Barotrauma due to obstruction of the breathing system during a CT-scan examination in a child

A case of pulmonary barotrauma is described in a child undergoing a CT scan in the prone position. Anaesthesia was uneventful until the final exiting movement from the scanner when inadvertent total occlusion of the expiratory limb of a Jackson-Rees modification of the Ayre's T-piece occurred. The rapid rise in intrapulmonary pressure caused bilateral pneumothoraces despite the use of an uncuffed tracheal tube. The unusual demands of anaesthesia in the X-ray department may have contributed to this uncommon complication of the use of an Ayre's T-piece.     

A CASE OF PITUITARY DEPENDENT CUSHING''S DISEASE WITH CLINICAL AND BIOCHEMICAL FEATURES OF THE ECTOPIC ACTH SYNDROME

A case of atypical pituitary dependent Cushing's disease is reported. The patient presented with clinical symptoms similar to those of the ectopic ACTH syndrome; notably a marked hypokalaemic alkalosis, widely fluctuating plasma cortisol levels, greatly elevated plasma ACTH levels, and failure to suppress both plasma cortisol and ACTH levels following high dose oral dexamethasone. However, a large aggressive pituitary tumour was detected by skull X-ray and computed tomography. Removal of the pituitary tumour led to full remission of the patient's Cushing's syndrome. Pro-opiomelanocortin (POMC) related peptides in the plasma and tumour tissue extract of this patient have been characterized by gel-filtration and Concanavalin-A Sepharose affinity chromatography, indicating processing of POMC in a manner more usually associated with ectopic tumours.