Mixed dust pneumoconiosis occurring in an unusual setting.

Mixed dust pneumoconiosis secondary to domestic wood smoke exposure is a cause of pneumoconiosis in women from developing countries, but is rarely seen in the USA. An elderly female non-smoker, who immigrated to the USA from Pakistan 10 years previously, presented with a worsening non-productive cough and dyspnoea on exertion. She did not have any occupational or environmental exposures other than utilising firewood for cooking while living in Pakistan.

Pneumothorax occurring after nasogastric tube removal.

An 85-year-old woman with failure to thrive due to poor oral intake was admitted owing to dehydration. A nasogastric (NG) tube was inserted for the initiation of enteral feedings. The tube position was confirmed by gastric auscultation after insufflating air through the tube.

Immeasurable glycosylated haemoglobin: a marker for severe haemolysis.

Glycosylated haemoglobin (HbA1c) is a measurement commonly performed in patients with diabetes. Factors causing a change in the life span of the red blood cell (RBC) can affect the measurement of HbA1c. Thus haemolysis is an important factor that may affect the HbA1c level determination.

Pulmonary artery catheter coiled in the main pulmonary artery trunk.

Pulmonary artery (PA) catheterisation has been performed for over four decades. It is utilised in intensive care units and perioperatively to titrate fluid and pressor therapy. Major and minor complications have been reported.

Altered mental status and complete heart block: an unusual presentation of aspirin toxicity.

Aspirin is one of the most commonly used medications. We report a patient who presented with severe weakness, altered mental status and complete heart block requiring temporary pacing. Despite the patient's family denying that the patient used aspirin, an arterial blood gas that revealed a respiratory alkalosis and metabolic acidosis suggested the diagnosis of salicylate toxicity.

Pseudochylothorax and diaphragmatic weakness secondary to a misplaced central venous catheter.

A 20-year-old woman admitted with an aspirin overdose was encephalopathic and was intubated for airway protection. Under sonographic guidance, a right internal jugular central venous catheter was inserted for volume resuscitation. She was agitated and required treatment with a propofol infusion.

Platypnea-Orthodeoxia syndrome after repair of a paraesophageal hernia.

The Platypnea-Orthodeoxia syndrome is characterised by dyspnoea and deoxygenation accompanying a change from the recumbent to the upright position. An 81-year-old woman had an elective paraesophageal hernia repair. She developed dyspnoea and hypoxemia post-operatively that was worse when upright.

Severe epistaxis after nasogastric tube insertion requiring arterial embolisation.

A 53-year-old dialysis patient was admitted with symptoms of a respiratory tract infection, abdominal pain and vomiting. She aspirated and required intubation. A nasogastric tube was placed with slight difficulty and the patient developed severe epistaxis.

Prosthetic valve endocarditis caused by Gemella sanguinis: a consequence of persistent dental infection.

Late prosthetic valve endocarditis is usually caused by streptococci, staphylococci, gram-negative bacilli and candida. The authors report the first case of prosthetic valve endocarditis caused by Gemella sanguinis. The patient's risk factors for the development of Gemella endocarditis were the persistent severe dental caries and the presence of prosthetic valves.

Systemic absorption of oral vancomycin in patients with Clostridium difficile infection.

Oral vancomycin is utilized in the treatment of severe Clostridium difficile infection (CDI). We prospectively measured serum vancomycin concentrations (SVC) in patients treated with oral vancomycin. The SVC was measured by immunoassay prior to, and at least 3 days after, the administration of oral vancomycin 125 mg every 6 h.

Superior vena cava syndrome caused by embolisation of liquid Onyx.

Superior vena cava syndrome (SVCS) is usually caused by a malignancy or the presence of an intravascular device in a central vein. A 74-year-old male with a history of a superior vena cava (SVC) stent underwent embolisation of a brain arterio-venous malformation through the right meningeal artery with liquid Onyx. Two weeks later he presented with acute respiratory failure, upper airway obstruction, plethora, varices of the chest wall and stridor.

Brucellosis presenting as septic shock.

Brucellosis generally presents with fever, malaise, weight loss and bone pain with either an abrupt or insidious onset. A 76-year-old man presented in April 2010 with fever of 103°F, severe tachycardia, tachypnoea and a blood pressure of 80/50 mm Hg requiring fluids and vasopressor support with norepinephrine. The patient had brucellosis in 1956 which was treated for 'many weeks' with tetracycline and streptomycin.

Chest tube drainage of transudative pleural effusions hastens liberation from mechanical ventilation.

Background: Pleural effusions occur frequently in patients requiring mechanical ventilatory support. Treatment of the precipitating cause and resolution of the pleural effusion may take considerable time. We retrospectively studied the effect of chest tube drainage of transudative pleural effusions on the liberation of patients from mechanical ventilatory support.

ACE inhibitor-induced angioedema in elderly African American females requiring tracheostomy.

Angioedema is a well-demarcated localized edema involving the deeper layers of the skin, subcutaneous tissue, mucosa, and submucosa. It is a well-recognized side effect of angiotensin-converting enzyme (ACE) inhibitor therapy. Prolonged angioedema is rare.