Providing perioperative care for patients with hip fractures

Providing perioperative care for patients with hip fractures can present major challenges for the anaesthesiologist. These patients often have multiple comorbidities, the deterioration of any one of which may have precipitated the fall. A careful balance has to be achieved between minimising the time before operation and spending time to optimise their medical status. This review will present insights into preoperative patient assessment and optimization in this group of patients from the anaesthesiologists’ perspective. In particular, it will highlight important medical issues of concern that may alter anaesthetic risks and management. With a greater understanding of what these issues are, potentially a more prompt and integrated approach to managing these patients may be made. Hopefully, this would result in minimising last minute cancellations due to medical reasons for these patients

MRI of the lung (2/3). Why … when … how?

Background Among the modalities for lung imaging, proton magnetic resonance imaging (MRI) has been the latest to be introduced into clinical practice. Its value to replace X-ray and computed tomography (CT) when radiation exposure or iodinated contrast material is contra-indicated is well acknowledged: i.e. for paediatric patients and pregnant women or for scientific use. One of the reasons why MRI of the lung is still rarely used, except in a few centres, is the lack of consistent protocols customised to clinical needs. Methods This article makes non-vendor-specific protocol suggestions for general use with state-of-the-art MRI scanners, based on the available literature and a consensus discussion within a panel of experts experienced in lung MRI. Results Various sequences have been successfully tested within scientific or clinical environments. MRI of the lung with appropriate combinations of these sequences comprises morphological and functional imaging aspects in a single examination. It serves in difficult clinical problems encountered in daily routine, such as assessment of the mediastinum and chest wall, and even might challenge molecular imaging techniques in the near future. Conclusion This article helps new users to implement appropriate protocols on their own MRI platforms. Main Messages • MRI of the lung can be readily performed on state-of-the-art 1.5-T MRI scanners. • Protocol suggestions based on the available literature facilitate its use for routine • MRI offers solutions for complicated thoracic masses with atelectasis and chest wall invasion. • MRI is an option for paediatrics and science when CT is contra-indicate

Interopservacijske razlike u dijagnosticiranju azbestoze prema klasifikaciji ILO

Inhalation of asbestos fibres leads to asbestosis of the pleura and the lung, with possible progression to lung cancer and malignant pleural or peritoneal mesothelioma. Asbestosis remains difficult to diagnose, especially in its early stages. The most important role in its diagnosis is that of chest radiographs. The aim of this cross-sectional study was to address interobserver variations in interpreting chest radiographs in asbestos workers, which remain to be an issue, despite improvements in the International Labour Office (ILO) classification system. In our ten-year study, we investigated 318 workers occupationally exposed to asbestos, and in 210 workers with diagnosed asbestos-related changes we compared interpretations of chest radiographs according to ILO by two independent radiologists. The apparent degree of interobserver variation in classifying lung fibrosis was 26.66 % for the diameter of changes and 42.2 % for the profusion of the changes. In cases with diffuse pleural thickening, the interobserver variation using ILO procedures was 34.93 %. This investigation raises the issue of standardisation and objectivity of interpretation of asbestosis according to the ILO classification system. This study has revealed a significant disagreement in the estimated degree of pleural and parenchymal asbestos pulmonary disease. This is why we believe highresolution computed tomography (HRCT) should also be used as a part of international classification.Azbestoza je bolest koja nastaje kao posljedica inhalacije azbestnih vlakana. Zahvaća pluća i pleuru, a ponekad može dovesti do karcinoma pluća, pleure i peritoneuma. Azbestozu je teško dijagnosticirati, osobito u početnom stadiju bolesti. U dijagnostici azbestoze presudna je radiološka obrada. Cilj ovog rada je utvrditi interopservacijske razlike u analizi radiograma prema kriterijima klasifikacije ILO kod profesjonalne azbestoze. U istraživanje je bilo uključeno 318 ispitanika profesionalno izloženih azbestnim česticama. U 210 ispitanika kojima je postavljena dijagnoza azbestoze usporedili smo radiološke nalaze analizirane od dvaju neovisnih radiologa eksperata u skladu s važećom klasifikacijom ILO. Uspoređujući rezultate analize malih zasjenjenja parenhima pluća prema njihovoj veličini, našli smo da se rezultati razlikuju u 26,66 % slučajeva, dok je prema prožetosti intersticija neslaganje bilo još učestalije, tj. zabilježeno je u 42,22 % slučajeva. U ispitanika s pleuralnim promjenama usporedili smo rezultate analize difuznih pleuralnih zadebljanja i našli neslaganje u debljini i/ili širini pleuralnih zadebljanja u 34,93 % slučajeva. Uočili smo značajno neslaganje u procjeni stupnja azbestne bolesti na pleuri i na parenhimu pluća. Zbog toga smatramo da je u kvantificiranju promjena izazvanih azbestom i u procjeni stupnja tjelesnog oštećenja nužno rabiti kompjutoriziranu tomografiju visoke rezolucije kao znatno osjetljiviju i pouzdaniju slikovnu tehniku

Prediction of early tolerance to enteral feeding in preterm infants by measurement of superior mesenteric artery blood flow velocity

AIMS—To evaluate whether serial Doppler measurements of superior mesenteric artery (SMA) blood flow velocity after the first enteral feed could predict early tolerance to enteral feeding in preterm infants.
METHODS—When clinicians decided to start enteral feeds, Doppler ultrasound blood flow velocity in the SMA was determined before and after a test feed of 0.5 ml milk. The number of days taken for infants to tolerate full enteral feeding (150 ml/kg/day) was recorded.
RESULTS—Fourteen infants (group 1) achieved full enteral feeding within seven days. Thirty infants (group 2) took 8-30 days. There was no difference in the preprandial time averaged mean velocity (TAMV) between the groups at a median age of 3 (2-30) days. In group 1, there was a significant increase in TAMV (p<0.01) above the preprandial level at 45 and 60 minutes, but this did not occur in group 2. An increase in TAMV by more than 17% at 60 minutes has a sensitivity of 100% and a specificity of 70% for the prediction of early tolerance to enteral feeds.
CONCLUSIONS—There is a significant correlation between an increase in mean SMA blood flow velocity and early tolerance of enteral feeding. Doppler measurements of SMA blood flow velocity may be useful for deciding when to feed high risk preterm infants.