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Dexmedetomidine use in the pediatric intensive care unit has increased in recent years. Reports of dexmedetomidine-associated drug fever have been described in adult patients; however, this has not been reported in the pediatric population. We report a case of persistent fever that resolved with the discontinuation of dexmedetomidine and successful transition to clonidine. This is the first report of dexmedetomidine drug fever in a pediatric patient.

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Postirradiation pseudosclerodermatous panniculitis is a rare complication of external beam radiotherapy. This inflammatory process typically presents as an erythematous indurated plaque in a previously irradiated region of skin. To date, 13 cases have been reported worldwide. We present a case of a 70-year-old female who received breast irradiation following conservation surgery for invasive breast carcinoma. In her third year of follow-up, she developed an enlarging mass, involving the subcutis and underlying breast tissue, associated with mammographically detected coarse calcifications and density, at the surgical site. This was deemed highly suspicious of recurrent malignancy. Following several benign needle core biopsies, she had an excision of the mass. This revealed a lobular panniculitis and irradiation-induced vascular changes affecting subcutaneous fat and underlying breast tissue. This is the 14th reported case of this rare entity. It is unique in the degree of involvement, affecting breast parenchyma as well as subcutaneous fat, and in its corresponding dramatic clinical and radiographic manifestations.

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OBJECTIVE: This prospective study assesses whether there are differences in accuracy of interpretation of diagnostic images among users of a picture archive and communication system (PACS) diagnostic workstation, compared with a less costly Web-based imaging system on a personal computer (PC) with a high-resolution monitor. METHODS: One hundred consecutive pediatric chest or abdomen and skeletal X-rays were selected from hospital inpatient and outpatient studies over a 5-month interval. They were classified as normal (n = 32), obviously abnormal (n = 33), or having subtle abnormal findings (n = 35) by 2 senior radiologists who reached a consensus for each individual case. Subsequently, 5 raters with varying degrees of experience independently viewed and interpreted the cases as normal or abnormal. Raters viewed each image 1 month apart on a PACS and on the Web-based PC imaging system. McNemar tests were used to compare accuracy of interpretation across both imaging systems. Confidence intervals (CIs) were calculated for differences in the proportion assessed incorrectly on the PACS, compared with the Web-based PC imaging system. RESULTS: There was no relation between accuracy of detection and the system used to evaluate X-ray images (P = 0.92). The total percentage of incorrect interpretations on the Web-based PC imaging system was 23.2%, compared with 23.6% on the PACS (P = 0.92). For all raters combined, the overall difference in proportion assessed incorrectly on the PACS, compared with the PC system, was not significant at 0.4% (95%CI, -3.5% to 4.3%). CONCLUSION: The high-resolution Web-based imaging system via PC is an adequate alternative to a PACS clinical workstation. Accordingly, the provision of a more extensive network of workstations throughout the hospital setting could have potentially significant cost savings.

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UNLABELLED: This study examined the degree to which cigar smokers inhale when they smoke cigars. A second objective was to assess the level of association between self-reported inhalation and observable cigar particle deposition in the lung. We hypothesized that cigar smokers with a history of cigarette smoking would show a greater amount of smoke deposition than would cigar smokers with no history of cigarette smoking. We conjectured that self-reported cigar smoke inhalation would be a reliable predictor of observable smoke particle deposition in the lung. METHODS: Twenty-four male cigar smokers were recruited to participate in the study. Twelve of the participants were current or past regular cigarette smokers, and the remaining 12 participants had no history of cigarette smoking. The volunteers completed an anonymous questionnaire commenting on the frequency of their current cigarette and cigar use as well as the degree to which they inhale when they smoke cigars. Volunteers smoked a cigar through a holder that permitted cigar smoke to mix with a radioaerosol of (99m)Tc-labeled sulfur colloid particles. The total radioactivity administered to each volunteer was 100 MBq. Lung ventilation scanning was subsequently performed. RESULTS: Total lung counts showed that volunteers inhaled the cigar smoke to varying degrees, although 100% of nonsmokers and 58% of smokers in the study reported that they never or rarely inhaled when they smoked cigars. With respect to total lung counts, smokers as a group inhaled less than their nonsmoking counterparts; however, this difference reflected a trend in the data and did not reach statistical significance. CONCLUSION: Contrary to the widely held belief that cigar smokers do not inhale when they smoke cigars, we concluded that cigar smoke is inhaled regardless of self-reported inhalation and smoking history.

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