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Journal of Cardiothoracic Surgery Jun 2024Late hemothorax is a rare complication of blunt chest trauma. The longest reported time interval between the traumatic event and the development of hemothorax is 44 days.
BACKGROUND
Late hemothorax is a rare complication of blunt chest trauma. The longest reported time interval between the traumatic event and the development of hemothorax is 44 days.
CASE PRESENTATION
An elderly patient with right-sided rib fractures from chest trauma, managed initially with closed thoracostomy, presented with a delayed hemothorax that occurred 60 days after initial management, necessitating conservative and then surgical intervention due to the patient's frail condition and associated complications.
CONCLUSIONS
This case emphasizes the clinical challenge and significance of delayed hemothorax in chest trauma, highlighting the need for vigilance and potential surgical correction in complex presentations, especially in the elderly.
Topics: Humans; Hemothorax; Wounds, Nonpenetrating; Thoracic Injuries; Rib Fractures; Male; Thoracostomy; Time Factors; Aged, 80 and over; Tomography, X-Ray Computed; Aged
PubMed: 38937751
DOI: 10.1186/s13019-024-02914-5 -
Scientific Reports Jun 2024We developed a composite symptom score (CSS) representing disease-related symptom burden over time in patients with malignant pleural mesothelioma (MPM). Longitudinal...
We developed a composite symptom score (CSS) representing disease-related symptom burden over time in patients with malignant pleural mesothelioma (MPM). Longitudinal data were collected from an open-label Phase IIB study in which 239 patients completed the validated MD Anderson Symptom Inventory for MPM (MDASI-MPM). A blinded, independent review committee of external patient-reported outcomes experts advised on MDASI-MPM symptoms to include in the CSS. Through iterative analyses of potential symptom-item combinations, 5 MPM symptoms (pain, fatigue, shortness of breath, muscle weakness, coughing) were selected. The CSS correlated strongly with the full MDASI-MPM symptom set (0.92-0.94) and the Lung Cancer Symptom Scale-Mesothelioma (0.79-0.87) at each co-administration of the scales. The CSS also had good sensitivity to worsening disease and global quality-of-life ratings. The MDASI-MPM CSS can be used as an outcome in MPM clinical trials, including in responder analyses and at the individual patient level. It is brief enough to administer frequently, including electronically, to better capture symptom trajectories during and after a trial and in clinical practice. As a single score, the CSS addresses multiplicity issues that can arise when several symptoms increase due to worsening disease. Our process can be adapted to produce a CSS for other advanced-cancer trials.
Topics: Humans; Mesothelioma, Malignant; Male; Female; Pleural Neoplasms; Aged; Middle Aged; Quality of Life; Lung Neoplasms; Mesothelioma; Patient Reported Outcome Measures; Fatigue; Symptom Assessment; Longitudinal Studies; Severity of Illness Index; Symptom Burden
PubMed: 38937473
DOI: 10.1038/s41598-024-62307-5 -
Turk Gogus Kalp Damar Cerrahisi Dergisi Apr 2024This study aimed to provide nuanced insights in managing patients with a history of coronavirus disease 2019 (COVID-19) pneumonia undergoing coronary artery bypass...
BACKGROUND
This study aimed to provide nuanced insights in managing patients with a history of coronavirus disease 2019 (COVID-19) pneumonia undergoing coronary artery bypass grafting.
METHODS
This retrospective cohort study involved 168 patients (131 males, 37 females; mean age: 61.2±9.7 years; range, 51 to 72 years) undergoing isolated coronary artery bypass grafting surgery between December 2021 and December 2023. The study examined factors such as age, sex, comorbidities, blood test results, vaccination status, operative parameters, and postoperative complications. Patients' health records were reviewed to confirm the presence of previous COVID-19 pneumonia and vaccination status. Patients were divided into two groups based on their history of COVID-19 pneumonia: Group 1 included 140 who had not been diagnosed with COVID-19 pneumonia, and Group 2 included 28 patients who had a documented history of COVID-19 pneumonia. Postoperative pulmonary complications, including atelectasis, pleural effusion, acute respiratory distress syndrome, and pneumonia, were noted.
