scholarly journals Penetration of the ascending aorta and bronchus by a crossbow bolt

2020 ◽  
Vol 30 (5) ◽  
pp. 792-793
Author(s):  
Yasuhiro Futamura ◽  
Hirotaka Watanuki ◽  
Masaho Okada ◽  
Katsuhiko Matsuyama
Keyword(s):  
Cardiopulmonary Bypass ◽  
Lung Ventilation ◽  
Ascending Aorta ◽  
The Body ◽  
Imaging Studies ◽  
Respiratory Condition ◽  
Differential Lung Ventilation ◽  
First Case ◽  
Aorta Injury ◽  
Successful Repair

Abstract We report the successful repair in a 29-year-old man who experienced penetration of the ascending aorta and bronchus by a crossbow bolt. Imaging studies revealed the arrow penetrating the sternum, right lung, ascending aorta and right bronchus, with mediastinal emphysema. The top of the arrow (8 mm in diameter) was deeply embedded in the body of the thoracic vertebra. The arrow was successfully removed while maintaining a stable respiratory condition by performing differential lung ventilation. There was no need for cardiopulmonary bypass. To our knowledge, this is the first case of a through-and-through penetrating ascending aorta injury.

scholarly journals The first case of COVID-19 pneumonia in a hemodialysis patient in Japan

2020 ◽  
Vol 9 (4) ◽  
pp. 404-408 ◽  
Author(s):  
Yusuke Kuroki ◽  
Kazutoshi Hiyama ◽  
Junya Minami ◽  
Miyoshi Takeuchi ◽  
Masumi Shojima ◽  
...  
Keyword(s):  
Medical Center ◽  
Fluid Management ◽  
The Body ◽  
Dialysis Membrane ◽  
Dialysis Therapy ◽  
Wuhan City ◽  
Respiratory Condition ◽  
First Case ◽  
Old Japanese ◽  
Chest X Ray

Abstract On 31 December 2019, cases of pneumonia whose cause was later identified as SARS-CoV-2 were detected in Wuhan City, Hubei Province of China, and now COVID-19 has spread worldwide. On March 1, 2020, a 69-year-old Japanese man who had been on hemodialysis for 3 years was diagnosed as having COVID-19 pneumonia and hospitalized at our Medical Center. Pulmonary CT revealed bilateral multiple consolidation with bilateral pleural effusion. Aggressive weight reduction was needed to improve the patient’s respiratory condition. Hemodialysis therapy was performed in isolation with hydroxychloroquine administration, but the formation of a dialysis membrane clot forced the withdrawal of dialysis therapy. Changing the dialysis membrane material and anticoagulant enabled the resumption of dialysis therapy, allowing the body weight to correct downward. On the 5th hospitalization day, the patient’s fever dropped and he showed improved oxygenation and chest X-ray. He was eventually discharged. The hydroxychloroquine and appropriate fluid management may have contributed to the patient’s recovery. Clinicians should pay close attention to avoid dialysis-related problems when treating a patient with COVID-19.

Cannulating a Dissecting Aorta Using Ultrasound-Epiaortic and Transesophageal Guidance

2011 ◽  
Vol 14 (6) ◽  
pp. 373 ◽  
Author(s):  
Saina Attaran ◽  
Maria Safar ◽  
Hesham Zayed Saleh ◽  
Mark Field ◽  
Manoj Kuduvalli ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Type A Aortic Dissection ◽  
Complete Rupture

<p>Management of acute Stanford type A aortic dissection remains a major surgical challenge. Directly cannulating the ascending aorta provides a rapid establishment of cardiopulmonary bypass but consists of risks such as complete rupture of the aorta, false lumen cannulation, subsequent malperfusion and propagation of the dissection.</p><p>We describe a technique of cannulating the ascending aorta in patients with acute aortic dissection that can be performed rapidly in hemodynamically unstable patients under ultrasound-epiaortic and transesophageal (TEE) guidance.</p>

scholarly journals The Impact of Lung Ventilation on Some Cytokines after Coronary Artery Bypass Grafting

2016 ◽  
Vol 106 (1) ◽  
pp. 87-93 ◽  
Author(s):  
V. Toikkanen ◽  
T. Rinne ◽  
R. Nieminen ◽  
E. Moilanen ◽  
J. Laurikka ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Radial Artery ◽  
Artery Bypass ◽  
Lung Ventilation ◽  
Interleukin 10 ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Background and Aims: Cardiopulmonary bypass induces a systematic inflammatory response, which is partly understood by investigation of peripheral blood cytokine levels alone; the lungs may interfere with the net cytokine concentration. We investigated whether lung ventilation influences lung passage of some cytokines after coronary artery bypass grafting. Material and Methods: In total, 47 patients undergoing coronary artery bypass grafting were enrolled, and 37 were randomized according to the ventilation technique: (1) No-ventilation group, with intubation tube detached from the ventilator; (2) low tidal volume group, with continuous low tidal volume ventilation; and (3) continuous 10 cm H2O positive airway pressure. Ten selected patients undergoing surgery without cardiopulmonary bypass served as a referral group. Representative pulmonary and radial artery blood samples were collected for the evaluation of calculated lung passage (pulmonary/radial artery) of the pro-inflammatory cytokines (interleukin 6 and interleukin 8) and the anti-inflammatory interleukin 10 immediately after induction of anesthesia (T1), 1 h after restoring ventilation/return of flow in all grafts (T2), and 20 h after restoring ventilation/return of flow in all grafts (T3). Results: Pulmonary/radial artery interleukin 6 and pulmonary/radial artery interleukin 8 ratios ( p = 0.001 and p = 0.05, respectively) decreased, while pulmonary/radial artery interleukin 10 ratio ( p = 0.001) increased in patients without cardiopulmonary bypass as compared with patients with cardiopulmonary bypass. Conclusions: The pulmonary/radial artery equation is an innovative means for the evaluation of cytokine lung passage after coronary artery bypass grafting. The mode of lung ventilation has no impact on some cytokines after coronary artery bypass grafting in patients treated with cardiopulmonary bypass.

