- Right-sided infective mural endocarditis complicated by septic pulmonary embolism and cardiac tamponade caused by MSSA. [Journal Article]
- HLHeart Lung 2018 May 23
- The appearance of right-sided mural infective endocarditis has rarely been reported. Here, we report the case of a 40-year-old male with a history of alcoholic liver disease who presented with a part...
The appearance of right-sided mural infective endocarditis has rarely been reported. Here, we report the case of a 40-year-old male with a history of alcoholic liver disease who presented with a partial loss of consciousness and fever. Chest computed tomography scans showed multiple pulmonary infiltration sites and cavities. A repeat transthoracic echocardiogram detected a vegetation on the right ventricular surface of the interventricular septum middle segment, as well as pericardial effusion. Blood, pericardial fluid, sputum, and scalp effusion cultures were positive for methicillin-sensitive Staphylococcus aureus. We diagnosed the patient with infective mural endocarditis complicated by septic pulmonary embolism, pericardial effusion, and cardiac tamponade. The patient was successfully treated with pericardiocentesis and appropriate antibiotics. Right-sided mural endocarditis complicated by pericardial effusion and cardiac tamponade is an uncommon condition in clinical practice. This case confirms the usefulness of transthoracic echocardiography in the early recognition of primary mural endocarditis and its associated complications.
- Methylprednisolone and plasmapheresis are effective for life-threatening diffuse alveolar hemorrhage and gastrointestinal hemorrhage in granulomatosis with polyangiitis: A case report and literature review. [Case Reports]
- MMedicine (Baltimore) 2018; 97(17):e0592
- CONCLUSIONS: Effective remission-induction therapy is a key to survival, while maintaining a balance between immunosuppression and avoiding infection is another challenge.
- Radiological signs associated with pulmonary multi-drug resistant tuberculosis: an analysis of published evidences. [Journal Article]
- QIQuant Imaging Med Surg 2018; 8(2):161-173
- CONCLUSIONS: Thick-walled multiple cavity lesions present the most promising radiological sign for MDR-TB diagnosis. For future studies cavity lesion characteristics should be quantified in details.
- Pharmacokinetics of rifapentine and rifampin in a rabbit model of tuberculosis and correlation with clinical trial data. [Journal Article]
- STSci Transl Med 2018 Apr 04; 10(435)
- In clinical trials of two rifamycin antibiotics (rifampin and rifapentine) for treating tuberculosis (TB), patients with cavitary lung lesions did not appear to derive benefit from rifapentine. Rifap...
In clinical trials of two rifamycin antibiotics (rifampin and rifapentine) for treating tuberculosis (TB), patients with cavitary lung lesions did not appear to derive benefit from rifapentine. Rifapentine was found not to outperform rifampin, despite a lower minimum inhibitory concentration against Mycobacterium tuberculosis in mouse models of TB. To understand these findings, we have developed a rabbit model of TB that reliably develops lung cavities with features similar to those of patients with pulmonary cavitary TB. After single or multiple doses of rifampin or rifapentine that produced human-equivalent plasma exposures, rabbits were sacrificed at different time points after dosing. We measured site-of-disease drug pharmacokinetics and tissue drug distribution. We used pharmacokinetic-pharmacodynamic (PK/PD) modeling to estimate drug penetration into different types of tubercular lesions. Both drugs penetrated rabbit lung cellular lesions, as well as the fibrotic cavity wall of cavitary lesions (penetration coefficients ≥1 compared to plasma). For the necrotic liquefied material inside cavitary lesions known as caseum (which contains high numbers of bacteria), the penetration coefficient was 1.0 for rifampin but only 0.25 for rifapentine. When estimates of site-of-disease drug PK were substituted into clinical PK/PD models, the relationship between site-of-action exposure and sputum culture conversion was significant (P < 10-7). We propose that poor penetration of rifapentine into lung cavitary lesions explains, in part, why rifapentine doses required to improve treatment outcomes in two phase 2 clinical trials were four times higher in TB patients with large cavities compared to TB patients without cavitary lung disease.
- Community-acquired necrotizing pneumonia with bacteremia caused by Pseudomonas aeruginosa in a patient with emphysema: An autopsy case report. [Journal Article]
- RIRespir Investig 2018; 56(2):189-194
- We report the case of a 47-year-old man with chronic obstructive pulmonary disease who was referred to our hospital for acute dyspnea. The radiologic findings revealed consolidation with a cavity in ...
We report the case of a 47-year-old man with chronic obstructive pulmonary disease who was referred to our hospital for acute dyspnea. The radiologic findings revealed consolidation with a cavity in the left upper lobe of the lung. Blood/sputum cultures detected Pseudomonas aeruginosa. Despite intensive care, the patient died from respiratory failure. Autopsy revealed multiple small necrotizing cavities that had coalesced. Although P. aeruginosa is a known causative pathogen of community-acquired pneumonia in patients with structural lung disease, the radiologic findings were non-specific. Irrespective of imaging findings, P. aeruginosa should be considered a cause of community-acquired pneumonia.
