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Cureus May 2024The significance of in infectious diseases, especially pleural infections, is gaining recognition. While traditional risk factors like dental procedures and...
The significance of in infectious diseases, especially pleural infections, is gaining recognition. While traditional risk factors like dental procedures and immunosuppression remain pivotal in differential diagnosis, there is an emerging recognition of unconventional clinical presentations and risk factors linked to infections by . This shift compels medical professionals to broaden their diagnostic and therapeutic strategies, underscoring the intricate and evolving nature of managing infections associated with this opportunistic bacterium. We describe the case of a 48-year-old immunocompetent woman with untreated hypertension who experienced a 15-day episode of right-sided chest pain, which worsened with a sudden onset of dyspnea, yet her daily activities remained unaffected. Physical examination suggested a pleuropulmonary syndrome due to significant pleural effusion, with a computed tomography (CT) scan of the lungs revealing about 50% effusion on the right side. Laboratory tests indicated elevated inflammatory markers. Ultrasound-guided thoracentesis extracted purulent fluid compatible with empyema, necessitating the placement of a pleural drain and multiple pleural cavity lavages using alteplase, which led to the removal of substantial infected fluid. Culture of the pleural fluid identified , which was pansusceptible. Treatment with intravenous ceftriaxone was administered, resulting in a favorable clinical outcome. This case highlights the critical nature of recognizing atypical clinical presentations and managing complex bacterial infections in the pleural space.
PubMed: 38883040
DOI: 10.7759/cureus.60482 -
Zhongguo Fei Ai Za Zhi = Chinese... May 2024Malignant pleural mesothelioma (MPM) is a rare cancer with high malignancy and aggressiveness on the pleural, caused by the following risk factors including asbestos... (Review)
Review
Malignant pleural mesothelioma (MPM) is a rare cancer with high malignancy and aggressiveness on the pleural, caused by the following risk factors including asbestos inhalation, genetic factors, and genetic mutation. The present chemotherapy, antiangiogenic therapy, and immunotherapy methods are ineffective and the survival time of patients is very short. There is an urgent need to find potential therapeutic targets for MPM. At present, it has been found the following types of targets: gene mutation targets such as BRCA associated protein 1 (BAP1) and cyclin-dependent kinase 2A (CDKN2A); epigenetic targets such as lysine (K)-specific demethylase 4A (KDM4A) and lysine-specific demethylase 1 (LSD1), and signal protein targets such as glucose-regulated protein 78 (GRP78) and signal transducer and activator of transcription 3 (STAT3). So far, available clinical trials include phase II clinical trials of histone methyltransferase inhibitor Tazemetostat, poly (ADP-ribose) polymerase (PARP) inhibitor Rucaparib and cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitor Abemaciclib, as well as phase I clinical trials of mesothelin-targeting chimeric antigen receptor T-cell immunotherapy (CAR-T) cell injection in the thoracic cavity and TEA domain family member (TEAD) inhibitor VT3989 and IK-930, and the results of these trials have showed certain clinical efficacy. .
Topics: Humans; Mesothelioma, Malignant; Mesothelioma; Lung Neoplasms; Molecular Targeted Therapy; Pleural Neoplasms; Animals; Endoplasmic Reticulum Chaperone BiP
PubMed: 38880927
DOI: 10.3779/j.issn.1009-3419.2024.102.18 -
Annals of Diagnostic Pathology Jun 2024Five cases of thoracic solitary fibrous tumor (SFT) with small cell features are presented mimicking a neuroendocrine neoplasm. The patients were four men and one woman...
