Myocardial injury during standard treatment of an adult with status asthmaticus.

Asthma affects 5%-10% of adults in the United States. Older adults (> 65 years) with asthma have higher rates of fatal asthma than younger adults. The occurrence of a respiratory emergency, such as status asthmaticus, would seem likely to create a situation of cardiopulmonary dysfunction conducive to myocardial ischemia. However, multiple studies of fatal or near-fatal asthma have failed to incriminate myocardial infarction as a contributing factor. We report a patient without underlying coronary artery disease who sustained myocardial injury consistent with myocardial ischemia and infarction during status asthmaticus while receiving recommended treatment without intravenous sympathomimetics or theophylline.

Fatal pseudomembranous colitis in a continent urinary neobladder.

Antibiotic-associated colitis is a significant clinical problem, especially in patients hospitalized for longer than three days. Clostridium difficile is now established as the most common nosocomial enteric pathogen causing antibiotic-associated colitis. The condition rarely occurs beyond the boundaries of the large bowel, but can represent significant diagnostic and therapeutic problems if it involves bowel that is used in the creation of a diversionary reservoir such as an ileo-cecal neobladder. We present what we believe to be the first reported case of fatal pseudomembranous colitis occurring in an ileo-cecal neobladder.

Intervention in patients with pneumothorax immediately following CT-guided fine needle aspiration of pulmonary nodules.

BACKGROUND: The incidence of pneumothorax (PTX) as a complication of computerized tomography guided fine needle aspirates (CT-FNA) of solitary pulmonary nodules (SPN) varies from 8-61%. It has been suggested that the practice of obtaining a delayed chest radiograph in patients who have undergone CT-FNA of SPN is not cost effective and adds little information concerning lung expansion obtained by CT at the end of the procedure. It, however, is not known what percent of patients with a PTX present immediately after CT-FNA but do not require prompt chest tube placement will progress and require intervention later. MATERIAL/METHODS: One hundred-fifty-eight consecutive patients undergoing CT-FNA of SPN were included in the study. Immediately after CT-FNA each patient was reimaged with the CT scanner to check for PTX. Patients with a PTX immediately after CT-FNA were assessed as to whether intervention was undertaken or whether the PTX enlarged and/or required drainage at a later time. RESULTS: Thirty-eight patients developed a PTX while still on the CT scanner. Twenty-nine patients with an immediate PTX did not require drainage of their pleural space. Chest tube placement was required promptly after the CT-FNA in 4 patients. Five patients had their pleural space drained at a later time due to an increasing size of the PTX and/or the development of symptoms attributed to the PTX. CONCLUSIONS: These data suggest that patients who develop a PTX immediately after CT-FNA but who do not require prompt pleural space evacuation should be followed closely both clinically and radiographically.