Heart & Lung: The Journal of Acute and Critical Care - Articles in Press

Redefining the role of telehealth for cardiovascular disease management - Corrected Proof

Ruth M. Kleinpell — 2012-01-27

Despite diagnostic and treatment advances, coronary heart disease (CHD) remains the leading cause of death in Americans aged more than 65 years. It is well recognized that CHD, including chronic heart failure (HF), often results in repeated hospitalizations, and represents a considerable economic burden to society.

Comment on “Optimizing the utility of high-resolution computed tomography in diagnosing exogenous lipoid pneumonia” - Corrected Proof

Kassem Harris, Michel Chalhoub — 2012-01-13

The authors appreciate Marchiori and colleagues’ interest in our article entitled “Lipoid Pneumonia: A Challenging Diagnosis.” Our patient was a 54-year-old man who presented with respiratory symptoms and was diagnosed with exogenous lipoid pneumonia (ELP) after an open lung biopsy. Computed tomography (CT) showed right middle lobe and right lower lobe lobulated soft-tissue density. The CT density within this mass-like consolidation ranged from −9 to +59 Hounsfield units (HU), which was not in the range usually seen in lesions with fatty component (−30 to −150 HU). In the appropriate clinical setting, the finding of a low-density lesion on chest CT is highly suggestive of ELP, but the absence of this CT characteristic does not exclude the diagnosis of ELP. Our patient had chronic obstructive lung disease with a history of smoking and gastrointestinal reflux disease. He had no history of exposure to any oil products. Our patient had risk factors for bronchogenic carcinoma; therefore, even if he had low CT density values, the lack of oil exposures in addition to a nondiagnostic bronchoscopy would warrant further investigation to exclude the possibility of an underlying malignancy; in view of that, open lung biopsy was thought to be the most appropriate approach.

American Association of Heart Failure Nurses’ mission, vision, and strategic plan: What do these mean to me—the member?? - Corrected Proof

Peggy Kirkwood — 2012-01-13

“If you don’t know where you are going, you will end up somewhere else.” Yogi Berra The foundation of any association should include a mission, a vision, and strategic goals. These statements guide the actions of the association and spell out it's overall path for current business and future activities. Ideally, these guiding documents are created at the inception of the organization and live as dynamic ideas requiring occasional review and reaffirmation or revision.

Heart & Lung’s 2011 Reviewer List - Corrected Proof

2012-01-11

The editor of Heart & Lung expresses gratitude to the following individuals who provided their scientific expertise and constructive advice in the review of manuscripts for the Journal in 2011:

The role of the endotracheal tube cuff in microaspiration - Corrected Proof

V. Anne Hamilton, Mary Jo Grap — 2012-01-03

Abstract: The cuff of the endotracheal tube (ETT) is designed to provide a seal within the airway, allowing airflow through the ETT but preventing passage of air or fluids around the ETT. Deliberate or inadvertent movement of the ETT may affect cuff pressure or shift folds in the cuff, mobilizing pooled secretions. When this seal is compromised, microaspirations contaminated with gastric contents or bacterially colonized oral secretions can occur that leave the patient susceptible to a host of problems, such as hypoxia, pneumonitis, and respiratory infections. These complications are costly in terms of morbidity and mortality, as well as hospital expense. We will discuss the role of the ETT cuff in microaspiration and identify potential directions for future research to improve outcomes in mechanically ventilated patients.

Legionella pneumophila community-acquired pneumonia (CAP) in a post-splenectomy patient with myelodysplastic syndrome (MDS) - Corrected Proof

Burke A. Cunha, Jean E. Hage — 2011-12-26

Abstract: Legionnaire’s disease is a cause of community-acquired pneumonia (CAP) in normal hosts, but those with impaired cell-mediated immunity (CMI) and T-lymphocyte function are particularly predisposed to Legionella species CAP. Myelodysplastic syndrome (MDS) is a disorder of the elderly that is associated with impaired CMI. Cases of MDS or Legionella species CAP are rare. Splenectomized patients primarily have impaired humoral immunity and B-lymphocyte function, and, to a lesser extent, some decrease in CMI. For this reason, Legionnaire’s disease has rarely been reported in splenectomized patients. We believe this to be the first reported case of Legionella pneumophila CAP in an asplenic patient with MDS.

Rare case of an unroofed coronary sinus - Corrected Proof

2011-12-26

Abstract: Unroofed coronary sinus (CS) is a rare congenital cardiac anomaly described by a communication between the CS and the left atrium due to the partial or complete absence of the CS roof. Echocardiography is the most widely used imaging modality for suspected unroofed CS, but it is limited in its ability to visualize the posterior cardiac structures. Multidetector computed tomography has allowed the visualization and accurate anatomic and morphologic evaluation of these structures. We report a rare case of unroofed CS found incidentally in a 41-year-old man who was studied by echocardiography and multidetector computed tomography.

Relationship between inspiratory muscle capacity and peak exercise tolerance in patients post-myocardial infarction - Corrected Proof

2011-12-19

Abstract: Objective: The study objective was to evaluate inspiratory muscle endurance in patients post-myocardial infarction without respiratory muscle weakness and its correlation with peak exercise capacity.Methods: Ten patients who recently had a myocardial infarction (recent infarction group [RIG]), 9 patients who less recently had a myocardial infarction (less recent infarction group [LIG]), and 12 healthy subjects (control group [CG]) underwent a cardiopulmonary exercise test and respiratory endurance protocol. Analysis of variance with post hoc Dunn comparisons was used to contrast performances on all tests, and Pearson's correlation was used to determine associations between variables.Results: The RIG presented lower maximal incremental pressure and oxygen consumption than the CG (P < .01). There was a positive correlation between peak oxygen uptake and both maximal inspiratory pressure (.68, P < .001) and maximal incremental pressure (.65, P < .001) in the RIG.Conclusion: The RIG showed lower maximal incremental pressure, which is related to peak exercise capacity. This novel relationship in functional capacity can indicate the need to improve muscle endurance in these patients even in the absence of inspiratory muscle weakness.

