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The Journal of Surgical Research Oct 2022
Letter Regarding: The Role of Pericardial Window Techniques in the Management of Penetrating Cardiac Injuries in the Hemodynamically Stable Patient: Where Does It Fit in the Current Trauma Algorithm?
Topics: Algorithms; Heart; Heart Injuries; Humans; Pericardial Window Techniques; Thoracic Injuries; Wounds, Penetrating
PubMed: 35595558
DOI: 10.1016/j.jss.2022.04.051 -
Medicine May 2020Lung cancer is the cancer with the highest incidence and mortality in China and worldwide. Among them, 85% are non-small cell lung cancer (NSCLC). No previous reports...
RATIONALE
Lung cancer is the cancer with the highest incidence and mortality in China and worldwide. Among them, 85% are non-small cell lung cancer (NSCLC). No previous reports have been published to describe the clinical effect of the immune checkpoint inhibitor (ICI) sintilimab in NSCLC yet.
PATIENT CONCERNS
We report a case of a 64-year-old woman with a 20-day history of chest pain with computed tomography scan showing a right lower lung mass.
DIAGNOSES
Squamous NSCLC was diagnosed by bronchoscopy.
INTERVENTIONS
The patient was treated with sintilimab plus nedaplatin and paclitaxel as neoadjuvant therapy for 3 cycles, followed by right thoracotomy, right middle lobectomy, right lower lobectomy, hilar lymphadenectomy, mediastinal lymphadenectomy, and pericardiostomy.
OUTCOMES
The patient was discharged from the hospital 12 days after operation. Pathological report showed no cancer residue in the lung tissue, the bronchial stump, the anastomotic lung marginal tissue, 2nd, 4th, 7th, 9th, 10th, 11th lymph nodes or in the peribronchial lymph nodes after repeated sampling. The pathological stage was deemed T0N0M0. She remained disease free until the latest follow up in July 2019.
LESSONS
Sintilimab is a promising drug for patients with locally advanced NSCLC. However, its efficacy still requires further clinical investigations.
Topics: Antibodies, Monoclonal, Humanized; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Middle Aged; Remission Induction
PubMed: 32481252
DOI: 10.1097/MD.0000000000019790 -
Cureus Apr 2023The advent of immune checkpoint inhibitors (ICIs) in the field of oncology has improved the outcome response rate for a variety of neoplastic pathologies with improved...
The advent of immune checkpoint inhibitors (ICIs) in the field of oncology has improved the outcome response rate for a variety of neoplastic pathologies with improved cellular specificity that lacks the traditional adverse effects associated with chemotherapy. However, ICIs are not without adverse associations, and a growing concern for modern clinicians is the balancing of interests that most occur to minimize these adverse effects while also improving patients' conditions from an oncologic perspective. This case presents a 69-year-old man who developed multiple episodes of significant pericardial effusion while receiving infusions of pembrolizumab for stage III-A adenocarcinoma for which he underwent a pericardiostomy procedure. Given the positive response of this immunotherapy on disease progression, the decision was made to continue the administration of pembrolizumab following the pericardiostomy with the plan of using serial echocardiography studies to monitor for the presence of clinically significant pericardial effusion in the future. In this way, the patient will still be able to receive optimal treatment for his advanced cancer while preserving adequate cardiac function.
PubMed: 37193471
DOI: 10.7759/cureus.37556 -
The Journal of Surgical Research Oct 2022
Response Regarding: The Role of Pericardial Window Techniques in the Management of Penetrating Cardiac Injuries in the Hemodynamically Stable Patient: Where Does It Fit in the Current Trauma Algorithm?
Topics: Algorithms; Heart; Heart Injuries; Humans; Pericardial Window Techniques; Thoracic Injuries; Wounds, Penetrating
PubMed: 35595559
DOI: 10.1016/j.jss.2022.04.049 -
International Journal of Infectious... Sep 2023We report a case of gonococcal pericarditis, which was unexpected due to its extremely unusual occurrence. A 42-year-old man presented with fever, chest pain, dyspnea,...
We report a case of gonococcal pericarditis, which was unexpected due to its extremely unusual occurrence. A 42-year-old man presented with fever, chest pain, dyspnea, and tachycardia. He was initially stable but rapidly deteriorated, developing pericardial effusion with tamponade requiring a pericardial window. Incompletely decolorized gram stain of the pericardial fluid initially suggested the presence of gram-positive diplococci, which wrongly directed treatment toward possible pneumococcal infection. Because cultures were negative, identification of the causative organism was attempted by molecular and genotyping analysis. These techniques identified Neisseria gonorrhoeae-multi-antigen sequence type 14994 (por 5136/tbpB 33) as the etiology, which has been associated with disseminated gonococcal disease. Real-time polymerase chain reaction showed no evidence of mutations within the N. gonorrhoeae penA gene responsible for causing ceftriaxone resistance. This was crucial in guiding antibiotic treatment, in light of the high prevalence of multi-drug-resistant N. gonorrhoeae. This case highlights the utility of diagnostic molecular techniques in identifying N. gonorrhoeae as the etiology of an exceedingly rare case of pericarditis.
