- Whole-lung Lavage and Pulmonary Alveolar Proteinosis: Review of Clinical and Patient-centered Outcomes. [Journal Article]
- JCJ Cardiothorac Vasc Anesth 2019 Mar 28
- CONCLUSIONS: The authors here present a retrospective study describing the perioperative and procedural management of PAP patients undergoing WLL to help familiarize providers with the management of this population (Fig 1). The findings of this study outline a successful and consistent approach to WLL using a multidisciplinary team experienced in this procedure. Even in experienced hands, procedural complications and 30-day postoperative complications emphasize the risk in this complex patient population.
- [Cirrhotic cardiomyopathy-associated acute cardiac failure in a patient with decompensated alcoholic cirrhosis with massive hepatic hydrothorax]. [Journal Article]
- NSNihon Shokakibyo Gakkai Zasshi 2019; 116(7):607-616
- Cirrhotic cardiomyopathy (CCM) is a chronic cardiac dysfunction in patients with cirrhosis and is characterized by altered diastolic relaxation, blunted contractile response to stress, and electrophy…
Cirrhotic cardiomyopathy (CCM) is a chronic cardiac dysfunction in patients with cirrhosis and is characterized by altered diastolic relaxation, blunted contractile response to stress, and electrophysiological abnormalities;however, causes of CCM are unknown. Moreover, reduced cardiac afterload due to cirrhosis-related vasodilatation often masks cardiac insufficiency, whereas rapid hemodynamic overload reveals the presence of cirrhotic cardiomyopathy. Herein, we present the case of previously unrecognized cirrhotic cardiomyopathy that became overt with the development of severe acute cardiac failure. The rapidly worsening hepatic hydrothorax increased cardiac preload and intrathoracic pressure, which impaired cardiac filling. Furthermore, cardiac contractile function might have been worsened by hypoxia due to passive atelectasis and concomitant anemia.
- Urgent-start peritoneal dialysis for patients with end stage renal disease: a 10-year retrospective study. [Journal Article]
- BNBMC Nephrol 2019 Jul 02; 20(1):238
- CONCLUSIONS: Urgent-start PD is a safe and efficacious option for unplanned ESRD patients. A well-trained PD team, a standardized catheter insertion procedure by experienced nephrologists, and a carefully designed initial PD prescription as well as comprehensive follow-up care, might be essential for the successful urgent-start PD program.
- Critically Ill Patients with End-Stage Liver Disease. [Review]
- EMEmerg Med Clin North Am 2019; 37(3):511-527
- Patients with end-stage liver disease (ESLD) who require intensive care unit admission have high rates of mortality. This article reviews the pathophysiology and emergency department assessment and m…
Patients with end-stage liver disease (ESLD) who require intensive care unit admission have high rates of mortality. This article reviews the pathophysiology and emergency department assessment and management of the most frequent conditions and complications encountered in critically ill ESLD patients including hepatic encephalopathy, gastrointestinal bleeding, sepsis and bacterial peritonitis, hepatorenal syndrome, severe coagulopathy, and hepatic hydrothorax.
- Natural Ehrlichia ruminantium infection in two captive Arabian tahrs (Arabitragus jayakari) in Oman. [Journal Article]
- TATrop Anim Health Prod 2019 Jun 19
- This study was investigated the cause of death of two captive adult Arabian tahrs (Arabitragus jayakari) died within 2-3 days after onset of fever and neurologic signs in a private farm in northern B…
This study was investigated the cause of death of two captive adult Arabian tahrs (Arabitragus jayakari) died within 2-3 days after onset of fever and neurologic signs in a private farm in northern Batinah Region of Oman. Blood counting revealed leukocytosis attributed to neutrophilia and serum chemistry showed hypoproteinemia, increased creatine kinase and BUN. Upon autopsy, the animals exhibited mild ascites and hydrothorax, prominent hydropericardium, with large pale-yellow clear fluid coagulum, prominent epicardial petechiation, as well as severe pulmonary edema associated with frothy fluid in airways. Brain edema with congestion of meningeal and parenchymal vessels was prominent. Histopathology revealed severe congestion and edema of both lung and brain as well as cardiac myopathy. Ehrlichia ruminantium colonies (the causative organism of cowdriosis; OIE-listed disease) were demonstrated in the capillary endothelium of fresh brain squash and lung macrophages. This is the first report of natural E. ruminantium infection in Arabian tahr, the highly endangered species, based on typical clinical signs of acute cowdriosis and demonstration of E. ruminantium colonies in the brain capillary endothelial cells.
