[Spontaneous retroperitoneal hemorrhage].

A 50-year old male presented to our emergency department with sudden abdominal pain. Upon arrival he was diaphoretic, pale and tachycardic. A CT showed retroperitoneal hemorrhage with suspected tumor at the left adrenal gland. He was quickly stabilized with intravenous fluids and blood transfusion. Rebleed occurs roughly a week after discharge and a new CT showed a visceral pseudoaneurysm from the left middle adrenal artery. The pseudoaneurysm was embolized and the patient discharged in good condition. Follow-up MRI depicted reabsorption of the hematoma and no adrenal tumor. Thus, the etiology of the previous retroperitonal hemorrhage is considered spontaneous.

Evaluation of clinical efficacy and safety of cervical trauma collars: differences in immobilization, effect on jugular venous pressure and patient comfort.

BACKGROUND: Concern has been raised that cervical collars may increase intracranial pressure in traumatic brain injury. The purpose of this study was to compare four types of cervical collars regarding efficacy of immobilizing the neck, effect on jugular venous pressure (JVP), as a surrogate for possible effect on intracranial pressure, and patient comfort in healthy volunteers. METHODS: The characteristics of four widely used cervical collars (Laerdal Stifneck(®) (SN), Vista(®) (VI), Miami J Advanced(®) (MJ), Philadelphia(®) (PH)) were studied in ten volunteers. Neck movement was measured with goniometry, JVP was measured directly through an endovascular catheter and participants graded the collars according to comfort on a scale 1-5. RESULTS: The mean age of participants was 27 ± 5 yr and BMI 26 ± 5. The mean neck movement (53 ± 9°) decreased significantly with all the collars (p < 0.001) from 18 ± 7° to 25 ± 9° (SN < MJ < PH < VI). There was a significant increase in mean JVP (9.4 ± 1.4 mmHg) with three of the collars, but not with SN, from 10.5 ± 2.1 mmHg to 16.3 ± 3.3 mmHg (SN < MJ < VI < PH). The grade of comfort between collars varied from 4.2 ± 0.8 to 2.2 ± 0.8 (VI > MJ > SN > PH). CONCLUSION: Stifneck and Miami J collars offered the most efficient immobilization of the neck with the least effect on JVP. Vista and Miami J were the most comfortable ones. The methodology used in this study may offer a new approach to evaluate clinical efficacy and safety of neck collars and aid their continued development.

[The incidence and mortality of ARDS at Landspítali - The National University Hospital of Iceland 2004-2008]. / Brátt andnaudarheilkenni á gjörgæsludeildum Landspítala 2004-2008.

OBJECTIVE: A retrospective study of the incidence, causes, mortality and treatment of patients with ARDS at Landspítali The National University Hospital of Iceland during the five year period 2004-2008 and comparing the results with an earlier study for the period 1988-1997. MATERIALS AND METHODS: All ICU admissions during the period 2004-2008 were reviewed, selecting patients according to the American-European consensus criteria for ARDS. Data were collected on age, gender, causes, length of stay, ventilator treatment and survival. RESULTS: A total of 6413 patients were admitted to the ICUs at Landspítali during the study period and 120 patients were found to have ARDS giving an incidence of 7,9/100.000 inhabitants. Average age was 55 years, 55% were males, length of stay was 13 days and hospital stay 24 days. ICU mortality was 30% and 90 day mortality was 39%. CONCLUSION: The incidence of ARDS seems to have increased some-what during the period 1988-1997. Mortality has decreased significantly probably due to improvements in intensive care treatment, especially ventilator treament with the use of lung protective ventilation, high frequency oscillation, prone position and ECMO.

[Computerized tomography guided percutaneous needle biopsies at Landspitali University Hospital. Indications, complications and results]. / Lungnaástungur med hjálp tölvusneidmynda á Landspítala. Abendingar, fylgikvillar og útkoma.

OBJECTIVE: Transthoracic needle aspiration biopsies (TNAB) are ideal for diagnosis of peripheral lung nodules. The purpose of the study is to investigate computerized tomography (CT) guided TNAB at Landspitali University Hospital (LUH) in regard to indications, complications, results and evaluate the diagnoses that were obtained with the biopsies. MATERIAL AND METHODS: Retrospective study where information was obtained from clinical charts at LUH. A list of TNAB done over an 18 month period in 2003 to 2004 was obtained from the Department of Medical Imaging. Indications for biopsy, pathology diagnosis, complications and treatment were studied. Further studies and final diagnosis were also studied. RESULTS: There were total of 93 patients that had TNAB. Records were available on 82 patients (46 males og 36 females). Most often the study was done because of cancer suspicion. Nodules were commonly 2-3 cm large. Most commonly there was one nodule that was peripheral. 25/82 (30%) patients developed pneumothorax after the procedure and four patients needed a chest tube. The most common diagnosis was cancer in 36/82 (44%), unspecific changes in 15/82, normal tissue in 12/82, inflammation in 9/82 and other benign causes in 10/82. The sensitivity to diagnose cancer was 61% and specificity 100%. The final diagnosis was cancer in 59/82 (72%) of the cases and benign causes in 23/82. CONCLUSIONS: The diagnostic yield of TNAB is lower in our study than in many previous studies. The rate of complications is similar. It it necessary to do followup studies in benign diagnoses because many of them have cancer when studied further.