RESULTS
Patients with a history of COVID-19 pneumonia (Group 2, n=28) demonstrated significantly higher seropositivity for COVID-19 (89.3% 29.3%, p=0.001) compared to those without a history (Group 1, n=140). Although pulmonary complications were higher in Group 2 (17.9% 3.6%, p=0.013), postoperative mortality rates did not differ significantly between the groups. Pleural effusion was markedly higher in Group 2 (14.3% 2.1%, p=0.015). Vaccination did not significantly affect perioperative and postoperative outcomes, except for a minor difference in postoperative drainage volume.
CONCLUSION
This study highlights the impact of prior COVID-19 pneumonia on postoperative outcomes in coronary artery bypass grafting patients. Although there was a rise in pulmonary complications, the mortality rates stayed similar among individuals with and without a prior history of COVID-19 pneumonia. Vaccination did not significantly influence outcomes, emphasizing the need for further research with larger cohorts to validate and expand upon these findings.
PubMed: 38933321
DOI: 10.5606/tgkdc.dergisi.2024.25993 -
Viruses Jun 2024The onset of the COVID-19 pandemic allowed physicians to gain experience in lung ultrasound (LUS) during the acute phase of the disease. However, limited data are... (Comparative Study)
Comparative Study
The onset of the COVID-19 pandemic allowed physicians to gain experience in lung ultrasound (LUS) during the acute phase of the disease. However, limited data are available on LUS findings during the recovery phase. The aim of this study was to evaluate the utility of LUS to assess lung involvement in patients with post-COVID-19 syndrome. This study prospectively enrolled 72 patients who underwent paired LUS and chest CT scans (112 pairs including follow-up). The most frequent CT findings were ground glass opacities (83.3%), subpleural lines (72.2%), traction bronchiectasis (37.5%), and consolidations (31.9%). LUS revealed irregular pleural lines as a common abnormality initially (56.9%), along with subpleural consolidation >2.5 mm ≤10 mm (26.5%) and B-lines (26.5%). A strong correlation was found between LUS score, calculated by artificial intelligence percentage involvement in ground glass opacities described in CT (r = 0.702, < 0.05). LUS score was significantly higher in the group with fibrotic changes compared to the non-fibrotic group with a mean value of 19.4 ± 5.7 to 11 ± 6.6, respectively ( < 0.0001). LUS might be considered valuable for examining patients with persistent symptoms after recovering from COVID-19 pneumonia. Abnormalities identified through LUS align with CT scan findings; thus, LUS might potentially reduce the need for frequent chest CT examinations.
Topics: Humans; COVID-19; Male; Female; Prospective Studies; Lung; Ultrasonography; Middle Aged; Tomography, X-Ray Computed; Aged; SARS-CoV-2; Adult
PubMed: 38932196
DOI: 10.3390/v16060905 -
Journal of Clinical Medicine Jun 2024: Lung ultrasound (LUS) is a tool of growing interest in Rheumatoid Arthritis (RA) oligo- symptomatic ILD to avoid. : We aimed to evaluate (i) the prevalence of pleural...
: Lung ultrasound (LUS) is a tool of growing interest in Rheumatoid Arthritis (RA) oligo- symptomatic ILD to avoid. : We aimed to evaluate (i) the prevalence of pleural (PLUS) and parenchymal (PAUS) abnormalities in LUS in the RA population and their possible correlation to biomarkers; (ii) the predictivity of gender, smoking habits, previous infections (past COVID-19 tuberculosis), and treatments; (iii) the differences in LUS between sexes. : We collected the data of 155 (15 early and 140 late) RA patients with mild respiratory symptoms, evaluating PLUS and PAUS, in fourteen lung areas and also summing the scores (LUS-T). : Only 13/155 (8.4%) were completely negative; LUS correlated to age (all parameters 0.0001), rheumatoid factor IgM (PLUS 0.0006, PAUS 0.02, LUS-T 0.001) and ACPA ( 0.001, 0.006, 0.001, respectively), and PLUS also correlated to IL6 ( 0.02). The male gender was predictive of all LUS evaluations ( 0.001, 0.05, 0.001, respectively), which were higher than in women ( 0.001, 0.01, 0.001, respectively). Other potential risk factors were independent, except biological treatments, which showed a low predictivity to PLUS ( < 0.05). We can conclude that LUS is a useful technique in RA low respiratory symptoms and correlates with age, the most important RA biomarkers, and male sex.