- Long-Term Outcomes of 92 Cases of Fetal Hydrothorax Including Thoracoamniotic Shunting. [Journal Article]
- FDFetal Diagn Ther 2019 Jun 18; :1-6
- CONCLUSIONS: The results showed that the survival rate and long-term outcomes of cases with hydrothorax have improved as TAS has become more prevalent. The reasons for these results need to be elucidated, and efforts are needed to further improve outcomes.
- [Postoperative complications after major lung resection]. [Review]
- RMRev Mal Respir 2019; 36(6):720-737
- CONCLUSIONS: Major lung resection has benefited from minimally invasive approaches and fast track to surgery. However, it is important to note the occurrence of new and specific complications related to those news surgical access.
- A Novel Diagnostic Approach for Suspected Icodextrin Pleural Effusion in a Peritoneal Dialysis Patient. [Case Reports]
- MCMayo Clin Proc Innov Qual Outcomes 2019; 3(2):238-240
- Symptomatic pleural effusion secondary to pleuroperitoneal communication in patients undergoing peritoneal dialysis (PD) occurs in approximately 2% of patients undergoing continuous ambulatory PD. Th…
Symptomatic pleural effusion secondary to pleuroperitoneal communication in patients undergoing peritoneal dialysis (PD) occurs in approximately 2% of patients undergoing continuous ambulatory PD. The classic presentation is that of a low-protein, high-glucose pleural aspirate consistent with the high dextrose concentrations present in standard PD fluids, hence the name sweet hydrothorax. Nevertheless, the increasing use of icodextrin calls for an innovative bedside diagnostic approach because icodextrin does not contain high concentrations of dextrose after all. We describe a patient with newly symptomatic right pleural effusion 2 months after starting continuous ambulatory PD with 2 exchanges every 12 hours. Prompt relief was achieved with therapeutic thoracentesis, but the pleural aspirate had less than 2 g/dL of protein (to convert to g/L, multiply by 10) and a glucose level of 108 mg/dL (to convert to mmol/L, multiply by 0.0555), lower than the blood glucose level of 139 mg/dL in the emergency department earlier the same night. The patient was allergic to iodinated contrast. We, therefore, used an innovative approach with biochemical fingerprint analysis of simultaneous pleural and peritoneal fluids for electrolytes, urea, creatinine, and measured osmolality. With the increasing use of icodextrin in contemporary PD worldwide, this innovative tactic is cheap, is easily available, and does not require sophisticated, expensive, and often unavailable options, such as isotope studies, dye studies, and iodinated contrast-enhanced computed tomography. To our knowledge, this is the first time that biochemical fingerprint analysis of simultaneous pleural and peritoneal fluids has been reported in the literature.
- Fatal Sarcocystis cruzi-induced eosinophilic myocarditis in a heifer in Uruguay. [Journal Article]
- JVJ Vet Diagn Invest 2019; 31(4):656-660
- Sarcocystis spp. are causative agents of bovine eosinophilic myositis and/or myocarditis, which are chronic subclinical myopathies that are occasionally responsible for condemnation at slaughterhouse…
Sarcocystis spp. are causative agents of bovine eosinophilic myositis and/or myocarditis, which are chronic subclinical myopathies that are occasionally responsible for condemnation at slaughterhouses. Sarcocystis cruzi is a protozoan parasite of worldwide distribution transmitted by canids, most commonly associated with subclinical infection in cattle. Although S. cruzi infections can rarely lead to fatal systemic disease, fatal cardiac cases with confirmation of the etiologic diagnosis have not been reported, to our knowledge. We describe herein an unusual case of S. cruzi-induced fatal bovine eosinophilic myocarditis. A 22-mo-old, Holstein-Hereford heifer, in a group of 110 cattle on pasture, manifested growth retardation and died in February 2017. Autopsy revealed myriad yellow-green 1-3-mm coalescing foci, surrounded by fibrosis, affecting ~75% of the ventricular myocardium. Pulmonary edema, ascites, and hydrothorax were consistent with chronic congestive heart failure. Histology revealed severe eosinophilic, granulomatous, necrotizing myocarditis, with multinucleate giant cells, fibrosis, and mineralization. Numerous thin-walled protozoan cysts resembling Sarcocystis spp. were present in the necrotic foci and within the sarcoplasm of adjacent cardiomyocytes. PCR and sequencing of the 18S rRNA gene revealed 99.9-100% homology with S. cruzi. Sarcocystosis can be a rare cause of fatal myocarditis in cattle.
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- Early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis: a randomised controlled trial. [Journal Article]
- LGLancet Gastroenterol Hepatol 2019; 4(8):587-598
- CONCLUSIONS: Early TIPS with covered stents improved transplantation-free survival in selected patients with advanced cirrhosis and acute variceal bleeding and should therefore be preferred to the current standard of care.