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Mosquera-Salas L, Salazar-Falla N, Perez B, Sangiovanni S, Sua LF, Fernández-Trujillo L. Acute respiratory failure as initial manifestation of conventional osteosarcoma rich in giant cells: a case report. J Med Case Rep 2020; 14:228. [PMID: 33228766 PMCID: PMC7684875 DOI: 10.1186/s13256-020-02562-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 01/02/2023] Open
Abstract
Background Osteosarcoma is a malignant tumor of the bone. The giant cell-rich osteosarcoma (GCRO) is a rare histological variant of the conventional osteosarcoma, accounting for 3% of all osteosarcomas. It has a variable clinical presentation, ranging from asymptomatic to multiple pathological fractures, mainly involving long bones, and less frequently the axial skeleton and soft tissues. Case presentation We present the case of a 25-year-old Hispanic woman, previously healthy, with a 1-month history of dyspnea on exertion, intermittent dry cough, hyporexia, and intermittent unquantified fever. She presented to the emergency department with a sudden increase in dyspnea during which she quickly entered ventilatory failure and cardiorespiratory arrest with pulseless electrical activity. Resuscitation maneuvers and orotracheal intubation were initiated, but effective ventilation was not achieved despite intubation and she was transferred to the intensive care unit of our institution. The chest radiograph showed a mediastinal mass that occluded and displaced the airway. The chest tomography showed a large mediastinal mass that involved the pleura and vertebral bodies. A thoracoscopic biopsy was performed that documented a conventional giant cell-rich osteosarcoma. The patient was considered to be inoperable due to the size and extent of the tumor and subsequently died. Conclusions The giant cell-rich osteosarcoma is a very rare histological variant of conventional osteosarcoma. Few cases of this type of osteosarcoma originating from the spine have been reported in the literature, and to our knowledge none of the reported cases included invasion to the chest cavity with airway compression and fatal acute respiratory failure that was present our case. Radiological and histological features of the GCRO must be taken into account to make a prompt diagnosis.
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Affiliation(s)
- Laura Mosquera-Salas
- General Medicine, Hospitalization Service, Fundación Valle del Lili, Carrera 98 #18-49, 760032, Cali, Colombia
| | - Nathalia Salazar-Falla
- Department of Internal Medicine, Fundación Valle del Lili, Carrera 98 #18-49, 760032, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Calle 18 #122-135, 760032, Cali, Colombia
| | - Bladimir Perez
- Faculty of Health Sciences, Universidad Icesi, Calle 18 #122-135, 760032, Cali, Colombia.,Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, Carrera 98 #18-49, 760032, Cali, Colombia
| | - Saveria Sangiovanni
- Clinical Research Center, Fundación Valle del Lili, Carrera 98 # 18-49, 760032, Cali, Colombia
| | - Luz F Sua
- Faculty of Health Sciences, Universidad Icesi, Calle 18 #122-135, 760032, Cali, Colombia.,Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, Carrera 98 #18-49, 760032, Cali, Colombia
| | - Liliana Fernández-Trujillo
- Faculty of Health Sciences, Universidad Icesi, Calle 18 #122-135, 760032, Cali, Colombia. .,Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology, Fundación Valle del Lili, Carrera 98 #18-49, Tower 6, 4th Floor, 760032, Cali, Colombia.
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Abstract
Patients with respiratory failure due to obstructive lung disease present a challenge to the emergency physician. These patients have physiologic abnormalities that prevent adequate gas exchange and lung mechanics which render them at increased risk of cardiopulmonary decompensation when managed with invasive mechanical ventilation. This article addresses key principles when managing these challenging patients: patient-ventilator synchrony, air trapping and auto-positive end-expiratory pressure, and airway pressures. This article provides a practical workflow for the emergency physician responsible for managing these patients.
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Schwarz EI, Bloch KE. Frontiers in Clinical Practice of Long-Term Care of Chronic Ventilatory Failure. Respiration 2019; 98:1-15. [PMID: 31170716 DOI: 10.1159/000499316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/02/2019] [Indexed: 11/19/2022] Open
Abstract
Home mechanical ventilation (HMV) is an effective long-term treatment for chronic hypercapnic respiratory failure. In addition to the established practice of providing HMV for the treatment of chronic ventilatory failure in slowly progressive neuromuscular and chest wall disease, there is accumulating evidence for improvement of quality of life and prolongation of survival by HMV in highly prevalent diseases like chronic obstructive pulmonary disease and ever-increasing obesity hypoventilation syndrome as well as rapidly progressive neuromuscular disease. The key concepts for successful HMV are an experienced team selecting the right patients, timely initiation of adequate ventilation via an appropriate interface, and monitoring effectiveness during regular long-term follow-up. Coaching of patients with chronic respiratory failure on long-term HMV within a dedicated service and collaborations with community services for home care are essential. The current review describes various important practical aspects of HMV that remain frontiers in the implementation of the current knowledge in clinical practice and may help in providing effective HMV to all those in need.