PubMed: 38930065
DOI: 10.3390/jcm13123534 -
Medicina (Kaunas, Lithuania) Jun 2024Hepatocellular carcinoma (HCC) stands as a significant contributor to cancer-related mortality globally. While the acute and often fatal manifestations of locally...
Hepatocellular carcinoma (HCC) stands as a significant contributor to cancer-related mortality globally. While the acute and often fatal manifestations of locally advanced HCC primarily present within the abdomen, it is crucial to recognize that the respiratory and circulatory systems can also fall victim due to the liver's unique anatomical position within the body. Here, we present the case of a 63-year-old male recently diagnosed with locally advanced HCC with vascular invasion. Shortly after receiving target therapy and focal radiotherapy, the patient developed repeated secondary infections and a persistent diaphragmatic defect. As the necrotic tissue invaded the pleural space, subsequent tumor-to-bronchial and tumor-to-cardiac fistulas emerged, resulting in an abnormal connection between the respiratory and cardiovascular systems, leading to massive air emboli in circulation. This report highlights the risk of supradiaphragmatic complications in HCC patients with post-treatment secondary infections, particularly in patients predisposed to developing diaphragmatic defects.
Topics: Humans; Male; Carcinoma, Hepatocellular; Middle Aged; Liver Neoplasms; Bronchial Fistula; Fistula; Heart Diseases
PubMed: 38929599
DOI: 10.3390/medicina60060982 -
Journal of Cardiothoracic Surgery Jun 2024Multiportal video-assisted thoracic surgery (mVATS) is the standard approach for the surgical treatment of spontaneous pneumothorax. However, uniportal VATS (uVATS) has... (Comparative Study)
Comparative Study
BACKGROUND
Multiportal video-assisted thoracic surgery (mVATS) is the standard approach for the surgical treatment of spontaneous pneumothorax. However, uniportal VATS (uVATS) has emerged as an alternative aiming to minimize surgical morbidity. This study aims to strengthen the evidence on the safety and efficiency of uVATS compared to mVATS.
METHODS
From January 2004 to December 2020, records of patients who had undergone surgical treatment for primary or secondary spontaneous pneumothorax were evaluated for eligibility. Patients who had undergone pleurectomy combined with bullectomy or apical wedge resection via uVATS or mVATS were included. Surgical characteristics and postoperative data were compared between patients who had undergone surgery via uVATS or mVATS. Univariable and multivariable analyses were performed to determine whether the surgical approach was associated with any complication (primary outcome), major complications (i.e., Clavien-Dindo ≥ 3), recurrence, prolonged hospitalization or prolonged chest drainage duration (secondary outcomes).
RESULTS
A total of 212 patients were enrolled. Patients treated via uVATS (n = 71) and mVATS (n = 141) were significantly different in pneumothorax type (secondary spontaneous; uVATS: 54 [76%], mVATS: 79 [56%]; p = 0.004). No significant differences were observed in (major) complications and recurrence rates between both groups. Multivariable analyses revealed that the surgical approach was no significant predictor for the primary or secondary outcomes.
CONCLUSIONS
This study indicates that uVATS is non-inferior to mVATS in the surgical treatment of spontaneous pneumothorax regarding safety and efficiency, and thus the uVATS approach has the potential for further improvements in the perioperative surgical care for spontaneous pneumothorax.
Topics: Humans; Pneumothorax; Thoracic Surgery, Video-Assisted; Male; Female; Adult; Retrospective Studies; Treatment Outcome; Postoperative Complications; Middle Aged
PubMed: 38926766
DOI: 10.1186/s13019-024-02931-4 -
BMJ Case Reports Jun 2024Implantation of cardiac devices is usually considered to be a safe procedure. Rare complications, such as pneumothorax, may occur after the procedure. The association...