Five cases of thoracic solitary fibrous tumor (SFT) with small cell features are presented mimicking a neuroendocrine neoplasm. The patients were four men and one woman aged 43 to 74 years who presented with symptoms of chest pain, cough, dyspnea or hemoptysis. Two tumors were intrapulmonary neoplasms, while three were pleural-based. Grossly, the tumors ranged in size from 4 to 6 cm and were white and solid; in two tumors necrosis was apparent. Histologically, they were characterized by a cellular proliferation composed of small cells with round nuclei and inconspicuous nucleoli. The cellular proliferation in some areas had a subtle nested pattern, while in other areas the tumor showed extensive sclerosis and small vessel proliferation. Cellular pleomorphism was not marked and the mitotic activity varied from 1 to 5 mitotic figures per 10 high power fields. Microscopically, necrosis was observed in two cases and focally present in one. Immunohistochemical stains showed tumors cells universally negative for pancytokeratin; in the two pulmonary cases, focal staining for synaptophysin, CD56, and INSM1 was observed. The unexpected lack of expression of pancytokeratin led to additional analysis revealing positive staining with CD34 and STAT6 confirming a diagnosis of SFT. Clinical follow-up showed tumor recurrence in one patient while three patients remained alive and well after a period of 12 to 20 months. The current cases highlight an unusual variant of SFT that may be confused with other small cell tumor entities, such as neuroendocrine or neuroectodermal tumors, especially when originating in the thoracic cavity.
PubMed: 38878688
DOI: 10.1016/j.anndiagpath.2024.152353 -
Cureus May 2024Solitary fibrous tumors (SFTs) are rare neoplasms primarily found in the pleural region but have been documented in diverse extrapleural sites, including the nasal...
Solitary fibrous tumors (SFTs) are rare neoplasms primarily found in the pleural region but have been documented in diverse extrapleural sites, including the nasal cavity and paranasal sinuses, albeit infrequently. Here, we present a case of a 48-year-old female who presented with a right-sided nasal mass and associated ophthalmologic symptoms, ultimately diagnosed with a benign spindle cell lesion localized to the nasal cavity. The patient underwent a comprehensive evaluation involving clinical examination, radiological imaging, and histopathological analysis, leading to the identification of a benign solitary fibrous tumor. Notably, diagnosing SFTs in the nasal cavity presents challenges due to their nonspecific clinical and imaging features, necessitating a multidisciplinary approach for accurate diagnosis and optimal management. Surgical excision, preferably via endoscopic techniques, remains the cornerstone of treatment based on tumor characteristics and extent. This case underscores the importance of recognizing uncommon presentations of sinonasal lesions, navigating diagnostic complexities, and emphasizing the critical role of multidisciplinary collaboration in achieving favorable treatment outcomes for patients with such nasal cavity tumors.
PubMed: 38868242
DOI: 10.7759/cureus.60220 -
Cancer Management and Research 2024In situations where pathological acquisition is difficult, there is a lack of consensus on distinguishing between adenocarcinoma and squamous cell carcinoma from imaging...
PURPOSE
In situations where pathological acquisition is difficult, there is a lack of consensus on distinguishing between adenocarcinoma and squamous cell carcinoma from imaging images, and each doctor can only make judgments based on their own experience. This study aims to extract imaging features of chest CT, extract sensitive factors through logistic univariate and multivariate analysis, and model to distinguish between lung squamous cell carcinoma and lung adenocarcinoma.
METHODS
We downloaded chest CT scans with clear diagnosis of adenocarcinoma and squamous cell carcinoma from The Cancer Imaging Archive (TCIA), extracted 19 imaging features by a radiologist and a thoracic surgeon, including location, spicule, lobulation, cavity, vacuolar sign, necrosis, pleural traction sign, vascular bundle sign, air bronchogram sign, calcification, enhancement degree, distance from pulmonary hilum, atelectasis, pulmonary hilum and bronchial lymph nodes, mediastinal lymph nodes, interlobular septal thickening, pulmonary metastasis, adjacent structures invasion, pleural effusion. Firstly, we apply the glm function of R language to perform logistic univariate analysis on all variables to select variables with P < 0.1. Then, perform logistic multivariate analysis on the selected variables to obtain a predictive model. Next, use the roc function in R language to calculate the AUC value and draw the ROC curve, use the val.prob function in R language to draw the Calibrat curve, and use the rmda package in R language to draw the DCA curve and clinical impact curve. At the same time, 45 patients diagnosed with lung squamous cell carcinoma and lung adenocarcinoma through surgery or biopsy in the Radiotherapy Department and Thoracic Surgery Department of our hospital from 2023 to 2024 were included in the validation group. The chest CT features were jointly determined and recorded by the two doctors mentioned above and included in the validation group. The included image feature data are complete and does not require preprocessing, so directly entering statistical calculations. Perform ROC curves, calibration curves, DCA, and clinical impact curves in the validation group to further validate the predictive model. If the predictive model performs well in the validation group, further draw a nomogram to demonstrate.
