Six Weeks Intercostal Drainage for Recurrent Tuberculous Hydropneumothorax-Port Sudan Teaching Hospital

2020 ◽  
Author(s):  
Murwan Mohamed Saeed
Keyword(s):  
Thoracic Surgery ◽  
Pleural Fluid ◽  
Teaching Hospital ◽  
Rare Complication ◽  
Antituberculous Therapy ◽  
Major Health Problem ◽  
Therapy Strategy ◽  
Cystic Changes ◽  
Surgical Emphysema ◽  
Morbidity Risk

Background: Tuberculosis is a major health problem in Sudan; the annual rate is 77/100.000, and it is the commonest endemic disease in Port Sudan. Hydro pneumothorax which is a rare complication that may recurrent after first intercostal drainage which is usually not respond to intercostal drainage up to seven days after which it needs thoracic surgery intervention either video assisted thoracoscope or even open thoracic surgery and there is no facilities for both in Port Sudan - Red sea state “ Sudan, so a trail of six weeks intercostal drainage and antituberculous therapy under direct observed therapy strategy (DOTS ) was done in order to overcome this problem and it showed a reasonable respond with minimal complications. Method: This is a prospective interventional hospital-based study which was done in Port Sudan teaching hospital from July 2010 to June 2018.10356 tuberculous patients were seen, (0.002%) of them developed recurrent hydropneumothorax, those were hospitalized, history was taken, physical examination and CXR were done and pleural fluid was examined for protein, cells and gene X pert. 28 F chest tube introduced and those patients. were followed clinically and radiologically while they continue on antituberculous therapy Results: From 10356 tuberculous patients 24 patients (0.002%) developed recurrent hydropneumothorax, 20 (83%) male, 4 (17%) female. Recurrence occurs between two to twelve days after first intercostal drainage. 16 patients (67%) were cases of hydropneumothorax, 4 patients pyopneumothorax and 2 patients (8.3%) were haemopneumothorax. 18 patients (75%) presented with cough, 18 patients (75%) SOB, 22 patients (91.7%) presented with chest pain and 5 patients (20.8%) presented haemoptysis. Pleural fluid was exudative in all patients and in all samples mycobacterium tuberculosis was not detected with gene Expert. Radiological findings beside hydropnemothorax showed cystic changes in 16 patients (66.7%), fibrotic changes in 16 patients (66.7%), and cavity formation in 6 patients (25%). Reexpansion occur in 22 patients (91.7%) and in 2 (8.3%) patients intercostal drainage didn't success and they died, 10 patients (41.7%) developed surgical emphysema, 4 (16.7%) patients developed brochopleural fistula and 2 (8.3 %) patients intercostal drainage didn't success and they died, 10 patients (41.7%) developed surgical emphysema, 4 (16.7%) patients developed brochopleural fistula and 2 (8.3 %) patients developed empyema necessitates.Success rate for management of hydropneumothorax(16.7%) patients developed brochopleural fistula and 2 (8.3 %) patients developed empyema necessitates. Success rate for management of hydropneumothorax in Port Sudan teaching hospital with six weeks intercostal drainage was 91.7% with 100% success in those with hydropneumothorax and haemopneumothorax and 50% in those with pyopneumothorax. Conclusion: Recurrent tuberculous hydropneumothorax although it is very rare, but it has serious morbidity. Risk factors for recurrent hydropneumothorax in those tuberculous patients are bronchiectasis sand patients with fibrotic and /or cavitatory radiological changes. 6 weeks intercostal drainage can replace thoracic surgery in managing recurrent hydropneumothorax and it showed good outcome with minimal complications that in majority resolved during course of management and rarely need further intervention.

scholarly journals Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis

2021 ◽  
Author(s):  
Ayah Megahed ◽  
Rahul Hegde ◽  
Pranav Sharma ◽  
Rahmat Ali ◽  
Anas Bamashmos
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Pleural Fluid ◽  
Rare Complication ◽  
Delayed Diagnosis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pleural Effusions ◽  
Diagnostic Challenge ◽  
Abdominal Symptoms ◽  
Pancreatic Duct Stenting

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

Surgical emphysema: a rare complication following cochlear implantation

2007 ◽  
Vol 8 (3) ◽  
pp. 158-161 ◽  
Author(s):  
Mohamed M Abo Khatwa ◽  
Anwar Khan ◽  
Jonathan Osborne
Keyword(s):  
Cochlear Implantation ◽  
Rare Complication ◽  
Surgical Emphysema

scholarly journals Lung herniation after uniportal video-assisted thoracic surgery lobectomy presenting with subcutaneous surgical emphysema

2015 ◽  
Vol 49 (4) ◽  
pp. 1288-1288 ◽  
Author(s):  
Vasileios K. Kouritas ◽  
Robert S. George ◽  
Alessandro Brunelli ◽  
Emmanouel Kefaloyannis
Keyword(s):  
Thoracic Surgery ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Lung Herniation ◽  
Surgical Emphysema