Systemic lupus erythematosus (SLE) cerebritis versus Listeria monocytogenes meningoencephalitis in a patient with systemic lupus erythematosus on chronic corticosteroid therapy: The diagnostic importance of cerebrospinal fluid (CSF) of lactic acid levels - Corrected Proof

Lucas M. McCaffrey, Andrew Petelin, Burke A. Cunha — 2011-12-19

Abstract: Background: Listeria monocytogenes is a motile, aerobic, Gram-positive intracellular bacillus that causes enteritis, meningitis, meningoencephalitis, or subacute bacterial endocarditis. Patients with impaired T-lymphocyte function/cell-mediated immunity are predisposed to intracellular pathogens, e.g., L. monocytogenes. In adults, infection by L. monocytogenes of the central nervous system (CNS) clinically manifests as either acute bacterial meningitis or meningoencephalitis. In patients with systemic lupus erythematosus (SLE) presenting with headache and fever, SLE cerebritis must be differentiated from acute bacterial meningitis by lumbar puncture and cerebrospinal fluid (CSF) analysis. Neuropathogenic viruses are the most common causes of meningoencephalitis. The most rapid and accurate way to differentiate bacterial meningoencephalitis from nonbacterial meningoencephalitis is CSF lactic acid levels.Methods: We present a patient receiving chronic corticosteroid therapy and manifesting SLE and severe L. monocytogenes meningoencephalitis. An early diagnosis of L. meningoencephalitis was achieved by demonstrating a very highly elevated level of lactic acid in his CSF, days before CSF and blood cultures tested positive for L. monocytogenes.Results and Conclusion: In this patient, the highly elevated levels of lactic acid in his CSF ruled out both viral meningoencephalitis and SLE cerebritis. The case was complicated by communicating hydrocephalus, and the patient later underwent placement of a shunt. He completed 6 weeks of meningeal dosed ampicillin.

Detecting myocardial ischemia with continuous ST-segment monitoring: Two case studies - Corrected Proof

Prasama Sangkachand, Monica Cluff, Marjorie Funk — 2011-12-19

Abstract: Continuous ST-segment ischemia monitoring is recommended for patients at significant risk for myocardial ischemia that, if sustained, may result in acute myocardial infarction or extension of a myocardial infarction. It is especially useful for patients who do not perceive or cannot communicate symptoms of ischemia. We report 2 case studies of young women with acute coronary syndrome who benefited from continuous ST-segment monitoring. One patient was critically ill and unresponsive, and one patient had atypical symptoms and some difficulty communicating clearly.

Fever of unknown origin (FUO) attributable to indolent lymphoproliferative disorder due to a plasmacytoma expressing immunoglobulin A - Corrected Proof

Burke A. Cunha, Andrew P. Petelin, George K. Turi, Attilio Oraji — 2011-12-16

Abstract: Background: The most common categories causing fevers of unknown origin (FUOs) include infective rheumatic/inflammatory disorders and malignancies. Among neoplastic causes of FUOs, lymphomas, hepatomas, renal hypo-nephromas, and hepatomas are the most common. Other malignancies rarely present with FUOs (eg, multiple myeloma).Case Report: We describe a 58-year-old man who presented with an FUO accompanied by night sweats, weight loss, and a groin mass. A biopsy of the groin mass (ie, his lymph node) was negative for infectious diseases, rheumatic or inflammatory diseases, and malignancies. Histochemical and immunological studies of the lymph node showed it to contain a plasmacytoma expressing immunoglobulin A (IgA). An immunohistochemical study of the plasma-cell infiltrate demonstrated strong CD138 staining. A bone marrow biopsy was negative for multiple myeloma.Conclusion: We believe this is the first reported rare case of an indolent, lymphoproliferative disorder attributable to an IgA-secreting plasmacytoma presenting as an FUO.

Cryptococcal pneumonia in a patient with presumptive sarcoidosis and selective immunoglobulin A deficiency - Corrected Proof

Jean E. Hage, Jason Wu, Burke A. Cunha — 2011-12-15

Abstract: Sarcoidosis is a multisystem granulomatous disease of unknown cause associated with impaired T-lymphocyte function and impaired cell-mediated immunity. Decreased cell-mediated immunity predisposes one to intracellular pathogens (eg, cryptococci).

Arteriovenous fistula of the wrist after transradial coronary intervention - Corrected Proof

Francesco Summaria, Enrico Romagnoli, Marina Mustilli — 2011-12-15

Yang et al recently reported on an interesting case of iatrogenic arteriovenous fistula (AVF) after a transradial coronary intervention. The authors described a radial AVF submitted to surgical revision after the discontinuation of short-term dual antiplatelet treatment in a patient with a previously implanted drug-eluting stent. Radial AVFs are a very rare complication of transradial percutaneous interventions. The more likely physiopathologic explanation for the formation of AVFs after a transradial percutaneous coronary intervention involves the superficial course of large veins near the radial artery (RA). The risk of this complication may be increased in cases of deeper artery course despite a lack of data to confirm this hypothesis. About one third of iatrogenic AVFs will close spontaneously within 1 year. Therefore, conservative management is often attempted first. In other patients, specific treatment is required to prevent serious local disability and circulatory complications. Previous studies reported on the successful management of symptomatic radial AVFs via surgical or percutaneous approaches. We recently reported on a 66-year-old man referred to our hospital because of right forearm swelling, edema, and pain related to an AVF of the wrist. One year earlier, the patient had undergone a primary transradial angioplasty for an segment elevation myocardial infarction. Considering the persistence of his symptoms and the disability in his forearm, we proceeded with a percutaneous closure of the fistula. Under ultrasound guidance, a 5-cm 5 French Introducer (Ultimum, St. Jude Medical, St. Paul, MN) was positioned in the proximal segment of the right RA (antegrade approach). A monorail 3.5 × 18 mm pericardium-covered stent (Aneugraft, ITGI Medical, Or Akiva, Israel) was then successfully implanted into the RA at the site of the fistula. The clinical and echo color Doppler findings during 6-month follow-up confirmed the patency of the RA and the closure of the fistula. Our experience confirms that in selected cases, eg, in the presence of an effective collateral flow from the homolateral ulnar artery as assessed by ultrasound, an iatrogenic radial AVF can be treated via a percutaneous antegrade approach with the use of a short introducer and a biocompatible coronary covered stent. This approach represents a safe alternative to surgical revision, when the discontinuation of dual antiplatelet treatment can lead to an increased risk of stent thrombosis, eg, among patients in whom a drug-eluting stent was previously implanted.

Optimizing the utility of high-resolution computed tomography in diagnosing exogenous lipoid pneumonia - Corrected Proof

Edson Marchiori, Gláucia Zanetti, Fernanda Bazi Fontes, Bruno Hochhegger — 2011-12-06

We read with great interest the article by Harris et al., who reported the case of a 54-year-old man who presented with a pulmonary opacity. The patient had a history of gastroesophageal reflux disease, and the pulmonary biopsy was consistent with exogenous lipoid pneumonia (ELP). The authors pointed out that the diagnosis of ELP is frequently missed or delayed because of the nonspecific clinical presentation and argued that it requires a high index of clinical suspicion.

