Organising pneumonia presenting as acute life threatening pulmonary haemorrhage.

Organising pneumonia, previously called bronchiolitis obliterans organising pneumonia is a clinicopathological entity of unknown aetiology, which has been reported with increasing frequency. Various modes of presentation have been described such as cough, fever, weight loss and alveolar opacities on chest radiograph. Haemoptysis as primary presenting symptom has only rarely been reported. The authors report a case in which massive life-threatening haemoptysis was the major presenting symptom. No aetiology was identified for the haemoptysis and the diagnosis was confirmed on postmortem histology. This case highlights the importance of considering organising pneumonia in the differential diagnosis of acute severe haemoptysis.

Twenty months' routine use of a new percutaneous tracheostomy set using controlled rotating dilation.

After a favorable trial period, we introduced the new percutaneous tracheostomy set, PercuTwist, in February of 2002 for our routine procedures. Over the next 20 mo, 90 procedures were performed with minimal complications. To prospectively evaluate this experience, we collected information on reasons for unit admission, operators' previous experience, the duration of prior tracheal intubation, the time needed for the procedure, the grading of the difficulty, the amount of bleeding, and the complications of the procedure. Twenty-two of 90 (24.4%) procedures were performed by senior consultants with experience; 68 of 90 (75.6%) were safely performed by intensive care residents under close bedside supervision. The mean time needed for the procedure was 13 min 7 s. In only one procedure during the entire study was any difficulty observed during the insertion process. This occurred because the initial skin incision was too small. However, no major bleeding or complications were encountered.