Topics: Male; Humans; Adult; Gonorrhea; Anti-Bacterial Agents; Ceftriaxone; Neisseria gonorrhoeae; Pericarditis; Pericardial Effusion; Antigens, Bacterial; Microbial Sensitivity Tests
PubMed: 37329948
DOI: 10.1016/j.ijid.2023.06.011 -
The American Journal of Cardiology Jul 2020Pericardial effusion (PE) prognosis depends on the underlying etiology. We sought to assess the outcome of patients with chronic (>3 months), large (diastolic echo-free... (Comparative Study)
Comparative Study
Pericardial effusion (PE) prognosis depends on the underlying etiology. We sought to assess the outcome of patients with chronic (>3 months), large (diastolic echo-free space >2 cm), idiopathic (without apparent etiology), C-reactive protein (CRP) negative PE, a topic where data are lacking. A total of n = 74 patients were enrolled in this study. Patients were treated by pericardiocentesis (n = 39) or surgical pericardial "window" (PW) (n = 13) or conservatively (n = 22). The median follow-up was 24 months (interquartile range: 15 to 38). Among those patients who had PE drained (n = 52), PE re-accumulation occurred in 32 cases (61.5%) and the rate was significantly higher in the pericardiocentesis subgroup (76.9% for pericardiocentesis vs 15.4% for PW group, p <0.001). Patients with re-accumulation had longer disease duration (32.1 ± 25.7 months vs 19.5 ± 23.8 months, p = 0.01), higher maximum PE diameter (32.2 ± 9.4 mm vs 26.1 ± 4.9 mm, p = 0.003) and larger PE volume drained at baseline (1,912 ± 707 mL vs 1,508 ± 387 mL, p = 0.04). Large PE re-accumulation occurred in 41% of patients who underwent pericardiocentesis and in 7.7% of those who underwent PW. In Cox survival analysis the only independent predictor of fluid re-accumulation was the type of intervention, with PW being associated with significantly reduced risk (hazard ratio 0.115, 95% confidence interval 0.015 to 0.875, p = 0.037). Major complications needing treatment were recorded in 12.8% and 15.4% (p = 0.999) of patients who underwent pericardiocentesis and PW, respectively. Moreover, invasive procedures were not helpful in establishing new diagnoses and guide treatment. In conclusion, in asymptomatic patients with chronic, large, hemodynamically insignificant, CRP negative, idiopathic PE, conservative management seems a more reasonable approach in most cases.
Topics: Aged; Asymptomatic Diseases; Conservative Treatment; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pericardial Effusion; Pericardial Window Techniques; Pericardiocentesis; Prospective Studies; Recurrence
PubMed: 32345471
DOI: 10.1016/j.amjcard.2020.03.035 -
BMJ Case Reports Aug 2020
Topics: Adenocarcinoma; Aged; Appendiceal Neoplasms; Cardiac Tamponade; Female; Heart Neoplasms; Humans; Pericardial Effusion; Pericardial Window Techniques
PubMed: 32816884
DOI: 10.1136/bcr-2020-235878 -
Brazilian Journal of Cardiovascular... Dec 2020A case of a 49-year-old patient, male, victim of stab wound, developing belatedly cardiac tamponade and hemodynamic stability was reported. The patient underwent a...
A case of a 49-year-old patient, male, victim of stab wound, developing belatedly cardiac tamponade and hemodynamic stability was reported. The patient underwent a pericardial window with drainage of pericardial effusion of blackened aspect; however, without visualization of the cardiac lesion, enlargement of the incision by median sternotomy was opted for. A hematoma was spotted at the left ventricle with epicardial lesion and a patch of pericardium was made with 3-0 polypropylene. The patient developed acute pulmonary edema and atrial fibrillation, which improved after the intensive care unit clinical management, with hospital discharge in the 7th postoperative day.
Topics: Cardiac Tamponade; Humans; Male; Middle Aged; Pericardial Effusion; Sternotomy; Wounds, Penetrating; Wounds, Stab
PubMed: 33306330
DOI: 10.21470/1678-9741-2019-0130 -
International Wound Journal Aug 2023We conducted a meta-analysis to assess the diagnostic performance of chest ultrasound compared with a pericardial window for the detection of occult penetrating cardiac... (Meta-Analysis)
Meta-Analysis
Effect of chest ultrasound compared with pericardial window for the diagnosis of occult penetrating cardiac wounds in hemodynamically stable subjects with penetrating thoracic trauma: A meta-analysis.
We conducted a meta-analysis to assess the diagnostic performance of chest ultrasound compared with a pericardial window for the detection of occult penetrating cardiac wounds in patients with penetrating thoracic trauma who were hemodynamically stable. A systematic literature search up to December 2022 was performed and 567 related studies were evaluated. The chosen studies comprised 629 penetrating thoracic trauma subjects who participated in the selected studies' baseline. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of different chest ultrasounds on wound infection after penetrating thoracic trauma by the dichotomous methods with a random or fixed effect model. The chest ultrasound resulted in significantly lower occult penetrating cardiac wounds detection (OR, 0.02; 95% CI, 0.01-0.08, P < 0.001), higher false positive (OR, 33.85; 95% CI, 9.21-124.39, P < 0.001), and higher false negative (OR, 27.31; 95% CI, 7.62-97.86, P < 0.001) compared with the pericardial window in penetrating thoracic trauma. The chest ultrasound resulted in significantly lower occult penetrating cardiac wound detection, higher false positives, and higher false negatives compared with the pericardial window in penetrating thoracic trauma. Although care should be taken when dealing with the results because all of the studies had less than 200 subjects as a sample size.
Topics: Humans; Pericardial Window Techniques; Thoracic Injuries; Ultrasonography; Wounds, Penetrating
PubMed: 36717766
DOI: 10.1111/iwj.14101 -
JACC. Cardiovascular Interventions Apr 2020
Topics: Balloon Occlusion; Blood Vessel Prosthesis Implantation; Cardiac Tamponade; Catheterization, Peripheral; Extracorporeal Membrane Oxygenation; Female; Hemodynamics; Humans; Middle Aged; Pericardial Effusion; Pericardial Window Techniques; Recurrence; Treatment Outcome; Vascular Access Devices; Vascular System Injuries
PubMed: 32007462
DOI: 10.1016/j.jcin.2019.11.038