Cardiac rehabilitation in skilled nursing facilities: A missed opportunity - Corrected Proof

2011-11-04

Abstract: Background: After hospitalization for a cardiac event, older adults are frequently discharged to a skilled nursing facility (SNF) for postacute care. The American Association of Cardiopulmonary Rehabilitation recommends that cardiac care be integrated into procedures at SNFs.Objective: We undertook this research to describe the characteristics of patients in SNFs after a cardiac event and the cardiac care delivered at SNFs.Methods: A dual approach included (1) a retrospective medical record review of consecutive patients admitted to 2 hospital-based SNFs after a cardiac event (n = 80), and (2) surveys from healthcare professionals (n = 21) working in these facilities.Results: Thirty-two percent of patients were not candidates for cardiac rehabilitative interventions because they had been rehospitalized, discharged to long-term care facilities, or manifested contraindications to exercise. No standard assessment of exercise tolerance was evident, and although 70% of patients were discharged home, cardiac-specific discharge education was seldom evident. Healthcare professionals in SNFs reported that standard procedures for cardiac care services were lacking.Conclusion: The integration of cardiac care into SNFs is important to ensure the safety of therapy and improve the transition of patients from SNFs to outpatient cardiac rehabilitation programs.

Spontaneous healing of posttraumatic focal coronary aneurysm: A case report - Corrected Proof

2011-11-04

Abstract: We report on the spontaneous healing of a posttraumatic focal coronary aneurysm in a previously healthy 61-year-old man after his involvement in a motor vehicle accident, resulting in blunt chest trauma that injured the anterior wall of his left ventricle.Left-sided cardiac catheterization and selective coronary angiography 1 month after the accident showed an aneurysm in the proximal part of the left anterior descending artery, and normal coronary arteries otherwise. Intravascular ultrasound revealed that the lesion was a pseudoaneurysm protruding toward the myocardium.Surgical removal of the aneurysm was not considered, and the patient was discharged after 2 months of uneventful hospitalization. Follow-up coronary angiography and intravascular ultrasound at 3 months and 1 year after the accident showed a total regression of the aneurysm. The patient has remained asymptomatic, with no residual ischemia 3 years after the accident.This case indicates that careful conservative treatment is a therapeutic option for posttraumatic coronary pseudoaneurysms.

Response to pulmonary vasodilator treatment in a former smoker with combined interstitial lung disease complicated by pulmonary hypertension: Case report and review of the literature - Corrected Proof

Valentina Mercurio, Guido Carlomagno, Serafino Fazio — 2011-11-04

Abstract: We describe a 76-year-old former smoker with a diagnosis of combined pulmonary fibrosis and emphysema associated with pulmonary hypertension and rapidly progressive right heart failure, in whom combined treatment with sitaxsentan and sildenafil resulted in sustained improvement of his clinical condition and exercise performance, without any relevant adverse events. Combined pulmonary fibrosis and emphysema comprises a recently identified syndrome, probably related to tobacco use, and characterized by the coexistence of upper-lobe emphysema and fibrotic changes of the lower lobes, preserved lung volumes, significant hypoxemia, and a high prevalence of pulmonary hypertension, resulting in severe dyspnea. To date, no prospective series, to the best of our knowledge, has reported on the effects of pulmonary vasodilator therapy in such patients.

Lethal hemorrhagic alveolitis after adenovirus pneumonia in a lung transplant recipient - Corrected Proof

2011-11-04

Abstract: Viral infections are frequent and severe in lung transplant recipients. They frequently occur during the first year after transplantation. We report on a rare case of bilateral adenovirus necrotizing pneumonia with a diffuse alveolar hemorrhage, 4 years after bilateral lung transplantation. The medical evolution was lethal in 72 hours because of respiratory, renal, and cardiac failure. Considering this case and the growing evidence on the severity of adenoviral infections, we call for controlled studies and therapeutic recommendations.

Factors associated with delayed care-seeking in hospitalized patients with heart failure - Corrected Proof

Nancy F. Altice, Elizabeth A. Madigan — 2011-11-04

Abstract: Objective: This study sought to evaluate the contributions of symptom recognition and clinical factors to delays in care-seeking.Methods: A descriptive correlational study design was used to study 75 patients (mean age, 74.7 years; SD, 10.86 years; range, 40 to 96 years) admitted to a tertiary-care medical center with recurrent symptoms (New York Heart Association classes 2 to 4). The sample was 52% male and 85.3% white. The Heart Failure Somatic Perception Scale (HFSPS) was used to examine symptoms, and additional data were collected on physiologic, social, and demographic factors.Results: The mean HFSPS score was 37.52 (range, 2 to 74; possible range, 0 to 90). Subjects reported 2 to 16 out of 18 possible symptoms. Durations of individual symptoms ranged from 5 minutes to 8 years, with individual patients describing a variety of symptom combinations and multiple time frames, depending on the specific symptom. Most subjects (80%) reported a mixture of acute and chronic symptoms. A pattern of chronic vs. acute symptoms was associated with proactive vs. emergent care-seeking, respectively. The HFSPS scores did not correlate with care-seeking behavior.Conclusion: Symptom recognition is a complex phenomenon, and few factors differentiate emergent from proactive care-seeking.

Medication adherence mediates the relationship between marital status and cardiac event-free survival in patients with heart failure - Corrected Proof

2011-11-04

Abstract: Objective: Prognosis is worse in unmarried patients compared with married patients with heart failure (HF). The reasons for differences in outcomes are unclear, but variations in medication adherence may play a role, because medication adherence is essential to achieving better outcomes. The study objective was to determine whether medication adherence mediated the relationship between marital status and cardiac event-free survival in patients with HF.Methods: Demographic, clinical, and psychosocial data were collected by questionnaires and medical record review for 136 patients with HF (aged 61 ± 11 years, 70% were male, 60% were in New York Heart Association class III/IV). Medication adherence was monitored objectively for 3 months using the Medication Event Monitoring System. Cardiac event-free survival data were obtained by patient/family interview, hospital database, and death certificate review. A series of regression and Cox survival analyses were performed to determine whether medication adherence mediated the relationship between marital status and event-free survival.Results: Cardiac event-free survival was worse in unmarried patients than in married patients. Unmarried patients were more likely to be nonadherent and 2 times more likely to experience an event than married patients (P = .017). Marital status was not a significant predictor of event-free survival after entering medication adherence in the model, demonstrating a mediation effect of adherence on the relationship of marital status to survival.Conclusion: Medication adherence mediated the relationship between marital status and event-free survival. It is important to design interventions to increase medication adherence that take into account subgroups, such as unmarried patients, who are at higher risk for nonadherence.

