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Thoracic trauma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Immediate ICD is the treatment of choice for all symptomatic pneumo- and hemothoraces. Asymptomatic pneumothoraces that are not evident on CXR but manifest on computed tomography (CT) scan do not necessarily require drainage. Nevertheless, these patients must be carefully observed in hospital and should be maintained on high-flow oxygen for 24–48 hours. There is some controversy around the conservative management of small-volume hemothoraces. In our experience, all traumatic hemothoraces require drainage by ICD insertion in order to prevent the complications of a retained hemothorax, including pneumonia, atelectasis, lung entrapment, and empyema. Acute, massive pulmonary hemorrhage may be rapidly addressed through median sternotomy and hilar clamping. Such a maneuver stems bleeding from the lung parenchyma and affords the opportunity to determine if the injury may be optimally addressed through a non-anatomical resection of lung, lobectomy, or pneumonectomy.
Fetal surgery
Published in Prem Puri, Newborn Surgery, 2017
Management of prenatally diagnosed CPAMs continues to evolve. A fetus of viable gestational age affected with a CPAM and associated hydrops should be delivered and undergo resection in the newborn period. In instances where a dominant macrocystic lesion is present in a previable fetus, thoracoamniotic shunt may reverse the hydrops fetalis.34 Needle drainage is ineffective, as rapid reaccumulation of fluid is the norm. Fetal pulmonary lobectomy for microcystic CPAM with associated hydrops has been shown to reverse fetal hydrops but is associated with preterm labor and prematurity.35 Interestingly, hydropic fetuses with large microcystic CPAMs can be successfully treated with administration of maternal steroids. This finding was discovered serendipitously at UCSF after several hydropic fetuses were treated with maternal steroids to enhance fetal lung maturity in preparation for fetal lung lobectomy. Subsequent fetal ultrasounds demonstrated resolution of the hydrops.36 Several prospective studies have confirmed the effectiveness of maternal steroids for the fetal treatment of large microcystic CPAMs.37 Macrocystic CPAMs do not respond to steroids and are still best managed with thoracoamniotic shunt placement or fetal surgery when fetuses develop hydrops (Figure 26.3).
Development of Vogt–Koyanagi–Harada Disease-like Uveitis during Treatment by Anti-programmed Death Ligand-1 Antibody for Non-small Cell Lung Cancer: A Case Report
Published in Ocular Immunology and Inflammation, 2022
Shunichi Suwa, Ryo Tomita, Keiko Kataoka, Shinji Ueno
A 76-year-old female patient was diagnosed with NSCLC in the Nagoya University Hospital in December 2010 and underwent right middle lung lobectomy. Later, the NSCLC metastasized to the pleura, and she was treated with chemotherapy beginning in January 2014. For the next four years, there was no progression of the cancer. However, positron emission tomography-computed tomography revealed metastases to the pleura and the mediastinal and hilar lymph nodes in October 2018. She was then treated with 1200 mg (25 mg/kg body weight) of intravenous atezolizumab about once every four weeks beginning in January 2019. After 19 cycles of the treatment over a 17-month period, she noticed an acute reduction in the vision of both eyes in May 2020. She was then referred to the Ophthalmology Clinic of Nagoya University in June 2020.
Identifying Novel Mutations in Iranian Patients with LPS-responsive Beige-like Anchor Protein (LRBA) Deficiency
Published in Immunological Investigations, 2021
Mehdi Ghaini, Mohammad Taghi Arzanian, Bibi Shahin Shamsian, Saeed Sadr, Pejman Rohani, Mohammad Keramatipour, Mehrnaz Mesdaghi, Shabnam Eskandarzadeh, Bernice Lo, Mahnaz Jamee, Zahra Chavoshzadeh
At 18 years old, he presented with fever, cough, and hemoptysis. Patchy alveolar opacity and pleural effusion were observed in CXR (chest X-ray) and evidence of porta hepatis and para-aortic lymphadenopathies were identified in chest CT scan. Smear testing and microscopy for the mycobacterium were negative. BAL culture was positive for gram-positive cocci and BAL fluid was positive for Epstein–Barr virus (EBV) and Cytomegalovirus (CMV). Finally, the diagnosis of a lung abscess was made, resulting in a right lung lobectomy (right lower lobe). He recovered but was subsequently re-admitted with productive cough, fever and chills, myalgia, and dyspnea. Upon physical examination, patchy hypopigmented lesions in the lumbar region and limbs, suggestive of vitiligo, were detected. He suffered from recurrent episodes of respiratory tract infections and started to develop interstitial lung disease.
Impact of unfavorable factors on outcomes among inoperable stage II-IV Nonsmall cell lung cancer patients treated with proton therapy
Published in Acta Oncologica, 2019
He J. Zhu, Romaine C. Nichols, Randal H. Henderson, Christopher G. Morris, Stella Flampouri, Dat C. Pham, Christopher L. Klassen, Vandana Seeram, James D. Cury, Lisa Jones, Lisa McGee, Bradford S. Hoppe
Patient- and disease-specific characteristics, retrospectively extracted from prospectively collected data forms or from patient medical records, are listed in Table 1. For the purposes of this study, 10 ‘unfavorable’ factors were identified as common exclusion criteria for LA-NSCLC trials and evaluated for each patient. Unfavorable factors included the following: age ≥80 years at diagnosis, prior lung lobectomy surgery, and the eligibility factors listed in the NRG 1308 trial [16]: stage IV (oligometastasis), weight loss exceeding 10% in 3 months, performance status (PS) of 2 or worse, poor baseline lung function defined as forced expiratory volume in 1 second (FEV1) less than 1.0 L or home oxygen dependency (at least nightly), history of lung cancer, prior 2nd nonthoracic cancer in the past 3 years (excluding nonmelanoma skin cancer), prior chest irradiation, and other severe comorbidities listed as ineligibility criteria in most currently accruing cooperative group trials, such as severe cardiac diseases requiring hospitalization within 6 months before the start of PT, severe nonmalignant pulmonary diseases requiring hospitalization within 1 month of the start of PT, or other organ system conditions precluding patients from receiving chemotherapy.