Broncho-pleuropericardial fistula complicating staphylococcal sepsis

This is a rare case of broncho-pleuropericardial fistula in a 12-year-old female who presented with fever, painful joint swelling, and pleural and pericardial effusion secondary to disseminated methicillin-sensitive Staphylococcus aureus infection. The pleural and pericardial effusion were drained, however, air leak was observed from both tubes and was synchronous with mechanical inspiration. A broncho-pleuropericardial fistula was suspected and confirmed with computed tomography. This case report demonstrated that disseminated S. aureus bacteremia could result in broncho-pleuropericardial fistula. The ability of disseminated staphylococcal infection to produce pnemopericardium should be added to the list of other complications associated with disseminated staphylococcal sepsis

Reduction of propofol pain Fentanyl vs lidocaine

To compare the local efficacy of lidocaine and fentanyl in reducing propofol injection pain [PIP], we conducted a prospective randomized double-blind study in 75 ASA I and II adult patients. When administered 20 seconds before propofol with a venous tourniquet, lidocaine but not fentanyl or placebo, reduced the incidence of moderate to severe pain on subsequent injection of propofol [P < 0.001]. Two patients [8%] in the lidocaine group [n = 25] experienced a moderate degree of pain and none experienced severe pain. Fifteen [60%] in the fentanyl group [n = 25] experienced moderate or severe degrees of pain, compared with 15 [60%] in the saline group [n = 25]. We conclude that lidocaine, acting locally, reduces propofol injection pain while fentanyl does not

Rapid postural redistribution of pulmonary opacities in adult respiratory distress syndrome [ARDS]

Although recognized for over 20 years, the adult Respiratory Distress Syndrome [A. R. D. S.] remains an ill defined and poorly understood condition. Accepted criteria for diagnosis are acute severe progressive respiratory distress not due to cardiac failure or chronic pulmonary disease, refractory hypoxemia, reduced pulmonary compliance and bilateral radiological lung opacities [1]. Although the infiltrates on chest X-ray are usually described as diffuse, they are more often non-uniform or patchy in distribution. These infiltrates or radiological opacities can be due to fluid, atelectasis, consolidation and later fibrosis. Furthermore, when examined by lung computed tomography [CT], the opacification is more often found in the postero-basal portions of the lungs [2]. We report a case of A. R. D. S. in which change in posture of the patient produced rapid redistribution of the pulmonary opacities into the dependent lung