IntroductionCognitive deficits in patients suffering from chronic obstructive pulmonary disease (COPD) have been described and hypoxaemia has been addressed as a possible cause. Cognitive functions in patients with interstitial lung disease (ILD) are not well studied. These patients are taking part in everyday traffic, but little is known regarding their driving performance. This study was conducted to determine the driving performance in patients with COPD and ILD, respectively compared to healthy controls using a driving simulator. Additionally, the effect of oxygen supply was addressed.Methods16 patients with COPD (8 receivers and 8 non-receivers of long-term oxygen therapy (LTOT)), 8 patients with ILD (consisting of idiopathic interstitial pneumonias) and 8 healthy controls were tested in a driving simulator. Each test lasted 45 min. In the oxygen intervention part of the study the patients were randomised to receive oxygen therapy in the first or second test and acted as their own controls.ResultsPatients with COPD had significantly impaired driving performance when comparing SD from the centre of the road and number of off-road events to controls. Patients with COPD receiving LTOT performed significantly worse than those not receiving LTOT when comparing SD and worse than the patients with ILD when comparing SD and off-road events. Patients with ILD performed similarly to controls (SD: LTOT 2.39*; no LTOT 0.69*; ILD 0.37; controls 0.36; *p<0.05. Off-road: LTOT 226.67*; no LTOT 78.92*; ILD 40.00; controls 25.78; *p<0.05). Oxygen therapy had no effect on driving performance.ConclusionsPatients with ILD performed similarly to controls in the driving simulator, whereas patients with COPD showed decreased driving performance, especially those receiving LTOT. Doctors should be aware of this when renewing the driving license of patients with COPD. Oxygen therapy showed no effect on driving performance.Trial registration numberNCT02125916

The present results show marked endothelial alterations after cardiac arrest and resuscitation reflected by increased endothelial plasma markers, impaired NO-mediated coronary vasodilatation in the early post-resuscitation phase and enhanced EDH-type vasodilatation in mesenteric arteries later in the post-resuscitation phase.

images in clinical medicineT h e ne w e ngl a nd jou r na l o f m e dicine n engl j med 371;2 nejm.org july 10, 2014 161A previously healthy 18-year-old man was admitted to the hospital with a 3-month history of coughing, expectoration of reddish sputum, weight loss, and fever; a small region of swelling had developed on his anterior chest wall in the preceding week. A computed tomographic (CT) scan of the chest obtained on admission showed a collar-button abscess (a subcutaneous abscess connected to a deeper abscess by a passage), consisting of an abscess in a lymph node in the left mediastinum (Panel A, red arrow) connected to a subcutaneous abscess in the anterior chest wall (Panel A, blue arrow). CT also revealed an extensive parenchymal abnormality in the left upper lobe. A sputum smear showed acidfast bacteria, and a culture grew pansusceptible Mycobacterium tuberculosis. Tests for human immunodeficiency virus were negative. The patient received 8 weeks of standard antituberculous treatment, but the infection progressed, with increased swelling, erythema, and fluctuation of the subcutaneous abscess (Panels B and C). The abscess was subsequently treated with open drainage. Pharmacologic treatment of a tuberculous abscess is seldom sufficient, and open drainage or surgical excision is often required. The patient has been without signs of relapse since surgery but required plastic surgery to improve the cosmetic result after drainage.