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Blood Jun 2023
Topics: Humans; Brentuximab Vedotin; Nivolumab; Lymphoma, B-Cell; Mediastinal Neoplasms; Mediastinum
PubMed: 37261857
DOI: 10.1182/blood.2023020396 -
Revue Des Maladies Respiratoires Mar 2021Pneumoconiosis is defined as a diffuse interstitial lung disease secondary to inhalation of mineral particles. Haemoptysis is common in pneumoconiosis. But it is usually...
INTRODUCTION
Pneumoconiosis is defined as a diffuse interstitial lung disease secondary to inhalation of mineral particles. Haemoptysis is common in pneumoconiosis. But it is usually secondary to bronchiectasis, bronchitis or pulmonary tuberculosis occurring with silicosis.
OBSERVATION
A 74-year-old Portuguese man, known to have chronic respiratory failure secondary to chronic silicosis, was treated for moderate haemoptysis. CT angiography revealed bilateral fibrosing peri-hilar masses, inferior lobe nodules and previously known mediastinal lymphadenopathy, without active bleeding. Fibreoptic bronchoscopy showed an anthracotic appearance with lesions typical of silicosis on pathological examination of trans-bronchial biopsies and needle aspiration of mediastinal adenopathy by endobronchial ultrasound.
CONCLUSION
After a full aetiological assessment, no cause other than silicosis has been identified. Haemoptysis is frequently observed in silicosis, but it results from silicosis complications. It is not a classic complication of isolated silicosis.
Topics: Aged; Bronchoscopy; Hemoptysis; Humans; Lung Diseases, Interstitial; Male; Mediastinal Diseases; Silicosis
PubMed: 33612346
DOI: 10.1016/j.rmr.2021.01.012 -
Archives of Disease in Childhood.... Dec 2019To present a structured approach to the management of a child with a mediastinal mass presenting to the emergency department. To raise awareness of presenting features... (Review)
Review
OBJECTIVES
To present a structured approach to the management of a child with a mediastinal mass presenting to the emergency department. To raise awareness of presenting features of less-obvious mediastinal masses and to encourage consideration of mediastinal masses in differential diagnoses.
METHODS
Review of the relevant literature and review of London Paediatric Cancer Network supportive guidelines and subsequent description of the approach to a child presenting with features suggestive of a mediastinal mass.
CONCLUSIONS
A systematic approach to history taking, clinical examination and investigation of a child presenting with a mediastinal mass will assist in the safe and timely management of children presenting when they are critically unwell. Anticipation of potential management complications and early transfer for ongoing management will improve patient outcomes and minimise morbidity.
Topics: Airway Management; Diagnosis, Differential; Humans; Mediastinal Neoplasms; Mediastinum; Medical History Taking; Physical Examination
PubMed: 31048342
DOI: 10.1136/archdischild-2018-315269 -
Deutsche Medizinische Wochenschrift... Aug 2023Diabetes mellitus is the most common metabolic disease with >500 million people affected worldwide and currently 8,7 million in Germany. About 90% of diabetes cases are... (Review)
Review
Diabetes mellitus is the most common metabolic disease with >500 million people affected worldwide and currently 8,7 million in Germany. About 90% of diabetes cases are due to type 2 diabetes mellitus (T2D). This form of diabetes is characterized by an increased release of proinflammatory adipokines, endothelial dysfunction and hyperglycemia, among others. Hypertension and dyslipidemia are also very commonly present. The prevalence of cardiovascular disease is about 2-3 times higher in T2D than in age-matched individuals without a diagnosis of diabetes. Cardiovascular mortality is also about twice as high in people with diabetes compared to a non-diabetic population. People with diabetes are therefore generally considered a high-risk cardiovascular group and require special attention in the diagnosis and treatment of cardiovascular disease. Contributing factors to reduce high cardiovascular risk include a healthy lifestyle, normalization of blood pressure, optimization of blood lipid levels, and specific diabetes therapy tailored to cardiovascular risk. This review addresses the specific treatment options for reducing cardiovascular risk in patients with diabetes mellitus.
Topics: Humans; Diabetes Mellitus, Type 2; Cardiovascular Diseases; Hypertension; Blood Pressure; Mediastinum; Risk Factors
PubMed: 37541293
DOI: 10.1055/a-1928-1360 -
Cell Reports Sep 2023HIV persists in tissues during antiretroviral therapy (ART), but the relative contribution of different anatomical compartments to the viral reservoir in humans remains...
