Chest
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The development of pulmonary granulomatosis following intravenous injection of medications intended for oral use has been well described previously. Talc is the most commonly implicated agent. We present a case of talc granulomatosis which developed in a patient following cocaine sniffing and suggest that this may be the cause of development of granulomata in drug addicts who deny any history of intravenous drug abuse.
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Retracted Publication
Efficacy of the phosphodiesterase inhibitor enoximone in complicated cardiac surgery.
Acute myocardial dysfunction during cardiac surgery involves various pathophysiologic mechanisms such as reduction in myocardial contractility and an increase in afterload induced by peripheral vasoconstriction. In 30 consecutive patients undergoing coronary artery bypass grafting (CABG) and ten consecutive patients with aortic valve replacement (AVR), in whom therapy with catecholamines was expected to be necessary during and after weaning from cardiopulmonary bypass (CPB) on the basis of a retrospective study ("control" patients), 1.0 mg/kg of the phosphodiesterase (PDE) inhibitor enoximone was administered ten minutes prior to weaning from bypass (enoximone group). In eight CABG and four AVR patients weaning was possible without further pharmacologic support. ⋯ Hemodynamic monitoring revealed a higher level in heart rate in the control patients with arrhythmia in seven of the CABG patients: MAP, right atrial pressure, cardiac index, and pulmonary capillary wedge pressure were without significant differences between the groups. Pulmonary artery pressure and TSR, however, increased more in the control group, indicating an increase in right and left ventricular afterload. The results of this study demonstrate that patients at risk of circulatory failure during or after weaning from CPB profit from pretreatment with PDE-III inhibitor enoximone due to a reduction in catecholamines and an improvement in hemodynamics.
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Randomized Controlled Trial Clinical Trial
Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial.
To compare conventional versus ultrasound-guided internal jugular vein cannulation techniques. ⋯ Intensivists can increase successful internal jugular vein cannulation using ultrasound guidance. Two-dimensional ultrasound should be considered for patients difficult to cannulate or those at high risk of cannulation complications.
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Intensive management of patients with severe head injury offers the best hope of minimizing death and functional disability in a young, working population. Secondary neurologic insult can be decreased by cardiorespiratory support and ICP control from the outset. ⋯ Care should not be withheld because of initially grim (and inaccurate) prognostic assessment. Newer techniques for assessing the adequacy of cerebral circulation may allow refinement of management strategies in the future.