Massive right-sided hemorrhagic pleural effusion due to pancreatitis; a case report

Respiratory monitoring dataset, with rapid expiratory occlusions, over increasing positive airway pressure ventilation

Resting breathing data was collected from 80 smokers, vapers, asthmatics, and otherwise healthy people in the low-risk clinical unit at the University of Canterbury. Subjects were asked to breathe normally through a full-face mask connected to a Fisher and Paykel Healthcare SleepStyle SPSCAA CPAP device. PEEP (Positive End-Expiratory Pressure) support was increased from 4 to 12 cmH2O in 0.5 cmH2O increments. Data was also collected during resting breathing at ZEEP (0 cmH2O) before and after the PEEP trial. The trial was conducted under University of Canterbury Human Research Ethics Committee consent (Ref: HREC 2023/04/LR-PS). Data was collected by and Dräeger PulmoVista 500 EIT machine and a custom Venturi-based pressure and flow sensor device connected in series with the CPAP and full-face mask. The outlined dataset includes pressure, flow, volume, dynamic circumference (thoracic and abdominal, and cross-sectional aeration. Subject demographic data was self-reported using a questionnaire given prior to the trial.

Respiratory pressure and split flow data collection device with rapid occlusion attachment

Respiratory model-based methods require datasets containing enough dynamics to ensure model identifiability for development and validation. Rapid expiratory occlusion has been used to identify elastance and resistance within a single breath. Currently accepted practice for rapid expiratory occlusion involves a 100 ms occlusion of the expiratory pathway. This article presents a low-cost modular rapid shutter attachment to enable identification of passive respiratory mechanics. Shuttering faster than 100 ms creates rapid expiratory occlusion without the added dynamics of muscular response to shutter closure, by eliminating perceived expiratory blockage via high shutter speed. The shutter attachment fits onto a non-invasive venturi-based flow meter with separated inspiratory and expiratory pathways, established using one-way valves. Overall, these elements allow comprehensive collection of respiratory pressure and flow datasets with relatively very rapid expiratory occlusion.

Strokes occurring in the hospital: Symptom recognition and eligibility for treatment in the intensive care units versus hospital wards

BACKGROUND:

Studies have shown that 4%–17% of acute ischemic strokes (AISs) occur in patients hospitalized for another reason; scanty data are available about the care delivery and outcome of this patient population.

MATERIALS AND METHODS:

All consecutive inhospital AISs over a 10-year period at our comprehensive stroke center were included in the study. We compared the meantime from last known neurologically intact to symptom detection and also eligibility for acute treatment of patients based on their physical location in the hospital with respect to the level of care when they were found to have the stroke symptoms.

RESULTS:

Fifty-three patients suffered inhospital AIS during this period (28 in intensive care units/emergency department [ICUs/ED] vs. 25 in regular floors). Only in four patients (7.5%), initial brain imaging was done within 25 min from symptom recognition (as recommended by the American Heart Association/American Society of Anesthesiologists guidelines). Forty-two (79%) underwent brain imaging within 6 h of symptom recognition; of them, 11 (26%) received intravenous thrombolysis (IVT) within the first 4.5 h of symptom onset and 7 (17%) underwent endovascular treatment (EVT). The mean (±standard deviation) time in minutes from last known neurologically intact to symptom detection for floor patients was significantly longer compared to the ICU/ED patients (194 [±149] vs. 74 [±45], P = 0.0003). Patients admitted to the ICU/ED had more chance of being recognized earlier and being eligible for IVT or/and EVT compared to the patients admitted to the regular floors (44% vs. 25%, P = 0.14); however, the difference did not reach statistical significance.

CONCLUSIONS:

ICU/ED patients had a significantly shorter time to stroke symptom detection from last known neurologically intact when compared to the regular floor patients. Furthermore, they had a trend toward a higher likelihood of being eligible for acute treatment compared to the regular floors, although the result did not reach statistical significance.

Rare case of bilateral pleural effusion caused by pancreaticopleural fistula

A 51-year-old man presented with dyspnoea and basithoracic pain. Chest X-ray revealed bilateral pleural effusion, which was managed by bilateral chest drain placement. The pleural fluid analysis showed elevated lipase. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a large fistula from the tail of the main pancreatic duct to the left pleural space. Definitive treatment was accomplished with ERCP guided large pancreatic stents placement.

Endoscopic management of pancreaticopleural fistula in a pediatric patient: A case report and literature review

INTRODUCTION

Pancreaticopleural fistula (PPF) is a rare but serious complication of pancreatic disorders. As the clinical presentations of PPF are often deceptive, it can cause a delay in the timely diagnosis and proper treatment. PPF is extremely uncommon in pediatric patients, and diagnostic and management strategies for PPF among pediatric patients are scanty.