Effect of coronary revascularization on serum collagen biomarkers and left ventricular remodeling in patients with acute myocardial infarction - Corrected Proof

Hai-Zhou Ren, Xue-Song Zhang, Le-Xin Wang — 2011-11-04

Abstract: Objective: After an acute myocardial infarction (AMI), early coronary revascularization alleviates the synthesis of cardiac collagen and ventricular remodeling. However, the impact of late coronary revascularization on the synthesis of myocardial collagen or on serum collagen biomarkers is unknown. This study aimed to investigate the effects of late coronary revascularization on serum collagen biomarkers after AMI.Methods: Forty-five patients were divided into early (n = 20) and late (n = 25) coronary revascularization groups. The early coronary revascularization group received either successful percutaneous coronary intervention (PCI) or thrombolytic therapy within 6 hours of their myocardial infarction (MI), whereas the late PCI group received PCI between 12 and 14 days after their MI. Serum type I procollagen (PICP) and type III procollagen (PIIINP) were measured by radioimmunoassay.Results: In the early coronary revascularization group, the amount of serum PICP on days 60 and 180 was similar to that of week 1 (P > .05). The PICP on days 90 and 180 in the late coronary revascularization group was higher than in the early coronary revascularization group at the same time point (P < .05). No significant difference was evident in mean serum PIIINP between the two groups on day 60 or 180 after the MI (P < .05).Conclusion: Late coronary revascularization in patients with acute ST-elevation MI was associated with an elevation in serum PICP. Early coronary revascularization should be performed in patients with ST-elevation, to alleviate myocardial remodeling.

Symptoms and functional performance in Korean immigrants with asthma or chronic obstructive pulmonary disease - Corrected Proof

2011-11-04

Abstract: Objectives: People with chronic obstructive lung diseases often experience a variety of symptoms. Few studies, however, have described these symptoms in detail. This study sought to examine concurrent symptoms, symptom clusters, and the effects of symptoms on functioning in Korean immigrants with asthma or chronic obstructive pulmonary disease (COPD).Methods: Outpatients with asthma or COPD participated in this cross-sectional, correlational study. Symptoms, dyspnea, mood, and functional performance were assessed with questionnaires. Descriptive and inferential statistics were used to analyze the data.Results: The most frequently reported symptom was shortness of breath. Three factors emerged from 16 symptoms. Age, mean severity score of 7 symptoms, working status, level of acculturation, and level of education explained significant variance in functional performance.Conclusion: The symptom cluster, consisting of 7 symptoms, showed the greatest effect on levels of functioning, which emphasizes the importance of assessment for coexisting symptoms in populations with these diseases.

Anticoagulation management in clinical practice: Preventing stroke in patients with atrial fibrillation - Corrected Proof

Kathleen Hickey — 2011-11-03

Abstract: Atrial fibrillation (AF) is a major and widely recognized risk factor for cardioembolic stroke. Prophylactic therapy for the prevention of stroke in patients with AF is often achieved through oral anticoagulation, specifically with warfarin, which has been used for this purpose for more than 50 years. Although warfarin therapy is effective when implemented appropriately, it is often underutilized and requires consistent monitoring to ensure both safety in avoiding bleeding and efficacy in preventing strokes. Because the burden of AF-related stroke continues to rise, healthcare professionals need to understand the strengths and limitations of current and emerging treatment options. This review outlines current practices for managing the risk of stroke with anticoagulation in patients with AF, and discusses how new oral anticoagulants may affect clinical practice.

Novel c.367_369del LMNA mutation manifesting as severe arrhythmias, dilated cardiomyopathy, and myopathy - Corrected Proof

2011-10-24

Abstract: Objective: The 3-bp deletion in exon 2 of the Lamin A/C (LMNA) gene has not been described in association with dilated cardiomyopathy, which is characterized by progressive heart failure, atrioventricular (AV) block, tachyarrhythmias, and variable skeletal muscle involvement.Case Report: In a 43-year-old woman with a long-term history of palpitations and newly diagnosed AV blocks I and II, ventricular ectopic beats, inducible nonsustained ventricular tachycardias (VTs), cardiac arrest, and successful resuscitation, an implantable cardioverter defibrillator was successfully implanted. Her family history was positive for sudden cardiac death (her father and sister), dyspnea and heart failure (her grandmother and sister), palpitations (her brother), and elevated levels of creatine-kinase (CK) (her sister). Two cousins had died of nonspecific muscular dystrophy at ages 10 years and 11 years. Upon neurological investigations revealing sore neck muscles, reduced tendon reflexes, and detached, spot-like white matter lesions bilaterally, a neuromuscular disorder was suspected. The direct sequencing of all exons and flanking intronic regions of the LMNA gene detected the heterozygote 3-bp deletion (AAG) c.367_369del in exon 2 of the gene. This mutation resulted in the deletion of a lysine at position 123 (p.lys123del) in the lamin A/C protein.Conclusions: The novel 3-bp deletion in exon 2 of the LMNA gene may phenotypically manifest as dilated cardiomyopathy, heart failure, severe tachyarrhythmias, and muscular dystrophy. Sudden cardiac death from ventricular fibrillation may be prevented in LMNA mutation carriers if the diagnosis is established early enough to implant a cardioverter defibrillator.

Pulmonary hemorrhage induced by epileptic seizure - Corrected Proof

Masanori Azuma, Isao Ito, Riki Matsumoto, Toyohiro Hirai, Michiaki Mishima — 2011-10-24

Abstract: We report a 35-year-old man who presented with pulmonary hemorrhage induced by an epileptic seizure. He had experienced recurrent episodes of massive hemoptysis after epileptic seizures since the age of 28 years. He was admitted to Kyoto University Hospital with massive hemoptysis and hypoxia after an epileptic seizure of a few minutes’ duration. Radiographic signs of infiltrations and hemorrhagic bronchoalveolar lavage fluid were observed. He was intubated and successfully treated with anti-epilepsy drugs and corticosteroids. Epileptic seizures may have induced increased pulmonary vascular permeability and structural damage to the blood–gas barrier, which may have caused pulmonary hemorrhage. Pulmonary hemorrhage could be in the list of differential diagnoses of hemoptysis in patients with epilepsy.

