Clinical review: Lung imaging in acute respiratory distress syndrome patients - an update

Over the past 30 years lung imaging has greatly contributed to the current understanding of the pathophysiology and the management of acute respiratory distress syndrome (ARDS). In the past few years, in addition to chest X-ray and lung computed tomography, newer functional lung imaging techniques, such as lung ultrasound, positron emission tomography, electrical impedance tomography and magnetic resonance, have been gaining a role as diagnostic tools to optimize lung assessment and ventilator management in ARDS patients. Here we provide an updated clinical review of lung imaging in ARDS over the past few years to offer an overview of the literature on the available imaging techniques from a clinical perspective.     

Transthoracic ultrasound approach of thoracic aorta in critically ill patients with lung consolidation

PURPOSE: Normally, the aortic arch and the descending aorta are not visible using transthoracic ultrasonography. We hypothesize that lung consolidation of upper and lower lobes, by opening an acoustic window, may allow the ultrasound examination of the thoracic aorta. METHODS: During a 2-month period, 18 consecutive patients hospitalized in the intensive care unit with consolidation of upper and/or lower lobes diagnosed by lung ultrasound were studied. The ascending and descending aorta and the aortic arch were systematically searched for by positioning the probe on the anterior, lateral, and posterior regions of the chest wall. RESULTS: Among the 16 patients with left lower lobe consolidation, the descending aorta was always visible by positioning the probe on lateral and posterior parts of the chest wall. In the 4 patients with consolidation of the left upper lobe, the aortic arch was visible when positioning the probe on anterior and upper parts of the left chest wall. In the patient with right upper lobe consolidation, both the ascending aorta and the aortic arch were visible when positioning the probe on anterior and upper parts of the right chest wall. CONCLUSIONS: In critically ill patients, the presence of consolidated upper and left lower lobes may allow the ultrasound examination of the different parts of the thoracic aorta.     

Les effets d’annonce dans l’infection à VIH et leur destin

Objectives

This article describes psychological reactions observed when a patient is informed he or she is infected with HIV. In order to cope with an HIV diagnosis some people may adopt unhealthy coping strategies. In spite of all the help they are surrounded with and all the medical advances which have taken place in the past 20 years discovering your HIV diagnosis is always experienced as a death sentence with far reaching consequences.

Cancer du sein sans atteinte ganglionnaire axillaire

Breast cancer is the most common cancer in women. In France, breast cancer incidence was 88.9 per 100,000 women in 2000. Early detection of breast tumours by screening mammography allows a breast conserving treatment, i.e., breast irradiation preceded by a lumpectomy and a sentinel node biopsy. The standard irradiation of early breast cancers consists in delivering 50 Gy to the whole breast in 2 Gy fractions over a five-week period followed by an additional dose targeting the tumour bed of 16 Gy in eight fractions. The 3D-conformal treatment planning optimizes dose distribution to the whole breast and to the tumour bed and lessens the normal tissue irradiation (heart and ipsilateral lung). The aim of this article is to describe epidemiologic, radio anatomic and prognostic features of early stage breast cancer and to propose guidelines for 3D-conformal treatment planning in early breast cancers. This review is illustrated by a case report.     

Minimum Alveolar Concentration of Volatile Anesthetics in Rats during Postnatal Maturation

Background: Although neonatal rats have become widely used as experimental laboratory animals, minimum alveolar concentration (MAC) values of volatile anesthetics in rats during postnatal maturation remain unknown.

Methods: We determined MAC values of volatile anesthetics in spontaneously breathing neonatal (2-, 9-, and 30-day-old) and adult Wistar rats exposed to increasing (in 0.1-0.2% steps) concentrations of halothane, isoflurane, or sevoflurane (n = 12-20 in each group), using the tail-clamp technique. MAC and its 95% confidence intervals were calculated using logistic regression and corrected for body temperature (37[degrees]C).

Results: In adult rats, inspired MAC values corrected at 37[degrees]C were as follows: halothane, 0.88% (confidence interval, 0.82-0.93%); isoflurane, 1.12% (1.07-1.18%); and sevoflurane, 1.97% (1.84-2.10%). In 30-day-old rats, the values were as follows: halothane, 1.14% (1.07-1.20%); isoflurane, 1.67% (1.58-1.76%); and sevoflurane, 2.95% (2.75-3.15%). In 9-day-old rats, inspired MAC values were as follows: halothane, 1.68% (1.58-1.78%); isoflurane, 2.34% (2.21-2.47%); and sevoflurane, 3.74% (3.64-3.86%). In 2-day-old rats, inspired MAC values were as follows: halothane, 1.54% (1.44-1.64%); isoflurane, 1.86% (1.72-2.01%); and sevoflurane, 3.28% (3.09-3.47%).