Implantation of cardiac devices is usually considered to be a safe procedure. Rare complications, such as pneumothorax, may occur after the procedure. The association with pneumopericardium or pneumomediastinum is even more uncommon. We present the case of a patient in his 70s, on haemodialysis, admitted for complete atrioventricular block. He underwent implantation of a dual-chamber pacemaker. He presented with chest pain the day after implantation. Chest CT scan revealed a pneumothorax associated with a pneumopericardium and pneumomediastinum 'pan pneumo', due to an atrial perforation. We opted for a conservative management strategy. Repeat CT scan of the chest 8 days after the procedure showed a complete resorption of the 'pan pneumo'. The objective of this case report is to describe this rare complication and provide further insight into its management, particularly in the absence of specific guidelines.
Topics: Humans; Pacemaker, Artificial; Male; Aged; Pneumothorax; Pneumopericardium; Mediastinal Emphysema; Atrioventricular Block; Tomography, X-Ray Computed; Heart Atria; Chest Pain
PubMed: 38926126
DOI: 10.1136/bcr-2024-260860 -
BMJ Case Reports Jun 2024Multiple myeloma is a rare haematological malignancy characterised by the clonal proliferation of plasma cells within the bone marrow. Typical manifestations include...
Multiple myeloma is a rare haematological malignancy characterised by the clonal proliferation of plasma cells within the bone marrow. Typical manifestations include bone pain, fatigue and monoclonal protein elevation in serum and urine. Less than 1% of cases develop myelomatous pleural effusion, a severe complication indicative of advanced disease and a very poor prognosis.Here, we present a case of a woman with a new diagnosis of multiple myeloma complicated by bilateral myelomatous pleural effusions as the initial presentation. This case underscores the diverse clinical spectrum of multiple myeloma, the significance of timely diagnosis and the threatening implications associated with myelomatous pleural effusions.
Topics: Humans; Multiple Myeloma; Female; Pleural Effusion, Malignant; Middle Aged; Aged; Pleural Effusion
PubMed: 38925672
DOI: 10.1136/bcr-2023-258935 -
European Journal of Immunology Jun 2024Tuberculosis (TB) was the leading cause of death from a single infectious agent before the coronavirus pandemic. Therefore, it is important to search for severity...
Tuberculosis (TB) was the leading cause of death from a single infectious agent before the coronavirus pandemic. Therefore, it is important to search for severity biomarkers and devise appropriate therapies. A total of 139 pulmonary TB (PTB) patients and 80 healthy controls (HCs) were recruited for plasma soluble CD137 (sCD137) detection through ELISA. Moreover, pleural effusion sCD137 levels were measured in 85 TB patients and 36 untreated lung cancer patients. The plasma cytokine levels in 64 patients with PTB and blood immune cell subpopulations in 68 patients with PTB were analysed via flow cytometry. Blood sCD137 levels were higher in PTB patients (p = 0.012) and correlated with disease severity (p = 0.0056). The level of sCD137 in tuberculous pleurisy effusion (TPE) was markedly higher than that in malignant pleurisy effusion (p = 0.018). Several blood cytokines, such as IL-6 (p = 0.0147), IL-8 (p = 0.0477), IP-10 (p ≤ 0.0001) and MCP-1 (p = 0.0057), and some laboratory indices were significantly elevated in severe PTB (SE) patients, but the percentages of total lymphocytes (p = 0.002) and cytotoxic T cells (p = 0.036) were significantly lower in SE patients than in non-SE patients. In addition, the sCD137 level was negatively correlated with the percentage of total lymphocytes (p = 0.0008) and cytotoxic T cells (p = 0.0021), and PTB patients with higher plasma sCD137 levels had significantly shorter survival times (p = 0.0041). An increase in sCD137 is a potential biomarker for severe TB and indicates a poor prognosis.
PubMed: 38922884
DOI: 10.1002/eji.202350796