Salicylate-induced pulmonary edema: clinical characteristics in children

A five-year retrospective study of pediatric salicylate intoxications (serum level greater than 300 micrograms/ml) revealed that 2/20 patients developed salicylate induced pulmonary edema. These patients had significantly higher initial anion gaps (P less than 0.02) and serum salicylate determinations (P less than 0.001) and tended to be younger with lower initial serum potassium and arterial carbon dioxide measurements. Both patients in the salicylate-induced pulmonary edema group died, whereas none in the non-pulmonary edema group died. Unlike other reports, these data suggest that pulmonary edema is not rare in severe pediatric salicylate ingestion and correlates with high serum salicylate levels and anion gaps. Early, aggressive detoxification, supportive therapy, and hemodynamic monitoring would appear to be indicated in these patients.     

Salicylate-induced rhabdomyolysis

A 42-year-old woman was hospitalized with aspirin intoxication. The patient developed massive skeletal muscle damage without any evidence of muscle compression, hyperthermia, or other predisposing factors. The exact mechanism by which salicylates cause muscle damage is unknown, but the muscle damage appears to be the result of a direct toxic effect. This represents the first case of isolated salicylate-induced rhabdomyolysis.     

Reporting near-miss events in nursing homes

Since the Institute of Medicine report To Err Is Human was published in 1999, improving patient safety has become a major initiative for nurses working in all care settings. Nursing homes are a fertile environment for both a high frequency of adverse events to occur and a high number of institutional barriers to reporting them. This article outlines the barriers to reporting adverse events in nursing homes and provides support for why reporting near-miss events can serve as a means of reducing these barriers. It also provides recommendations and specific strategies for how to implement near-miss reporting systems in nursing homes such as policy changes, supportive leadership, and educating nurses about near-miss events. Further nursing research in this evolving area of patient safety is warranted.     

Ventilation-perfusion pulmonary scintigraphy for diagnosis of pulmonary thromboembolism

Ventilation-perfusion pulmonary scintigraphy with analysis ofventilation-perfusion ratio, apex-base ventilation and perfusion gradient, pulmonary perfusion, and the condition of alveolar permeability at the 10th and 30th min after inhalation of radiopharmaceutical was carried out in 16 patients with clinical and scintigraphic signs of thromboembolism of distal pulmonary artery branches and 10 controls. Thromboembolism of distal pulmonary artery branches was manifested by an increase in apex-base ventilation and perfusion gradient in both involved and intact lungs vs. the same parameters in healthy people. Patients with bilateral thromboembolism of distal pulmonary artery branches were characterized by an increase in ventilation-perfusion ratio and retardation of alveolar permeability.     

肺结核的影像诊断

肺结核是最常见的胸部疾病之一。近年来肺结核的发病率明显增高。免疫损害患者的增多是结核病发病率增高的重要原因［１ -３］。肺结核的影像检查方法有常规Ｘ线胸片、ＣＴ、ＨＲＣＴ等。本文着重介绍肺结核的影像表现及病理基础。１肺结核的基本病理表现认识肺结核的病理表现是理解其影像的基础。肺结核的主要病理改变为渗出性改变、增殖性改变和干酪性坏死。此三种病变 ,尤其是前两种 ,常同时存在。渗出性病变为肺泡内的结核性炎性渗出 ,经治疗后可残存不同程度的纤维瘢痕组织。增殖性病变是结核肉芽肿 ,即结核结节。干酪性坏死为特异性坏…     

肺隐球菌病的CT诊断

目的：探讨肺隐球菌病（PC）的CT表现,以期提高CT诊断水平。方法：搜集2008年3月～2009年7月间收治经病理学或实验室检查证实的10例PC患者的CT及相关临床实验室资料,结合相关文献回顾性分析其胸部CT表现。结果：本组患者以中年男性为主,多数合并免疫抑制疾病,临床症状不明显或无特异性,其胸部CT表现可归纳为以下4种：结节或肿块型6例,病灶孤立或多发,合并“晕征”及空洞等;浸润实变型2例;小结节或网织结节型1例;混合型病变1例。多数病灶位于外周肺野或胸膜下区,且以右肺下叶多见。结论：PC的CT表现多种多样,无明显特异性征象,影像工作者应提高对该病的重视,结合临床、病理及实验室检查,以便早期诊断。     

Ultrasound diagnosis of pulmonary embolism

Common pulmorary is the most unexpected mortal event in necropsy, antemortem correctly diagnosed in 28–39%. Clinical symptoms are non-specific, and chest radiography is not very helpful. Scintigraphic investigations, helical computed tomography and pulmonary angiography have a high diagnostic accuracy but they are not always available. With a suitable sonographic equipment, it is possible to visualize subpleural lesions bedside. Clinical studies and the sonographic appearance with pathologic correlation showed pulmonary infarctions in location, form and size exactly corresponding with pathological findings. Fresh reperfusable infarcts were homogenous and relatively hypoechoic. Older infarcts were well demarcated, mainly wedge shaped. Triangular pleural based lesions, more roughly structured, were observed with a hyperechoic reflex in the center corresponding to the bronchiole: a sign of segmental involvement. In massive central lung embolism, both fresh and old infarctions are found. An imminent larger embolism can be predicted, for instance, in a deep venous thrombosis of the lower limb, as proven by bedside antemortem ultrasound examination. With one ultrasound system, we can ‘kill 3 birds with one stone’: source, way and outcome of pulmonary embolism.     

肺血栓栓塞症的规范化诊断

静脉血栓栓塞症（venous thromboembolism．VTE）是继心血管血栓和脑血管血栓后的第三大血栓疾病。深静脉血栓形成（deep thromboembolism，DVT）和肺血栓栓塞症（pulmonary thromboembolism，PTE）是VTE病程中的两个连续阶段，也是VTE在不同脏器中的表现。诊断PTE时应联想到DVT，诊断DVT时也应联想到PTE，两者不能偏废，也不能分割，以免漏诊。     

Present-day diagnosis of pulmonary thromboembolism

Main complains, clinical appearance of the disease and laboratory findings have been evaluated for 28 patients with pulmonary embolism and its complications. The diagnosis made at x-ray and computed tomography examination proved valid in 85% of cases confirming the efficiency of their combined use in this disease. The author believe a comprehensive approach promising in solving the problem of pulmonary embolism.     

肺Wegener''s肉芽肿病的CT诊断与鉴别诊断

目的 探讨肺Wegener's肉芽肿病的CT表现,提高对该病的诊断水平.方法总结分析经病理证实的韦格纳肉芽肿17例,男10例,女7例,年龄11-72‘岁,平均年龄37.5岁.所有的患者均行胸部CT平扫加增强扫描.结果 CT表现有:大片状浸润病灶4例,小片状浸润病灶5例,多发结节影(直径小于3cm)9例,肿块(直径大于3cm)2例,空洞11例,条状阴影4例,磨玻璃影3例,肺不张2例,支气管狭窄阻塞2例.部分病例多种病灶混合存在,并互相转化,病灶增多或减少.结论 肺Wegener's肉芽肿病的表现呈多样性,以片状浸润、结节和空洞病变最常见,薄壁空洞和环形空洞具特征性.此病要与肺癌,结核、肺炎与脓肿等疾病相鉴别.