30 research outputs found
An integrated approach to diagnosis and management of severe haemoptysis in patients admitted to the intensive care unit: a case series from a referral centre
BACKGROUND: Limited data are available concerning patients admitted to the intensive care unit (ICU) for severe haemoptysis. We reviewed a large series of patients managed in a uniform way to describe the clinical spectrum and outcome of haemoptysis in this setting, and better define the indications for bronchial artery embolisation (BAE). METHODS: A retrospective chart review of 196 patients referred for severe haemoptysis to a respiratory intermediate care ward and ICU between January 1999 and December 2001. A follow-up by telephone interview or a visit. RESULTS: Patients (148 males) were aged 51 (± sd, 16) years, with a median cumulated amount of bleeding averaging 200 ml on admission. Bronchiectasis, lung cancer, tuberculosis and mycetoma were the main underlying causes. In 21 patients (11%), no cause was identified. A first-line bronchial arteriography was attempted in 147 patients (75%), whereas 46 (23%) received conservative treatment. Patients who underwent BAE had a higher respiratory rate, greater amount of bleeding, persistent bloody sputum and/or evidence of active bleeding on fiberoptic bronchoscopy. When completed (n = 131/147), BAE controlled haemoptysis in 80% of patients, both in the short and long (> 30 days) terms. Surgery was mostly performed when bronchial arteriography had failed and/or bleeding recurred early after completed BAE. Bleeding was controlled by conservative measures alone in 44 patients. The ICU mortality rate was low (4%). CONCLUSION: Patients with evidence of more severe or persistent haemoptysis were more likely to receive BAE rather than conservative management. The procedure was effective and safe in most patients with severe haemoptysis, and surgery was mostly reserved to failure of arteriography and/or early recurrences after BAE
Risk factors associated with fatal pulmonary hemorrhage in locally advanced non-small cell lung cancer treated with chemoradiotherapy
<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to identify the risk factors associated with fatal pulmonary hemorrhage (PH) in patients with locally advanced non-small cell lung cancer (NSCLC), treated with chemoradiotherapy.</p> <p>Methods</p> <p>The medical records of 583 patients with locally advanced NSCLC, who were treated with chemoradiotherapy between July 1992 and December 2009 were reviewed. Fatal PH was defined as PH leading to death within 24 h of its onset. Tumor cavitation size was defined by the cavitation diameter/tumor diameter ratio and was classified as minimum (< 0.25), minor (≥ 0.25, but < 0.5), and major (≥ 0.5).</p> <p>Results</p> <p>Of the 583 patients, 2.1% suffered a fatal PH. The numbers of patients with minimum, minor, and major cavitations were 13, 11, and 14, respectively. Among the 38 patients with tumor cavitation, all 3 patients who developed fatal PH had major cavitations. On multivariate analysis, the presence of baseline major cavitation (odds ratio, 17.878), and a squamous cell histology (odds ratio, 5.491) proved to be independent significant risk factors for fatal PH. Interestingly, all patients with fatal PH and baseline major cavitation were found to have tumors with squamous cell histology, and the occurrence of fatal PH in patients having both risk factors was 33.3%.</p> <p>Conclusions</p> <p>Patients at high risk of fatal PH could be identified using a combination of independent risk factors.</p
Pneumoperitoneum and pneumomediastinum: unusual complications of laparoscopy.
Pneumoretroperitoneum and pneumomediastinum are rare complications of laparoscopy. We report one such case. The mechanism of development of these complications is explained. No specific treatment needs to be instituted in most of these patients
Deflation of the ′obstinate′ Foley′s urinary catheter balloon : a new technique.
We have successfully deflated "obstinate" Foley′s urinary catheter balloons in 15 cases in the last six months with the help of a simple bedside procedure using an angiographic guide-wire
Duodenal Tuberculosis: Radiological Features on Barium Studies and their Clinical Correlation in 28 Cases
BACKGROUND: A retrospective analysis of 28 cases of duodenal
tuberculosis (TB) was done to evaluate radiological findings and their
value in the diagnosis of the disease. subjects AND METHODS: Upper
gastrointestinal and small bowel series of 28 patients with duodenal
tuberculosis were analysed for radiological findings. The diagnosis of
duodenal TB was confirmed by surgery and biopsy in 18, on the basis of
radiological findings and response to treatment in 9, and on the basis
of findings on upper gastrointestinal scopy and biopsy in 1 patient.
