Nitrogen dioxide (NO 2 ) is one of a number of nitrogen compounds that are by-products of combustion and occur in domestic environments following the use of gas or other fuels for heating and cooking. In this study, we examined the effect of two levels of NO 2 on symptoms, lung function and airway hyperresponsiveness (AHR) in asthmatic adults and children. In addition, in the same subjects, we examined the effects of the same levels of NO 2 mixed with combustion by-products from a gas space heater.The subjects were nine adults, aged 19-65 yrs, and 11 children, aged 7-15 yrs, with diagnosed asthma which was severe enough to require daily medication. All subjects had demonstrable AHR to histamine. Exposures were for 1 h on five separate occasions, 1 week apart, to: 1) ambient air, drawn from outside the building; 2) 0.3 parts per million (ppm) NO 2 in ambient air; 3) 0.6 ppm NO 2 in ambient air; 4) ambient air + combustion by-products + NO 2 to give a total of 0.3 ppm; and 5) ambient air + combustion by-products + NO 2 to give a total of 0.6 ppm. Effects were measured as changes in lung function and symptoms during and 1 h after exposure, in AHR 1 h and 1 week after exposure, and in lung function and symptoms during the week following exposure.Exposure to NO 2 either in ambient air or mixed with combustion by-products from a gas heater, had no significant effect on symptoms or lung function in adults or in children. There was a small, but statistically significant, increase in AHR after exposure to 0.6 ppm NO 2 in ambient air. However, there was no effect of 0.6 ppm NO 2 on AHR when the combustion by-products were included in the test atmosphere nor of 0.3 ppm NO 2 under either exposure condition.We conclude that a 1 h exposure to 0.3 or 0.6 ppm NO 2 has no clinically important effect on the airways of asthmatic adults or children, but that 0.6 ppm may cause a slight increase in airway hyperresponsiveness. Eur Respir J., 1996, 9, 910-918.
Gallstone ileus is an uncommon condition that is difficult to diagnose clinically. Although several cases have been reported in the literature, radiolucent gallstones in the setting of gallstone ileus are an exceedingly rare occurrence, and we have not identified any authors who used magnetic resonance imaging (MRI) for the acute diagnosis of this condition. While an MRI is the gold standard for visualizing gallstones, inpatient MRIs are difficult to obtain, even in resource-rich settings. However, if given a high index of suspicion for gallstone ileus, it is pertinent to advocate for an inpatient MRI despite a resolution of patients' symptoms due to the nature of the disease symptomology.
A mid-50s woman presented with acute right upper quadrant pain 1-day post second cycle of pembrolizumab. She has a significant history for two concurrent malignancies: a solitary oligometastatic hepatic melanoma (NRAS mutant) of unknown primary diagnosed 2 months prior, and a 10-year history of breast carcinoma with pulmonary metastases on palliative chemotherapy. Multiphase CT scan demonstrated active venous bleeding without active arterial bleeding. The patient received two units of packed red blood cells, followed by selective transcatheter arterial embolisation (TAE) of the right hepatic artery branches to segment 7 and 8. Spontaneous rupture of solitary liver metastases are exceedingly rare. TAE is a safe and effective treatment choice in patients with spontaneous rupture. Given progressive tumour burden, changes in management with a different immunotherapy agent can be considered.
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