- [A clinican linical analysis of 29 cases of chronic pulmonary aspergillosis]. [Journal Article]
- ZJZhonghua Jie He He Hu Xi Za Zhi 2018 Feb 12; 41(2):100-104
- Objective: To improve the understanding of chronic pulmonary aspergillosis (CPA) by analyzing the clinical manifestations, imaging and pathological features, diagnosis, treatment and prognosis of th...
Objective: To improve the understanding of chronic pulmonary aspergillosis (CPA) by analyzing the clinical manifestations, imaging and pathological features, diagnosis, treatment and prognosis of this disease. Methods: Cases of CPA, proven by microbiological evidence based on pathological study in Fuzhou General Hospital of the People's Liberation Army and Affiliated Fuzhou City First Hospital of Fijian Medical University from January 2006 to October 2016 were retrospectively analyzed. Results: The patients consisted of 17 males and 12 females, aged 24 to 75 years, mean (42±16) years. The underlying disorders included post-tuberculosis infection (n=11), bronchiectasis (n=8), chronic obstructive pulmonary disease (n=3) and diabetes mellitus (n=2). The main clinical symptoms included productive cough (n=25), chronic sputum production (n=18) and hemoptysis (n=15). Serum GM antigen tests were performed in 19 cases, and the result was positive in 12 patients. BALF GM antigen tests were performed in 2 cases, both of which were positive. Chest CT showed that the lesions were located predominantly in the upper lobes (n=24). Single cavity with interior irregular intraluminal material (n=16) and multiple cavities with interior irregular intraluminal material (n=10) were the most frequent CT findings, while the "air crescent sign" was found in 13 cases. In the 22 patients who underwent surgical treatment, Aspergillus filaments were found in the cavity (n=20) or the bronchi (n=2) of lung samples, and histological examination didn't show tissue invasion by fungi. Surgical therapy was performed in 22 patients, with complete remission in 19 cases, and death in 3 cases. Anti-fungal therapy was administered in 6 patients, with partial remission in 4, and stable disease in 2 cases. One patient was not treated. Conclusions: CPA is more frequently seen in patients with underlying chronic pulmonary diseases. The common CT findings are single or multiple cavities with interior irregular intraluminal materials. Aspergillus filament in the cavity or bronchi of lung samples, without parenchymal invasion, is the proof of CPA. The surgical cure rate for simple aspergilloma and aspergillus nodule is high, while the risk of operation for chronic cavitary disease is high. GM antigen test may be an evidence for diagnosing CPA.
- Multiple Lung Cavities in Hodgkin's Lymphoma. [Journal Article]
- JCJ Coll Physicians Surg Pak 2018; 28(1):82-83
- Laparoscopic Management of Penetrating Thoracoabdominal Trauma. [Journal Article]
- JLJ Laparoendosc Adv Surg Tech A 2018; 28(6):736-739
- CONCLUSIONS: In hemodynamically stable patients, the transabdominal laparoscopic approach is a feasible and effective approach to penetrating thoracoabdominal trauma.
- Microfluidic chest cavities reveal that transmural pressure controls the rate of lung development. [Journal Article]
- DDevelopment 2017 Dec 01; 144(23):4328-4335
- Mechanical forces are increasingly recognized to regulate morphogenesis, but how this is accomplished in the context of the multiple tissue types present within a developing organ remains unclear. He...
Mechanical forces are increasingly recognized to regulate morphogenesis, but how this is accomplished in the context of the multiple tissue types present within a developing organ remains unclear. Here, we use bioengineered 'microfluidic chest cavities' to precisely control the mechanical environment of the fetal lung. We show that transmural pressure controls airway branching morphogenesis, the frequency of airway smooth muscle contraction, and the rate of developmental maturation of the lungs, as assessed by transcriptional analyses. Time-lapse imaging reveals that branching events are synchronized across distant locations within the lung, and are preceded by long-duration waves of airway smooth muscle contraction. Higher transmural pressure decreases the interval between systemic smooth muscle contractions and increases the rate of morphogenesis of the airway epithelium. These data reveal that the mechanical properties of the microenvironment instruct crosstalk between different tissues to control the development of the embryonic lung.
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- Hodgkin's Lymphoma as a Multiloculated Lung Cavity Lesion. [Journal Article]
- GJGulf J Oncolog 2017; 1(24):61-65
- CONCLUSIONS: Pulmonary manifestation of Hodgkin's lymphoma has already been reported and must be part of the differential diagnosis of lung cavity lesions, even if the likelihood is low based on previous reports, especially in younger individuals. Multiloculated lung cavities can be the first presentation of Hodgkin's lymphoma.