Management of thoracic empyema: review of 112 cases

To review our experience in treatment of patients with thoracic empyema at a teaching hospital chart of patients were retrospectively reviewed over a 72-month period. A total of 112 patients (94 men, 18 women, mean age: 39, range: 6-89 years) underwent therapeutic procedures for thoracic empyema between 2001-2006. The causes of empyema included parapneumonic empyema (60.7%), thoracic trauma (20.5%), surgical procedures (7.1%) and seeding from an extra-pulmonary source (11.7%). Multiloculated empyemas were documented in 45 patients (40%). Insertion of chest tube was the first procedure in 103 patients (92%). Nineteen patients (17%) were treated by thoracotomy, ten patients (8.9%) had fibrinolytic therapy, eight patients (7.2%) underwent video assisted thoracic surgery (VATS) and sixteen patients (14.3%) had subsequent radiologic-guided drainage. Thoracotomy-Decortication was successful in 90% of patients undergoing surgery and the least successful intervention was tube thoracostomy alone. Twelve of 112 patients (10.7%) died in the hospital including one patient in the thoracotomy group. Long-term follow-up was available in 67 patients including all of patients requiring surgery and fibrinolytic therapy. Thirty four patients (50%) obtained complete functional recovery. Simple drainage as the first procedure for the treatment of thoracic empyema has a high failure rate. Selection of a therapeutic option should be based on age, underlying disease, stage of the empyema, state of the loculation, local expertise and availability. Surgical procedures such as VATS or thoracotomy are recommended as the first procedure in elderly patients and advanced empyema.     

Effect of salt loading on nitric oxide synthase expression in normotensive rats

Elevation of arterial blood pressure (BP) with high salt intake in Dahl salt-sensitive rats is associated and perhaps, in part, due to downregulation of renal and vascular production of nitric oxide (NO) and nitric oxide synthase (NOS) expressions. Several recent studies have revealed a significant increase in BP in Sprague-Dawley rats on high salt intake. Given the apparent salt sensitivity of Sprague-Dawley rats, we hypothesized that chronic high salt intake may affect NO system in these rats in a manner resembling that reported in salt-sensitive (not salt-resistant) Dahl rats. The effects of a high salt diet (chow containing 8% NaCl) of 48-h or 3-week duration was studied on immunodetectable endothelial (eNOS), inducible (iNOS), and neuronal (nNOS) NOS expressions of relevant organs in male Sprague-Dawley rats. The results were compared with those obtained in the control animals fed a regular no-added salt diet (0.2% NaCl). Consumption of a high salt diet for 3 weeks induced hypertension (HTN) (158 +/- 6 v 115 +/- 5 mm Hg, P < .01) and widespread downregulation of iNOS expression in renal cortex, renal medulla, aorta, and heart. Similarly, chronic salt loading resulted in marked downregulation of eNOS expression in renal cortex and aorta and lowered expressions of nNOS in the brain, renal cortex, and renal medulla. In comparison, short-term salt loading resulted in significant reduction of iNOS in the renal cortex and aorta and of eNOS in the aorta together with significant elevation of nNOS expression in renal medulla and brain. Thus, chronic consumption of a high salt diet resulted in moderate HTN in normotensive Sprague-Dawley rats. This was accompanied by widespread downregulation of various NOS isotypes that undoubtedly contributed to the development and maintenance of HTN in this model.     

PRE-HOSPITAL EMERGENCY CARE: EVALUATION OF AN AUSTRALIAN SYSTEM

The efficacy of the Sydney ambulance paramedic service in dealing with out-of-hospital cardiac and other emergencies was examined. The outcome of 182 cases (from a total of 1,799 casualty calls) treated by a paramedic service was compared with the outcome of 104 similar cases (from a total of 2,376 calls) treated by a general duties service. There were 33 cases of cardiac arrest in the general duties group; resuscitation was attempted in 12 and none survived. There were 49 cases of cardiac arrest in the paramedic group; resuscitation was attempted in 21 cases and 4 survived. There were 35 cases of suspected myocardial infarction in the general duties group; 7 died compared with 58 cases and 4 deaths, in the paramedic group (mortality 20%, cf. 7%; difference not significant). The increased cost of a paramedic call, less than half of an entire hospital day, appears justified by better results.     

Nephrotoxicity of paraquat in man.