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Affiliation(s)
- Esther I Schwarz
- Department of Respiratory Medicine, Sleep Disorders Centre and Neuromuscular Centre, University Hospital of Zurich, Zurich, Switzerland.,Lane Fox Respiratory Unit and Sleep Disorders Centre, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Konrad E Bloch
- Department of Respiratory Medicine, Sleep Disorders Centre and Neuromuscular Centre, University Hospital of Zurich, Zurich, Switzerland,
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Kim SM, Kang SW, Choi YC, Park YG, Won YH. Successful Extubation After Weaning Failure by Noninvasive Ventilation in Patients With Neuromuscular Disease: Case Series. Ann Rehabil Med 2017; 41:450-455. [PMID: 28758083 PMCID: PMC5532351 DOI: 10.5535/arm.2017.41.3.450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/27/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To report successful cases of extubation from invasive mechanical ventilation at our institution using pulmonary rehabilitation consisting of noninvasive ventilation (NIV) in neuromuscular patients with experience of reintubation. Methods Patients who experienced extubation failure via the conventional weaning strategy but afterwards had extubation success via NIV were studied retrospectively. Continuous end-tidal CO2 (ETCO2) and pulse oxyhemoglobin saturation (SpO2) monitoring were performed. Extubation success was defined as a state not requiring invasive mechanical ventilation via endotracheal tube or tracheotomy during a period of at least 5 days. Results A total of 18 patients with ventilatory failure who initially experienced extubation failure were finally placed under part-time NIV after extubation. No patient had any serious or long-term adverse effect from NIV, and all patients left the hospital alive. Conclusion NIV may promote successful weaning in neuromuscular patients with experience of reintubation.
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Affiliation(s)
- Sun Mi Kim
- Department of Medicine, Graduate School of Yonsei University, Seoul, Korea
| | - Seong-Woong Kang
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Chul Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Grisold A, Brandl I, Lindeck-Pozza E, Pöhnl R, Pratschner T, Schmaldienst S, Höftberger R, Grisold W. Transient paralysis of diaphragm in Waldenstroms disease; a focal variant of Guillain-Barré syndrome? J Neurol Sci 2016; 366:1-2. [PMID: 27288766 DOI: 10.1016/j.jns.2016.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/15/2016] [Accepted: 04/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Grisold
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Ingrid Brandl
- Department of Pathology, Kaiser Franz Joseph Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Elisabeth Lindeck-Pozza
- Department of Neurology, Kaiser Franz Joseph Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Rainer Pöhnl
- Department of Internal Medicine III, Kaiser Franz Joseph Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Thomas Pratschner
- Department of Surgery, Kaiser Franz Joseph Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Sabine Schmaldienst
- Department of Internal Medicine I, Kaiser Franz Joseph Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Romana Höftberger
- Clinial Institute of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Wolfgang Grisold
- Department of Neurology, Kaiser Franz Joseph Hospital, Kundratstraße 3, 1100 Vienna, Austria
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Sanjuán-López P, Valiño-López P, Ricoy-Gabaldón J, Verea-Hernando H. Amyotrophic lateral sclerosis: impact of pulmonary follow-up and mechanical ventilation on survival. A study of 114 cases. Arch Bronconeumol 2014; 50:509-13. [PMID: 24931271 DOI: 10.1016/j.arbres.2014.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/04/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study the impact of ventilatory management and treatment on the survival of patients with amyotrophic lateral sclerosis (ALS). METHOD Retrospective analysis of 114 consecutive patients admitted to a general hospital, evaluating demographic data, type of presentation, clinical management, treatment with mechanical ventilation and survival. STATISTICS descriptive and Kaplan-Meier estimator. RESULTS Sixty four patients presented initial bulbar involvement. Overall mean survival after diagnosis was 28.0 months (95%CI, 21.1-34.8). Seventy patients were referred to the pulmonary specialist (61.4%) and 43 received non-invasive ventilation (NIV) at 12.7 months (median) after diagnosis. Thirty seven patients continued to receive NIV with no subsequent invasive ventilation. The mean survival of these patients was 23.3 months (95%CI, 16.7-28.8), higher in those without bulbar involvement, although below the range of significance. Survival in the 26 patients receiving programmed NIV was higher than in the 11 patients in whom this was indicated without prior pulmonary assessment (considered following diagnosis, P<.012, and in accordance with the start of ventilation, P<.004). A total of 7 patients were treated invasively; mean survival in this group was 72 months (95%CI, 14.36-129.6), median 49.6±17.5 (95%CI, 15.3-83.8), and despite the difficulties involved in home care, acceptance and tolerance was acceptable. CONCLUSIONS Long-term mechanical ventilation prolongs survival in ALS. Programmed pulmonary assessment has a positive impact on survival of ALS patients and is key to the multidisciplinary management of this disease.
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Affiliation(s)
- Pilar Sanjuán-López
- Servicio de Neumología, Complexo Hospitalario Universitario A Coruña, CHUAC, A Coruña, España
| | - Paz Valiño-López
- Servicio de Neumología, Complexo Hospitalario Universitario A Coruña, CHUAC, A Coruña, España
| | - Jorge Ricoy-Gabaldón
- Servicio de Neumología, Complexo Hospitalario Universitario A Coruña, CHUAC, A Coruña, España
| | - Héctor Verea-Hernando
- Servicio de Neumología, Complexo Hospitalario Universitario A Coruña, CHUAC, A Coruña, España.
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