False-positive transbronchial needle aspiration in bronchogenic carcinoma.

In a patient with bronchogenic carcinoma, a transbronchial needle aspiration of subcarinal and paratracheal lymph nodes was performed for purposes of staging. On cytologic examination of the specimen, a clump of malignant cells was found; however, subsequent mediastinoscopy and thoracotomy showed no evidence of metastases to mediastinal lymph nodes. We postulate that specimens from transbronchial needle aspiration can be contaminated with tumor cells located on the airway surface epithelium.

Name that tone. The proliferation of alarms in the intensive care unit.

The proliferation of alarms on equipment in ICUs contributes to a level of noise that can disturb both patient and staff. To determine whether these alarms are identifiable by sound alone to our ICU staff, we recorded 33 audio signals commonly heard on the ward, 10 of which we defined as critical alarms. One hundred subjects (25 physicians, 41 nurses, and 34 respiratory therapists) listened individually in a quiet room to the tape recording that consisted of 10 s of audible followed by a 10-s pause for a written response. Only 50 percent of the critical alarms and only 40 percent of the noncritical sounds were correctly identified. By occupation, registered respiratory therapists scored highest, followed by nurses, nonregistered therapists, and physicians. Those with > 1 year ICU work experience scored higher than those with less than 1 year. We conclude that the myriad of alarms that regularly occur in the ICU are too much for even experienced ICU staff to quickly discern. Patient and caregiver alike could benefit by a graded system in which only urgent problems have audible alarms, and these should be covered by regular in-service training.

Cavitary pneumonia due to Yersinia enterocolitica in a healthy man.

A previously healthy 51-year-old man was admitted to the hospital because of pulmonary infiltrates of the right upper lung field with cavitation. Blood cultures were sterile. Sputum and stool cultures grew Yersinia enterocolitica. The patient was treated with intravenous ampicillin and recovered. Review of the literature yielded five previously reported sputum-positive cases of Y. enterocolitica pulmonary infections in patients with significant underlying diseases. All patients recovered.

Spontaneous pneumothorax in weightlifters.

Spontaneous pneumothorax is infrequently caused by strenuous exertion. To our knowledge there has only been one case of spontaneous pneumothorax associated with weightlifting reported in the medical literature. We describe three consecutive cases of spontaneous pneumothorax associated with weightlifting. We postulate that spontaneous pneumothorax in these patients may be secondary to improper breathing techniques. It is important that physicians and weight trainers be aware of the association between weight lifting and spontaneous pneumothorax and assure that proper instruction is given to athletes who work with weights.

Spontaneous endobronchial erosion and expectoration of a retained intrathoracic bullet: case report.

In all four previously reported cases of endobronchial erosion from retained intrathoracic foreign objects, the object eventually required surgical removal. We report the case of a patient with a bullet in the left hemithorax who developed bronchial erosion and hemoptysis 3 months after the injury, with subsequent expectoration of the bullet. Although most foreign bodies within the thorax pose no special problems, migration of the object or the development of symptoms warrants investigation and possibly subsequent surgical removal of the object.