ID: 61: WARFARIN, HEMOTHORAX AND THROMBOLYTICS

2016 ◽  
Vol 64 (4) ◽  
pp. 973.2-974 ◽  
Author(s):  
S Naqvi ◽  
KS Allen
Keyword(s):  
Pleural Fluid ◽  
Rare Complication ◽  
Treatment Options ◽  
Rare Condition ◽  
Bleeding Risk ◽  
Supplemental Oxygen ◽  
Tube Thoracostomy ◽  
Safe Procedure ◽  
Retained Hemothorax ◽  
Intrapleural Administration

IntroductionHemorrhagic complications due to Warfarin use are frequently seen. Hemothorax is a rare complication, and trauma is a major risk factor. Massive non-traumatic hemothorax is an extremely rare condition.Tube thoracostomy drainage is the primary mode of treatment. In cases of retained hemothorax, surgical procedures are recommended. Treatment options are limited for patients who are not surgical candidates.First described in 1981, intrapleural administration of fibrinolytics seems to be a safe procedure for treatment of retained traumatic hemothorax. Intrapleural administration of t-PA & DNase has also been successfully used for infected pleural fluid & is associated with reduced hospital stay & need for surgery.Our report focuses on successful treatment of Coumadin induced non-traumatic hemothorax with these agents.Case ReportA 72 yo male on Coumadin for Afib, was brought to the hospital because of SOB, confusion & hypoxemia in the 70's. CXR revealed new large left sided pleural effusion. Relevant labs included Hgb of 6.7 g/dl (4 gram below baseline), INR 7.1 & platelet count 323. Sampling of the pleural fluid showed Hgb of 7.2 & hemotocrit 21.6. Coagulopathy was corrected and decision was made to proceed with tube thoracostomy.Patient drained almost a liter of old blood in the subsequent 24 hrs. It stopped afterwards. CXR revealed improved but persistent opacity. His health precluded surgery as an option. After long discussion with the patient, t-PA 10 mg & DNase 5 mg Once Daily was started. Pt. received a total of 3 doses with significant improvement in symptomatology and imaging. He drained almost 7 liters of old blood and was able to come off of supplemental oxygen. Hgb stayed stable after initial resuscitation.DiscussionFor treatment of retained hemothorax secondary to trauma, administration of fibrinolytics has been validated in several studies. Response measured by radiologic/clinical improvement as well as PFTs is impressive. Bleeding risk is low & pleuritic pain is the most common reported adverse effect.We propose that t-PA & DNase at the dose of 10 mg & 5 mg Daily respectively, is a safe treatment for selected patients with spontaneous non-traumatic hemothorax secondary to Coumadin use.More data is needed in medical ICU patients before this regimen can be generalized.Abstract ID: 61 Figure 1

scholarly journals Clinical Characteristics of Severe Covid Pneumonia: Exploring New Trends in ICU

2020 ◽  
Author(s):  
Aftab Akhtar ◽  
Sheher Bano ◽  
Ahtesham Iqbal ◽  
Moazma Ramzan ◽  
Aayesha Qadeer ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Rare Complication ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Severe Pneumonia ◽  
Icu Mortality ◽  
Icu Stay ◽  
Vasopressor Support ◽  
Study Population ◽  
Surgical Emphysema

Abstract Background: In late December 2019, Covid-19 emerged as clusters of pneumonia of unknown cause in a province of china, Wuhan. Etiological agent was identified as novel coronavirus that resembles severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East Respiratory syndrome coronavirus (MERS-CoV) and has zoonotic transmission. Covid pneumonia can remain asymptomatic, present as mild infection, severe pneumonia or respiratory failure. Diagnosis is based on rRT-PCR carried out on respiratory secretions. Covid related mortality exceeds 50% once patient requires ICU admission. Objective: To study the characteristics of ICU population admitted to ICU of Shifa International hospital.Results: we prospectively analysed 74 patients which included 43.3% females and 56.7% males. Commonest symptoms were shortness of breath (94.5%), fever (74.3%) and cough (74.3%). Most of our study population consisted of non-smokers (79.7%) and had hypertension (59.4%) followed by diabetes (47.2%). Hydroxychloroquine (HCQ) and azithromycin combination is superior to hydroxychloroquine and doxycycline in reducing mortality (p=0.023) whereas Doxycycline alone resulted in increased mortality (p=0.009). Those who did not require antibiotics or required only narrow spectrum antibiotics had increased survival and reduced requirement of invasive mechanical ventilation (p=< 0.0001). in our study population, (44.9%) developed acute kidney injury, 2.7% needed re-intubations 10.8% developed surgical emphysema and 2.7 % thromboembolic events despite full anticoagulation. ICU mortality was 41.8% and was higher in females (59.4%, p=0.008), those who had SOFA score > 3.5 at time of admission, raised D-Dimers > 931 ng/ml, NLR > 9.2. It was further high in those who required invasive mechanical ventilation and vasopressor support (58.1% mortality p=< 0.001). ICU stay was more prolonged in those requiring invasive mechanical ventilation as compared to those who did not. (23 days vs 6 days, p=0.001). Mean plateau pressure was 19.6 ± 7.6; mean Driving pressures 14.4 ± 4.6; mean PaO2/FiO2 150.7 ± 73.9; mean SPO2/FiO2 173.9 ± 106.9; mean PEEP was 8.2 ±4.33.Conclusion: We concluded that severe covid pneumonia is common amongst males, non-smokers those who had comorbid. HCQ and azithromycin combination is superior to combination of HCQ and doxycycline or doxycycline alone and QT prolongation is a rare complication. Baseline NLR, APACHI II, SOFA, SAPS II, NUTRIC scores, D-Dimers, invasive ventilation and vasopressor support are important tools to predict ICU mortality. Invasive mechanical ventilation carries higher mortality and associated with more prolonged ICU stay. AKI is most common complication followed by shock and surgical emphysema. CRP, Ferritin levels has no impact on outcome.

