The role of PET scan in monitoring the progression of fibrosing mediastinitis.

We present the case of a 31-year-old man who presented with acute chest pain. Computed tomography scan showed a mediastinal mass engulfing right main-stem bronchus and another mass surrounding descending aorta. Positron emission tomography (PET) scan showed high mass metabolic activity. Histopathological evaluation revealed fibroinflammatory scarring. He was diagnosed with idiopathic fibrosing mediastinitis, started on prednisone and tamoxifen treatment, and monitored with serial PET scans. Nine months after treatment initiation, paraaortic abnormality had resolved and mediastinal mass had regressed.

Attitudes of experiential education directors regarding tobacco sales in pharmacies in the USA.

OBJECTIVES: Accreditation guidelines in the USA suggest that experiential sites for pharmacy students should demonstrate 'a strong commitment to health promotion and illness prevention'; however, most community pharmacies sell tobacco products. This study aimed to determine the proportion of students rotating through advanced pharmacy practice experience (APPE) sites where tobacco is sold and experiential education directors' perception regarding the sales of tobacco in APPE sites. METHODS: A brief survey was distributed by mail to experiential education directors at US pharmacy schools. The survey characterized the proportion of students who rotate at practice sites where tobacco is sold, directors' perceptions of tobacco sales in experiential sites, and the number of hours of tobacco education in their pharmacy curricula. KEY FINDINGS: Directors (n = 81; 63%) estimated that 69% of students rotate through sites where tobacco is sold. If given the opportunity to choose between two potential sites, where one sells tobacco and the other does not, 40% of directors would be unlikely to choose a site that sold tobacco. CONCLUSIONS: With respect to tobacco sales, pharmacy schools are largely noncompliant with guidelines and resolutions of professional organizations.

The effect of race on long term mortality in mechanically ventilated patients.

OBJECTIVE: Determine the impact of race on one-year mortality following mechanical ventilation. BACKGROUND: There is a lack of prospective studies on the effect of race on survival following mechanical ventilation. METHODS: Observational study of adult patients on ventilatory support for <24 h prior to enrollment. Socioeconomic factors, laboratory and clinical data were recorded. Primary outcome was one-year mortality. RESULTS: We enrolled 178 patients; 100 African American (AA), 78 other races (OTH). One-year mortality for AA was 49% and 33% for OTH (p = 0.035). After correcting for covariates, race was not significantly associated with mortality (p = 0.42). AA patients had higher mean arterial blood pressure, serum creatinine, heart rate, and peak (p < 0.01) and mean (p = 0.05) airway pressures. CONCLUSIONS: AA patients who underwent mechanical ventilation had greater one-year mortality, although race per se was not a significant factor. It remains to be determined if strict blood pressure control and lower airway pressures may improve survival in this racial group.

Decreased respiratory rate variability during mechanical ventilation is associated with increased mortality.

OBJECTIVE: Patients on ventilatory support often experience significant changes in respiratory rate. Our aim was to determine the possible association between respiratory rate variability (RRV) and outcomes in these patients. DESIGN: A longitudinal, prospective, observational study of patients mechanically ventilated for at least 12 h performed in a medical-surgical intensive care unit. Patients were enrolled within 24 h of the initiation of ventilatory support. We measured airway signals continuously for the duration of ventilatory support and calculated expiratory flow frequency spectra at 2.5-min intervals. We assessed RRV using the amplitude ratio of the flow spectrum's first harmonic to the zero frequency component. Measures of the amplitude ratio were averaged over the total monitored time. Patients with time-averaged amplitude ratios <40 % were classified as high RRV and those ≥40 % as low RRV. All-cause mortality rates were assessed at 28 and 180 days from enrollment with a Cox proportional hazards model adjusted for disease acuity by the simplified acute physiology score II. RESULTS: We enrolled 178 patients, of whom 47 had high RRV and 131 low RRV. Both groups had similar disease acuity upon enrollment. The 28- and 180-day mortality rates were greater for low RRV patients with hazard ratios of 4.81 (95 % CI 1.85-12.65, p = 0.001) and 2.26 (95 % CI 1.21-4.20, p = 0.01), respectively. Independent predictors of 28-day mortality were low RRV, i.v. vasopressin, and SAPS II. CONCLUSIONS: Decreased RRV during ventilatory support is associated with increased mortality. The mechanisms responsible for this finding remain to be determined.

Differentiation of bone and soft tissues in formalin-fixed, paraffin-embedded tissue by using methylene blue/acid fuchsin stain.

OBJECTIVE: To find a staining method for formalin-fixed, paraffin-embedded tissue that would distinguish bone from surrounding soft tissues, including muscle, periosteal tissue and bone marrow. STUDY DESIGN: A variety of stains were tested and compared with hematoxylin-eosin. The potential value of any given stain was evaluated based on its ability to stain bone and soft tissues different colors or shades that could be readily identified in photomicrographs. Stains were evaluated using both endochondral (tibia) and intramembranous bone (calvaria) samples. RESULTS: In contrast to standard hematoxylin-eosin stain, which stains both bone and soft tissues pink, the methylene blue/acid fuchsin stain demonstrates remarkable contrast between bone and other tissues. Methylene blue/acid fuchsin stained bone bright pink and the surrounding soft tissues blue-purple. CONCLUSION: In addition to the superior staining properties of methylene blue/acid fuchsin, other benefits of this stain include its stability, ease of use and low cost. This stain has many potential applications in the study of erosive bone disease in humans and also in animal models for research.