scholarly journals What Open-Lung Biopsy Teaches Us about ARDS in COVID-19 Patients: Mechanisms, Pathology, and Therapeutic Implications

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Yassamine Abourida ◽  
Houssam Rebahi ◽  
Hajar Chichou ◽  
Hicham Fenane ◽  
Yassine Msougar ◽  
...  
Keyword(s):  
Open Lung Biopsy ◽  
High Dose ◽  
Microbiological Analysis ◽  
Severe Hypoxemia ◽  
Therapeutic Implications ◽  
Open Lung ◽  
Vascular Congestion ◽  
Space Effect ◽  
Pulmonary Parenchyma ◽  
Dual Mechanism

Difficulties have risen while managing Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19, although it meets the Berlin definition. Severe hypoxemia with near-normal compliance was noted along with coagulopathy. Understanding the precise pathophysiology of this atypical ARDS will assist researchers and physicians in improving their therapeutic approach. Previous work is limited to postmortem studies, while our report addresses patients under protective lung mechanical ventilation. An open-lung minithoracotomy was performed in 3 patients who developed ARDS related to COVID-19 and were admitted to the intensive care unit to carry out a pathological and microbiological analysis on lung tissue biopsy. Diffused alveolar damage with hyaline membranes was found, as well as plurifocal fibrin microthrombi and vascular congestion in all patients’ specimens. Microbiological cultures were negative, whereas qualitative Reversed Transcriptase Polymerase Chain Reaction (RT-PCR) detected SARS-CoV-2 in the pulmonary parenchyma and pleural fluid in two patients. COVID-19 causes progressive ARDS with onset of severe hypoxemia, underlying a dual mechanism: shunt effect through diffused alveolar damage and dead space effect through thrombotic injuries in microvascular beds. It seems reasonable to manage this ventilation-perfusion ratio mismatch using a high dose of anticoagulant combined with glucocorticoids.

scholarly journals Rapidly progressive organising pneumonia associated with cytomegalovirus infection in a patient with psoriasis

2016 ◽  
Vol 67 (3) ◽  
Author(s):  
M. Messina ◽  
N. Scichilone ◽  
F. Guddo ◽  
V. Bellia
Keyword(s):  
Lung Biopsy ◽  
Cytomegalovirus Infection ◽  
Supplemental Oxygen ◽  
Pharmacological Therapy ◽  
Open Lung Biopsy ◽  
High Dose ◽  
Radiographic Images ◽  
Open Lung ◽  
Supplemental Oxygen Therapy ◽  
Pulmonary Status

A 63-year-old woman experienced progressive respiratory distress and psoriatic plaques. The radiographic images showed diffuse interstitial infiltrates. The surgical open lung biopsy revealed an obliteration of the alveolar spaces by plugs of connective tissue distributed within the terminal bronchioles, alveolar ducts and spaces. No relevant cause was determined, and she was diagnosed with idiopathic organising pneumonia. The patient was discharged with oral glucocorticosteroid and supplemental oxygen therapy. One month later, the patient’s pulmonary status had progressively worsened, and she was re-admitted. She required higher oxygen concentrations and mechanical ventilation. Pharmacological therapy included high-dose steroids and cyclophosphamide. Serological assays revealed high antibodies titers (both IgM and IgG) to cytomegalovirus. Therefore, ganciclovir was added to the regimen. Despite the therapy, she died as a result of the disease. The review of the current literature on the topic is also presented.

929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Oyende ◽  
J Jackman
Keyword(s):  
White Cell Count ◽  
General Surgeon ◽  
High Dose ◽  
General Anaesthetic ◽  
Microbiological Analysis ◽  
Reactive Protein ◽  
Affected Tissue ◽  
Life Threatening ◽  
History Of ◽  
High Degree

Abstract Introduction Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated. Presentation We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well. Discussion Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes. Conclusion Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.

scholarly journals Clinical presentation and immunological features of Post-Malaria Neurologic Syndrome: a case report and review of literature

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Nadia Castaldo ◽  
Carlo Tascini ◽  
Paola Della Siega ◽  
Maddalena Peghin ◽  
Davide Pecori
Keyword(s):  
Unmet Need ◽  
Specific Treatment ◽  
Rare Condition ◽  
Acute Disseminated Encephalomyelitis ◽  
Intravenous Immunoglobulins ◽  
Neurological Involvement ◽  
Systematic Research ◽  
High Dose ◽  
Microbiological Analysis ◽  
Randomized Controlled Studies

