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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
Hydrothorax is an easily observable collection of fluid in the pleural space. It can be unilateral or bilateral, and when severe and presenting early in pregnancy, can lead to pulmonary hypoplasia. In the presence of severe-moderate ascites, liquid is evident throughout the abdominal circumference. With mild ascites, careful attention is necessary to differentiate true ascites from the hypoechogenic rim produced by dorsal and abdominal musculature just beneath the abdominal wall. Pericardial effusion distends the pericardium without any motion during cardiac activity. Placental edema is diagnosed when its thickness is >6 cm, and polyhydramnios is conventionally defined as an amniotic fluid index ≥25 cm, or a maximum pocket of amniotic fluid ≥8 cm.
Gynaecology: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
In suspected OHSS the examination must identify or exclude dehydration, enlarged ovaries, ascites and any signs of thromboembolism (1). A full cardiovascular and respiratory examination is needed to check for pericardial effusion or hydrothorax (1). The blood pressure, pulse rate and respiratory rate must be recorded (1). Any degree of dehydration needs to be noted and abdominal girth and weight measured (1). Investigations include a full blood count for haemoglobin concentration, haematocrit and white cell count, which may indicate dehydration and a predisposition to thromboembolism (1). Urea, electrolytes and liver function tests are performed to check for severity of dehydration affecting renal and liver function (1). A pelvic ultrasound scan checks for ovarian size and ascites (1). A chest radiograph, electrocardiogram (ECG) and echocardiogram need to be arranged if a hydrothorax or pericardial effusion is suspected (1).
Giovanni Battista Morgagni and eighteenth-century physical examination
Published in Christopher Lawrence, Medical Theory, Surgical Practice, 2018
Cullen’s interest in nosology led him to attend very carefully to the distinctions to be made between diseases. Yet he seems to have employed physical signs of any sort very rarely indeed in differential diagnosis. There are only two examples of physical examination in the lengthy First Lines. Cullen wrote that tympanites was distinguishable from anasarca partly by the fact that in the former ‘the swelling does not readily yield to any pressure’ and ‘being struck, it gives a sound like a drum’.27 In the latter condition, on the other hand, the swelling, when pressed with the finger, ‘forms a hollow that remains for some little time after the pressure is removed’.28 In ascites ‘the fluctuation of the water within, may be perceived by the practitioner’s feeling, and sometimes by his hearing’.29 Similarly, Cullen held the ‘most decisive’ symptom in the recognition of hydrothorax to be fluctuation of water in the chest, ‘perceived by the patient himself, or by the physician, upon certain movements of the body’.30
Indwelling tunneled pleural catheters in patients with hepatic hydrothorax: A single-center analysis for outcomes and complications
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2023
Fatmah F. Alhabeeb, Katia Carle-Talbot, Natalie Rakocevic, Tinghua Zhang, Michael Mitchell, Kayvan Amjadi, Chanel Kwok
Conventional chest tube placement is rarely a favorable option for refractory hydrothorax because of rapid fluid re-accumulation after removal of the chest tube. This intervention is also associated with potential complications including electrolyte imbalance, renal failure, protein loss and increased risk of infection.6 Furthermore, due to the continuous production of the effusion, successful removal of the chest tube is challenging as the minimal drainage volume that traditionally implies safe removal is rarely achieved. TIPS requires high level of expertise that is not available at every center. Often, there are greater contraindications than indications, limiting the number of appropriate candidates. Furthermore, loco-regional criteria for liver transplant candidacy are quite variable. Often patients are excluded based on their age or comorbidities. Those that do qualify may endure a significant wait time due to scarcity of resources. Thus, there is a need for an alternative therapy either for palliation or as a bridge to transplantation.
Application of Narrow-Band Imaging thoracoscopy in diagnosis of pleural diseases
Published in Postgraduate Medicine, 2020
Xinglu Zhang, Feng Wang, Zhaohui Tong
The specimens taken under the two modes were categorized as NBI positive or negative and WLT positive or negative. The pathologist was blinded to the categorization and assessed each specimen from A and B bottles. Based on the pathologic diagnosis, patients were classified as malignancy, tuberculous pleuritis, connective tissue disease, and nonspecific inflammation. In this study, true positive (TP) was defined as patients whose abnormal endoscopic findings accorded with pathologic examination identifying with specific diagnosis as mentioned above. False positive (FP) was defined as patients whose endoscopic findings were abnormal while the pathologic examination was indicated normal. On the other hand, patients seemingly with normal thoracoscopic images but actually with abnormal pathologic results were considered false negative (FN). Patients with normal endoscopic findings and normal specimens were defined as true negative (TN). After a six-month follow-up visit, we identified the final ‘negative’ diagnosis when those patients didn’t get new etiological diagnosis and the hydrothorax no longer relapsed after being charged from our center.
The local efficacy and influencing factors of ultrasound-guided percutaneous microwave ablation in colorectal liver metastases: a review of a 4-year experience at a single center
Published in International Journal of Hyperthermia, 2019
Si Qin, Guang-Jian Liu, Meijin Huang, Jun Huang, Yanxin Luo, Yanling Wen, Yimin Wang, Limei Chen
It is difficult to clearly display lesions close to the diaphragm when using trans-abdominal US because of gas in the lungs, which can result in an insufficient ablation margin. Moreover, tumors near the diaphragm are often undertreated for fear of damaging the diaphragm and lungs, and the intolerable pain during the ablation procedure [20,28]. In our study, these factors led to a higher LTP rate for lesions near the diaphragm. Artificial hydrothorax is an effective method to improve the visibility of lesions adjacent to the diaphragm. The fluid collection can simultaneously protect the lung from thermal injury and reduce pain during the procedure [29]. In our study, there were 5 lesions in 4 patients who underwent artificial hydrothorax, and they presented no complications or LTP. The lack of a significant difference may be due to the small number of cases; thus, a larger sample size is needed.