Scuba diving-induced pulmonary edema in a swimming pool.

SCUBA diving-induced pulmonary edema is a rare syndrome that has been previously reported to occur in cold water. We present a case of SCUBA diving-induced pulmonary edema in a 52-year-old man diving in a warm swimming pool. The pathophysiology of this syndrome is unclear, but it is unrelated to either barotrauma or decompression illness. This patient developed frank pulmonary edema while submerged, which resolved after surfacing. As with other patients who have had this syndrome, he did not have any cardiorespiratory disease. The presentation and pathophysiology of SCUBA diving-induced pulmonary edema are discussed.

Value of routine anaerobic blood cultures for pediatric patients.

OBJECTIVE: Anaerobic bacteremia rarely occurs in children. Therefore we assessed the usefulness of routinely obtaining anaerobic blood cultures in our pediatric patients. STUDY DESIGN: Records of 9360 paired aerobic anaerobic blood culture bottles (Bactec NR660 System) containing blood specimens from pediatric inpatients and outpatients at Duke University Medical Center, Durham, N.C., were reviewed retrospectively. Yield and speed of detection were calculated for each bottle and compared for statistical significance by the McNemar test. RESULTS: A total of 723 clinically important microorganisms were isolated; only 15 (2.1%) were strict anaerobes. Significantly more microorganisms (p < 0.001), especially staphylococci, nonfermenting gram-negative rods, enteric gram-negative rods, and yeasts, were detected by use of the aerobic bottle. The anaerobic bottle was important in identifying an anaerobic microorganism as the cause of sepsis in only five patients, all of whom were at increased risk of having anaerobic infection. CONCLUSIONS: Anaerobic blood cultures are rarely helpful in the majority of pediatric patients and usually show positive results only in clinical settings associated with anaerobic infection. Microorganisms that prefer an aerobic environment, such as Pseudomonas aeruginosa and yeasts, are now far more common than anaerobes in children; aerobic culturing of the entire volume of blood collected might increase the yield from pediatric blood cultures.