RESULTS: The study included 28 patients (14 males, 14 females). The
mean age was 32.1 (range 5-65). Twenty-three (82.2%) patients presented
with obstructive symptoms while five manifested with dyspeptic
symptoms. Of the latter, 4 had ulcerations in the third and fourth
parts of the duodenum. In the remaining patient, the mucosa of the
duodenum could not be clearly visualised. Two patients had extrinsic
impression at the D2-D3 and D3-D4 segments. In 23 patients with
obstructive symptoms, 18 demonstrated luminal narrowing of varying
degrees and 5 had a sharp band-like cut-off at the third part of the
duodenum. Of the 18 patients with luminal narrowing, 13 had extrinsic
compression, 12 had proximal dilatation and 14 had ulcerations mainly
in the second and third parts of the duodenum. Biliary involvement was
seen in 3 patients without any signs or symptoms directly referable to
the biliary involvement. CONCLUSION: Though duodenal TB lacks specific
radiological features, barium studies help to localise and define the
area of narrowing and ulcerations and help to confirm the presence of
lymph nodes causing compression of the duodenum
Pica and the radiologist – beyond the radiology report … digging deeper
Pica is a psychological disorder of intentional and craving consumption of non-nutritive substances over a period of time. This is seen at an age when such a behavior is developmentally inappropriate. Substances such as wall paint, soil, hair, and feces have been reported as being consumed. Complications of this condition may range from being self-limiting to life-threatening. Radiological examinations play a crucial role in the diagnosis and management of this condition. We present a case of a 9-year-old boy who presented with chronic abdominal pain with history of persistent consumption of pencil erasers. Abdominal radiographs showed radio-opaque foreign bodies, and etiological diagnosis was made when the radiologist obtained a detailed history from the patient's mother. We also discuss the radiographic evaluation of the pencil eraser and the reason why it is densely radio-opaque
Duodenal Tuberculosis: Radiological Features on Barium Studies and their Clinical Correlation in 28 Cases
BACKGROUND: A retrospective analysis of 28 cases of duodenal
tuberculosis (TB) was done to evaluate radiological findings and their
value in the diagnosis of the disease. subjects AND METHODS: Upper
gastrointestinal and small bowel series of 28 patients with duodenal
tuberculosis were analysed for radiological findings. The diagnosis of
duodenal TB was confirmed by surgery and biopsy in 18, on the basis of
radiological findings and response to treatment in 9, and on the basis
of findings on upper gastrointestinal scopy and biopsy in 1 patient.
RESULTS: The study included 28 patients (14 males, 14 females). The
mean age was 32.1 (range 5-65). Twenty-three (82.2%) patients presented
with obstructive symptoms while five manifested with dyspeptic
symptoms. Of the latter, 4 had ulcerations in the third and fourth
parts of the duodenum. In the remaining patient, the mucosa of the
duodenum could not be clearly visualised. Two patients had extrinsic
impression at the D2-D3 and D3-D4 segments. In 23 patients with
obstructive symptoms, 18 demonstrated luminal narrowing of varying
degrees and 5 had a sharp band-like cut-off at the third part of the
duodenum. Of the 18 patients with luminal narrowing, 13 had extrinsic
compression, 12 had proximal dilatation and 14 had ulcerations mainly
in the second and third parts of the duodenum. Biliary involvement was
seen in 3 patients without any signs or symptoms directly referable to
the biliary involvement. CONCLUSION: Though duodenal TB lacks specific
radiological features, barium studies help to localise and define the
area of narrowing and ulcerations and help to confirm the presence of
lymph nodes causing compression of the duodenum
E-Medicine - The Art and Science of Web-Based Literature Search: The MEDLINE
The utility of a thorough literature search is not limited to a student
preparing for a seminar or dissertation, but is also required for those
engaged in patient care. It has been shown that use of on-line
literature searches early in the course of hospitalisation
significantly reduces the duration of hospital stay 1 and traditional
paper-based references play only a limited role in clinical problem
solving 2 . However, with limited resources in terms of time and money
and the ever-expanding literature volume, one would like to perform a
search that is not only comprehensive or complete, but also do it in
the shortest possible time. If the way we perform a search is not
proper, we could well be a victim of the most fundamental computer
adage: garbage in, garbage out 3 . This happens because computer based
literature databases make it possible for us to just punch in a few
words and get some relevant results. We get the satisfaction of
obtaining an instantaneous result. However, it is worth pondering
whether this is the best response
E-Medicine - The Art and Science of Web-Based Literature Search: The MEDLINE
The utility of a thorough literature search is not limited to a student
preparing for a seminar or dissertation, but is also required for those
engaged in patient care. It has been shown that use of on-line
literature searches early in the course of hospitalisation
significantly reduces the duration of hospital stay 1 and traditional
paper-based references play only a limited role in clinical problem
solving 2 . However, with limited resources in terms of time and money
and the ever-expanding literature volume, one would like to perform a
search that is not only comprehensive or complete, but also do it in
the shortest possible time. If the way we perform a search is not
proper, we could well be a victim of the most fundamental computer
adage: garbage in, garbage out 3 . This happens because computer based
literature databases make it possible for us to just punch in a few
words and get some relevant results. We get the satisfaction of
obtaining an instantaneous result. However, it is worth pondering
whether this is the best response