Recurrence of sarcoidosis: The follow-up of splenic involvement - Corrected Proof

Ying-Ting Wang, Yi-Ping Han, Qiang Li, He-Zhong Chen — 2011-10-24

Abstract: We report the case of a 53-year-old woman who initially presented with an intermittent dry cough that had lasted for 6 months. An investigation into these symptoms with thoracic computed tomography demonstrated hyperdense shadows in her lungs, and ultrasonography showed the presence of multiple hypoechoic nodules on her spleen. A lung biopsy was then performed, which revealed noncaseating epithelioid cell granulomas. Magnetic resonance imagining of her spleen was performed, which showed low signal intensity. The patient was treated with glucocorticoids, and 3 months later the lesions in her lungs had disappeared completely. Five months later, the lesions in her spleen had disappeared also. However, after 13 months of low-dose prednisone, a miliary pattern was observed on the patient's chest x-ray, although no lesions were observed in her spleen. Laboratory tests demonstrated that her blood level of angiotensin-converting enzyme had increased to 96 IU/L. The dose of prednisone was then increased, and the lung images returned to normal after 2 months of therapy.

The natural course of traumatic myocardial infarction in a young patient with angiographically normal coronary arteries - Corrected Proof

Shi-Wei Yang, Yu-Jie Zhou, Zhen-Feng Guo, Da-Yi Hu — 2011-10-19

Abstract: A 23-year-old man with no history of heart disease was admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University for an abnormal electrocardiogram of ST-T changes mimicking myocardial infarction. Catheterization revealed normal coronary and peripheral arteries. The echocardiogram and delayed enhancement cardiovascular magnetic resonance imaging indicated a markedly reduced left ventricular function and enlarged left ventricular cavity with evidence of fibrous tissue. Given the patient’s history of multiple blunt trauma 7 years previously and acute myocardial infarction diagnosis at that time, he was diagnosed with traumatic myocardial infarction (TMI). We describe the natural course of such a patient with TMI. There is a possibility of spontaneous healing of coronary artery dissection induced by trauma. Although early revascularization may be helpful for preventing cardiac remodeling after TMI in some cases, more data are needed to compare the long-term outcome among different interventions in large sample cases.

Renal transplant with bronchiolitis obliterans organizing pneumonia (BOOP) attributable to tacrolimus and herpes simplex virus (HSV) pneumonia - Corrected Proof

Burke A. Cunha, Uzma Syed, Nardeen Mickail — 2011-10-13

Abstract: Background: Solid organ transplants (SOTs) may be complicated by a wide variety of infectious and noninfectious pulmonary disorders. Transplant patients receive immunosuppressive drugs to prevent rejection, but these drugs also predispose them to infection. Because immunosuppressive therapy impairs T-lymphocyte function, ie, cell-mediated immunity, such therapy, not surprisingly, predisposes patients to intracellular pulmonary pathogens. Community-acquired pneumonia (CAP) in patients with SOT usually involves one of the common typical or atypical bacterial CAP pathogens infecting immunocompetent hosts. The most frequent intracellular CAP pathogens in SOTs during immunosuppressive therapy are viral, eg, cytomegalovirus (CMV), respiratory syncytial virus (RSV), and herpes simplex virus (HSV). In addition, intracellular fungal pathogens are also common in patients with SOTs during immunosuppressive therapy, eg, Pneumocystis (carinii) jiroveci pneumonia (PCP). In addition, a variety of noninfectious disorders are not uncommon in patients with SOTs, including bronchiolitis obliterans organizing pneumonia (BOOP). Bronchiolitis obliterans organizing pneumonia may be associated with a variety of infectious agents, or may be attributable to drugs, including some immunosuppressive agents.Methods: The clinical approach to CAP in patients with SOTs may be based on the appearance of the chest x-ray (CXR) or chest computed tomography scan, combined with the degree of hypoxemia (ie, the A-a gradient). Patients with SOTs and with a normal or nearly normal CXR and a high degree of hypoxemia (A-a gradient, >35) most often have an early viral pneumonia, eg, CMV or early PCP. If the CXR reveals bilateral patchy interstitial infiltrates and severe hypoxemia, the differential diagnosis is limited to moderate or severe viral pneumonia or PCP. Patients with SOTs and presenting with diffuse infiltrates and mild to moderate hypoxemia (A-a gradient, <35) are usually prone to noninfectious disorders, eg, congestive heart failure, pulmonary embolism, or drug-induced pneumonias. In patients with SOTs and CAP with focal or lobar infiltrates, the distribution of pathogens is the same as in immunocompetent hosts, ie, either a bacterial or atypical CAP pathogen.Case Report and Conclusion: A renal transplant patient developed bilateral patchy interstitial infiltrates with severe hypoxemia during hospitalization. The most likely differential diagnostic possibilities included PCP and BOOP. Bronchoalveolar lavage was performed to rule out PCP, and indicated cytopathic effects diagnostic of HSV pneumonia. Lung biopsy pathology confirmed the diagnosis of BOOP. In reviewing the patient’s medications, we surmised that tacrolimus may have caused BOOP. The tacrolimus was discontinued, and the patient received acyclovir for HSV pneumonia.

Relationship between red cell distribution width and right ventricular dysfunction in patients with chronic obstructive pulmonary disease - Corrected Proof

2011-10-13

Abstract: Background: Chronic obstructive pulmonary disease (COPD) is a progressively debilitating disease limiting patients’ survival. The prognosis of COPD worsens with the addition of right ventricular (RV) failure. Red cell distribution width (RDW) is a measure of variability in the size of circulating erythrocytes, and is a powerful predictor of outcomes in patients with both chronic and acute left heart failure. Here we attempted to test whether RDW could provide an early marker of RV failure in patients with COPD.Methods: Thirty-nine consecutive patients with COPD were enrolled in the study. All patients had at least 10 years’ history of COPD, and all were treated appropriately. Thirty-nine age-matched and sex-matched individuals were enrolled for comparison. Red cell distribution width was obtained in all patients before transthoracic echocardiography. Right ventricular parameters were evaluated, and RV failure was identified via lateral tricuspid annulus longitudinal motion and systolic-tissue Doppler velocity, using transthoracic echocardiography.Results: Patients with COPD had significantly higher RDW values compared with control subjects (patients with COPD, mean ± SD, 16.1 ± 2.5; range, 12.3 to 23.3; control subjects, mean ± SD, 13.6 ± 1.3; range, 11.7 to 18.3; P < .001). In multivariable logistic regression, the presence of high RDW was the only parameter independently predicting RV failure in patients with COPD (odds ratio, 2.098; P = .017). Levels of RDW, obtained before echocardiography, predicted the presence of RV failure with a sensitivity of 70% and specificity of 93.1%, with a cutoff value of >17.7.Conclusion: Red cell distribution width may be used to identify COPD patients with RV failure.

