Respiratory failure produced by severe procainamide intoxication in a patient with preexisting peripheral neuropathy caused by amiodarone.

We describe a patient in whom respiratory failure, due to extreme neuromuscular weakness, was produced by procainamide intoxication superimposed on a peripheral neuropathy secondary to long-term amiodarone therapy. Respiratory failure reversed rapidly after procainamide was discontinued, and the serum level fell to a therapeutic range.

Complications of transthoracic needle biopsy decreased with isobutyl 2-cyanoacrylate: a pilot study.

To explore the possibility of performing percutaneous lung biopsy safely in patients mechanically ventilated with positive-end expiratory pressure (PEEP), transthoracic needle biopsy was performed in 16 anesthetized mongrel dogs mechanically ventilated with 10 cm H2O of PEEP. To obtain the biopsy sample, a 25-gauge "skinny needle" was passed through a 20-gauge sheath and placed up to 6.25 cm deep. After satisfactory samples were obtained, both needles were withdrawn in the control group, but in the treated group, the outer sheath was used to inject 0.5 ml of isobutyl 2-cyanoacrylate to seal the needle track. Pneumothorax was present in 7 (87.5%) of 8 dogs in the control group and in 2 (25%) of 8 dogs in the treated group (p = .0147). Lung tissue exhibited an apparent foreign-body granulomatous inflammatory reaction. This technique could extend the benefits of transthoracic needle biopsy to mechanically ventilated patients, but further studies to prove the safety of isobutyl 2-cyanoacrylate are necessary.

Interstitial pulmonary fibrosis in an automobile body shop worker.

Interstitial pulmonary fibrosis (IPF) is often of uncertain etiology and is therefore named 'idiopathic' pulmonary fibrosis. Some occupational exposures, however, are known to cause interstitial fibrosis, asbestos and silica being well-known examples. We present clinical and pathological findings of a case with IPF and the results of microchemical analysis of inorganic particulate matter in the lung tissue. A very high lung burden of inorganic contaminants was found, including silica and metallic compounds. Emphasis is given to the importance of obtaining detailed occupational histories and conducting microchemical analysis of lung tissue in order to clarify etiological factors in cases with 'idiopathic' pulmonary fibrosis.

Pulmonary artery catheter-induced hemorrhage.

Pulmonary artery rupture by a flow-directed balloon-tipped catheter is a rare complication if guidelines for insertion of catheters are strictly applied. It should be stressed that the need for a "confirmed" wedge pressure should be weighed against the very real risk of this potentially fatal complication. Users of this catheter should expect and anticipate distal migration of the catheter tip. Great care must be exercised in inflating the balloon, particularly when the location of the catheter tip in the pulmonary vascular bed is unknown. Excessive catheter manipulation should be avoided. Hemoptysis, hemothorax, cardiac or respiratory instability in patients who have the PA catheter should be suspected to have this grave complication and appropriate emergency measures should be taken until this complication has been ruled out.