Shisha smoking as a possible cause of bilateral granulomatous lung lesions.

A 19-year-old male who regularly smoked tobacco shisha pipes presented with pleuritic chest pain, dyspnoea, and cough. He was found to have multiple bilateral lung nodules on computed tomography. A biopsy of the lung revealed necrotizing granulomatous inflammation but without evidence of infection, foreign body, vasculitis, or malignancy. There was spontaneous and complete clinical and radiographic resolution over the next 12 weeks following cessation of shisha use.

Delays in the assessment and management of primary lung cancers in South Auckland.

AIM: To determine the patient characteristics, referral patterns and delays in assessment and treatment of patients with primary lung cancer in South Auckland, New Zealand and compare with international standards. METHODS: Retrospective review of the clinical records of 80 patients referred to a secondary care respiratory service and diagnosed with primary lung cancer in 2004. RESULTS: Eighty-five percent of inpatient referrals and 48.5% of outpatient referrals were for advanced stage lung cancers. The median interval from receipt of outpatient referral to first chest physician assessment was 18 days, with median interval from the first chest physician assessment to bronchoscopy of 17 days and for staging CT chest of 16 days. For patients requiring a CT-guided percutaneous needle aspiration for diagnosis, there was a further median delay of 37 days after the initial CT scan. The median interval from the date of receipt of initial outpatient referral to diagnosis was 38 days, but for early stage lung cancers it was 54 days. The median interval to diagnosis for inpatient admissions was 6 days after the first respiratory assessment. CONCLUSION: The intervals for initial assessment, diagnosis and treatment of lung cancer in South Auckland do not meet the recommendations of international guidelines, especially for early stage lung cancers. Organisational and resource changes are required at each point in the diagnostic and management pathway to reduce delays.

Too much of a good thing, is it bad? Adrenaline on trial.

Adrenaline is vital in the treatment of severe allergic reactions (anaphylaxis), however it is often underutilised or inappropriately administered. Adrenaline treatment is not without risk and most adverse reactions to adrenaline occur when it is given in overdose or as an intravenous bolus. We report a case of myocardial injury and hypotension following inappropriate administration of adrenaline.