Patients' descriptions of dysphoria associated with cardiac tamponade - Corrected Proof

Yuko Ikematsu, Janet A. Kloos — 2011-10-13

Abstract: Background: Cardiac tamponade is difficult to diagnose. Patients often experience sustained distress. Mood changes in the early stages of cardiac tamponade were previously described. However, precise descriptions of these moods have not been reported.Objective: We sought to describe the mood changes specifically referred to as dysphoria in the patients' own words.Methods: Structured and semistructured interviews were performed with 29 patients who had survived cardiac tamponade.Results: Twenty-six patients (89.6%) affirmed some dysphoric mood. “A bad thing is happening” was most frequently affirmed. “Felt anxious,” “could not stay still,” and “difficult to settle down” followed. Answers to open-ended questions and free comments were categorized into “fear,” “anxiety,” “impending doom,” “ill feeling,” “unusual,” “uncertain,” “depressed,” and “discouraged.”Conclusion: The majority of patients surviving cardiac tamponade experienced a dysphoric mood. Mood changes may provide a reliable indicator for those at risk for cardiac tamponade.

Widespread systemic embolization with isolated tricuspid valve endocarditis - Corrected Proof

Smita I. Negi, Aashish Anand — 2011-10-10

Abstract: Concurrent systemic and pulmonary septic emboli from isolated right-sided infective endocarditis are rare. One mechanism described is that of intrapulmonary shunting. We describe a case of widespread pulmonary and systemic septic embolization with sequelae in an intravenous drug user with concomitant chronic hepatitis C infection and discuss possible mechanisms involved in the pathogenesis.

Mediastinitis and blood transfusion in cardiac surgery: A systematic review - Corrected Proof

Lee Boon Ang, Evangeline N. Veloria, Eileen Y. Evanina, Arlene Smaldone — 2011-10-03

Abstract: Background: Mediastinitis, a serious complication after cardiac surgery, increases morbidity, mortality, and cost of care. Accumulating evidence implicates blood transfusions in the development of mediastinitis.Objectives: We conducted a systematic review to evaluate the association between allogeneic blood transfusion and mediastinitis in adult cardiac surgery patients.Results: After a search of Medline, PubMed, Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and the Institute for Scientific Information's Web of Knowledge (1990-2010) for relevant studies, 7 (3 prospective cohort and 4 retrospective reviews) met our inclusion/exclusion criteria. Between 20% and 80.2% of patients received blood transfusions, with an incidence of mediastinitis ranging from 0.1% to 2.3%. Five studies demonstrated an independent association between red blood cell transfusion and mediastinitis. Two studies identified a dose-response relationship.Conclusion: The findings of this systematic review suggest that allogeneic red blood cell transfusions are associated with an increased risk of mediastinitis in patients undergoing cardiac surgery. Individual risks and benefits should be assessed in each patient before a red blood cell transfusion.

Enhancing patient safety with intelligent intravenous infusion devices: Experience in a specialty cardiac hospital - Corrected Proof

Jacqueline L. Wood, Jeremy S. Burnette — 2011-09-20

Abstract: Objective: The study objective was to evaluate patient safety, increase nursing satisfaction, and affect economic factors through implementation of intelligent intravenous (IV) infusion devices in a specialty cardiac hospital. Intelligent IV infusion devices have been shown to decrease medication errors associated with inpatient infusions.Methods: Intelligent IV infusion device evaluation and drug library creation were conducted by a multidisciplinary team within the hospital. Devices were then implemented into patient care, and the impact was analyzed over a 9-month period.Results: Post-implementation data showed that compliance was approximately 100%. A total of 494 critical catches occurred over the study period, resulting in an estimated annual savings of $7,513,333. End-users became familiar with the new technology and recognized the increase in safety measures and time spent with patients.Conclusion: This evaluation suggests that intelligent IV infusion devices resulted in decreased costs and a safer environment for patients.

Guidelines to prevent catheter-associated urinary tract infection: 1980 to 2010 - Corrected Proof

Laurie J. Conway, Elaine L. Larson — 2011-09-20

Abstract: Objectives: We set out to review and compare guidelines to prevent catheter-associated urinary tract infection (CAUTI), examine the association between recent federal initiatives and CAUTI guidelines, and recommend practices for preventing CAUTI that are associated with strong evidence and are consistent across guidelines.Background: Catheter-associated urinary tract infections are the most common healthcare-associated infection, and a cause of significant morbidity and mortality in critically ill patients.Methods: A search of the English-language literature for guidelines in the prevention of adult CAUTI, published between 1980 and 2010, was conducted in Medline and the National Guideline Clearinghouse.Results: Many recommendations were consistent across 8 guidelines, including limited use of urinary catheters, the insertion of catheters aseptically, and the maintenance of a closed drainage system. The weight of evidence for some endorsed practices was limited, and different grading systems made comparisons across recommendations difficult. Federal initiatives are closely aligned with the 4 most recent guidelines.Conclusion: Additional research into the prevention of CAUTI is needed, as is a harmonization of guideline grading systems for recommendations.

Case of interstitial lung disease possibly induced by exposure to iron dust - Corrected Proof

2011-09-07

Abstract: Interstitial lung diseases are primarily attributable to occupational or environmental exposures to dusts and irritants. We report on a case of interstitial lung disease, possibly secondary to iron exposure. Our male patient presented with cough and shortness of breath of more than 20 years’ duration after his occupational exposure had ended. A chest radiograph showed patchy shadows throughout both lower fields, and computed tomography showed ground-glass-like opacification, with fibrosis in the lower lobes. A lung biopsy revealed foamy cells in the alveolar spaces, with bronchiolitis obliterans. Microelemental analysis showed an increased level of iron in the lung tissue. After treatment with N-acetyl cysteine effervescent tablets, the patient’s symptoms gradually improved. This probable case of iron-induced interstitial lung disease suggests the importance of obtaining a patient’s history of occupational and environmental exposures for the sake of an accurate diagnosis.