RESULTS
This study extracted 19 imaging features from the chest CT scans of 75 patients downloaded from TCIA and finally selected 18 complete data for analysis. First, univariate analysis and multivariate analysis were performed, and a total of 5 variables were obtained: spicule, necrosis, air bronchogram Sign, atelectasis, pulmonary hilum and bronchial lymph nodes. After conducting modeling analysis with AUC = 0.887, a validation group was established using clinical cases from our hospital, Draw ROC curve with AUC = 0.865 in the validation group, evaluate the accuracy of the model through Calibrate calibration curve, evaluate the reliability of the model in clinical practice through DCA curve, and further evaluate the practicality of the model in clinical practice through clinical impact curve.
CONCLUSION
It is possible to extract influential features from ordinary chest CT scans to determine lung adenocarcinoma and squamous cell carcinoma. The model we have set up performs well in terms of discrimination, accuracy, reliability, and practicality.
PubMed: 38855330
DOI: 10.2147/CMAR.S462951 -
European Journal of Case Reports in... 2024Studies have shown major cardiovascular effects associated with ketamine use disorder including dose-dependent negative inotropic effects. Preoperative ketamine use has...
BACKGROUND
Studies have shown major cardiovascular effects associated with ketamine use disorder including dose-dependent negative inotropic effects. Preoperative ketamine use has been linked to ketamine-induced stress cardiomyopathy.
CASE PRESENTATION
A 28-year-old female with a history of recurrent cystitis and ketamine use disorder (twice weekly for 14 years) presented with bilateral lower extremity oedema and shortness of breath for 3 months. She was tachycardic with a troponin level of 0.07 ng/ml and a B-type natriuretic peptide (BNP) level of 2511 pg/ml. Electrocardiogram showed normal sinus rhythm and transthoracic echocardiography (TTE) showed left ventricular ejection fraction (EF) of 15%, dilated left ventricle, and severe tricuspid and mitral regurgitation. Computed tomography (CT) scan of the chest and abdomen showed bilateral pleural effusions with congestive hepatopathy and ascites. The patient was started on intravenous furosemide, metoprolol, and sacubitril/valsartan. Rheumatological workup including complement levels, and antinuclear anti-double-stranded DNA was negative. A repeat TTE 2 weeks later revealed an EF of 25% and moderate tricuspid regurgitation. Four months later, the EF was 54% with normal left ventricular cavity size.
CONCLUSION
Although ketamine use disorder is increasing, data on long-term side effects is minimal. Screening for ketamine use disorders should be considered in patients presenting with acute systolic heart failure. Long-term studies are needed to evaluate the benefits of adding ketamine screening to standard urine toxicology.
LEARNING POINTS
Ketamine use disorder can lead to severe cardiovascular complications, including acute systolic heart failure, likely due to its direct negative inotropic effects and dose-dependent impact on cardiac function.Clinicians should consider screening for ketamine use disorder in young adults presenting with acute systolic heart failure, especially when other common aetiologies have been ruled out.Early recognition and prompt treatment of ketamine-induced heart failure with diuretics and guideline-directed medical therapy can lead to significant improvement in cardiac function, but long-term management should also focus on ensuring cessation of ketamine use disorder.
PubMed: 38846645
DOI: 10.12890/2024_004470 -
Respirology Case Reports Jun 2024Hydropneumothorax following lobectomy or pneumonectomy is relatively uncommon, with an incidence of 1%-5%. It involves air and fluid in the pleural cavity, often due to...
