Bed numbers. Inadmissible evidence

Little research has been done on the number of intensive care beds the UK needs, and provision varies widely across the country. There is no indication of systematic under-provision of intensive care unit beds in the UK. There is confusion about appropriate referrals and admissions. Research suggests that with the current number of beds there are 2,100-2,500 avoidable deaths a year. But it is unclear how many of these would be avoided by providing extra beds.     

Hyaline membrane disease treated with bovine surfactant

Six preterm infants with severe hyaline membrane disease requiring ventilation were treated, at a median age of 15.5 hours, with a single intratracheal bolus of a bovine surfactant suspension. Arterial oxygenation increased dramatically, and chest radiograms showed improvement after two to four hours. However, a variable degree of deterioration occurred within 24 hours. All of the infants required oxygen therapy for several weeks, and one developed severe bronchopulmonary dysplasia.     

Elevated serum tryptase levels identify a subset of patients with a myeloproliferative variant of idiopathic hypereosinophilic syndrome associated with tissue fibrosis,poor prognosis,and imatinib responsiveness

Since serum tryptase levels are elevated in some patients with myeloproliferative disorders, we examined their utility in identifying a subset of patients with hypereosinophilic syndrome (HES) and an underlying myeloproliferative disorder. Elevated serum tryptase levels (> 11.5 ng/mL) were present in 9 of 15 patients with HES and were associated with other markers of myeloproliferation, including elevated B12 levels and splenomegaly. Although bone marrow biopsies in these patients showed increased numbers of CD25+ mast cells and atypical spindle-shaped mast cells, patients with HES and elevated serum tryptase could be distinguished from patients with systemic mastocytosis and eosinophilia by their clinical manifestations, the absence of mast cell aggregates, the lack of a somatic KIT mutation, and the presence of the recently described fusion of the Fip1-like 1 (FIP1L1) gene to the platelet-derived growth factor receptor alpha gene (PDGFRA). Patients with HES and elevated serum tryptase were more likely to develop fibroproliferative end organ damage, and 3 of 9 died within 5 years of diagnosis in contrast to 0 of 6 patients with normal serum tryptase levels. All 6 patients with HES and elevated tryptase treated with imatinib demonstrated a clinical and hematologic response. In summary, elevated serum tryptase appears to be a sensitive marker of a myeloproliferative variant of HES that is characterized by tissue fibrosis, poor prognosis, and imatinib responsiveness.     

Verification of CT number to density conversion for a simulator-T attachment

The calculation and verification of a CT number to density conversion table for a simulator-CT attachment known as Scanvision, which provides CT images for radiotherapy treatment planning, is presented. While the linear fit for CT-number-to-density is similar to most conventional doughnut gantry CT scanners, an offset of approximately 178 Hounsfield units was found for air using a polyethylene normalisation, and approximately 262 for air using air normalisation. The offset continues for other low-density samples. Results show that the simulator-CT reproducibly measures CT numbers. However a separate calibration line needs to be entered into the radiotherapy planning computer to ensure accurate CT-number-to-density. conversion.