ABSTRACT
BACKGROUND: Electronic (e-) cigarettes are used to heat liquids producing aerosols for inhalation. Recently there have been reports of a large number of adverse outcomes relating to e-cigarette consumption (vaping), which has been referred to as "vaping associated pulmonary illness" (VAPI). AIM: This review provides an overview of clinical, radiological and pathological features of VAPI in the literature. We also describe a case of VAPI, presenting with symptoms of bronchiolitis, responding well to azithromycin in addition to the usual treatments provided for such cases. METHODS: We searched original papers, observational studies, case reports, and meta-analyses published between 2000 and 2019 in English in PubMed database using the keywords: e-cigarette, "vaping associated pulmonary illness", VAPI, EVALI, vaping AND "lung injury". We also used data of the Centers of Disease Control (CDC) website. RESULTS: From an initial search of PubMed, 62 potential articles were identified, and another 9 studies were identified from the bibliographies of retrieved articles. In this search we found 7 case series and 16 case reports, which were included in the review. In this search we also found 4 review articles. CONCLUSION: VAPI is a syndrome presenting with isolated pulmonary or combined pulmonary, gastrointestinal and constitutional symptoms and can be rapidly progressive, leading to respiratory failure, often requiring invasive respiratory support. There is an urgent need for more research on VAPI especially relating to etiology, treatment and prevention.
Subject(s)
Bronchiolitis/drug therapy , Electronic Nicotine Delivery Systems/statistics & numerical data , Lung Diseases/etiology , Vaping/adverse effects , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Adult , Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , Bronchiolitis/diagnosis , Bronchiolitis/pathology , Bronchoalveolar Lavage/methods , Female , Humans , Lung Diseases/diagnosis , Lung Diseases/epidemiology , Lung Diseases/mortality , Lung Injury/complications , Lung Injury/physiopathology , Male , Middle Aged , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
OBJECTIVES: To identify imaging algorithms and indications, CT protocols, and radiation doses in polytrauma patients in Swiss trauma centres. METHODS: An online survey with multiple choice questions and free-text responses was sent to authorized level-I trauma centres in Switzerland. RESULTS: All centres responded and indicated that they have internal standardized imaging algorithms for polytrauma patients. Nine of 12 centres (75 %) perform whole-body CT (WBCT) after focused assessment with sonography for trauma (FAST) and conventional radiography; 3/12 (25 %) use WBCT for initial imaging. Indications for WBCT were similar across centres being based on trauma mechanisms, vital signs, and presence of multiple injuries. Seven of 12 centres (58 %) perform an arterial and venous phase of the abdomen in split-bolus technique. Six of 12 centres (50 %) use multiphase protocols of the head (n = 3) and abdomen (n = 4), whereas 6/12 (50 %) use single-phase protocols for WBCT. Arm position was on the patient`s body during scanning (3/12, 25 %), alongside the body (2/12, 17 %), above the head (2/12, 17 %), or was changed during scanning (5/12, 42 %). Radiation doses showed large variations across centres ranging from 1268-3988 mGy*cm (DLP) per WBCT. CONCLUSIONS: Imaging algorithms in polytrauma patients are standardized within, but vary across Swiss trauma centres, similar to the individual WBCT protocols, resulting in large variations in associated radiation doses. KEY POINTS: ⢠Swiss trauma centres have internal standardized imaging algorithms for trauma patients ⢠Whole-body CT is most commonly used for imaging of trauma patients ⢠CT protocols and radiation doses vary greatly across Swiss trauma centres.
Subject(s)
Algorithms , Multiple Trauma/diagnostic imaging , Trauma Centers/statistics & numerical data , Clinical Protocols , Emergency Medical Services , Humans , Radiation Dosage , Surveys and Questionnaires , Switzerland , Tomography, X-Ray Computed/methods , Whole Body Imaging/methodsABSTRACT
May-Thurner syndrome is known as compression of the left common iliac vein by the right common iliac artery. We describe a case of an atypical compression of the inferior vena cava by the right common iliac artery secondary to a high aortic bifurcation. Despite an extensive collateral network, there was a significant venous gradient between the iliac veins and the inferior vena cava above the compression. After stenting the venous pressure gradient disappeared. Follow-up 4 months later revealed a good clinical response with a patent stent.