The objective of this study is to compare the efficacy of talc administered as slurry (5 g in 50 mL saline) via tube thoracostomy with that of bleomycin (1 mg/kg in 50 mL saline) (which is the most effective agent other than talc). In a randomised, prospective comparative study, twenty-six consecutive patients with proven malignant pleural effusions (recurrent after at least two pleuroscenteses) in whom no pleurodesis attempt had yet been made, and who were symptomatic, had a Karnovski index < or = 50, and an expected survival of one year or less, were included. ⋯ There were no major complications (e.g., empyema) or side-effects. In conclusion, talc slurry and bleomycin are equally effective in achieving chemical pleurodesis via thoracostomy in patients with malignant pleural effusions, and the safety profile of both agents is similar. Since talc is substantially less expensive than bleomycin, talc slurry probably represents the agent of choice for chemical tube thoracostomy pleurodesis.
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The introduction of semi-automatic external defibrillators (SAEDs) allowed emergency medical technicians (EMTs) to deliver electroshocks in cases of out-of-hospital ventricular fibrillation (VF) or ventricular tachycardia (VT), often many minutes before the arrival of the mobile intensive care unit (MICU) team. In this observational study we report on the results obtained by the EMTs from the fire departments of Gent, Aalter and Brugge. In Gent, an SAED project started in May 1991. ⋯ In Aalter the number of treated cases is tool low to draw conclusions. Anyhow, the global survival rate in the three areas remains low. Therefore, more efforts are needed to strengthen the other links of the chain of survival (early access to the emergency medical services-system, early basic cardiopulmonary resuscitation and early advanced life support.