PATIENT CONCERNS

A 12-year-old girl presented with cough and dyspnea owing to massive right-side pleural effusion confirmed by Chest X-ray. Biochemical examination of pleural effusion revealed a significant elevation of amylase level. Imaging modalities showed dilated pancreatic duct and fistulous tract connecting pancreatic duct and right thorax.

DIAGNOSIS

Chronic pancreatitis with PPF was diagnosed.

INTERVENTIONS

Medical therapy was initially attempted for 2 weeks. Endoscopic therapy with naso-pancreatic drainage tube placement was then performed without any complications after failed medical therapy.

OUTCOMES

The patient has remained healthy and symptom-free during 2 years of follow-up.

CONCLUSION

When pediatric patients presented with recurrent pleural effusion with unknown etiology, PPF should be taken into consideration. Pleural effusion amylase level is the most important laboratory test and magnetic resonance cholangiopancreatography is recommended to visualize the fistula. Optimal management of PPF should be based on pancreatic duct morphology.

Malignant Cerebral Venous Infarction: Decompressive Craniectomy versus Medical Treatment

BACKGROUND

Cerebral venous thrombosis (CVT) is a common type of stroke in young adults and associated with 8% mortality. High intracranial pressure (ICP) and brain herniation are the most common causes of death in these patients. In contrast with malignant arterial middle cerebral infarction, there are few studies reporting the efficacy of decompressive craniectomy (DC) for treatment of high ICP in patients with CVT. In this study, we assess the clinical outcome of patients with CVT with impending brain herniation treated with DC versus medical management.

METHODS

In this retrospective study, medical records of all patients with CVT admitted to our hospital were reviewed. Patients with the following inclusion criteria were entered into the study: 1) CVT proven by contrast-enhanced magnetic resonance venogram and/or computed tomography venogram, 2) malignant CVT (impending brain herniation according to imaging and clinical finding), and 3) age between 16 and 80 years. Patients with deep venous system thrombosis, Glasgow Coma Scale (GCS) score of 3, and bilateral nonreactive midposition pupils or mydriasis on admission were excluded. Patients were classified into 2 groups: surgical group (DC group) including patients who received medical treatment and DC and medical group (MG) including patients who received only medical treatment. Outcomes and complications were assessed and compared between the 2 groups.

RESULTS

Of 357 patients with CVT hospitalized in our center, 48 patients entered into the study. Twenty-three patients were managed medically, and 25 patients were managed surgically. There was no significant difference between the groups concerning age, sex, presenting symptoms, transient and permanent risk factors of CVT, GCS score on admission, and pupils' reactivity on admission. All patients in the MG died during hospitalization in comparison with 8 patients in the DC group (100% vs. 32%, P < 0.001). Favorable outcome (modified Rankin scale score 0-2) was achieved in 52% of the DC group and 0% of the MG group (P < 0.001).

CONCLUSIONS

The results of our study confirmed that in contrast with DC, medical treatment could not prevent transtentorial herniation. DC is not only lifesaving for patients with CVT with impending brain herniation but also results in favorable outcome in most patients.

[A rare cause of haemorrhagic pleurisy: Dissection of the aorta]

INTRODUCTION

Haemorragic pleurisy is fairly common. The etiology is dominated by tumors and tuberculosis. The rupture of intra-thoracic vessels into the pleural cavity is a much rarer cause and the diagnosis is often delayed.

OBSERVATION

A 77-year-old patient without previously known hypertension was hospitalized for investigation of a fluid density opacity occupying the entire left hemithorax. Thoracentesis revealed a non-coagulable haemorrhagic fluid. A computed tomography scan showed a Stanford type B aortic dissection. The patient was given anti-hypertensive treatment for one year.

CONCLUSIONS

Aortic dissection remains among the diagnoses to consider in the case of a haemorrhagic pleural effusion despite absence of the usual suggestive symptoms.

Hemorrhagic pleural effusion secondary to sarcoidosis: A brief review

Pleural effusion is considered to be a rare manifestation of pulmonary sarcoidosis, but hemorrhagic effusion secondary to it is a very uncommon clinical presentation. This case is reported due to the rare manifestation in pulmonary sarcoidosis presenting clinically as hemorrhagic pleural effusion.

Bilothorax following cholecystectomy in a dog

A 10-year-old, entire female Pyrenean shepherd dog was presented for acute onset of gastroenteritis. An abdominal ultrasound examination showed the presence of a suspected gall bladder mucocele. After surgery for cholecystectomy, the dog showed signs of an acute onset of respiratory distress due to bilothorax. The bilothorax responded well to medical treatment that comprised of thoracocentesis and oral steroids.