Renal function studies were performed in three cases of paraquat poisoning. Acute renal failure was observed in all three cases. Glomerular filtration rate improved for two patients who survived three weeks, illustrating the reversible nature of paraquat-induced acute renal failure. A mild to moderate transient proteinuria was observed during the first and second weeks following paraquat ingestion. Renal glucosuria, marked amino aciduria, and increased fractional excretion of phosphorus, sodium, and uric acid were observed. These findings, which have not been previously described in man, are indicative of proximal tubular dysfunction and parallel observations previously made in experimental animals.     

Childhood Pityriasis Rosea

Abstract: Pityriasis rosea (PR) is an acute, self‐limiting papulosquamous disorder of unknown etiology. Published studies of childhood PR are scarce and most are reviews. The aim of this study was to determine the demographic and clinical features of childhood PR.     

Neurological and adrenal dysfunction in the adrenal insufficiency/alacrima/achalasia (3A) syndrome

Review of 20 patients with glucocorticoid deficiency (three cases also with salt loss) associated with absent tear secretion (19 cases) and achalasia of the cardia (15 cases) revealed neurological abnormalities in 17 including hyper-reflexia, muscle weakness, dysarthria, and ataxia together with impaired intelligence and abnormal autonomic function, particularly postural hypotension. These findings indicate that significant neurological problems are common in this multisystem disorder.     

Functional, biochemical, and histopathologic consequences of high-dose interleukin-2 administration in rats

A variety of side effects have been reported with the use of interleukin-2 alone or in combination with lymphokine-activated killer cells in patients with disseminated neoplasms. The present study was undertaken to determine the effects of high-dose interleukin-2 administration in normal rats. Sprague-Dawley rats were treated with intravenous recombinant interleukin-2 (900,000 IU/kg/day) for 9 consecutive days. Animals were placed in individual metabolic cages, and arterial blood pressure, food intake, body weight, and urine output were monitored. On day 10, animals were killed by exsanguination, various tissues were harvested, and a variety of hematologic and chemical assays were performed. The results were compared with those of placebo-injected normal control and pair-fed groups. The interleukin-2-treated group exhibited anorexia, weight loss, hypotension, anemia, leukocytosis, lymphocytosis, eosinophilia, hypercalcemia, azotemia, and a marked urinary concentration defect. Histologic examination of various tissues revealed widespread infiltration with mono-nuclear cells and eosinophils in most organs, especially in the lungs and liver of interleukin-2-treated animals. Other abnormalities included severe panlobular hepatitis, hepatocellular necrosis, and thymic involution. Renal involvement was mild and consisted of focal interstitial infiltration by mononuclear cells. According to these observations, administration of high-dose interleukin-2 in normal rats results in a score of significant functional, biochemical, and histologic abnormalities.     

Effect of heparin on mesangial cell growth and gene expression of matrix proteins

Background. Mesangial cell (MC) proliferation and matrix expansion are characteristics of many glomerulopathies. Heparin has been shown to inhibit MC proliferation in vitro and mitigate cell proliferation, matrix expansion, proteinuria, renal insufficiency, and hypertension in experimental glomerulonephritis and subtotal renal ablation. We examined the effect of standard heparin on MC proliferation and matrix protein expression in vitro which necessarily excludes the confounding influences of haemodynamic, inflammatory, heamostatic, and various other processes that are present in vivo. Methods. Gene expression and release of fibronectin (FN), collagen IV and laminin by cultured rat MC were tested in the presence and absence of heparin. In addition the effect of transforming growth factor-{beta}1 (TGF-{beta}1) on the gene expression of those matrix proteins was assessed. Results. Within a 3-1000 &mgr;g/ml concentration range, heparin inhibited gene expression and release of FN by 10% fetal calf serum (FCS)-stimulated MC in a concentration-dependent manner. At concentrations of 300 and 1000 &mgr;g/ml, heparin inhibited fibronectin mRNA levels in TGF-{beta}1 (6 ng/ml) stimulated cells. However, heparin had no effect on gene expression or release of collagen IV or laminin under these conditions. Heparin markedly inhibited 10% FCS-stimulated MC proliferation in a concentration-dependent manner. Conclusions. Heparin inhibited MC growth and fibronectin production. These effects may, in part, account for the reported beneficial effects of heparin on the course of renal disease in experimental animals.