Pneumopericardium after blunt chest trauma: mechanical ventilation with positive pressure must be avoided

A 38-year-old polytraumatized man was admitted with signs of cardiogenic shock (low blood pressure, tachycardia, tachypnea, and elevated central venous pressure). A near tension pneumopericardium was revealed by thorax CT. Air from the pericardial sac remissed 4 days later conservatively, avoiding invasive or non-invasive mechanical ventilation. The use of positive-pressure ventilation, with or without intubation, would probably lead to tension pneumopericardium-cardiac tamponade, needing emergent decompression.     

Gemcitabine combined with gefitinib in patients with inoperable or metastatic pancreatic cancer: a phase II Study of the Hellenic Cooperative Oncology Group with biomarker evaluation

The combination of gemcitabine and gefitinib was evaluated in advanced pancreatic cancer. Totally, 53 patients were treated with a 7 week cycle of gemcitabine (1,000 mg/m(2) given weekly) followed by six 4 week cycles of gemcitabine given on days 1, 8 and 15. Gefitinib 250 mg was administered daily. Responses were seen in 6, and stabilization of the disease in 12 patients. The main toxicity was myelotoxicity (92%). The 6-month progression-free survival (PFS) was 30%. Median PFS was 4.1 months and median survival 7.3 months with a 1 year survival rate of 27%. The above combination demonstrated promising activity in advanced pancreatic cancer.     

Differential cardiovascular responses during weaning failure: effects on tissue oxygenation and lactate

Objective To test the following two hypotheses during weaning failure: (a) mixed venous oxygen saturation (SvO₂) does not decrease in patients whose oxygen consumption does not increase, and (b) blood lactate may increase in patients who demonstrate substantial decreases in SvO₂.Design and setting A prospective observational and physiological study in a 30-bed university intensive care unit.Patients and participants 18 patients who failed weaning and 12 patients who succeeded weaning (controls).Measurements and results Hemodynamics, global tissue oxygenation, cardiovascular response (cardiac index/oxygen extraction diagram), and blood lactate were measured in ventilator-supported patients undergoing a spontaneous breathing trial. In patients who failed without having increased their oxygen consumption (n=9) the increase in oxygen delivery was accompanied by a decrease in oxygen extraction (by 15±4%). In patients who failed (n=9) having increased their oxygen consumption (by >10%) this increase was met mainly by an increase in oxygen extraction (by 30±7%). SvO₂ increased by 2±1% in the former patients, whereas it decreased by 20±5% in the latter. Arterial lactate increased (range 2.3–3.1 mM/l) in only three patients who failed to have increased oxygen consumption and exhibited heart failure and the highest decreases in SvO₂ (by 12–39%).Conclusions Patients whose SvO₂ does not decrease during weaning failure do not have increased oxygen consumption probably due to respiratory center depression in some of them. Patients whose SvO₂ decreases have increased oxygen consumption.Electronic Supplementary Material Electronic supplementary material to this paper can be obtained by using the Springer Link server located at .This article refers to the editorial available at     

Infliximab for treatment of pyoderma gangrenosum associated with clinically inactive Crohn's disease. A case report

We report the case of a 57-year old female patient with refractory to treatment pyoderma gangrenosum associated with clinically inactive Crohn's disease. Pyoderma gangrenosum was successfully treated with Infliximab, a chimeric monoclonal antibody that inhibits tumour necrosis factor alpha (TNF-alpha). Our case report suggests that Infliximab, a therapeutic agent for refractory and fistulizing Crohn's disease, may also be safe and effective in the treatment of Crohn's disease associated pyoderma gangrenosum, even though the inflammatory bowel disease is clinically inactive and repeated infusions may be required for successful treatment.     

Complications of Percutaneous Nephrostomy, Percutaneous Insertion of Ureteral Endoprosthesis, and Replacement Procedures

Purpose: The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses. Methods: During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting). Results: There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter. Conclusion: The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures.