JOURNAL Previously Revista Portuguesa De Pneumologia

Total Page:16

File Type:pdf, Size:1020Kb

JOURNAL Previously Revista Portuguesa De Pneumologia JOURNAL Previously Revista Portuguesa de Pneumologia volume 25 / especial congresso 3 /Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 ISSN 2531-0429 www.journalpulmonology.org Portada_25_3.indd 1 29/10/19 14:56 JOURNAL Previously Revista Portuguesa de Pneumologia volume 25 / especial congresso 3 /Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 www.journalpulmonology.org ISSN 2531-0429 www.journalpulmonology.org Volume 25. Especial Congresso 3. Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 Contents Oral communications . 1 Commented posters . 45 Exposed posters . 122 00 Sumario 25-3.indd 1 29/10/19 14:58 Pulmonol. 2019;25(Esp Cong 3):1-44 JOURNAL Previously Revista Portuguesa de Pneumologia volume 25 / especial congresso 3 /Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 www.journalpulmonology.org ISSN 2531-0429 www.journalpulmonology.org ORAL COMMUNICATIONS 35th Congress of Pulmonology Praia da Falésia – Centro de Congressos Epic Sana Algarve, 7th‑9th November 2019 CO 001. NONSPECIFIC VENTILATORY PATTERN: Conclusions: Interpretation of PFT using fixed percentages may EVALUATION BY FIXED PERCENTAGES VERSUS LIMITS lead to an overvaluation of functional changes, particularly in fe- OF NORMALITY male gender and older ages. This work attests the importance of using LLN versus fixed percentage as recommended in international C. Rijo, M. Silva, T. Duarte, S. Sousa, P. Duarte guidelines. Centro Hospitalar de Setúbal, EPE-Hospital de São Bernardo. Keywords: Pulmonary function test. Nonspecific ventilatory Introduction: Non-specific ventilatory pattern (NVP) is defined as pattern. Fixed percentage. Limits of normality. a low forced vital capacity (FVC), a low maximum expiratory volume at first second (FEV1), normal FEV1/FVC ratio and a normal total lung capacity (TLC). The American Thoracic Society/European Re- CO 002. EXERCISE TEST RESULTS IN PATIENTS spiratory Society (ATS/ERS) guidelines recommends the interpreta- WITH ALVEOLAR‑CAPILLARY DIFFUSION IMPAIRMENT: tion of pulmonary function tests (PFT) based on normal limits of A COMPARATIVE ANALYSIS normality (5th percentile), not taking into consideration the use of fixed percentages of the predicted value. T. Oliveira, P. Pinto, V. Almeida, R. Carvalho, M.J. Fernandes, Objectives: Evaluate PVI tests defined by fixed percentage and J. Gomes reinterpret them using the lower limits of normality (LLN), accord- Centro Hospitalar Universitário do Porto-Hospital de Santo ing to the European Coal and Steel Community (ECSC) reference António. equations. Methods: Retrospective study of the analysis of pulmonary function Introduction: Exercise capacity impairment in chronic respiratory tests (body plethysmography) performed since 2017 according to patients is multifactorial and stems from the pathophysiological ATS/ERS quality criteria. All PFT characterized by a NVP defined by specificities of each disease. In COPD, among other factors, the role fixed percentages were included. The tests were reanalyzed using of dynamic hyperinflation is recognized. In diffuse lung diseases, re- the limits of normality. All data were analyzed using software IBM® duction of lung compliance and lung microvasculopathy are relevant. SPPS® Statistics version 22. Additionally, alveolar-capillary diffusion impairment is present in Results: 111 plethysmographys with NVP by fixed percentage (54.9% both COPD patients – namely in the context of pulmonary emphysema males and 92.8% Caucasian) were included, with an average of – and patients with diffuse (mainly fibrotic) lung diseases. The 1-min- 62.16 years. The same tests were reanalyzed by the LLN method: ute sit-to-stand (1-STS) and 6-minute walk test (6MWT) evaluate the 58.6% of the NVP became normal (NP), 35.1% continued as NVP and exercise capacity of chronic respiratory patients. 6.3% became restrictive ventilatory pattern (RVP). A statistically Objectives: Compare patients with COPD and diffuse lung diseases significant difference was found in distribution between gender – with alveolar-capillary diffusion impairment – in their results in (p = 0.018), for men and women groups, we obtained 49.2% and 70% 1-STS and 6MWT tests. Understand the performance of these two of NP, respectively. The patterns defined by the LLN showed statis- tests in the measurement of exercise capacity impairment of these tically significant differences in age and the group of NP showed patients. older ages (p = 0.002 in men and p < 0.001 in women). A statisti- Methods: Prospective study taking place at the Pulmonology De- cally significant difference was noticed when comparing groups partment of a University Hospital Center including patients with below and over 75 years (p = 0.014). In the group older than 75 prescription of 6MWT, without exclusion criteria for 1-STS. Patients years, we observed 16 PN (88.9%), in comparison to the group with first perform the 6MWT or 1-STS and, after rest, the other test. In 75 years or less (52.7% PN). this analysis, only patients with DLCO < 80% predicted are included 2531-0437/© 2019 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 01 Comunicaciones 25-3.indd 1 29/10/19 14:58 2 35th Congress of Pulmonology and two groups of patients are compared: COPD and/or pulmonary RV (r = 0.273, p = 0.005) and DLCO (r = -0.409, p = 0.001). In a emphysema (COPD-E) [N = 54] and diffuse lung diseases(DLD) multivariate analyses to assess the influence of PFT on distance and [N = 24]. The SPSS® program for statistical analysis has been used. dessaturation of 6MWD, a 6MWD < 350m was positively associated Results: In COPD-E and DLD patients, respectively, the prevalence with final Borg index (r² = 0.140, p = 0.01). of men is 66.7 and 62.5%(p = 0.799), the mean age is 64.6 and 61 Conclusions: Despite observed correlations between PFT parame- years(p = 0.448), the mean BMI is 25.8 and 27.7 kg/m2 (p = 0.074), ters and 6MWT (distance, dSO2), none of the studied PFT para- the proportion of patients with mMRC dyspnea ≥ 2 is 56.6% and meters were able to predict the final 6MWT outcome, pointing out 29.2% (p = 0.03), the proportion of patients under home oxygen that other determinants may be involved. therapy is 11.1% and 4.2% (p = 0.427) and the mean DLCO is 52.6% Keywords: COPD. 6MWT. Lung function. and 54.8% (p = 0.559). In COPD-E patients, pre-BD FEV1 (median) = 44.6%; in DLD patients, pre-BD TLC(mean) = 89.7%. In DLD patients, the main diagnoses are: hypersensitivity pneumonitis(n = 5), idio- pathic pulmonary fibrosis(n = 4), non-specific interstitial pneumonia CO 004. AMYOTROPHIC LATERAL SCLEROSIS: IMPORTANT (n = 4) and sarcoidosis(n = 4). In 1-STS, no significant differences SURVIVAL FACTORS between both groups were found in the blood pressure, heart rate B. Mendes, A. Mineiro, C. Figueiredo, M. Cabral, A. Magalhães, and SpO2 responses, or end-test Borg (dyspnea/fatigue) scores. N. Caires, J. Rosa, M. Dias, J. Cardoso COPD-E patients performed significantly less repetitions than DLD patients (24.4 ± 6.1 and 30.2 ± 10.2, respectively; p = 0.015). In the Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa 6MWT, no significant differences between both groups were found Central. in the blood pressure, heart rate and SpO2 responses; However, Introduction: Amyotrophic lateral sclerosis (ALS) is a rare progres- end-test Borg(dyspnea) score is significantly higher in COPD-E pa- sive neurodegenerative disease of the motor neuron, that ultimate- tients than in DLD patients (5 ± 5 and 2.5 ± 5, respectively; p = 0.023) ly leads to respiratory failure and death. The median survival of but no significant differences in end-test Borg (fatigue) scores were these patients is 2 to 5 years since the beginning of the disease. found. 6MW Distance is lower in COPD-E patients (395.5 ± 143m) Factors as age, female gender and bulbar symptoms onset seem to than in DLD patients (413.1 ± 128.3m), but this difference is not be related to poor prognosis. statistically significant (p = 0.914). Objectives: Functional and clinical characterization of the patients Conclusions: Although both groups presented similar degrees of with ALS and analyse their survival. alveolar-capillary diffusion impairment, COPD-E patients had worse Methods: We conducted a retrospective study with evaluation of overall performance and became more symptomatic than DLD pa- all patients with ALS that were referred to our centre’s pulmon- tients in these exercise tests. Furthermore, in these patients with ology consultation during a ten-year period. Clinical and respira- alveolar-capillary diffusion impairment, the number of repetitions tory functional test data were recorded. We used the software performed on 1-STS seems to better express the greater limitation IBM SPSS Statistics 25 for data analyses. Kaplan-Meier curves of exercise capacity in COPD-E patients than the 6MWDistance. were used to analyse overall survival and Mantel-Cox test to com- Thus, the 1-STS test may be more indicative of the contribution of pare survival between groups. To compare the mean between specific COPD-E factors in exercise capacity impairment, namely FVC we used the parametric independent t-test. The results are dynamic hyperinflation. presented in mean (± standard deviation) or median [25 percen- Keywords: 6-minute walk test. 1-minute sit-to-stand. COPD. tile-75 percentile]. Diffuse lung disease. Alveolar-capillary diffusion impairment. Results: Forty-three patients were included in the study, 21 of them female gender (48.9%). The mean age of diagnosis in women (67.5 (± 2.1) years) was more advanced than in men (62.6 (± 2)).
Recommended publications
  • Hepatic Hydrothorax Without Apparent Ascites and Dyspnea - a Case Report
    Case Report DOI: 10.7860/JCDR/2018/37185.12181 I nternal Medicine Hepatic Hydrothorax without Apparent S ection Ascites and Dyspnea - A Case Report JING HE1, RASHA HAYKAL2, HONGCHUAN COVILLE3, JAYA PRAKASH GADIKOTA4, CHRISTOPHER BRAY5 ABSTRACT A 78-year-old female with a past medical history of alcoholic cirrhosis was hospitalised with recurrent lower gastrointestinal bleeding due to rectal ulcers. The ulcers were successfully treated with cautery and placement of clips. However, a recurrent large right-sided pleural effusion without apparent ascites and dyspnea were found incidentally during the hospitalisation. The initial fluid analysis was exudate based on Light’s criteria with high protein. The fluid analysis was repeated five days later, after rapid reaccumulation which revealed transudates. Other causes of pleural effusion like heart failure, renal failure or primary pulmonary diseases were excluded. Hepatic hydrothorax was considered and the patient was started with the treatment of Furosemide and Spironolactone. The atypical presentation of hepatic hydrothorax may disguise the diagnosis and delay the treatment. Therefore, for a patient with recurrent, unexplained unilateral pleural effusions, even with atypical fluid characterisation and in the absence of ascites, hepatic hydrothorax should still remain on the top differential with underlying cirrhosis to ensure optimal treatment. Keywords: Cirrhosis, Light criteria, Liver, Pleural effusion CASE REPORT Haemogram Levels Normal range A 78-year-old Caucasian female, with a past medical history of alcoholic cirrhosis, admitted for recurrent rectal bleeding secondary WBC 6.9 (4.5-11.0 thousands/mm3) to rectal ulcers and was successfully treated with cautery and Neutrophils % 78 H (50.0-75.0 %) placement of clips.
    [Show full text]
  • Interventional Pulmonology: a New Medical Specialty Tiberiu R
    IMAJ • VOL 16 • June 2014 REVIEWS Interventional Pulmonology: A New Medical Specialty Tiberiu R. Shulimzon MD Department of Interventional Pulmonology, Pulmonary Institute, Sheba Medical Center, Tel Hashomer, Israel (ultrasound) and invasive methods (medical thoracoscopy, tun- ABSTRACT: Interventional pulmonology (IP) is the newest chapter in neled pleural catheters). IP is now reaching the field of cellular respiratory medicine. IP includes both diagnostic and thera- and molecular biology. Different markers of micro- and nano- peutic methods. Nanotechnology, in both instrumental engin- dimensions are being developed together with optical visual eering and optical imaging, will further advance this com- technologies with the purpose of studying the cellular changes petitive discipline towards cell diagnosis and therapy as part of of inflammation and malignancy. This review will focus on the future’s personalized medicine. some of the latest developments in diagnostic and therapeutic IMAJ 2014; 16: 379–384 interventional pulmonology. KEY WORDS: interventional pulmonology (IP), confocal laser endomicroscopy (CLE), optical coherence tomography (OCT), bronchial thermoplasty (BT), bronchoscopic lung DIAGNOSTIC INTERVENTIONAL PULMONOLOGY volume reduction (BLVR) Most of the advances in diagnostic IP involved image acqui- sition and sampling instruments at bronchoscopy. However, some of the new imaging techniques reach the alveoli (alveos- copy) and the pleural cavity (pleuroscopy). t is estimated that chronic respiratory diseases cause IMAGE
    [Show full text]
  • Update on Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis
    J Bras Pneumol. 2015;41(5):454-466 http://dx.doi.org/10.1590/S1806-37132015000000152 REVIEW ARTICLE Update on diagnosis and treatment of idiopathic pulmonary fibrosis José Baddini-Martinez1, Bruno Guedes Baldi2, Cláudia Henrique da Costa3, Sérgio Jezler4, Mariana Silva Lima5, Rogério Rufino3,6 1. Divisão de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil. 2. Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, ABSTRACT Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil. Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of 3. Disciplina de Pneumologia e Tisiologia, unknown etiology, which is associated with a progressive decrease in pulmonary Faculdade de Ciências Médicas, function and with high mortality rates. Interest in and knowledge of this disorder have Universidade do Estado do Rio de grown substantially in recent years. In this review article, we broadly discuss distinct Janeiro, Rio de Janeiro, Brasil. aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We 4. Ambulatório de Pneumologia, Hospital list the current diagnostic criteria and describe the therapeutic approaches currently Ana Nery, Salvador, Brasil. available, symptomatic treatments, the action of new drugs that are effective in slowing 5. Ambulatório de Doenças Pulmonares Intersticiais, Hospital do Servidor the decline in pulmonary function, and indications for lung transplantation. Público Estadual de São Paulo, São Keywords: Idiopathic pulmonary fibrosis/diagnosis; Idiopathic pulmonary fibrosis/therapy; Paulo, Brasil. Idiopathic pulmonary fibrosis/rehabilitation. 6. Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
    [Show full text]
  • Section 8 Pulmonary Medicine
    SECTION 8 PULMONARY MEDICINE 336425_ST08_286-311.indd6425_ST08_286-311.indd 228686 111/7/121/7/12 111:411:41 AAMM CHAPTER 66 EVALUATION OF CHRONIC COUGH 1. EPIDEMIOLOGY • Nearly all adult cases of chronic cough in nonsmokers who are not taking an ACEI can be attributed to the “Pathologic Triad of Chronic Cough” (asthma, GERD, upper airway cough syndrome [UACS; previously known as postnasal drip syndrome]). • ACEI cough is idiosyncratic, occurrence is higher in female than males 2. PATHOPHYSIOLOGY • Afferent (sensory) limb: chemical or mechanical stimulation of receptors on pharynx, larynx, airways, external auditory meatus, esophagus stimulates vagus and superior laryngeal nerves • Receptors upregulated in chronic cough • CNS: cough center in nucleus tractus solitarius • Efferent (motor) limb: expiratory and bronchial muscle contraction against adducted vocal cords increases positive intrathoracic pressure 3. DEFINITION • Subacute cough lasts between 3 and 8 weeks • Chronic cough duration is at least 8 weeks 4. DIFFERENTIAL DIAGNOSIS • Respiratory tract infection (viral or bacterial) • Asthma • Upper airway cough syndrome (postnasal drip syndrome) • CHF • Pertussis • COPD • GERD • Bronchiectasis • Eosinophilic bronchitis • Pulmonary tuberculosis • Interstitial lung disease • Bronchogenic carcinoma • Medication-induced cough 5. EVALUATION AND TREATMENT OF THE COMMON CAUSES OF CHRONIC COUGH • Upper airway cough syndrome: rhinitis, sinusitis, or postnasal drip syndrome • Presentation: symptoms of rhinitis, frequent throat clearing, itchy
    [Show full text]
  • UNC Health Care Clinic-Based Ambulatory Care Pharmacy Internship Internship Director: Ellina K
    UNC Health Care Clinic-Based Ambulatory Care Pharmacy Internship Internship Director: Ellina K. Max, PharmD, BCACP, CPP; [email protected] OVERVIEW OF INTERNSHIP The UNC Clinic-Based Ambulatory Care Pharmacy Internship is a two-year experience that combines concentrated summer programs with requirements during the academic year. It is aimed at providing future pharmacy leaders with exposure to the complexities of ambulatory care practice sites and the role of a Clinical Pharmacist Practitioner (CPP) in a unique clinic setting. The student intern will be exposed to a broad range of services and programs, with a focus in a specific therapeutic area, sharing in the goal to maintain UNC Medical Center’s Department of Pharmacy mission to provide patient-centered medication management that optimizes outcomes through an alignment of practice, education, research, and leadership. The program offers a number of opportunities for intern exploration that may include pharmacy technician activities, pharmacist shadowing in a variety of clinics, medication reconciliation and patient counseling, active learning, literature reviews, leadership and mentorship opportunities, and ownership and completion of patient- related and/or quality improvement projects in collaboration with CPP’s in their respective clinics. Interns will also have the opportunity to practice good communication skills through patient interactions as well as discussions and presentations with pharmacists, residents, and other health care professionals. PROGRAM FORMAT The internship encompasses a concentrated experience during the summer that continues throughout the academic year. Students completing the program should expect to gain an understanding of clinical programs and operations within the UNC Medical Center Specialty and Primary Clinic (SCP) team practice sites that often include a specialty pharmacy component.
    [Show full text]
  • Asphyxia Neonatorum
    CLINICAL REVIEW Asphyxia Neonatorum Raul C. Banagale, MD, and Steven M. Donn, MD Ann Arbor, Michigan Various biochemical and structural changes affecting the newborn’s well­ being develop as a result of perinatal asphyxia. Central nervous system ab­ normalities are frequent complications with high mortality and morbidity. Cardiac compromise may lead to dysrhythmias and cardiogenic shock. Coagulopathy in the form of disseminated intravascular coagulation or mas­ sive pulmonary hemorrhage are potentially lethal complications. Necrotizing enterocolitis, acute renal failure, and endocrine problems affecting fluid elec­ trolyte balance are likely to occur. Even the adrenal glands and pancreas are vulnerable to perinatal oxygen deprivation. The best form of management appears to be anticipation, early identification, and prevention of potential obstetrical-neonatal problems. Every effort should be made to carry out ef­ fective resuscitation measures on the depressed infant at the time of delivery. erinatal asphyxia produces a wide diversity of in­ molecules brought into the alveoli inadequately com­ Pjury in the newborn. Severe birth asphyxia, evi­ pensate for the uptake by the blood, causing decreases denced by Apgar scores of three or less at one minute, in alveolar oxygen pressure (P02), arterial P02 (Pa02) develops not only in the preterm but also in the term and arterial oxygen saturation. Correspondingly, arte­ and post-term infant. The knowledge encompassing rial carbon dioxide pressure (PaC02) rises because the the causes, detection, diagnosis, and management of insufficient ventilation cannot expel the volume of the clinical entities resulting from perinatal oxygen carbon dioxide that is added to the alveoli by the pul­ deprivation has been further enriched by investigators monary capillary blood.
    [Show full text]
  • Unusual Case of Non-Resolving Necrotizing Pneumonia: a Last Resort Measure for Cure
    eCommons@AKU Department of Surgery Department of Surgery June 2016 Unusual case of non-resolving necrotizing pneumonia: a last resort measure for cure. Naseem Salahuddin Aga Khan University, [email protected] Naila Baig Ansari Aga Khan University Saulat H. Fatimi Aga Khan University, [email protected] Follow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_surg Part of the Surgery Commons Recommended Citation Salahuddin, N., Ansari, N., Fatimi, S. (2016). Unusual case of non-resolving necrotizing pneumonia: a last resort measure for cure.. JPMA: Journal of the Pakistan Medical Association, 66(6), 754-756. Available at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_surg/566 754 CASE REPORT Unusual case of non-resolving necrotizing pneumonia: A last resort measure for cure Naseem Salahuddin, 1 Naila Baig-Ansari, 2 Saulat Hasnain Fatimi 3 Abstract pathogen of acute CAP, 2,3 and accounts for most cases of To our knowledge, this is an unusual case of a community- slowly resolving pneumonia.The majority of previously acquired pneumonia (CAP) with sepsis secondary to healthy hospitalized patients with severe CAP responded Streptococcus pneumoniae that required lung resection satisfactorily to prompt initiation of appropriate antibiotic for a non-resolving consolidation. A 74 year old previously therapy; however, it is estimated that 10% of hospitalized healthy woman, presented with acute fever, chills and CAP patients have slowly resolving or nonresolving pleuritic chest pain in Emergency Department (ED). A disease. 4 diagnosis of CAP was established with a Pneumonia Severity Index CURB-65 score of 5/5. In the ER, she was Case Report promptly and appropriately managed with antibiotics History: A 74 year old woman who was previously and aggressive supportive therapy.
    [Show full text]
  • Mantke, Peitz, Surgical Ultrasound -- Index
    419 Index A esophageal 218 Anorchidism 376 gallbladder 165 Aorta 364–366 A-mode imaging 97 gastric 220 abdominal aneurysm (AAA) AAA (abdominal aortic aneurysm) metastasis 142 20–21, 364, 366 20–21, 364, 366 pancreatic 149, 225 dissection 364, 366 Abdominal wall Adenofibroma, breast 263 perforation 366 abscess 300–301 Adenoma pseudoaneurysm 364 diagnostic evaluation 297 adrenal 214 Aortic rupture 20 hematoma 73, 300, 305 colorectal 231, 232 Aplasia, muscular 272 rectus sheath 297–300 duodenal papilla 229, 231 Appendicitis 1–4 hernia 300, 302–304 gallbladder 165 consequences for surgical indications for sonography 297 hepatic 54, 58, 141 treatment 2 seroma 298, 300, 305 multiple 141 sonographic criteria 1 trauma 297–300 parathyroid 213 Archiving 418 Abortion, tubal 30 renal 241 Arteriosclerosis 346, 348 Abscess thyroid 202–203 carotid artery 335, 337, 338 abdominal wall 300–301 Adenomyomatosis 8, 164, 165 plaque 337, 338, 345, 367, 370 causes 301 Adrenal glands 214–216 Arteriovenous (AV) malformation amebic 138 adenoma 214 139, 293, 326–329 breast 264 carcinoma 214 Artery chest wall 173, 178 cyst 214 carotid 334–339 diverticular 120, 123 hematoma 214 aneurysm 338 drainage 85–88, 93 hemorrhage 214 arteriosclerosis 335 hepatic 6, 138, 398 hyperplasia 214 plaque characteristics inflammatory bowel disease limpoma/myelipoma 214 337, 338, 345 116, 119 metastases 214 bifurcation 334, 337 intramural 5 sonographic criteria 214 bulb 339 lung 183, 186, 190 tuberculosis 214 dissection 338, 339, 346 pancreatic 11 Advanced dynamic flow (ADF) sonographic
    [Show full text]
  • Imaging: Results and Hospital Course: • Patient Initially Presented to RMH on 8/20/2019
    Introduction / HPI: Imaging: Results and Hospital Course: • Patient initially presented to RMH on 8/20/2019. He was treated for RLE 27 yo male with past medical history of IVDA presented to cellulitis with a washout; as well as, IV Cefazolin for MSSA + Blood Roxborough Memorial Hospital (RMH) with right leg swelling for 5 cultures. Blood cultures remained positive x4; spurring a TTE, which was days and shortness of breath. The patient stated that 5 days prior he negative for vegetations. CXR preformed demonstrated concern for septic was using heroin and injecting the needle into his right medial foot. He embolic, spurring a Chest CT with reported finding of said that the following day he noticed a blister forming and sliced it hydropneumothorax. Patient was transferred to TJUH on 8/28 for the with a knife that he cleaned with soap and water. The next day he possibility of needing cardiothoracic surgery capabilities. noticed swelling of his foot with progressing redness and pain traveling up his leg to his knee. He described the pain as a 5 out of 10 when at • He was admitted to the TJUH SICU. Subsequently the patient had rest and a 7 out of 10 when walking on it. He stated that he has been multiple episodes of bloody BM’s and his Hgb dropped to 6.9. He taking 1 tablet of Motrin per day for last 3 days with minimal received 2 units pRBC’s with appropriate hemodynamic response. GI was relief. He endorsed shortness of breath when at rest and exertion, chest consulted, whom preformed an EGD and colonoscopy on 9/9.
    [Show full text]
  • Hepatic Hydrothorax: an Updated Review on a Challenging Disease
    Lung (2019) 197:399–405 https://doi.org/10.1007/s00408-019-00231-6 REVIEW Hepatic Hydrothorax: An Updated Review on a Challenging Disease Toufc Chaaban1 · Nadim Kanj2 · Imad Bou Akl2 Received: 18 February 2019 / Accepted: 27 April 2019 / Published online: 25 May 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Hepatic hydrothorax is a challenging complication of cirrhosis related to portal hypertension with an incidence of 5–11% and occurs most commonly in patients with decompensated disease. Diagnosis is made through thoracentesis after exclud- ing other causes of transudative efusions. It presents with dyspnea on exertion and it is most commonly right sided. Patho- physiology is mainly related to the direct passage of fuid from the peritoneal cavity through diaphragmatic defects. In this updated literature review, we summarize the diagnosis, clinical presentation, epidemiology and pathophysiology of hepatic hydrothorax, then we discuss a common complication of hepatic hydrothorax, spontaneous bacterial pleuritis, and how to diagnose and treat this condition. Finally, we elaborate all treatment options including chest tube drainage, pleurodesis, surgical intervention, Transjugular Intrahepatic Portosystemic Shunt and the most recent evidence on indwelling pleural catheters, discussing the available data and concluding with management recommendations. Keywords Hepatic hydrothorax · Cirrhosis · Pleural efusion · Thoracentesis Introduction Defnition and Epidemiology Hepatic hydrothorax (HH) is one of the pulmonary com- Hepatic hydrothorax is defned as the accumulation of more plications of cirrhosis along with hepatopulmonary syn- than 500 ml, an arbitrarily chosen number, of transudative drome and portopulmonary hypertension. It shares common pleural efusion in a patient with portal hypertension after pathophysiological pathways with ascites secondary to por- excluding pulmonary, cardiac, renal and other etiologies [4].
    [Show full text]
  • Inflammatory Diseases of the Brain in Childhood
    Inflammatory Diseases of the Brain in Childhood Charles R. Fitz1 From the Children's National Medical Center, Washington, DC Pediatric inflammatory disease may resemble found that the frequency of congenital involve­ adult disease or show remarkable, unique char­ ment increases with each trimester, being 17%, acteristics. This paper summarizes the current 25%, and 65%. However, infection severity de­ imaging of pediatric diseases with emphasis on creases in each trimester. The true frequency of those that are the most different from adult ill­ early cases may have been underestimated in nesses. their study, because spontaneous abortions were not included in the retrospective analysis. Congenital Infections Intracranial calcification is the most notable radiologic sign. Basal ganglial, periventricular, Most intrauterine infections are acquired and peripheral locations are all common (Fig. 1). through the placenta, although transvaginal bac­ Large basal ganglial calcifications are related to terial infections may also occur. The TORCH early infection, as is hydrocephalus. The hydro­ eponym remains a good reminder for these enti­ cephalus is invariably secondary to aqueductal ties, identifying toxoplasmosis, others, rubella, stenosis (2), and often has a characteristically cytomegalic virus, and herpes simplex. A second marked expansion of the atria and occipital horns H for HlV or perhaps the words A (AIDS) TORCH (Fig. 2), probably partly due to associated tissue should now be used, as AIDS becomes the most loss. This is associated with increased periventric­ common maternally transmitted infection. ular calcification in the author's experience. Mi­ crocephaly is common, and encephalomalacia is seen occasionally (2). Hydrencephaly has also Toxoplasmosis been reported (3). This infection is passed to humans from cats, Because calcifications are common and fairly since the oocyst of the Toxoplasma gondii para­ characteristic, computed tomography (CT) is site is excreted in cat feces.
    [Show full text]
  • Study Guide Medical Terminology by Thea Liza Batan About the Author
    Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails ­proficiency­in­communicating­with­healthcare­professionals­such­as­physicians,­nurses,­ or dentists.
    [Show full text]