Diagnostic Imaging of Child Abuse

PEDIATRICS ◽  
1991 ◽  
Vol 87 (2) ◽  
pp. 262-264
Author(s):  
Keyword(s):  
Child Abuse ◽  
Diagnostic Imaging ◽  
Diagnostic Yield ◽  
Young Infant ◽  
Clinical Information ◽  
The Body ◽  
Pediatric Radiologist ◽  
Imaging Studies ◽  
Skeletal Injury ◽  
Infant And Young Child

The concept of child abuse as a medical entity has its origins in the radiologic studies of the pediatric radiologist Dr John Caffey, as well as many other specialists in the field of diagnostic imaging. When all cases of child abuse and neglect are studied, the incidence of physical alterations documentable by diagnostic imaging is relatively small. However, imaging studies are often critical in the infant and young child with evidence of physical injury, and they also may be the first indication of abuse in a child who is seen initially with an apparent natural illness. As most conventional imaging studies performed in this setting are noninvasive and entail minimal radiation risks, recommendations regarding imaging should focus on examinations, which provide the highest diagnostic yield at acceptable costs. SKELETAL IMAGING Although skeletal injuries rarely pose a threat to the life of the abused child, they are the strongest radiologic indicators of abuse. In fact, in the young infant, certain radiologic abnormalities are sufficiently characteristic to allow a firm diagnosis of inflicted injury in the absence of clinical information. This fact mandates that imaging surveys performed to identify skeletal injury be carried out with the same level of technical excellence utilized in examinations routinely performed to evaluate accidental injuries. The "body gram" or abbreviated skeletal surveys have no place in the imaging of these subtle, but highly specific bony abnormalities. In general, the radiographic skeletal survey is the method of choice for skeletal imaging in cases of suspected abuse. Modern pediatric imaging systems commonly use special film, cassettes, and intensifying screens to minimize exposure.

Feeding gastrostomy stoma site cutaneous myiasis: a rare entity

2021 ◽  
Vol 14 (7) ◽  
pp. e244352
Author(s):  
Snehasis Das ◽  
Naveen Kumar Gaur ◽  
Oseen Hajilal Shaikh ◽  
Uday Shamrao Kumbhar
Keyword(s):  
Medical History ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Metastatic Carcinoma ◽  
The Body ◽  
Rare Entity ◽  
Stoma Site ◽  
Endoscopic Gastrostomy ◽  
First Case ◽  
Cutaneous Myiasis

Infestation of any dead or necrotic tissues by the larvae of flies (maggots) is myiasis. This form of habitation is not restricted to any particular tissues in the body and can occur anywhere. However, myiasis at the surgical stoma site is very rare. We present a 55-year-old woman diagnosed with metastatic carcinoma of the oesophagus who underwent feeding gastrostomy (FG). The patient later presented with worms at the FG site. We removed the FG tube, cleared all the maggots, thoroughly cleaned the wound and placed a new FG tube. Although its occurrences have been reported enough in medical history, there are only two documented cases of percutaneous endoscopic gastrostomy stoma site myiasis. Hence, we present the first case in the literature of cutaneous myiasis around an FG stoma site.

scholarly journals Pulmonary Fibrosis after Pegylated Liposomal Doxorubicin in Elderly Patient with Cutaneous Angiosarcoma

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Marco Mazzotta ◽  
Raffaele Giusti ◽  
Daniela Iacono ◽  
Salvatore Lauro ◽  
Paolo Marchetti
Keyword(s):  
Elderly Patient ◽  
Case Report ◽  
Pulmonary Fibrosis ◽  
Pulmonary Toxicity ◽  
Liposomal Doxorubicin ◽  
Pegylated Liposomal Doxorubicin ◽  
The Body ◽  
Rare Cancer ◽  
True Incidence ◽  
First Case

Introduction. Angiosarcoma is a rare cancer of the inner lining of blood vessels and can arise anywhere in the body, most commonly presenting as cutaneous disease in elderly patient, involving head and neck (H&N), especially the scalp. Pegylated liposomal doxorubicin (PLD) is one of the available treatments in patients with advanced or metastatic disease. Common toxicities are myelosuppression, palmar-plantar erythrodysesthesia, nausea, and stomatitis. Regarding PLD-related pulmonary fibrosis in an uncommon toxicity, there are few cases reported in literature. None of these occurred in angiosarcoma.Methods. This is a case report describing an elderly patient treated with PLD for advanced H&N cutaneous angiosarcoma who developed G5 pulmonary toxicity after the second PLD administration.Results. According to our data and patient clinical outcome, we believe that she passed away from fatal PLD-induced pulmonary fibrosis. This is the first case of fatal interstitial pneumonitis in a 77-year-old woman treated with PLD for angiosarcoma. The case has been reported for its rarity.Conclusions. Pathophysiology of this phenomenon is still unclear and more studies are necessary to understand the true incidence of pulmonary toxicities in patients in treatments with PLD and its mechanism.

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