Carbamazepine-induced systemic lupus erythematosus presenting as cardiac tamponade.

Here we report the case of a patient who presented with acute cardiac tamponade due to drug-induced systemic lupus erythematosus (SLE). The patient had been treated for a seizure disorder with carbamazepine, a drug that has previously been demonstrated to cause SLE-like syndromes. Further serologic analysis demonstrated the likelihood of drug-induced SLE in this patient, with the rare presentation of cardiac tamponade.

Late onset of subcutaneous emphysema and hypercarbia following laparoscopic cholecystectomy.

Laparoscopic surgical techniques are increasingly being applied to treat intraperitoneal abnormalities. These minimally invasive techniques potentially offer decreased operation time, decreased morbidity, and decreased length of hospitalization stays. These procedures, however are not without potential morbidity. Herein we describe two patients treated with laparoseopic cholecystectomy whose cases were complicated with subcutaneous emphysema and hyperearbia without pneumothorax. In each of these cases, carbon dioxide gas was used to induce pneumoperitoneum. In one of the cases, the hypercarbia was a late event occurring during the surgery, and in the second case, the first such description in the literature (to our knowledge), hypercarbia developed after termination of the induced pneumoperitoneum.

Flock worker's lung: chronic interstitial lung disease in the nylon flocking industry.

BACKGROUND: Two young men working at a nylon flocking plant in Rhode Island developed interstitial lung disease of unknown cause. Similar clusters at the same company's Canadian plant were reported previously. OBJECTIVE: To define the extent, clinicopathologic features, and potential causes of the apparent disease outbreak. DESIGN: Case-finding survey and retrospective cohort study. SETTING: Academic occupational medicine program. PATIENTS: All workers employed at the Rhode Island plant on or after 15 June 1990. MEASUREMENTS: Symptomatic employees had chest radiography, pulmonary function tests, high-resolution computed tomography, and serologic testing. Those with unexplained radiographic or pulmonary function abnormalities underwent bronchoalveolar lavage, lung biopsy, or both. The case definition of "flock worker's lung" required histologic evidence of interstitial lung disease (or lavage evidence of lung inflammation) not explained by another condition. RESULTS: Eight cases of flock worker's lung were identified at the Rhode Island plant. Three cases were characterized by a high proportion of eosinophils (25% to 40%) in lavage fluid. Six of the seven patients who had biopsy had histologic findings of nonspecific interstitial pneumonia, and the seventh had bronchiolitis obliterans organizing pneumonia. All seven of these patients had peribronchovascular interstitial lymphoid nodules, usually with germinal centers, and most had lymphocytic bronchiolitis and interstitial fibrosis. All improved after leaving work. Review of the Canadian tissue specimens showed many similar histologic findings. Among the 165-member study cohort, a 48-fold or greater increase was seen in the sex-adjusted incidence rate of all interstitial lung disease. CONCLUSIONS: Work in the nylon flocking industry poses substantial risk for a previously unrecognized occupational interstitial lung disease. Nylon fiber is the suspected cause of this condition.