HIV persists in tissues during antiretroviral therapy (ART), but the relative contribution of different anatomical compartments to the viral reservoir in humans remains unknown. We performed an extensive characterization of HIV reservoirs in two men who donated their bodies to HIV cure research and who had been on suppressive ART for years. HIV DNA is detected in all tissues, with large variations across anatomical compartments and between participants. Intact HIV genomes represent 2% and 25% of all proviruses in the two participants and are mainly detected in secondary lymphoid organs, with the spleen and mediastinal lymph nodes harboring intact viral genomes in both individuals. Multiple copies of identical HIV genomes are found in all tissues, indicating that clonal expansions are common in anatomical sites. The majority (>85%) of these expanded clones are shared across multiple tissues. These findings suggest that infected cells expand, migrate, and possibly circulate between anatomical sites.
Topics: Male; Humans; Anti-Retroviral Agents; HIV Infections; Proviruses; Clone Cells; Lymph Nodes; CD4-Positive T-Lymphocytes; Viral Load
PubMed: 37676762
DOI: 10.1016/j.celrep.2023.113053 -
Kyobu Geka. the Japanese Journal of... Sep 2022Mediastinal tumors rarely lead to acute symptomatic manifestations due to spontaneous rupture and perforation, intra-tumoral hemorrhage, and bacterial contamination....
Mediastinal tumors rarely lead to acute symptomatic manifestations due to spontaneous rupture and perforation, intra-tumoral hemorrhage, and bacterial contamination. Moreover, giant mediastinal tumors can compress and infiltrate surrounding mediastinal structures, such as the trachea, bronchus, cardiac sac, and superior vena cava, at the first visit. In addition, mediastinal mature teratomas include various ectopic tissues such as digestive glands and sebaceous glands that can cause specific pathological conditions. To address and properly manage patients with these rare conditions, prior learning must be emphasized to facilitate in clinical decision-making. In this article, we classified four pathological conditions of emergency due to mediastinal tumors. These include the clinical conditions resulting from the compression of anatomical structures by the tumor, those resulting from infiltration and extension into the surrounding mediastinal structures by the tumor, the specific conditions attributable to mature teratomas, and the occurrence of hemothorax due to spontaneous rupturing of the tumor. Based on the review of our cases and other recently reported cases, we summarize and discuss practical pitfalls and pearls in the emergency surgical management of these rare but life-threatening clinical situations.
Topics: Humans; Mediastinal Neoplasms; Mediastinum; Rupture, Spontaneous; Teratoma; Vena Cava, Superior
PubMed: 36155587
DOI: No ID Found -
Best Practice & Research. Clinical... Jun 2023Mature B-cell lymphoma in children, adolescents and young adults comprises three major histological subtypes including in order of frequency Burkitt, germinal center... (Review)
Review
Mature B-cell lymphoma in children, adolescents and young adults comprises three major histological subtypes including in order of frequency Burkitt, germinal center diffuse large B-cell lymphoma and primary mediastinal B-cell lymphoma. The cure rate of the first two with aggressive short chemotherapy based on clinical grouping is ∼90% in resource rich countries. Recent data has shown that incorporation of immune therapy has enhanced event free survival in advanced patients. Future studies will address the possibility of reducing the burden of chemotherapy by substitution of immune based therapies.
Topics: Humans; Child; Adolescent; Young Adult; Lymphoma, Large B-Cell, Diffuse; B-Lymphocytes; Germinal Center
PubMed: 37353299
DOI: 10.1016/j.beha.2023.101463 -
The Laryngoscope Nov 2021To better assess rates of postoperative complications and mortality following esophageal dilation, and to identify factors associated with adverse outcomes. (Observational Study)
Observational Study
OBJECTIVES/HYPOTHESIS
To better assess rates of postoperative complications and mortality following esophageal dilation, and to identify factors associated with adverse outcomes.
STUDY DESIGN
Observational, retrospective cohort study.
METHODS
We queried a national database of insurance claims for Current Procedural Terminology (CPT) codes representing esophageal dilation performed between 2011 and 2017. Patients aged 18 to 100 who were continuously enrolled with their insurance provider were included. Demographic information, additional CPT codes, concomitant diagnoses, and anticoagulant medication data were collected for all patients included. Postoperative mortality was assessed and International Classification of Diseases (ICD)9/10 codes for complications, including esophageal perforation, hemorrhage, mediastinitis, and sepsis were flagged.
