Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography

Objective  To present a novel algorithm for estimating recruitable alveolar collapse and hyperdistension based on electrical impedance tomography (EIT) during a decremental positive end-expiratory pressure (PEEP) titration. Design  Technical note with illustrative case reports. Setting  Respiratory intensive care unit. Patient  Patients with acute respiratory distress syndrome. Interventions  Lung recruitment and PEEP titration maneuver. Measurements and results  Simultaneous acquisition of EIT and X-ray computerized tomography (CT) data. We found good agreement (in terms of amount and spatial location) between the collapse estimated by EIT and CT for all levels of PEEP. The optimal PEEP values detected by EIT for patients 1 and 2 (keeping lung collapse <10%) were 19 and 17 cmH₂O, respectively. Although pointing to the same non-dependent lung regions, EIT estimates of hyperdistension represent the functional deterioration of lung units, instead of their anatomical changes, and could not be compared directly with static CT estimates for hyperinflation. Conclusions  We described an EIT-based method for estimating recruitable alveolar collapse at the bedside, pointing out its regional distribution. Additionally, we proposed a measure of lung hyperdistension based on regional lung mechanics.     

Zinner's syndrome: an up-to-date review of the literature based on a clinical case

The authors made an up-to-date review of the literature concerning the management of Zinner's syndrome and evaluated a young patient with Zinner's syndrome who had presented with urinary and ejaculatory complaints. Physical examination and transrectal ultra-sonography showed a 7.0 cm right seminal vesicle cyst. Magnetic resonance imaging (MRI) confirmed the diagnosis of Zinner's syndrome. Oligoasthenoteratozoospermia was present at the two seminal analyses. Symptomatic improvement was achieved with conservative measures. Actually, the patient is still on a follow-up programme. The diagnosis is usually established at the age of increased sexual activity. Patients may be asymptomatic or present pain, irritative urinary or ejaculatory symptoms and infertility. MRI has proved to be the best imaging examination. Treatment should be adapted to symptoms, surveillance being the best option in the absence of clinical manifestations. Surgical approach may be adequate when conservative measures prove ineffective. Zinner's syndrome should be suspected if a male young patient presents with unilateral renal agenesis and pelvic complaints and has a supraprostatic mass on digital rectal examination. The initial approach should be medical, but invasive procedures may be the only way to solve the patient's complaints. Nowadays, laparoscopic and robotic techniques must replace the open surgical approach.     

An anatomical study on the lingual–facial trunk

Purpose  We quantified variations of the lingual artery origin, measured the lingual artery origin distance from clinical relevant landmarks and compared the lingual artery diameters with normal and variable origin. Methods  Forty-two formalin fixed male cadavers were bilaterally evaluated. Measurements were performed with the aid of an electronic digital caliper. Results  The origin distances from the common carotid artery bifurcation was 1.05 ± 0.11 and 1.02 ± 0.11 cm for the right and left lingual arteries respectively with no differences compared to the lingual–facial trunks. The diameters of the lingual arteries were 0.25 ± 0.01 and 0.26 ± 0.01 cm for the right and left sides, respectively, while the lingual–facial trunks showed diameters of 0.21 ± 0.02 and 0.24 ± 0.02 cm for the right and left sides, respectively. Conclusions  The present study adds information on the lingual artery diameter and its anatomical relation to clinically useful landmarks.     

Community-based early intervention: the Coimbra project (Portugal)

The Coimbra Early Intervention Project was undertaken to develop the first co-ordinated, multidisciplinary, interagency programme involving health care, education and social services, using existing resources in the community. The programme operates region wide and supports annually about 160 families and children with disabilities or at risk. Thirty-three per cent of the 601 children served so far had developmental delay, 22% belonged to high-risk families and 45% had risk factors and disabilities. In spite of difficulties, the programme success has increased awareness of the need to integrate and co-ordinate multiple community services and to develop legislation for the provision of early intervention services.     

Large mammary hamartoma of axillary supernumerary breast tissue

Hamartoma is an uncommon breast tumor and it is extremely rare to find it in ectopic breast tissue. We report the first case, to our knowledge, of a large hamartoma axillary supernumerary breast tissue. This report describes the case of a 33-year-old Brazilian patient who detected a lump in her left axillary supernumerary breast tissue at the same time as she was diagnosed with systemic erythematous lupus and corticoid treatment was initiated. The lesion showed progressive growth, reaching considerable proportions within a year, and it was removed with good esthetic and functional results.