呼吸器・呼吸器内科

Disseminated pulmonary mucormycosis is an uncommon and aggressive life threatening condition associated with a high mortality rate. Pulmonary mucormycosis can spread to contralateral lung before it is even detected, increasing mortality rate with little chance of cure. Our report describes an aggressive case of disseminated mucormycosis, involving bronchial necrosis leading to a bilobectomy with tissue flap coverage. Although our report describes a fatal outcome, this case evaluates the role for surgery in the treatment of difficult infections.

A 70-year-old non-smoking woman was found to have 23 mm sized lung adenocarcinoma. Intraoperative frozen sections were performed which confirmed the diagnosis of adenocarcinoma. Surgical material revealed presence of tumor nests spreading through airspaces (STAS) as far as 9 mm from the edge of the main tumor. Based on the presence of STAS, resection of the remaining left upper lobe was performed after the first operation, and no residual tumor or STAS was detected. A retrospective review of the frozen sections showed the presence of STAS. This report indicates that evaluation of STAS at the time of surgery may help improve the clinical course of a patient undergoing limited resection.

Dermatomyositis (DM) is a subset of idiopathic inflammatory myopathies (IIM) which is characterized by chronic inflammation of skin and muscle weakness, and often involving other organs, such as skin, heart, gastrointestinal tract, pulmonary, and joints. Interstitial lung disease (ILD) is the most common internal organ manifestation that affects the prognosis of DM patients. The mortality is very high in DM-ILD patients especially in those with rapid ILD due to the lack of effective treatment. An early diagnosis of ILD in DM patients is critical important. In recent years, many studies focused on detecting serological biomarkers that can be used in prediction and evaluation of DM-ILD. Here we reviewed recent studies about serological biomarkers of DM-ILD. An overview of those biomarkers may help us have a better management of DM-ILD and may give us a better understanding about the pathogenesis of DM-ILD.

Introduction: Iatrogenic tracheal rupture is a rare potentially life-threatening lesion. The best treatment has still not been determined in the case of mechanically ventilated patients for whom surgery has a high mortality rate.

The aim of this study is to assess the role of conservative management in patients with iatrogenic posterior tracheal wall perforation and to verify its role in critically ill mechanically ventilated patients.

Methods: We reviewed the cases occurred at our hospital: a retrospective study was performed and 7 patients over a four-year period were identified. Conservative treatment consisted in endoscopic evaluation of tracheal tear healing and O2 therapy when dealing with spontaneous breathing patients with none or few symptoms without progression. When symptoms progressed and spontaneous ventilation wasn’t possible, patients underwent tracheal intubation or tracheostomy tube replacement and inflation of the cuff distal to the tear. This conduct has been chosen in membranous trachea injuries, independent of the injury size, diagnostic delay, or cause.

Results: Conservative therapy was attempted in 5 over 7 cases, it was successful in all 5 cases without complications. No clinically evident mediastinitis or postoperative tracheobronchial stenosis was observed on endoscopic follow up.

Conclusion: Our retrospective analysis showed that nonsurgical treatment could be a safe and suitable solution to achieve tracheal healing secondary to membranous injury. In cases where mechanical ventilation is needed, bridging the tear with the tracheal tube seems to give good results. Surgical treatment is advisable in cases of mediastinitis, progression of emphysema and difficulty in bridging the defect with an artificial airway. In the lack of randomized clinical trials comparing surgical and conservative treatments we reviewed our cases and created the ConservAtive vs surgery registry of tracheal ruPTUREs (CAPTURE registry) to collect data from different centers to provide clinicians with further evidences.

Objective: Human tuberculosis is a global public health problem where considerable numbers are infected by Mycobacterium tuberculosis and are at a risk of developing active tuberculosis. Tuberculosis is a problem for the livestock’s as well. Tuberculosis in humans should be considered early in the evaluation of patients with chronic cough and risk factors like HIV/AIDS are diagnosed. The aim of this study was to know the status of the clinical signs that could be noticed by presumptive TB cases and look livestock ownership with the existence of chronic cough in their animals.

Methodology: The study was cross-sectional and conducted in purposefully selected ten districts encompassing 26 peasant associations. The study populations were individuals or households who suffered from a chronic cough for more than two weeks. Pretested questionnaire was used to collect the required information and the data were collected by health extension workers. The data were checked and entered into excel spreadsheet and exported to SPSS version 20.0 software. The data were cleaned and checked before analysis. Descriptive statistics used to analyze the data and graphs as well as tables used to present the findings. The ethical clearance was obtained from the University of Gondar Ethical Review Board and permission obtained from respective health departments.

Results: In this study 681 individuals were found to have chronic cough/presumptive tuberculosis cases. More than half (nearly 53%) of them lives in the high altitudes and 49% reported a cough duration of >2 weeks to 4 weeks, while 18.7% coughed for more than one year. Among the cases 63.7%, 73.6% and 19.2%, showed productive cough, tried getting treatments and used home remedies, respectively. Three fourth of the participants reported the presence of fever, night sweat and fatigue while a quarter of them claimed blood in the sputum. Eighty three point seven percent of them own livestock and 38.4% of their animals were suffering from chronic cough. Of the coughing animals 21.4% received modern treatment, of which only 7.4% responded to the treatment. Likewise, 63.5% of livestock owners shared house with their animals.

Conclusion and Recommendations: Presumptive tuberculosis cases could be characterized by having an indicator clinical signs for tuberculosis. In this study three fourth of the participants reported the presence of fever, fatigue and night sweating while a quarter of them claimed the presence of hemoptysis. Of the owned animals 38.4% showed chronic cough and among the treated animals for the cough only 7.4% responded to the treatment. The practice of house sharing with animals was 63.5%. The presence of chronic cough in animals and less treatment response with a significant proportion of house sharing practice might play a role in the tuberculosis disease epidemiological dynamics. Therefore, identification of causes of chronic cough, early diagnosis of presumptive tuberculosis cases, providing better attention to animal health and avoiding of common house utilization with animals is suggested.

Introduction: Mechanical ventilation is a critical component of modern intensive care medicine, but the process of discontinuing mechanical ventilation could be difficult in some cases. Several studies demonstrated that the combination of diaphragmatic inactivity and mechanical ventilation periods over than 18 hours is associated with atrophy of human diaphragm myofibers. Thus, the disuse atrophy of human diaphragm myofibers could be a major contributor for weaning failures.
Indeed, its proper assessment of the respiratory muscle impairment depends on the use of appropriate tests. The predicting weaning indexes are still the most commonly used tests in clinical practice at ICUs around the world, because they are more widely known and easy to use in different diseases.
Objective: The aim of the present article is to describe advantages, procedures, and clinical applicability of a new method called timed inspiratory effort index, or TIE index, to assess inspiratory muscle strength and specifically address the diagnosis of muscle fatigue in patients under mechanical ventilation.
Methods: This short review about a new method to assess endurance and inspiratory muscle strength of patients with respiratory weakness and undergoing weaning from mechanical ventilation.
Main recommendations: The analysis of respiratory muscle function through the TIE method translates a new feature to the intensive care fast, easy, accurate, reproducible and secure. In addition, to aid in the differential diagnosis of respiratory muscle fatigue directly predict weaning, may lead the most appropriate respiratory muscle training in prolonged weaning patients.
Conclusion: In summary, nowadays, the TIE index can be considered one of the most appropriate methods to evaluate the various interactions in a critical patient under mechanical ventilation. Therefore, TIE index performance as a weaning predictor is among the best rates ever reported in literature.