RESULTS
We identified 202,965 encounters for esophageal dilation. Of these procedures, 193 were performed on a patient who underwent percutaneous endoscopic gastrostomy (PEG) during the study period and was analyzed separately. Another 244 dilations were excluded due to repeat entries. Of the remaining 202,528 procedures remaining, 42,310 were repeat dilations in the same patient. Data analysis was confined to each patient's initial dilation. 160,218 initial dilations remained. Of these, 62,107 were performed on male patients and 98,111 were performed on female patients. The average age was 57.7 years. There were 12 mortalities within 30 days postoperatively, representing 0.0075% of all dilations. Esophageal perforation and esophageal hemorrhage were the most common reported complications, with 139 and 110 occurrences, respectively. The overall per-dilation complication rate was 0.215%.
CONCLUSIONS
Evidence from a national insurance claim database suggests that esophageal dilation is a safe procedure with a low rate of serious complications and a 30-day all-cause mortality rate of less than 1 per 10,000 dilations.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:2436-2440, 2021.
Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Current Procedural Terminology; Databases, Factual; Deglutition Disorders; Dilatation; Esophageal Diseases; Esophageal Perforation; Esophagus; Female; Gastrostomy; Hemorrhage; Humans; International Classification of Diseases; Male; Mediastinitis; Middle Aged; Postoperative Complications; Retrospective Studies; Sepsis
PubMed: 33305828
DOI: 10.1002/lary.29322 -
World Journal of Surgical Oncology Dec 2019The cavernous hemangioma of mediastinum (CHM) is a rare benign lesion caused by congenital vascular dysplasia. However, its incidence is extremely low, and patients... (Review)
Review
BACKGROUND
The cavernous hemangioma of mediastinum (CHM) is a rare benign lesion caused by congenital vascular dysplasia. However, its incidence is extremely low, and patients often lack relevant clinical symptoms. So we analyzed retrospectively some cases to investigate the imaging features of cavernous hemangioma of mediastinum (CHM) and improve the diagnostic accuracy.
METHODS
The CT/MRI imaging features and clinical information of 19 patients with CHM were analyzed retrospectively.
RESULTS
The lesions of 18 CHM patients were single. Twelve cases in the anterior mediastinum and 8 in the posterior mediastinum. The diameter of CHM ranges from 2.0 to 7.0 cm. Thirteen cases were oval-shaped or round, 4 cases were lobulated, and 2 cases were irregular. Phleboliths or nodular calcification were identified in four cases. High signal of T2WI lipid suppression in two cases and blood vessel shadows were observed in two cases. After contrast-enhanced scan, the nodular enhancement of arteries were identified in 14 cases and contrast agent was further filled of the venous phase, where "fast in and slow out" feature was performed. One case showed inhomogeneous enhancement, one case performed "fast in and slow out" feature of multiphase-enhanced MRI. Besides, aberrant veins can be seen in or around the lesion among five cases.
CONCLUSIONS
CHM is more frequently located at the anterior mediastinum than at the posterior mediastinum. The performance of phleboliths, high signal on T2WI fat suppression and DWI, the nodular enhancement of the artery, venous and delayed phase filling, enhanced "fast in and slow out," and aberrant veins in the lesion are helpful for the diagnosis and differential diagnosis. Multiple period contrast-enhanced CT and MRI scan is helpful for the diagnosis of CHM.
Topics: Adult; Aged; Female; Follow-Up Studies; Hemangioma, Cavernous; Humans; Magnetic Resonance Imaging; Male; Mediastinal Neoplasms; Middle Aged; Prognosis; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 31801558
DOI: 10.1186/s12957-019-1742-1 -
Journal of Veterinary Diagnostic... Mar 2022Three calves were submitted to the Iowa State University Veterinary Diagnostic Laboratory for diagnostic evaluation following an abrupt increase in morbidity and...
Three calves were submitted to the Iowa State University Veterinary Diagnostic Laboratory for diagnostic evaluation following an abrupt increase in morbidity and mortality in a calf herd associated with epistaxis and widespread hemorrhage. Each of the submitted calves had moderate-to-severe hemorrhage within various tissues and body cavities, including the thymus, subcutaneous region of the neck, mediastinum, lungs, pericardial sac, heart, spleen, perirenal fat, urinary bladder, and skeletal muscle, including the diaphragm. An anticoagulant rodenticide screen was performed on the livers of each calf. Significant concentrations of chlorophacinone were detected at 4.2, 3.6, and 2.9 ppm in liver. Multiple piles and an open pail of white powdery material were present within the facility in which the calves were housed and were identified as the sources of chlorophacinone. Acute hemorrhage and death occurred in fourteen 1.5-mo-old, crossbred calves following ingestion of the vitamin K antagonist chlorophacinone.
Topics: Animals; Anticoagulants; Cattle; Cattle Diseases; Hemorrhage; Indans; Rodenticides
PubMed: 35000500
DOI: 10.1177/10406387211069369