Incidence of iatrogenic pneumothorax following acupuncture treatments in Taiwan

2019 ◽  
Vol 37 (6) ◽  
pp. 332-339
Author(s):  
Shun-Ku Lin ◽  
Jui-Ming Liu ◽  
Ren-Jun Hsu ◽  
Heng-Chang Chuang ◽  
Ying-Xue Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Logistic Regression ◽  
Thoracic Surgery ◽  
Chronic Bronchitis ◽  
Rare Complication ◽  
Incidence Rates ◽  
Residential Area ◽  
Research Database ◽  
Multivariate Logistic Regression ◽  
History Of

Background: Pneumothorax is a rare complication of acupuncture and the risk factors are unclear. Objective: This study analysed the incidence of post-acupuncture pneumothorax requiring hospitalisation in a one-million-sample cohort derived from Taiwan’s National Health Insurance Research Database. Methods: We tracked this cohort between 1997 and 2012 and recorded all medical insurance information. Subjects were categorised according to gender, insurance amount, comorbidities, residential area, and number of acupuncture treatments. Pneumothorax risk was evaluated according to different demographic and medical variables by logistic regression analysis using an adjusted odds ratio (aOR) with a 95% confidence interval (95% CI). Results: Overall, 411 734 patients undergoing 5 407 378 acupuncture treatments were identified with data collected over the first 7 days after acupuncture. The incidence rates of iatrogenic pneumothorax were 0.87 per 1 000 000 acupuncture treatments overall and 1.75 per 1 000 000 acupuncture treatments in “at-risk” anatomical areas. Multivariate logistic regression demonstrated that a history of thoracic surgery (aOR 7.85, 95% CI 3.49 to 9.25), chronic bronchitis (aOR 2.61, 95% CI 1.03 to 6.87), emphysema (aOR 4.87, 95% CI 1.03 to 7.96), pneumonia (aOR 2.09, 95% CI 1.44 to 2.72), tuberculosis (aOR 3.65, 95% CI 1.39 to 9.56), and lung cancer (aOR 3.85, 95% CI 1.53 to 9.73) may increase the post-acupuncture risk of iatrogenic pneumothorax. Men had a higher risk of pneumothorax than women (aOR 3.41, 95% CI 1.36 to 8.57). The number of treatments was not associated with risk of pneumothorax. Conclusions: Patients with a history of lung disease including chronic bronchitis, emphysema, tuberculosis, lung cancer and pneumonia, and a history of thoracic surgery, might have an increased post-acupuncture risk of pneumothorax. This information may possibly help physicians avoid post-acupuncture pneumothorax.

scholarly journals Pattern of acute poisoning in teaching hospital, northwest Ethiopia

2016 ◽  
Vol 4 (1) ◽  
pp. 47 ◽  
Author(s):  
Getnet Mequanint Adinew ◽  
Assefa Belay Asrie
Keyword(s):  
Teaching Hospital ◽  
Health Problem ◽  
Supportive Therapy ◽  
Public Health Problem ◽  
Acute Poisoning ◽  
Northwest Ethiopia ◽  
Major Public Health Problem ◽  
Major Health Problem ◽  
Hospital Emergency Room ◽  
Study Population

