Lymphangiomas in children: MR imaging

Seventeen lymphangiomas in 15 patients were imaged with magnetic resonance (MR) to define the nature, extent, and anatomic relationships of these lesions. The MR and pathologic findings were then compared to determine the histologic basis for the signal-intensity characteristics of these lesions. The signal intensity of 13 lesions was similar to or slightly less than that of muscle on T1-weighted images and greater than that of fat on T2-weighted images. This appearance correlated with the presence of ectatic lymphatic channels containing clear fluid on histologic section. Four lymphangiomas had high signal intensity, approximately equal to that of fat, on T1-weighted images, reflecting the presence of clotted blood or small cystic spaces with a higher ratio of fat to fluid. Sixteen of 17 lesions had visible septations on MR images. The authors' experience suggests that most lymphangiomas have a characteristic appearance on MR images. The information obtained with MR imaging can help in providing a preoperative diagnosis, in planning surgical resection, and in defining recurrence.     

The evaluation and treatment implications of isolated pulmonary nodules in patients with a recent history of breast cancer

BACKGROUND: Breast cancer patients with pulmonary lesions are often assumed to have metastatic disease and treated palliatively. We evaluated the proportion of these patients who actually have primary lung tumor (PLT) and assessed their outcome. METHODS: We performed a 10-year retrospective review of the cancer registry in a community hospital system. RESULTS: Among 54 breast cancer patients with pulmonary nodules, biopsy was pursued in 30. Although metastatic breast cancer (MBC) was presumed in 24, biopsy showed MBC in 9 patients and PLT in 21. The two groups differed in age, stage, breast tumor size, nodal involvement, and estrogen receptor (ER) positivity. However, no variable excluded the possibility of PLT. Of those with PLT, 11 had early-stage lung disease; 9 underwent curative resection. CONCLUSIONS: Women with breast cancer and 1 or more pulmonary lesions without evidence of other metastatic disease require work-up of pulmonary lesions. Aggressive evaluation can afford treatment of lung cancer and impact survival.     

Acidente vascular cerebral no perioperatório após ressecção transuretral de próstata: alto índice de suspeita e estabilização de parâmetros fisiológicos podem salvar vidas

We report a case of a 72 year old hypertensive male who developed severe hypertension followed by neurological deterioration in the immediate postoperative period after transurethral resection of prostate. While arterial blood gas and laboratory tests excluded transurethral resection of prostate syndrome or any other metabolic cause, reduction of blood pressure failed to ameliorate the symptoms. A cranial CT done 4 hours after the onset of neurological symptoms revealed bilateral gangliocapsular and right thalamic infarcts. Oral aspirin was advised to prevent early recurrent stroke. Supportive treatment and mechanical ventilation ensured physiological stability and the patient recovered completely over the next few days without any residual neurological deficit.     

The critical care pharmacist: an essential intensive care practitioner

Clinical pharmacy services in the critical care setting have expanded dramatically and include assisting physicians in pharmacotherapy decision making, providing pharmacokinetic consultations, monitoring patients for drug efficacy and safety, providing drug information, and offering medical education to physicians, nurses, and patients. Measurable clinical effects of these services include reduced drug errors and adverse drug events, decreased morbidity and mortality rates, and a positive pharmacoeconomic impact by decreasing overall health care costs.     

Analysis of a population-based Pneumocystis carinii pneumonia index as an outcome measure of access and quality of care for the treatment of HIV disease

OBJECTIVES: A population-based Pneumocystis carinii pneumonia (PCP) Index was developed in New York City to identify geographic areas and subpopulations at increased risk for PCP. METHODS: A zip code-level PCP Index was created from AIDS surveillance and hospital discharge records and defined as (number of PCP-related hospitalizations)/(number of persons living with AIDS). RESULTS: In 1997, there were 2262 hospitalizations for PCP among 39 740 persons living with AIDS in New York City (PCP Index =.05691). PCP Index values varied widely across neighborhoods with high AIDS prevalence (West Village =.02532 vs Central Harlem =.08696). Some neighborhoods with moderate AIDS prevalence had strikingly high rates (Staten Island =.14035; northern Manhattan =.08756). CONCLUSIONS: The PCP Index highlights communities in particular need of public health interventions to improve HIV-related service delivery.