Fatal air embolism during renal dialysis.

Air embolism during renal dialysis is extremely rare because of the safeguards built into the apparatus and procedures currently used. This case is attributable to improper techniques used with venous access outside the monitored system.On completion of dialysis and disconnect from the machine and its safeguards, this patient had leg cramps. This common postdialysis complaint is routinely treated with intravenous saline from a fresh bag hung outside the machine for this purpose. Unfortunately, a previously used bag had not been replaced and soon ran empty after being connected to the patient's venous access. It was replaced hurriedly with a new bag without first bleeding the system of air.The patient collapsed, was transported to a hospital, and died 72 hours later without regaining consciousness. The diagnosis was confirmed by radiological and pathological examinations.The various mechanisms and pathways of venous to material transit are discussed.

Role of radiology in a national initiative to interdict drug smuggling: the Dutch experience.

OBJECTIVE: The purpose of this pictorial essay is to describe the role of radiology in a national initiative to intercept illegal narcotics concealed within the bodies of human transporters. CONCLUSION: Radiologic examination is increasingly important in identifying intracorporeal drug smuggling as improved wrapping techniques undermine the usefulness of blood and urine testing and clinical observation. Detection rates of high accuracy, sensitivity, and specificity are achieved by experienced radiologists.

Perivascular fibrosis in the bone marrow in sickle cell disease.

CONTEXT: Magnetic resonance imaging of bone marrow in homozygous sickle cell disease (hemoglobin [Hb] SS) shows nonhomogeneous, mottled signals that increase with age and number of crises. The pattern of these signals is reminiscent of the underlying vascular architecture, but histopathology of this tissue has not been adequately studied. OBJECTIVE: To elucidate the histopathology of blood vessels in the bone marrow in sickle cell disease. DESIGN: Retrospective histochemical morphometric study of bone marrow arteries by point counting in HbSS (13 cases) and sickle cell Hb C (HbSC) (8 cases) compared to nonanemic normal controls (HbAA) (10 cases). All patients were nondiabetic, normotensive, younger than 37 years, and matched for age group. RESULTS: The mean point count for perivascular fibrous tissue was significantly greater in the HbSS group (P <.001) in both small (P <.001) and medium-sized (P =.002) vessels, and in both age groups (pediatric, P <.001; adult, P =.005) compared with the HbAA group. Additional analysis showed the difference was significant in HbSS pediatric small vessels (P <.001) and in pediatric and adult medium vessels (P =.045 and P =.03, respectively). Ratios of fibrous tissue to muscle showed proportionately greater fibrous tissue in HbSS pediatric small (P <.001) and medium-sized vessels (P =.02), and in adult large vessels (P =.03). Mean point counts for muscle were significantly decreased in HbSS small vessels when all ages were compared as a group (P =.02), but when compared by age groups, counts were significantly increased in adult HbSS medium-sized vessels (P =.01). Overall mean point counts for muscle and fibrous tissue in the HbSC group were intermediate between those of the HbSS and HbAA groups, but were not significantly different from counts in the HbAA group (P =.78 and P =.35, respectively). CONCLUSION: In sickle cell disease, arterial vessels in the bone marrow show significantly increased fibrous connective tissue and changes in muscle that vary with age and vessel size.