Diffuse Subcutaneous Emphysema Following Tracheal Perforation Andrew Keenan, William Browne, Maneesh Bhargava AJRCCM Articles in Press. Published on 17-March-2017 as 10.1164/rccm.201611-2394IM     A 77-year-old woman without prior lung disease experienced a respiratory arrest at home requiring an emergency medical response. A King LT TM supraglottic airway was placed as endotracheal intubation was unsuccessful. She developed massive soft tissue swelling during ...

Sepsis的概念与译名：内涵重于形式 北京协和医院内科ICU 刘光云，杜斌 Sepsis是重症监护病房中危重病患者死亡的主要原因。由于缺乏特异性治疗措施，根据共识定义与诊断标准进行早期发现与早期诊断，成为降低sepsis病死率的关键。 1992年发表的欧美共识会议标准将sepsis定义为感染引起的全身炎症反应综合征(SIRS)。尽管这一定义受到质疑，但其实质是认为感染引发的过度全身反应（即sepsis）才是引起器官功能障碍甚至死亡的主因[1]。这一概念沿用至今。2001年更新的sepsis诊断标准旨在改进诊断的特异性，但由于缺乏...

Poisoning Clues on the Skin: 10 Cases Jessica Harmon, MD; Raffi Kapitanyan, MD  |  April 6, 2017 This image shows an individual suffering a severe allergic reaction 4 days after exposure to poison oak. Acute poisonings often manifest on the skin, with presentations that can provide vital diagnostic clues to the clinician. Sinister or dangerous etiologies may be responsible for cutaneous signs, and consultation with the local poison control center (USA: 1-800-222-122...

Images in Clinical Medicine Incidental Finding of Oleothorax Abhilash Koratala, Vikrampal Bhatti. N Engl J Med 2017; 376; e21 DOI:10.1056/NEJMicm1609176   An 86-year-old woman with hypertension who had been treated for pulmonary tuberculosis in the 1950s presented with burning chest and epigastric pain. She had no respiratory symptoms. After acute coronary syndrome was ruled out, she was treated for gastroesophageal reflux, which relieved her symptoms. A chest radiog...

Effects of Variable Pressure Support Ventilation on Regional Homogeneity and Aeration Tommaso Mauri, Marta Lazzeri, Alfio Bronco, et al. Am J Respir Crit Care Med 2017; 195: e27-e28 Figure 1.Physiologic effects of variable pressure support assessed by electrical impedance tomography. After application of variable pressure support, distribution of tidal ventilation within the patient’s chest became more homogeneous (A and B) and was associated with improved lung aerati...

Lobar Necrosis from Pulmonary Embolism Ramiro Fernandez ,  Jonathan M. Tomasko ,  Daphne Edgren, et al Am J Respir Crit Care Med 2017; 195: 685-686 A 63-year-old male heart transplant recipient with recurrent lower extremity deep vein thrombosis, receiving warfarin, with chronically reduced glomerular filtration rate (30 ml/min), presented with worsening cough and dyspnea. Laboratory testing revealed normal blood cell counts, mildly elevated C-reactive protein, and in...

[编者按]：以下病例来自即将发表的麻省总医院病例。诊断是什么？哪种诊断检查最可能有帮助？请就诊断发表你的意见，并对应当进行何种诊断检查发表评论。正确的诊断以及病例完整介绍及诊疗过程将于2017年3月23日的新英格兰医学杂志发表。 A 27-Year-Old Woman with Nausea, Vomiting, Confusion, and Hyponatremia Presentation of Case 病例报告 Dr. Meaghan E. Colling (Medicine): A 27-year-old woman was admitted to this hospital because of nausea, vomiting, confusion, and hyponatremia. Meaghan E. Co...

Images in Clinical Medicine Empyema Necessitatis Ronaldo A. Gismondi, M.D., Ph.D. Luiz F.F. de Souza, M.D. N Engl J Med 2017; 376: e13 DOI: 10.1056/NEJMicm1608914 A 40-year-old man presented with a 3-month history of fever, weight loss, dyspnea, and cough. Physical examination revealed a tender, bulging anterior thoracic mass and a small ulcerative lesion that was inferomedial to the right nipple (Panel A). Computed tomographic scans showed a pleural effusion (Pa...

16 Anatomic Mnemonics Editor: Christine Wiebe  |  March 14, 2017 How do you remember the anatomical structures housed by the retroperitoneum? Nick Love, PhD, a second-year medical student at Stanford University, created these whimsical images to help remember parts of the human anatomy. All images courtesy of Nick Love, PhD The heart's left ventricle pumps blood throughout the entire body. After leaving the left ventricle, blood enters the aorta, brachiocephalic trunk, t...

Images in Clinical Medicine Gas in the Left Atrium and Ventricle Mary Thomson, Fredy El Sakr. N Engl J Med 2017; 376: 683 A 60-year-old man with coronary artery disease, ischemic cardiomyopathy with biventricular implantable cardioverter–defibrillator placement, and atrial fibrillation presented with chest pain and numbness in both arms. During his initial presentation, he suddenly collapsed and became unresponsive. Computed tomographic (CT) angiography of his chest...