Tension hydrothorax in a patient with a history of pulmonary tuberculosis

A tension hydrothorax is a massive pleural effusion that leads to hemodynamic instability. Here we present a case of tension hydrothorax secondary to poorly differentiated carcinoma. A 74-year-old male smoker presented after a one-week history of dyspnea and unintentional weight loss. Physical exam demonstrated tachycardia, tachypnea, and decreased breath sounds diffusely over the right lung. Imaging revealed a massive pleural effusion causing mass effect on the mediastinum with tension physiology. Chest tube placement revealed an exudative effusion with negative cultures and cytology. Pleural biopsy revealed atypical epithelioid cells consistent with poorly differentiated carcinoma.

Malpositioned nephrostomy tube with associated hemorrhagic pleural effusion

Pleural effusion of extra-vascular origin has a large differential diagnosis. Ultrasonography can be utilized alongside pleural fluid analysis to determine a pleural effusion's complexity and size, thus helping aid in both diagnostic and therapeutic management. We describe the case of a 38-year-old male with a prior medical history of neurogenic bladder and nephrolithiasis with percutaneous nephrostomy tube placed one week prior to presentation. Using ultrasonography, the nephrostomy tube was determined to be positioned within the pleural cavity with a resultant hemorrhagic pleural effusion.

Lux study: Contribution of a three-dimensional, high dynamic range, ultra-high-definition heads-up visualization system to a significant delivered light intensity decrease during different types of ocular surgeries

OBJECTIVE

To explore the hypothesis that using a large, three-dimensional (3D), ultra-high-definition (4K), heads-up display (HUD) system in a real-life setting may be associated with a significant reduction in light intensity (LI) delivered during various types of eye surgery.

METHODS

Single center, post-learning curve observational study of 142 independent consecutive cases: 73 cataracts and 69 vitrectomies (VR). For each group, the only variable setting was the LI. The LI delivered by each source was calibrated in lumens (lm).

RESULTS

In the VR group, the delivered LI dramatically decreased from the 80% reference to 27.8%±13.2% (P<0.0001) (4.3 to 1.5lm). Among these surgeries, 91.3% needed 40% or less LI (2.3lm). The corneal transparency and quality of pupil dilation showed some correlation with the results. In the cataract group, the difference was even more spectacular, from 80% to 15%±11.3% (P<0.0001) (2.5 to 0.3lm). Among these surgeries, 80.8% required less than 20% LI (0.5lm). The surgical time, LI variations and type of cataract seemed to influence the results, down to 9.6%±5.4% (P<0.0001) (0.22lm) for nuclear cataracts, which represented 63% of the cataract sample.

CONCLUSION

The digital signal amplification with this HUD system allows comfortable posterior as well as anterior segment surgery despite the decrease in incident light, suggesting an unprecedented reduction in the risk of phototoxicity compared to conventional systems as well as a likely improvement in patient comfort.

Isolated Kaposi sarcoma of the finger pulp in an AIDS patient

A 63-year-old woman with long-standing AIDS and previous Kaposi sarcomas of the lower limb presented to our consultation complaining of a painful left ring finger with pulp enlargement. X-rays revealed an osteolytic lesion of the distal phalanx. We suspected an isolated osseous Kaposi sarcoma and at surgery we found a hemorrhagic lesion with bone extension into the phalanx. Bone involvement is rare in Kaposi sarcoma and even rarer in patients without a cutaneous location.