<p><strong>Background:</strong> Acute poisoning is considered a major health problem worldwide and is a frequent cause of hospital admission. It is estimated that poisons are responsible for more than 1 million illnesses worldwide annually.</p><p><strong>Objective:</strong> To evaluate retrospectively the pattern of acute poisoning in teaching hospital, northwest Ethiopia.</p><p><strong>Materials and methods:</strong> This was an observational, retrospective study. The study population includes all patients who visiting Gondar teaching hospital emergency room who were diagnosed with acute poisoning from September 2010 to December 2014. All data were analyzed using SPSS 20.</p><p><strong>Result:</strong> Acute poisoning cases constituted 0.67% of the 34320 admissions to the emergency department. Of these 233 patients, 148 (63.5%) were female and 85 (36.5%) were male.88.42% were younger than 30 years of age and the frequency of acute poisoning declined with advanced age. Organophosphates were the most frequent cause of poisoning and accounted for 89 cases (38.2%). Intentional poisoning comprised 57.5 %.83.6 %( 195 cases) of the cases were ingested orally, the mean arrival time to the emergency unit after poisoning was 4.2 hours and the average duration of hospital stay was 11.26hours. It was found that 60 % of the cases were simply received supportive therapy. The most common factors contributing to intentional poisoning was quarreled with their family (54.2%) followed by love affairs (18.4%). The mortality rate was 0.43%</p><p><strong>Conclusions:</strong> The data observed in this hospital based shows acute poisoning remains a major public health problem with pesticide poisoning remaining the most common and therefore concerning poison.</p>

Assessment of the Sociodemographic Profile, Pattern, and Outcomes of Intentional Poisoning Cases in an Emergency Department of a Tertiary Care Teaching Hospital

Crisis ◽  
2020 ◽  
Vol 41 (6) ◽  
pp. 490-494
Author(s):  
Abhimanyu Parashar ◽  
Madhan Ramesh
Keyword(s):  
Emergency Department ◽  
Teaching Hospital ◽  
Strong Association ◽  
Tertiary Care ◽  
Care Hospital ◽  
Major Health Problem ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching ◽  
South Indian ◽  
Sociodemographic Profile

Abstract. Background: Intentional self-poisoning has become a major health problem in low- and middle-income countries. Aims: We aimed to assess the sociodemographic profile, pattern, and outcomes of intentional poisoning cases in the emergency department of a tertiary care teaching hospital. Method: A prospective observational study was conducted at the department of emergency medicine of a South Indian tertiary care hospital for 1 year to study the sociodemographic profile, pattern, and outcomes of intentional poisoning cases. Results: The majority of poisonings were observed in the male population (64.5%) and among the age group of 19–40 years (65.2%). Poisoning was prevalent in rural/semi-urban populations (77.5%) and in people engaged in agriculture (28.4%) for their livelihood. Pesticides were the most common agents implicated (65.9%) in poisonings. Based on the Glasgow Coma Scale (GCS) and Poison Severity Scale (PSS), the majority of people with poisoning presented with mild (53.9%) and minor symptoms (36.3%). In 78.5% of the cases, patients recovered while mortality was observed in 5.4% of cases. Conclusion: There was a strong association between outcomes of poisoning and age. Organophosphate pesticides were the most commonly implicated substances in poisonings. Regulation policies should be made by the government to regulate the transport, distribution, and use of insecticides and pesticides.

scholarly journals Acardiac twins: A Case Report

2014 ◽  
Vol 3 (1) ◽  
pp. 34-37
Author(s):  
Babita Thapa ◽  
Meena Thapa ◽  
Rosina Manandhar
Keyword(s):  
Case Report ◽  
Teaching Hospital ◽  
Twin Pregnancy ◽  
Rare Complication ◽  
Multiple Pregnancy ◽  
College Teaching ◽  
Induction Of Labor ◽  
Upper Extremities ◽  
Medical College ◽  
Male Twin

Acardiac anomaly is a rare complication of multiple pregnancy. We report a case at Kathmandu Medical College Teaching Hospital. A 23-year-old multigravida was diagnosed on ultrasonography as having monochorionic monoamniotic twin pregnancy with polyhydramnios and one malformed dead foetus at 18 weeks of gestation. Hence, induction of labor was considered at 36 weeks of gestation. She delivered a macerated male (twin A). Twin B was acardiac with the upper portion consisting of a soft globular mass, the head and upper extremities were absent. The placenta was single. Autopsy revealed absence of heart in twin B. DOI: http://dx.doi.org/10.3126/jkmc.v3i1.10922  Journal of Kathmandu Medical College Vol. 3, No. 1, Issue 7, Jan.-Mar., 2014, Page: 34-37

scholarly journals Cytokine & chemokine response in the lungs, pleural fluid and serum in thoracic surgery using one-lung ventilation

2011 ◽  
Vol 8 (1) ◽  
pp. 32 ◽  
Author(s):  
Andreas Breunig ◽  
Franco Gambazzi ◽  
Beatrice Beck-Schimmer ◽  
Michael Tamm ◽  
Didier Lardinois ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Pleural Fluid ◽  
Lung Ventilation ◽  
One Lung Ventilation
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