Hydropneumothorax following lobectomy or pneumonectomy is relatively uncommon, with an incidence of 1%-5%. It involves air and fluid in the pleural cavity, often due to intraoperative injury, infection, bronchopleural fistula, or mechanical ventilation. Careful management, including drainage and addressing the underlying cause, is essential to prevent serious outcomes.
PubMed: 38845822
DOI: 10.1002/rcr2.1397 -
Heliyon Jun 2024Bilateral first rib fractures are rare. This article presented the diagnosis and treatment of a case of bilateral first rib fractures with multi-organ complications and...
BACKGROUND
Bilateral first rib fractures are rare. This article presented the diagnosis and treatment of a case of bilateral first rib fractures with multi-organ complications and discussed the injury mechanism.
CASE PRESENTATION
A 15-year-old girl fell off a motorcycle. She complained of right neck root pain and right upper limb weakness. The myodynamia of the right upper limb was grade 0, and the sensation disappeared below the level of the elbow joint. The computed tomography (CT) showed bilateral first rib fractures and transverse process fracture of the 6th cervical vertebra. Chest CT revealed a massive hemothorax in the right thoracic cavity, and head magnetic resonance imaging showed bilateral cerebellar infarction. Cervical computed tomography angiography (CTA) revealed a lumen occlusion at the origin of the right subclavian artery. The patient underwent an emergency thoracoscopy, and a re-examination of chest CT indicated that no obvious pleural effusion was found after the hemothorax was cleared. The patient underwent right subclavian arteriography and interventional endovascular thrombolysis, and the right subclavicular artery was patency postoperative. Bilateral first rib fractures and cerebellar infarction were treated conservatively. The brachial plexus injury did not show any signs of recovery after conservative treatment, and she was recommended to be transferred to a superior hospital for surgical treatment.
CONCLUSIONS
The injury mechanism of bilateral first rib fractures with multi-organ complications was closely related to the initial factor of the right neck root colliding with a bulge on the ground. We believe that the fractures occur as a result of a combination including a high energy trauma from direct impact and a low-energy mechanism from violent muscle contraction caused by neck hyperextension. This case report was helpful for clinicians to understand bilateral first rib fractures and their complications.
PubMed: 38841484
DOI: 10.1016/j.heliyon.2024.e31310 -
Archivos Espanoles de Urologia May 2024Percutaneous nephrolithotomy (PCNL) is the first treatment for complex renal and/or ureteral calculi. This paper presents a case of hemorrhagic shock resulting from...
BACKGROUND
Percutaneous nephrolithotomy (PCNL) is the first treatment for complex renal and/or ureteral calculi. This paper presents a case of hemorrhagic shock resulting from diaphragm injury due to PCNL, which has not been reported so far.
CASE PRESENTATION
A 55-year-old Asian woman presented with a 2 × 2 cm calculus located in the upper calyx of the right kidney. After her uncomplicated PCNL operation, the patient's blood pressure decreased to less than 90/60 mmHg, and her hemoglobin level dropped from 128 g/L to 76 g/L. Physical examination and bedside ultrasound indicated a small amount of pleural effusion. Subsequently, a diagnostic puncture of the chest cavity was performed and revealed the presence of fresh blood. Therefore, thoracic closed drainage was conducted, and 950 mL of fresh blood was drained through a drainage tube. Intraoperatively, observation showed that the nephrostomy tube had penetrated the kidney through the diaphragm. The nephrostomy tube was subsequently removed, and the diaphragm was repaired.
CONCLUSIONS
Hemorrhagic shock due to diaphragm injury is an unusual complication after PCNL. This complication should be considered if pleural effusion is present and if blood pressure progressively drops with no other obvious explanation. The recommended treatments include diagnostic thoracentesis and thoracic exploration.
Topics: Humans; Shock, Hemorrhagic; Female; Middle Aged; Nephrolithotomy, Percutaneous; Diaphragm; Kidney Calculi
PubMed: 38840290
DOI: 10.56434/j.arch.esp.urol.20247704.61