Perfusion sensitive contrast-enhanced magnetic resonance imaging of dysembryoplastic neuroepithelial tumour: a new neuroimaging finding

Dysembryoplastic neuroepithelial tumours (DNTs) are benign lesions affecting young people and are associated with epilepsy. There have been described more than 300 cases in the literature and the clinical, pathological and radiological findings are well known. Recent advances in neuroimaging allow the acquisition of cerebral microcirculation parameters by perfusion weighted imaging, giving additional diagnostic information improving the diagnostic accuracy. The aim of this study is to show the perfusion sensitive contrast-enhanced magnetic resonance imaging findings of a case of DNT as an additional neuroradiological finding. Further investigation of microcirculation parameters may be helpful to establish the correct diagnosis of such tumours.     

Interrelationship between blood and tissue lactate in a general intensive care unit: A subcutaneous adipose tissue microdialysis study on 162 critically ill patients

Purpose

The aim of the study was to study the interrelationship between blood and tissue lactate in critically ill patients with or without shock admitted in a general intensive care unit.

Materials and Methods

We studied 162 mechanically ventilated patients: 106 with shock (septic shock, 97; cardiogenic shock, 9) and 56 without shock (severe sepsis, 38; systemic inflammatory response syndrome, 18). A microdialysis catheter was inserted in the subcutaneous adipose tissue of the upper thigh, and interstitial fluid was collected every 4 hours for a maximum of 6 days. We assessed the relationship between tissue and blood lactate using cross-approximate entropy and cross-correlation analysis.

Results

Patients with shock had higher area under the curve for blood (261 vs 175 mmol/L*hours, P < .0001) and tissue lactate (386 vs 281 mmol/L*hours, P < .0001) compared with patients without shock. The interrelationship of tissue-blood lactate, as assessed with cross-approximate entropy, was more regular in patients with shock compared with patients without shock. Cross-correlation of tissue vs blood lactate yielded higher correlation coefficients in patients with shock compared with those without shock, being higher when tissue lactate preceded blood lactate by 4 hours compared with tissue vs blood lactate with no lag time.

Conclusions

In critical illness, the detailed dynamics between blood and tissue lactate are affected by the presence of shock. In patients with shock, microdialysis-assessed tissue lactate is higher compared with those without shock and may detect metabolic disturbances before these become evident in the systemic circulation.     

Evaluation of arterial blood sampling using the B 109 syringe (radiometer)

Arterial blood gas measurements were performed after sampling with two different syringes (B 109 Radiometer and "ONCE" ASIK) and storage of the samples at 0-4 degrees C for 15 min. The blood samples were analysed in an ABL3 blood gas analyser. We found no statistically significant difference between the mean PaO2, PaCO2 and pH values with either technique of sampling. The B 109 syringe does not offer any advantages over the common plastic 2.5 ml. syringe ("ONCE").     

Sevoflurane as a single anesthetic and physostigmine failure to enhance arousal

AIM: Sevoflurane is recommended for inhalational induction of anesthesia. Physostigmine may antagonize general anesthetics. The study investigates sevoflurane as a single anesthetic and its possible antagonism by physostigmine. METHODS: In 60 women scheduled for breast lump excision, anesthesia was induced with 8% sevoflurane. After 3 min of sevoflurane inhalation, a laryngeal mask airway (LMA) was inserted. Anesthesia was maintained with spontaneous ventilation at end tidal sevoflurane 3%. Systolic and diastolic blood pressure, heart rate and end tidal CO(2) were recorded intraoperatively. After skin closure and at end tidal sevoflurane 0.9%, physostigmine 2 mg or normal saline was given. After 2 min systolic, diastolic blood pressure, heart rate and end tidal CO(2) were recorded and sevoflurane was discontinued. Time to eyes opening, LMA removal and verbal response was recorded. Patients were also assessed for orientation, sedation, sitting ability and the 'picking up matches' test at 0, 15 and 30 min after LMA removal. RESULTS: Systolic, diastolic blood pressure and heart rate increased after laryngeal mask placement (P=0.0001, P=0.0001 and P=0.0001, respectively). Orientation, sitting ability and 'picking up' matches were similar in the 2 groups. Sedation at 15 min was less in the control group (P=0.004). CONCLUSIONS: Sevoflurane can be used as a single anesthetic but its recovery is not enhanced by physostigmine.     

N-terminal fragment of B-type natriuretic peptide (NT-proBNP), a marker of cardiac safety during antipsychotic treatment

Background  

The potential cardiotoxicity of antipsychotic drugs is well known. The N-terminal fragment of B-type natriuretic peptide (NT-proBNP) is considered to be a possible biomarker in clinical practice for the diagnosis and prognosis in patients with suspected heart failure. This pilot evaluation tests the influence of antipsychotic drugs on NT-proBNP concentration in view of the hypothesis that NT-proBNP could be used as marker for the tolerability and safety of antipsychotic medications.