Intraabdominal hypertension (IAH) develops frequently in patients with septic shock. Even a moderate increase in intraabdominal pressure (IAP) in this setting could be associated with high lactate levels. The authors conducted a prospective, observational, nonrandomized control trial in the surgical intensive care unit of an academic tertiary center. Twenty-seven patients with septic shock (septic shock group), and 19 patients undergoing abdominal surgery with more than two risk factors for IAH (postoperative control group) were admitted consecutively to the intensive care unit. IAP was measured every 6 hours during the first 48 hours. IAH was diagnosed with two consecutive measurements greater than 20 mm Hg. The main outcome measures were prevalence of IAH in septic shock and control groups; and comparative lactate levels, norepinephrine requirements and organ dysfunctions in patients with and without IAH in both groups. Fifty-one per cent of patients with septic shock and 31 per cent of control patients developed IAH. Patients with septic shock with and without IAH were comparable in peak norepinephrine dose, sequential organ failure assessment score, and mortality. However, peak lactate levels were significantly higher in patients with septic shock and IAH compared with those without IAH (3.5 mmol/L versus 1.9 mmol/L, P < 0.04). There was a significant positive temporal correlation between IAP and lactate levels in patients with septic shock with IAH. Peak levels of both occurred early and decreased progressively over time. Control patients with and without IAH exhibited comparable peak lactate levels. Intraabdominal hypertension is very common in septic shock and appears to be related to high lactate levels, which diminish as IAP decreases. Future studies should address the usefulness of IAP monitoring in patients with septic shock.
Inflammatory myofibroblastic tumor (IMT) is a rare lesion of unknown etiology and difficult diagnosis. The treatment of IMT is controversial. We report a case of IMT of the temporal bone in a young man presenting with a progressive hearing loss. Three years after diagnosis, partial hearing improvement has been documented.
Inflammatory pseudotumor, also known as inflammatory myofibroblastic tumor, is a nonneoplastic fibroinflammatory lesion originally described in the lung, which can occur in extrapulmonary locations, including head and neck. Nevertheless, occurrence in the temporal bone is unusual (1). We present computed tomography (CT) and magnetic resonance (MR) imaging findings of an inflammatory pseudotumor of the petrous apex in a 28-year-old male patient who presented with cephalea and experienced epilepsy from his childhood but probably due to other cause because petrous apex tumors hardly ever cause seizures. The peculiarity of this case is that the lesion spontaneously evolved satisfactory. FIG. 1. Axial high-resolution CT scan showing an osteolytic lesion (arrow) affecting the petrous apex, the lateral aspect of the clivus, and the adjacent carotid and jugular foramina. FIG. 2. T2-weighted MR axial image (A) showing a hyperintense lesion (arrow) affecting the petrous apex and the lateral aspect of the clivus. PostYgadolinium T1-weighted MR axial image (B) showing intermediate to remarkable enhancement of the lesion (arrow).
The objective of this study was to compare telephone speech perception and subjective preferences in cochlear implant users with two different speech-processing strategies: high-definition continuous interleaved sampling (HDCIS) and fine structure processing (FSP). A randomized double-blind study was designed for intra-individual comparison of HDCIS and FSP. Twenty-five post-lingually deafened patients with either the PulsarCI(100) or SonataTI(100) and Opus2 acoustic processor were tested consecutively with both coding strategies, assigned in a random order. Disyllabic word speech perception was tested 6 weeks after each fitting under the following conditions: landline use with (LWN) and without (LWoN) background noise, mobile use with (MWN), and without (MWoN) background noise and mobile use with a Bluetooth magnetic field transmitter necklace (MB). Changes in health-related quality of life (QoL) were assessed using the Glasgow Benefit Inventory (GBI) and Faber's questionnaire. Personal preferences between strategies were surveyed upon completion of the study. All subjects included in this study performed better with FSP in the landline tests. There was an improvement of 11.5 % in LWN use (p = 0.014; CI 95 % = 3-20 %) and 10 % in LWoN use (p = 0.001; CI 95 % = 5-15 %). MWoN showed an improvement of 6.3 % with FSP (p = 0.03; CI 95 % = 0-13 %). MB tests showed an improvement of 11 % with FSP (p < 0.05; CI 95 % = 1.5-22 %). Quality of life was significantly better using FSP. Eighty-four percent of participants preferred FSP. The FSP speech coding strategy improved the speech recognition of cochlear implant users when using the telephone compared to HDCIS. Cochlear implantation with FSP coding improved QoL.
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