Inexperienced nurses and doctors are equally efficient in managing the airway in a manikin model - Corrected Proof

2011-09-07

Abstract: Objective: The aim of the present study was to investigate whether minimally trained medical and nursing school graduates would be equally efficient in placing a laryngeal mask airway (LMA) and in intubating the trachea with the Macintosh blade or a videolaryngoscope in a manikin model. Airway management is an essential skill for both physicians and nurses who may be confronted with a critically ill patient, because in the emergency department the airway is not exclusively managed by medical personnel. Several studies have shown that other healthcare professionals are not any less efficient in securing the airway.Methods: Ninety-six graduates from medical and nursing faculties comprised our study population. After a brief educational session, participants were randomly allocated into 3 groups to secure the airway in manikins with 3 techniques: LMA (The Laryngeal Mask Company Limited, Buckinghamshire, UK) insertion and intubation with the Macintosh blade and with a videolaryngoscope (GlideScope, Verathon Inc, Bothell, WA). The number of attempts until the first successful intubation, time required for the first successful attempt, and severity of dental trauma were assessed.Results: No statistically significant difference was observed between physicians and nurses in the number of attempts and in the time required for the first successful attempt with any of the 3 techniques studied. From the 3 techniques studied, LMA placement was the fastest (P < .001). No significant difference was observed between physicians and nurses in the severity of dental trauma.Conclusion: Nurses are as efficient as physicians in managing the airway safely and adequately with the 3 different techniques in manikins.

Cardiopulmonary exercise test in patients with subacute pulmonary emboli - Corrected Proof

Yan Topilsky, Courtney L. Hayes, Amber D. Khanna, Thomas G. Allison — 2011-09-07

Abstract: Objective: Patients presenting with suspected pulmonary embolism (PE) may present a challenge, particularly if diagnostic testing is not immediately available or clinically not indicated (iodine allergy, pregnancy, renal dysfunction). These patients have abnormal regional gas exchange that can be recognized by a cardiopulmonary exercise test (CPET), which may become helpful in their evaluation.Methods: A retrospective analysis was performed of outpatients evaluated for subacute exertional dyspnea of 2 to 12 weeks duration with a test for PE and CPET. A total of 108 patients met inclusion criteria. Thirty patients (27.8%) had confirmed PE.Results: The patients with PE had increased nadir ventilatory equivalent ratio for carbon dioxide (VE/VCO2), decreased peak oxygen uptake/predicted, and decreased end exercise saturation (P < .005 for all). All patients but 1 had normal breathing reserve (>15%). A normal nadir VE/VCO2 excluded PE with 100% sensitivity. By using a “flow chart strategy,” the exercise test had 92.8% sensitivity and 92.1% specificity for PE. Eight patients with PE died during follow-up (3.8 ± 4.6 years), 6 of PE-related causes. Peak VO2/kg was the best predictor of all-cause mortality and nadir VE/VCO2 for PE-related mortality. There were no serious complications from any of the exercise tests.Conclusion: PE may be excluded by a normal nadir VE/VCO2 in patients presenting with subacute dyspnea. A combination of decreased peak VO2/kg, increased nadir VE/VCO2, normal breathing reserve, and exercise-induced desaturation may be sensitive and specific for PE. CPET may assist in identifying subacute PE in patients with contraindications to use of computed tomography angiography or ventilation perfusion scans.

Superior vena cava and right atrium wall infective endocarditis in patients receiving hemodialysis - Corrected Proof

2011-09-07

Abstract: Infective endocarditis is significantly more common and causes greater morbidity and mortality in patients receiving hemodialysis than in the general population. Episodes of bacteremia during hemodialysis are primarily the result of frequent vascular access through an arteriovenous fistula, a vascular graft, or an indwelling vascular catheter. This leads to dialysis access infection and secondary bacteremia. We describe 4 cases of patients receiving hemodialysis, with an indwelling intravascular dialysis catheter, who developed right-sided endocarditis with vegetations located exclusively on the superior vena cava and right atrium wall. All patients had persistent bacteremia with Staphylococcus, secondary to an indwelling intravascular hemodialysis catheter, which led to seeding of the right-sided cardiac wall, causing infective endocarditis. The rates of acceptance for hemodialysis are increasing, along with improved survival in this group of patients. This will probably lead to an increase in the incidence of infective endocarditis, with atypical presentations such as superior vena cava and right-sided cardiac wall endocarditis.

Arteriovenous fistula of the wrist after transradial coronary intervention - Corrected Proof

Jeong Hoon Yang, Hyeon-Cheol Gwon, Jeong Euy Park, Young Bin Song — 2011-08-11

Abstract: The transradial approach for percutaneous coronary intervention (PCI) is a common route, but is associated with a few local complications. Access site complications, such as hematoma, radial artery spasm, and a reduced radial pulse, are reported frequently. However, an arteriovenous fistula (AVF) in the wrist related to the procedure is extremely rare. We encountered an AVF of the wrist after a transradial coronary intervention (TRI). The patient complained of a thrill detected in his right wrist, 2 months after TRI. Color Doppler ultrasonography demonstrated an AVF with a high turbulent velocity at the site of communication that required surgical revision. This appears to be a very unusual complication related to the transradial approach for PCI.

Influenza A presenting as viral encephalitis in an adult - Corrected Proof

Burke A. Cunha, Michael Corbett, Nardeen Mickail — 2011-08-11

Abstract: In adults, influenza A may be accompanied by a variety of neurological findings. Influenza-associated encephalitis (IAE) is rare in adults, and usually follows influenza A after 2 days. In patients with influenza who later develop encephalitis, the diagnosis of IAE is relatively straightforward. We present a rare case of IAE in an adult who presented with viral encephalitis that was later attributed to antecedent influenza A.

Cardiorenal syndrome - Corrected Proof

John Wynne, Sara Y. Narveson, Laszlo Littmann — 2011-07-26

Abstract: The combination of decompensated heart failure and kidney failure is frequently referred to as the “cardiorenal syndrome.” The cause and pathophysiology of this entity are complex and poorly understood, and treatment options are limited. This report describes 2 patients who were hospitalized for decompensated heart failure and developed diuretic resistance with rapidly worsening renal function. Understanding the underlying causes helped break the cardiorenal syndrome in the first patient but only had a transient beneficial effect in the second patient.

