Measurement of alveolar derecruitment in patients with acute lung injury: computerized tomography versus pressure–volume curve

Introduction  

Positive end-expiratory pressure (PEEP)-induced lung derecruitment can be assessed by a pressure–volume (P–V) curve method or by lung computed tomography (CT). However, only the first method can be used at the bedside. The aim of the study was to compare both methods for assessing alveolar derecruitment after the removal of PEEP in patients with acute lung injury or acute respiratory distress syndrome.     

Lenticulostriate vasculopathy in twin-to-twin transfusion syndrome.

Intracranial pathology is a common and important complication in extremely low birth weight babies. Lenticulostriate vasculopathy (LSV) is an abnormal finding on cranial ultrasounds of sick babies and has been associated with congenital infection, chromosomal aberration and twin-to-twin transfusion. We describe a previously unreported situation of LSV being detected in both donor and recipient twin. This pair of monochorionic, diamniotic twins was admitted to the Neonatal Intensive Care Unit at 28 weeks of gestation. The mother underwent an emergency caesarean section because ultrasound and Doppler studies showed stage III twin-to-twin transfusion syndrome. The first twin weighed 998 g and second twin weighed 600 g. The first twin had an uneventful stay, whereas the second twin needed prolonged continuous positive airway pressure and indomethacin for patent ductus arteriosus. Both of them developed LSV. The clinical significance of this condition on the neuro-developmental outcome of a neonate has not yet been fully determined.     

Symmetrical brainstem encephalitis caused by herpes simplex virus

We describe a 53-year-old man with herpes simplex virus (HSV) brainstem encephalitis diagnosed based by positive HSV immunoglobulin M antibodies from cerebrospinal fluid. The MRI findings of this case had three unique features. First, the lesions were symmetrical. Second, the lesions may have been associated with reactivation of HSV infection in the region of the trigeminal nerve. Third, diffusion-weighted and apparent diffusion coefficient (ADC) imaging, conducted for the first time on an HSV brainstem encephalitis case, suggested that the lesions were associated with vasogenic edema.     

COMPARISON OF THORACIC ELECTRICAL BIOIMPEDANCE AND THERMODILUTION FOR THE MEASUREMENT OF CARDIAC INDEX IN PATIENTS WITH SEVERE SEPSIS

Cardiac index was measured using thoracic bioimpedance (Clbi)and thermodilution (Cltd) in 19 patients with proven sepsis,undergoing artificial ventilation of the lungs. There was apoor correlation between the techniques (r = 0.36, 242 datasets, regression line Clbi = 0.16 Cltd + 2.56 litre min^–1m^–2). The overall bias (Cltd-Clbi) was 1.69 litre min^–1m^–2 with limits of agreement (precision) of +4.17 to –0.79litremin^–1 m^–2. In individual patients the bias was from0.46 to 4.56 litre min¹ m^–2 with the limits of agreementfrom ±0.29 to ±2.55 litre min^–1 m^–2around the bias values. The two techniques cannot be used interchangeablyin this group of patients. (Br. J. Anaesth. 1993; 70: 58–62) ^*Present address, for correspondence: Nuffield Department ofAnaesthetics, Radcliffe Infirmary, Woodstock Road, Oxford OX26HE