Abstract Background Malaria still represents a major health threat, in terms of both morbidity and mortality. Complications of malaria present a diversified clinical spectrum, with neurological involvement leading to the most serious related-conditions. The authors recently encountered a case of a 60-year old Italian man presenting with confusion, language disturbances and Parkinson-like syndrome 3 weeks after complete remission from severe Plasmodium falciparum cerebral malaria. Chemical and microbiological analysis revealed aseptic meningitis, diffuse encephalitis and abnormal immune-activation. Re-infection and recrudescence of infection were excluded. Further analysis excluded paraneoplastic and autoimmune causes of encephalitis. A diagnosis of Post-Malaria Neurological Syndrome (PMNS) was finally formulated and successfully treated with high dose of steroids. Methods A systematic research of current literature related to PMNS was performed. Results 151 cases of PMNS were included, the majority of which occurred after severe P. falciparum infections. Four main clinical pattern were identified: 37% of the cases presented as “classical” PMNS, 36% presented as delayed cerebellar ataxia (DCA), 18% resembled acute inflammatory demyelinating polyneuropathy (AIDP), and 8% presented as acute disseminated encephalomyelitis (ADEM)-like form. Differentiation between different forms was not always simple, as clinical and radiological findings frequently overlap. Overall, in almost all of the tested cases, cerebrospinal fluid was found pathological; EEG revealed nonspecific encephalopathy in 30% of classical PMNS and 67% ADEM; imaging tests were found abnormal in 92% of ADEM-like forms. Pathogenesis remains unclear. An autoimmune mechanism is the most corroborated pathogenic hypothesis. Overall, the majority of PMNS cases revert without specific treatment. In most severe forms, high dose steroids, intravenous immunoglobulins, and plasmapheresis have been shown to improve symptoms. Conclusions PMNS is a disabling complication of malaria. The overall incidence is not known, due to frequent misdiagnosis and under-reporting. Pathogenesis is not also fully understood, but rapid response to immune-modulating treatment along with similarities to auto-immune neurological disease, strongly support a dysregulated immunological genesis of this condition. The lack of randomized controlled studies regarding therapeutic approaches is a major unmet need in this setting. A systematic collection of all the PMNS cases would be desirable, in order to increase awareness of this rare condition and to prospectively investigate the most appropriate management.

Open lung biopsy in patients on mechanical ventilation with suspected diffuse lung disease

2009 ◽  
Vol 15 (4) ◽  
pp. 597-611
Author(s):  
Natália Melo ◽  
Sandra Figueiredo ◽  
António Morais ◽  
Conceição Souto Moura ◽  
Paulo Pinho ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Disease ◽  
Lung Biopsy ◽  
Open Lung Biopsy ◽  
Diffuse Lung Disease ◽  
Open Lung ◽  
Diffuse Lung

PULMONARY ALVEOLAR PROTEINOSIS IN THREE INFANTS

PEDIATRICS ◽  
1968 ◽  
Vol 41 (2) ◽  
pp. 510-515
Author(s):  
Robert H. Wilkinson ◽  
William A. Blanc ◽  
Jack W. C. Hagstrom
Keyword(s):  
Pulmonary Alveolar Proteinosis ◽  
Clinical Course ◽  
Open Lung Biopsy ◽  
Early Age ◽  
True Nature ◽  
Radiographic Appearance ◽  
Open Lung ◽  
Respiratory Involvement ◽  
Results Of Treatment ◽  
Alveolar Proteinosis

Chronic lung disease in children may present a perplexing diagnostic problem. While open lung biopsy usually will provide a diagnosis without excessive morbidity, we believe that pulmonary alveolar proteinosis can be diagnosed radiographically, and we wish to point out the early age at which this disease can occur. The clinical course of three infants is described together with the necropsy findings. Two 3-month-old and one 23-month-old infants are reported. The radiographic appearance of diffuse alveolar consolidation and the progressive respiratory involvement should alert physicians to the true nature of this disease. Recovery is reported in adults, but results of treatment in infants is disappointing.

Diagnostic Open Lung Biopsy in the Critically Ill Child

PEDIATRICS ◽  
1973 ◽  
Vol 52 (4) ◽  
pp. 605-608
Author(s):  
Stacy A. Roback ◽  
William H. Weintraub ◽  
Mark Nesbit ◽  
Panayiotis K. Spanos ◽  
Barbara Burke ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Critically Ill ◽  
Lung Tissue ◽  
Lung Biopsy ◽  
Open Lung Biopsy ◽  
University Of Minnesota ◽  
Biopsy Technique ◽  
Open Lung ◽  
Critically Ill Child ◽  
The University

Forty-six open biopsies in 40 acutely ill children with rapidly decreasing pulmonary reserve were performed at the University of Minnesota Hospitals between January 1, 1970, and January 1, 1972. Tissue obtained was adequate in all patients and no serious complications ensued. Information obtained resulted in the change in treatment in 30 patients. This procedure is recommended over closed biopsy when the magnitude of the patient's illness and degree of pulmonary function do not allow acceptance of the risks known to occur with a closed biopsy technique and when histologic examination of lung tissue is required.

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