Pneumomediastinum after injection injury to the hand.

Pneumomediastinum as a consequence of injection injury to the hand has not been previously reported. We present a 22-year-old male who developed pneumomediastinum when a high pressure hose injected air into his hand. The anatomic continuity between peripheral ulnar neurovascular bundle and the hilar vessels provided the route for air entering the hypothenar eminence to penetrate the mediastinum. After ruling out life-threatening causes of pneumomediastinum such as esophageal perforation, his management included observation and serial radiographs. By one week there was complete resolution of the mediastinal air. This report demonstrates that pneumomediastinum may be associated with air injection injury of the hand, and that expectant management is appropriate.

Translabial ultrasonography and placenta previa: does measurement of the os-placenta distance predict outcome?

The aim of this study was to assess the value of the measurement of os-placenta distance by translabial ultrasonography in the evaluation of placenta previa. This method was used in 40 women with suspected placenta previa to measure the distance between the placenta and internal cervical os. Sonographic diagnoses were compared to placental location determined at delivery. Translabial ultrasonography proved superior to the transabdominal route in both diagnosis and exclusion of placenta previa. Measurement of the os-placenta distance can be used as an adjunct to clinical assessment to predict the likelihood of safe vaginal delivery in cases of suspected placenta previa.

Assessment of postnatal gestational age using sonographic measurements of femur length.

Assessment of gestational age in the premature newborn infant is both essential and difficult. The purpose of this study is to evaluate a new method for the assessment of gestational age in premature neonates using femur length measurements obtained by ultrasonography and compare these with an established clinical method. Forty-seven newborn infants with true gestational age calculated by reliable last menstrual period, further confirmed by obstetric ultrasonographic estimation performed at <18 weeks, were enrolled within 3 days of birth. Birth weight, length, and head circumference were appropriate for the true gestational age. The modified Ballard maturational scoring system was used to determine gestational age. A trained sonographer imaged the femur and measured the shaft of the femur using electronic calipers. Gestational age was estimated from an average of six femur length measurements by a radiologist blinded to the study using tables of fetal femur length measurements. Results indicate that gestational age assessment by ultrasonography has an excellent correlation with true gestational age (r = 0.93), as does assessment by the Ballard score (r = 0.87), with no statistical difference between both the correlations' coefficients. We conclude that gestational age assessment in newborn infants weighing <1500 g, without intrauterine growth retardation, by sonographic measurement of femur length is an excellent means to estimate true gestational age. Furthermore, the sonographic method is ideal for sick, paralyzed neonates and may be useful in the design of future clinical trials.

A comparison between IVIg and plasma exchange in Guillain-Barré syndrome: a review and decision analysis of the two treatment modalities.

Plasma exchange (PE) has been established as an effective treatment for Guillain-Barré syndrome (GBS), and until recently, was the only treatment significantly to modify the disease course. Data from a recently published Dutch study suggest that intravenous immunoglobulin (IVIg) is as effective as PE in improving the speed of recovery and lessening disability. Recent small case series in the United States have shown unexpectedly high relapse rates in patients with GBS treated with IVIg. At present, clinicians face a dilemma in choosing between the two options, because there is uncertainty about the efficacy and relapse rate associated with IVIg. In this article, we perform a decision analysis that takes into account the efficacy of therapy, relapse rates, and patient preferences with respect to particular outcomes. Although both modalities are quite costly, an economic analysis shows a slight cost advantage for IVIg. Plasma exchange remains to preferred treatment, based on a decision analysis and currently available data. Results of future IVIg trials can be compared to the PE data using the decision-analysis model.

Pulmonary sclerosing hemangioma: unusual cause of a solitary pulmonary nodule.

Pulmonary sclerosing hemangiomas are rare, benign neoplasms, which are usually solitary. The authors describe the computed tomography-pathological correlation in a case of pulmonary sclerosing hemangioma. Computed tomography demonstrated a smoothly marginated, homogeneously enhancing nodule, 1.5 cm in diameter. Pathologically the lesion was well circumscribed, soft and hemorrhagic on its cut surface. Microscopic examination revealed a sclerosing hemangioma, predominantly of the hemorrhagic type.

Computed tomography of cardiac and pericardial tumors.

Computed tomography (CT) scans in 30 patients with neoplastic involvement of the heart and pericardium were retrospectively reviewed. Computed tomography was compared with echocardiography in three of four patients with large primary cardiac tumors and in three patients with metastatic pericardial disease. Computed tomography was superior to echocardiography in determining tumor extent and site of origin of a right atrial sarcoma, as well as in assessing tumor extent and presence of pulmonary arterial hypertension in a left atrial malignant fibrous histiocytoma and a left atrial myxoma. Pericardial effusions were detected by echocardiography in two out of three patients with metastatic pericardial disease, but the malignant nature of the effusion was not recognized; in all three cases CT showed nodular pericardial thickening. Of the 23 patients with evidence on CT of direct extension of anterior mediastinal masses, bronchogenic carcinoma or mesothelioma to the pericardium 21 had nodular pericardial thickening and 2 diffuse thickening; only 6 had pericardial effusion. We conclude that CT is useful in the characterization of large primary cardiac tumors that are incompletely visualized with echocardiography. Computed tomography is superior to echocardiography in assessing tumor involvement of the pericardium because pericardial effusions are often absent; CT is also superior in identifying nodular pericardial thickening.

Phosphorylation of a chromaffin granule-binding protein in stimulated chromaffin cells.

A procedure was devised to determine whether in the stimulated chromaffin cell phosphate is incorporated into specific proteins ("chromobindins") that bind to chromaffin granule membranes in a Ca2+-dependent manner. Cells were preincubated with 32P-labeled orthophosphate, then challenged with secretory stimuli. A postmicrosomal supernatant fraction was prepared from the cells and incubated with unlabeled chromaffin granule membranes in the presence of 5 mM Ca2+. Proteins that bound to the membranes were isolated by centrifugation and examined for 32P content by electrophoresis and autoradiography. Stimulation by carbamylcholine, nicotine, 56 mM K+, or 2 mM Ba2+ led to the incorporation of 32P into a 37-kDa protein that had previously been characterized as a substrate for protein kinase C in vitro (chromobindin 9, or CB9; Summers, T. A., and Creutz, C. E. (1985) J. Biol. Chem. 260, 2437-2443). Incorporation of 32P into this protein was dependent on extracellular Ca2+ and followed a time course that paralleled secretion of catecholamines, returning to base-line levels after 30 min, when secretion terminated. 32P was also incorporated into a 58-kDa protein that may be tyrosine hydroxylase and into an unidentified 28-kDa protein in response to cell stimulation, but neither of these proteins bound to granule membranes in a Ca2+-dependent manner. Treatment of cells with phorbol 12,13-dibutyrate, an activator of protein kinase C, led to 32P incorporation into the 37-kDa protein that was only 30% of the level obtained with nicotinic stimulation, suggesting that additional kinases may be involved in phosphorylating this protein in the stimulated cell.