Dabigatran Associated Leukocytoclastic Vasculitis.

Common side effects of dabigatran are bleeding, bruising, nausea, diarrhea, and abdomen discomfort. Skin reactions were not often noted (<0.1%). We report a case of 70-year-old male who developed dabigatran related skin reaction resistant to usual therapy. Skin biopsy revealed leukocytoclastic vasculitis.

Aluminium phosphide-induced leukopenia.

Acute intoxication from the pesticide aluminium phosphide is a relatively rare, life-threatening condition in which cardiovascular decompensation is the most feared problem. We report the case of a patient exposed to aluminium phosphide-liberated phosphine gas. It resulted in the development of a gastroenteritis-like syndrome accompanied by severe reduction in white blood cell numbers as an early and prominent manifestation. By affecting important physiological processes such as mitochondrial function and reactive oxygen species homeostasis, phosphine could cause severe toxicity. After presenting the characteristics of certain leucocyte subpopulations we provide the current molecular understanding of the observed leukopenia which in part seems paradoxical.

Are troponin assays occasionally deceiving us?

Troponin (I or T) is the principal marker of myocardial injury used in clinical practice. Although immune-based methods to determine troponin I levels are generally reliable, the presence of human antibodies interfering with the assays components could lead to erroneous results. In this report, we will discuss the case of a patient with misleadingly elevated troponin I due to high rheumatoid factor titer and provide an insight into the responsible molecular mechanisms.

Quetiapine-associated pancreatitis in a geriatric critical care patient with delirium.

We report the case of a 78-year-old male who developed acute pancreatitis related to quetiapine that was administered for the treatment of delirium. No evidence of hypertriglyceridemia, infection, ischemia, chololithiasis or hypercalcemia could be documented.Clinicians should be alerted when treating critical care patients with antipsychotics, as risks might present and potentially lead to hazardous results.

Carboplatin-induced hypersensitivity reaction.

We describe a 65-year-old female with relapsed ovarian cancer who developed a severe hypersensitivity reaction during the second cycle of carboplatin treatment. The patient developed respiratory failure, acute respiratory distress syndrome and hypotension, requiring admission to the intensive care unit.

Relative contributions of the ribcage and abdomen to lung volume displacement during speech production.

We tested the hypothesis that the pattern of chest wall configuration during speech production correlates with the pattern of chest wall motion during resting breathing. Twenty-one men (age 40 +/- 8 years) with ankylosing spondylitis and varied degrees of ribcage involvement participated in the study. None of the patients had an obvious speech abnormality. Ribcage and abdominal displacements during quiet breathing and during reading were measured with a respiratory plethysmograph. Measurements were taken in the sitting and standing body positions. In each body position, ribcage or abdominal displacements during quiet breathing correlated with the corresponding chest wall displacements recorded during reading (P < 0.001). In addition, linear regression analysis showed that the slope of the chest wall motion loop during quiet breathing correlated with the ratio of ribcage to abdomen contribution to lung volume displacement during reading (r = 0.78, P < 0.001 for sitting and r = 0.64, P = 0.002 for standing position). The slopes of the regression lines did not differ between the sitting and standing body position (P > 0.05). We conclude that the relative contribution of the ribcage and abdomen to lung volume displacement during speech production correlates with the relative ribcage and abdomen contribution to tidal volume during quiet breathing; our data support the notion that the pattern of chest wall configuration during quiet breathing largely predicts the pattern of ribcage and abdomen displacement during speech.

Chest wall motion during speech production in patients with advanced ankylosing spondylitis.

PURPOSE: To test the hypothesis that ankylosing spondylitis (AS) alters the pattern of chest wall motion during speech production. METHOD: The pattern of chest wall motion during speech was measured with respiratory inductive plethysmography in 6 participants with advanced AS (5 men, 1 woman, age 45+/-8 years, Schober test 1.45+/-1.5 cm, Bath Ankylosing Spondylitis Functional Index [BASFI] score 6+/-1.7) and 6 healthy volunteers, matched for age and gender. Measurements were made with participants in the upright seated and upright standing body position. RESULTS: During reading in the seated and standing body positions, the rib cage wall volume displacements were smaller and abdominal wall volume displacements were larger in participants with AS than in healthy controls. There were no differences in the overall lung volume displacements recorded during the expiratory limb of reading in either body position. In the participants with AS, the rib cage remained near the end-expiratory level in both the seated and standing body position, differing from that for the control group. CONCLUSION: In individuals with advanced AS, the abdomen is the primary contributor to volume displacement. In the absence of speech impairment in participants with AS, the data show the capacity of the abdomen to compensate for the decreased compliance of the rib cage.

Inter-session reproducibility of peak expiratory flow with standardized expiratory maneuvers.

BACKGROUND: In adults performing forceful expiratory maneuvers, the length of post-inspiratory pause prior to forced expiration may influence the subsequently measured peak expiratory flow (PEF) and increase its variability. We investigated the effects of two different lengths of breath-hold at total lung capacity (TLC) on the short-term reproducibility of PEF in healthy volunteers. METHODS: Forty-six healthy volunteers (age 34.6+/-8.5; 23 men) performed a series of maximal forceful expirations in two different test sessions, separated by approximately 2 weeks. In each test-session, PEF was measured with two different types of maneuvers. One maneuver (P) included a brief (<2s) post-inspiratory pause at TLC prior to forced expiration, whereas the second maneuver (NP) included no pause at TLC. The speed of inspiration to TLC was fast and similar for both maneuvers. In a given test session, all volunteers performed four efforts for each type of maneuver. The highest PEF for each maneuver was used for analysis. The Bland-Altman statistical analysis was used to determine inter-session reproducibility of PEF. RESULTS: Within-maneuver analysis of the between-test session reproducibility of PEF showed that neither maneuver systematically biased the measured PEF (mean difference 0.02L/s for the P and 0.17L/s for the NP maneuver). Inter-maneuver between-test session analysis similarly showed that neither maneuver introduced a systematic bias in the maximal PEF (mean difference ranged from -0.15 to -0.01L/s). The limits of agreement were comparable in all maneuver-pair analyses. CONCLUSIONS: Forceful expiratory maneuvers with or without a brief (<2s) pause at TLC produce comparable PEF values in test-retest sessions.