Right heart and pulmonary thromboembolism from extensive splanchnic vein thrombosis after splenectomy for myeloproliferative disease - Corrected Proof

2011-06-20

Abstract: Background: Splenectomy is a risk factor for both portal-vein and chronic thromboembolic pulmonary hypertension. The underlying mechanism is unclear, but may involve a hypercoagulable state.Methods: We describe 1 patient with polycythemia vera who developed extensive portal thrombosis of the portal, suprahepatic, and inferior cava veins, leading to right heart thromboembolism, with a resultant pulmonary embolism subsequent to splenectomy despite heparin prophylaxis.Results: In this patient, several mechanisms may have played a role, including perioperative stress, thrombocytosis, thrombophilia, and associated chronic liver disease. Nevertheless, combined treatment with intravenous heparin and thrombolysis and the myeloproliferative inhibitor hydroxyurea was associated with a favorable outcome.Conclusion: The risk of pulmonary thromboembolic complications and their management after splenectomies for hematologic disease warrant further study.

Interventricular septal rupture caused by vehicular trauma - Corrected Proof

Sébastien Robinet, Philippe Morimont, Bernard Lambermont, Jean Olivier Defraigne — 2011-06-20

Abstract: We report the case of a patient admitted at the emergency unit after a severe car accident. As ECG showed a ST segment elevation in all leads, the working diagnosis was coronary dissection. Coronary angiography revealed a large interventricular septal rupture, confirmed by echocardiography. After discussion and as haemodynamics permitted, 6 weeks of medical observation were decided. A surgical repair was then performed, and provided a perfect repair of the shunt. We discuss about the prevalence and management of this rare traumatic complication.

Recurrent fever of unknown origin (FUO): Aseptic meningitis, hepatosplenomegaly, pericarditis and a double quotidian fever due to juvenile rheumatoid arthritis (JRA) - Corrected Proof

Burke A. Cunha, Jean E. Hage, Yelda Nouri — 2011-03-31

Abstract: Background: Fever of unknown origin (FUO) has been defined as a fever of ≥101°F that persists for 3 weeks or more. It is not readily diagnosed after 1 week of intensive in-hospital testing or after intensive outpatient or inpatient testing. Fevers of unknown origin may be caused by infectious diseases, malignancies, collagen vascular diseases, or a variety of miscellaneous disorders. The relative distribution of causes of FUOs is partly age-related. In the elderly, the preponderance of FUOs is attributable to neoplastic and infectious etiologies, whereas in children, collagen vascular diseases, neoplasms, and viral infectious disease predominate. The diagnostic approach to FUOs depends on a careful analysis of the history, physical findings, and laboratory tests. Most patients with FUOs exhibit localizing findings that should direct the diagnostic workup and limit diagnostic possibilities. The most perplexing causes of FUOs involve those without specific diagnostic tests, e.g., juvenile rheumatoid arthritis (JRA) or adult Still’s disease. In a young adult with FUO, if all of the cardinal symptoms are present, JRA may present either a straightforward or an elusive diagnosis, if key findings are absent or if the diagnosis goes unsuspected.Methods: We present a 19-year-old man with a recurrent FUO. His illness began 3 years before admission and has recurred twice since. In the past, he did not manifest arthralgias, arthritis, or a truncal rash. On admission, he presented with an FUO with hepatosplenomegaly, aseptic meningitis, and pericarditis. An extensive diagnostic workup ruled out lymphoma and leukemia. Moreover, a further extensive workup eliminated infectious causes of FUO appropriate to his clinical presentation, ie, tuberculosis, histoplasmosis, brucellosis, Q fever, typhoid fever, Epstein-Barr virus, infectious mononucleosis, cytomegalovirus, human herpes virus (HHV)-6, babesiosis, ehrlichiosis, viral hepatitis, and Whipple’s disease.Results: The diagnosis of JRA was based on the exclusion of infectious and neoplastic disorders in a young adult with hepatosplenomegaly, aseptic meningitis, pericarditis, and a double quotidian fever. With JRA, tests for rheumatic diseases are negative, as they were in this case. The only laboratory abnormalities in this patient included elevated serum transaminases, a mildly elevated erythrocyte sedimentation rate, and a moderately elevated level of serum ferritin.Conclusion: Diagnostic fever curves are most helpful in cases where the diagnosis is most elusive, as was the case here. Relatively few disorders are associated with a double quotidian fever, ie, visceral leishmaniasis, mixed malarial infections, right-sided gonococcal acute bacterial endocarditis, and JRA. Because the patient received antipyretics during the first week of admission, fever was not present. After infectious disease consultation during week 2 of hospitalization, antipyretics were discontinued, and a double quotidian fever was present, which provided the key diagnostic clue in this case.

Idiopathic lipoid pneumonia successfully treated with prednisolone - Corrected Proof

2011-03-21

Abstract: Lipoid pneumonia (LP) is a rare type of pneumonia that is radiologically characterized by lung infiltrates, although imaging alone may not be diagnostic. We describe an unusual 61-year-old patient with idiopathic LP presenting as a solitary pulmonary nodule mimicking lung cancer because of its rapid growth. After treatment with oral prednisone, a control chest radiogram indicated complete normalization of the radiologic features. This case shows that LP should be considered in the diagnostic assessment of any undefined pulmonary mass, after malignancy has been pathologically excluded.

Hydatid cyst, an unusual cause of spontaneous hemothorax and diagnostic thoracoscopy: Case report - Corrected Proof

2011-03-21

Abstract: Hydatid disease is a common parasitic disease in areas where sheep and cattle are raised and is currently endemic in the eastern and southwestern parts of Turkey. Patients with hydatid cysts typically present with cough, chest pain, dyspnea, hemoptysis, or allergic reactions. When ruptured, these cysts may cause hemoptysis, dyspnea, and hydatid thorax. Previously published series of cyst hydatid have reported cyst hydatid rupture and hemothorax secondary to trauma, but nontraumatic hemothorax due to spontaneous rupture of hydatid cyst has not been defined. We discuss the clinical features of a patient with no history of trauma who presented to the emergency department with hemoptysis and dyspnea and was found to have hemothorax due to spontaneous rupture of the hydatid cyst on videothoracoscopic investigation and underwent thoracotomy for hydatid disease treatment.

Recurrent Pseudomonas aortic root abscess complicating mitral valve endocarditis - Corrected Proof

2011-03-18

Abstract: We report on a man with Pseudomonas aeruginosa endocarditis causing an aortic root abscess. He underwent surgery with a homograft aortic root replacement and insertion of a tissue aortic valve. The patient then manifested recurrent aortic root infection and respiratory arrest, and eventually succumbed to sepsis. This case highlights the aggressive nature of an uncommon pathogen causing an atypical but lethal form of endocarditis, despite modern medical and surgical treatment.