Abdominal compartment syndrome in the intensive care unit

The abdominal compartment syndrome is an increasingly recognized complication of both medical and surgical patients in the ICU setting. This syndrome has been described in a wide variety of clinical scenarios and results from a persistent elevation in intra-abdominal pressure characterized by graded organ system dysfunction. Manifestations of abdominal compartment syndrome include cardiovascular, pulmonary, renal, splanchnic, and neurologic impairment. The diagnosis of abdominal compartment syndrome requires a high level of clinical suspicion combined with an increased intra-abdominal pressure, usually obtained via urinary bladder pressure measurement. Patients at risk for abdominal compartment syndrome warrant close monitoring and we recommend prompt abdominal decompression following documentation of increased intra-abdominal pressure in the setting of physiologic compromise. Abdominal compartment syndrome can significantly contribute to the morbidity and mortality of both medical and surgical patients alike in the ICU. The signs and symptoms of abdominal compartment syndrome should become familiar to all critical care practitioners.     

Cisplatin resistance in human cancers

Cancer chemotherapeutic agents primarily act by damaging cellular DNA directly or indirectly. Tumor cells, in contrast to normal cells, respond to cisplatin with transient gene expression to protect and/or repair their chromosomes. Repeated cisplatin treatments results in a stable resistant cell line with enhanced gene expression but lacking gene amplification for the proteins that will limit cisplatin cytotoxicity. Recently, several new human cell lines have been characterized for cisplatin resistance. These cell lines have led to a better understanding of the molecular and biochemical basis of cisplatin resistance. The c-fos proto-oncogene, a master switch for turning on other genes in response to a wide range of stimuli, has been shown to play an important role in cisplatin resistance both in vitro and in patients. Based on these studies, new strategies have been developed to circumvent and/or exploit clinical cisplatin resistance.     

Efficacy of the American Heart Association/American Stroke Association guidelines for ultra-early,intentional antihypertensive therapy in intracerebral hemorrhage

Whether the intentional antihypertensive therapy recommended by the American Heart Association/American Stroke Association (AHA/ASA) guidelines has clinical benefit for patients who have acute spontaneous intracerebral hemorrhage (ICH) has yet to be proven. We retrospectively reviewed the clinical charts of 175 patients with putaminal or thalamic ICH with acute hypertension to examine the correlation between the efficacy of antihypertensive therapy within 3 hours of onset, hematoma expansion (HE) after hospitalization and clinical outcome. The aim of the antihypertensive therapy was to achieve and maintain a systolic blood pressure of 120 mm Hg to 160 mm Hg until the second CT scan. The mean arterial pressure (MAP) after admission was the average MAP values measured every hour for the first 3 hours of hospitalization or until the second CT scan, if this was performed within the same timeframe. Thirty-two (18.3%) patients were found to have HE. Prior to the second CT scan, antihypertensive medications were administered to all patients without any major complications. A multiple logistic regression analysis revealed that a MAP of >110 mm Hg after admission was the only variable independently associated with HE (odds ratio [OR] = 3.455; 95% confidence interval [CI] = 1.510–8.412; p = 0.004). Modified Rankin Scale scores of ?3 on day 30 were significantly more common in those patients without HE (p = 0.002).Our findings suggest that there are clinical benefits, by the prevention of subsequent HE, in maintaining a MAP level lower than that recommended by the AHA/ASA (110 mm Hg) after hospitalization for patients who have ICH.     

Staff injuries after patient-staff incidences in psychiatric acute wards

The aim of the study was to describe the pattern of injuries to various body parts in patient-staff incidents; 507 patient-staff incidents in a psychiatric acute ward during the period 1990-1997 were included. Staff members registered 193 injuries in the head, 112 in the trunk, 265 in the upper extremities and 69 in the lower extremities. No differences between the two sexes or between different levels of education among the nurses were found in the pattern of injuries. Doctors were more often injured in the head and less often injured in the upper extremity than the nurses. The head was more often injured when there was no understandable provocation before the incident and seldom injured when the patients were denied something. Injuries to the trunk were more frequently followed by use of parenteral medication. Parenteral medication and holding the patient with force were more frequently used in incidents where more than one body part was injured. The knowledge of injures after patient-staff incidences may contribute to the education and protective training of the staff of psychiatric acute wards.     

Bronchioloalveolar carcinoma arising in a congenital pulmonary airway malformation in a child: case report with an update of this association

An 8-year-old girl was evaluated for a mass in the left pulmonary lobe. Her clinical history was remarkable for an intermittent dry cough since the age of 2, with recurrent episodes of purulent sputum and fever. She underwent left lower lobectomy, which was found to be a bronchioloalveolar carcinoma arising in a type 1 congenital pulmonary airway malformation at pathologic examination. No additional therapies were undertaken. Two years after resection, imaging studies showed 5 contralateral pulmonary nodules suggestive of disseminated disease with a poor outcome. A review of presentation, treatment, and outcome of this association was made.     

Do physicians improve their communication skills between finishing medical school and completing internship? A nationwide prospective observational cohort study

Objective

To test whether young physicians improve their communication skills between graduating from medical school and completing clinical internship, and to explore contributing background and/or internship factors.

Methods

Norwegian medical students graduating June 2004 were invited to take part in a videotaped standardized patient interview February 2004. Of the 111 students who originally participated, 62 completed a second interview February 2006. Observed communication skills were assessed with the Arizona Communication Interview Rating Scale (ACIR).

Results

The level of communication skills increased significantly during the period for participants overall; and for females but not males. General social skills reached significantly higher levels than specific professional skills, both types of skill improving during the study. Independent predictors were working in local hospitals, learning atmosphere and low stress.At school completion, 50% reached a level defined as ‘advanced beginner’. Towards the end of the internship, 58% reached ‘capable’ and 27% ‘competent’ levels of communication skills.

Conclusions

Female physicians improved most in communication skills, the gender difference being multivariate mediated through low stress levels and learning atmosphere. The findings support the division of communication skills into general social and specific professional skills.

Practice implications

The relatively low proportion of young physicians, especially males, developing the capability to practise independently at internship completion indicates a need for more effective training in communication skills, during both medical school and internship.