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Nonimmune Hydrops Fetalis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Chelsea DeBolt, Katherine Connolly, Mary E. Norton, Joanne Stone
Similar management has been proposed for fetuses with pulmonary sequestration and CPAM since the development of hydrops in this setting is associated with poor prognosis if untreated. Macrocystic lesions in fetuses with hydrops may be treated expectantly, or with needle drainage or thoraco-amniotic shunt placement. For microcystic lesions in fetuses with hydrops, management options include expectant management, steroid administration, or open fetal surgery. In a non-randomized study comparing steroid treatment with fetal surgery, there was a statistically significant increase in resolution of hydrops in the steroid group, though no difference in survival was seen. [23]. Intrapleural injection of OK-432, a sclerosant product obtained from group A Streptococcus pyogenes, has been shown to have promising results in three studies reported [20]. The practice of serial thoracocentesis (e.g., every 48 hours) is discouraged.
Management of the Sick Child
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
It is particularly important to look for signs of tension pneumothorax (absent breath sounds, hyper-resonant percussion, shift in mediastinum). If suspected, perform urgent needle thoracocentesis in the second intercostal space mid-clavicular line on the same side as the pneumothorax.
Effects of treatment on the thorax
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Dhakshina Moorthy Ganeshan, Herman I Libshitz, Revathy B Iyer
Effusions are usually small and more frequently seen with CT (Figure 38.5). They are indistinguishable from malignant pleural effusions. They usually develop within 6 months of therapy and may resolve spontaneously (31). Rapid increase or reaccumulation after thoracocentesis suggests a malignant origin. If cytological examination is negative, prolonged follow-up may be necessary. Calcification can also occur in thymic cysts following radiation therapy (Figure 38.6). Very rarely, malignant pleural mesotheliomas may develop after radiotherapy (33).
Heart of lymphoma: a case report
Published in Acta Cardiologica, 2023
Annemie Jacobs, Thomas Gevaert, Wim Volders, Dieter De Cleen, Katrien Van Kolen, Frank Cools, Steven Hellemans
On gastroscopic review, several small erosions in the corpus and antrum were noted, as well as linear bulboduodenal ulcers, which could be responsible for the anaemia. Also, thoracocentesis from the unilateral pleural effusion was executed, and it showed benign, inflammatory findings on analysis. On transthoracic echocardiography, a mass (dd thrombus) near the tricuspid valve, and on the right sight of the right atrium was detected. Signs of right ventricular failure were noticed (pulmonary hypertension, flattening of the interventricular septum and D-shaping of the left ventricle). Empirical treatment with anticoagulation was started, although an intermediate dose was chosen due to the severe anaemia. Given the suspicion of pulmonary embolism, an additional CT thorax was prosecuted and revealed a limited amount of pericardial effusion, in the presence of a new mediastinal tumour with invasion of the right atrium and ventricle (Figure 2(A,B)).
Diagnostic value of soluble biomarkers for parapneumonic pleural effusion
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Xi-Shan Cao, Wen-Qi Zheng, Zhi-De Hu
The currently available diagnostic tools for PPE include medical imaging, bacterial culture, thoracoscopy and biomarkers [9]. Chest X-ray, ultrasound and CT are common imaging methods for PPE identification, but all of them have disadvantages such as subjectivity, requirement for special training, high cost, and radiation hazard. Microbiological examination is the gold standard for the diagnosis of PPE, but its sensitivity and long turn-around time limit its clinical utility. The sensitivity of pleural fluid culture in patients with pleural infection is 50–70% [15,17,18]. The sensitivity of pleural fluid culture in UPPE was only 7% [15]. Thoracoscopy has a high diagnostic yield for PPE, but it is an invasive procedure and 45% of patients have pain, which makes them uncomfortable and requires additional analgesics [19]. In addition, thoracoscopy requires special training, which limits its application in areas with insufficient medical resources. Measurements of serum and pleural fluid biomarkers have the advantages of objective results and a short turn-around time; thus they may be a practical diagnostic tool [13]. Thoracocentesis, used to obtain pleural fluid for biomarker measurement, is an invasive procedure with complications such as iatrogenic pneumothorax [20], re-expansion pulmonary edema, and bleeding [21]; however, its level of invasiveness is lower than that for thoracoscopy or pleural biopsy. Here, we review the diagnostic and stratified values of various biomarkers in pleural fluid and circulation for PPE.
A one-week internal medicine procedure rotation designed to increase procedural opportunities and competency
Published in Hospital Practice, 2021
André M. Mansoor, Ali Chisti, Atif Zaman, Alan J. Hunter, Sima S. Desai
Mounting literature describes a variety of benefits to the implementation of procedural curricula and standardized rotations into internal medicine residency programs. Outcomes have primarily focused on increasing procedural opportunities for house staff, an important factor in satisfying ABIM’s new procedural requirements, and improvements in cognitive and technical skills, comfort performing procedures, and satisfaction with procedural training [3,8–13]. Rotations are typically 2–4 weeks in duration and offer dedicated lecture time and simulation labs [8–11], which are potentially costly. It is not clear whether shorter rotations featuring self-directed curricula can achieve similar outcomes. Most rotations described in the literature feature exposure to paracentesis, thoracentesis, lumbar puncture, and central catheter placement; some procedures, like peripheral IV insertion and arterial blood draw, have not been included in previous studies.