[A case report: young man survived penetrating knife stabs to the heart and lung]. / Fallbeskrivning: yngling överlevde direktträffar av kniv i hjärta och lunga.

In Sweden, penetrating injuries to the lung and especially to the heart are fortunately rare. We hereby present a case-report on a young man who was stabbed in the right lung and heart. The paramedics arrived at the scene one minute after the alarm and instituted mechanical ventilation and fluid infusion. Ten minutes later the young man arrived at the emergency department. By then the patient was in deep shock without spontaneous breathing, was darkly cyanotic, showed indeterminately palpable pulses and non-reacting pupils. ECG-monitoring showed sinus-rhythm. Massive fluid infusion was initiated and the adolescent was immediately transported to the operating room. On the way to the operating room the patient's heart arrested. A lateral thoracotomy was performed to relieve the cardiac tamponade, and internal heart massage was initiated. Injuries to the lung and heart were reached through sternotomy. Thanks to prompt initial handling by the paramedics and emergency personnel, a trauma-trained senior surgeon and rather direct lines of communication at the small hospital, the young man could return to ordinary activities with neither physical nor neurological deficit.

Different populations of rheumatoid adherent cells mediate activation versus suppression of T lymphocyte proliferation.

Adherent cells from synovial tissue of rheumatoid arthritis patients were fractionated on Percoll density gradients and analyzed to determine phenotypes, effects on allogeneic T lymphocyte proliferation, and production of prostaglandin E2 (PGE2). Cells expressing HLA-DR predominated in all fractions, and esterase-positive cells were enriched in light fractions. Heavy cells were potent stimulators in the mixed lymphocyte reaction and produced little PGE2, whereas light cells suppressed the mixed lymphocyte reaction and produced a large quantity of PGE2. These results suggest that macrophage-like synovial cells that suppress T helper lymphocyte activity are generated secondary to synovial lymphocyte activation in rheumatoid arthritis.

Intrathoracic goitre with the superior vena cava syndrome, hoarseness and acute stridor.

A 69-year-old man presented with acute stridor and was found to have the superior vena cava syndrome and bilateral laryngeal paresis. A clinical diagnosis of malignancy was made, but before any definite investigations could be made an emergency operation had to be performed to relieve the trachea. On operation the patient was found to have a benign goitre. The literature on the subject is discussed. Since the great majority of cases with the superior vena cava syndrome is caused by malignant diseases, it has been suggested that in acute cases radiation therapy should be started without a microscopic diagnosis if necessary, but such a practice must be warned strongly against.