scholarly journals A clinical case of management of a newborn with anterior mediastinal teratoma (not prenatally detected) in a city maternity hospital

2020 ◽  
pp. 81-86
Author(s):  
A.O. Pysariev ◽  
◽  
N.P. Honcharuk ◽  
I.I. Hatsko ◽  
N.L. Savostikova ◽  
...  
Keyword(s):  
Intensive Therapy ◽  
Expectant Management ◽  
Lung Ventilation ◽  
Maternity Hospital ◽  
Anterior Mediastinum ◽  
Cartilage Tissue ◽  
Observation Data ◽  
Mediastinal Teratoma ◽  
Key Words Newborn ◽  
Chest X Ray

Teratomas are tumors which are composed of tissues derived of more than one germ cell layer; they appear between 3-6 weeks of pregnancy and are present more often in females. A prognosis for life depends on the timely diagnosis of the mass and a possibility of surgical treatment. An article presents a case of a female neonate born with severe respiratory insufficiency. Antenatal ultrasound at 19-20 and 30-31 weeks exposed the myoma of the uterus and a probability of large birth weight. Immediately after birth a neonate requested urgent intubation, artificial lung ventilation, intensive therapy for hemodynamic stabilization. The thoracic surgeon suspected the presence of cystic adenomatous malformation upon the chest X-ray and clinical observation data and defined expectant management and prolongation of intensive therapy. Autoptical evidence is a large mediastinal teratoma 10×8×5 cm, weight 135.0 gram, moderate secondary hypoplasia of lungs. Histological processing revealed mass lesion of the anterior mediastinum in a capsule, which was presented with immature discohesive mesenchyme with lymphoid assembly, brain tissue and multiple cysts of different size with inclusions of cartilage tissue. Effective correct and precise antenatal visualization, which can defined the type of maternity hospital, postnatal MRT and timely provided therapy intervention surgical mass removal including — these are key factors of successful management newborns suffering from anterior mediastinal teratomas. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: newborn, mediastinal teratoma, diagnostics, therapy.

scholarly journals Transfusion-related acute lung injury (TRALI) in two thalassaemia patients caused by the same multiparous blood donor

2017 ◽  
Vol 9 (1) ◽  
pp. e2017060
Author(s):  
George J Kontoghiorghes
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Blood Donor ◽  
Intensive Therapy ◽  
Hla Antigens ◽  
Hla Class I ◽  
Intensive Therapy Unit ◽  
X Ray ◽  
Red Blood Cell Transfusions ◽  
Chest X Ray

Two separate episodes of transfusion-related acute lung injury (TRALI) in thalassaemia patients caused by red blood cell transfusions from the same multiparous blood donor are reported. Both cases had the same symptomatology and occurred 10-60 minutes of transfusion. The patients presented dyspnea, sweating, fatigue, dizziness, fever, and sense of losing consciousness. The chest x-ray showed a pulmonary oedema-like picture with both lungs filled with fluid. The patients were treated in the intensive therapy unit. They were weaned off the ventilator and discharged following hospitalization 7 and 9 days respectively. The TRALI syndrome was diagnosed to be associated with HLA-specific donor antibodies against mismatched HLA-antigens of the transfused patients. Haemovigilance improvements are essential for reducing the morbidity and mortality in transfused patients. Blood from multiparous donors should be tested for the presence of IgG HLA-Class I and –Class II antibodies before being transfused in thalassaemia and other chronically transfused patients.

Vats Plication of the Diaphragm a Descriptive Observational 10-Year Southampton Experience

2017 ◽  
Vol 12 (6) ◽  
pp. 398-405
Author(s):  
Rhona J. Taberham ◽  
Adnan Raza ◽  
Aiman Alzetani ◽  
Edwin B. Woo ◽  
Martin H. Chamberlain ◽  
...  
Keyword(s):  
Adult Population ◽  
Intensive Therapy ◽  
Forced Expiratory Volume ◽  
Intensive Therapy Unit ◽  
Randomized Controlled Studies ◽  
Risk Patients ◽  
Chest X Ray ◽  
X Ray Computed ◽  
The Mean

Objective The aim of the study was to report the safety and efficacy of video-assisted thoracoscopic (VATS) plication of the diaphragm at our institution between 2006 and 2016. Methods Adult patients selected on etiology and combination of investigations including plain chest x-ray, computed tomography of chest and abdomen, lung functions in supine and sitting positions, radiological/ultrasonic screening for diaphragmatic movement, and phrenic nerve conduction studies. We incorporated a triportal VATS and Endostitch device for plication, using CO2 insufflation to maximum 12 mm Hg. Bilateral simultaneous plication and high-risk patients were electively admitted to intensive therapy unit postoperatively. Results Thirty-five patients (24 males) had their diaphragm plicated. The mean age was 56.6 years (range = 23–76 years). The mean body mass index was 32.1 (range = 22.2–45.4). Twenty one were right, 13 left, 2 patients had VATS simultaneous bilateral plication, and 1 had sequential VATS bilateral plication. Paralysis was idiopathic in 17, posttraumatic in 5, postremoval of mediastinal tumor in 4, and postcardiac surgery in 3. All patients presented with lifestyle-limiting dyspnea and orthopnea, three were on nocturnal noninvasive ventilation. Five were diabetic and 16 were smokers. The mean supine forced expiratory volume in the first second was 62.5% of predicted. Twenty two were performed by VATS (63%), three converted to thoracotomy, and 13 were open limited thoracotomy (historic). The mean hospital stay was 4.5 days (range = 1–18, mode 2 days). Intensive therapy unit admission was required in six patients for mechanical ventilation 0 to 3 days. Five patients (14%) had no improvement in symptoms. There were no deaths, no 30-day readmissions, and no long-term neuralgia in this series. Conclusions We found minimal access VATS plication of the diaphragm to be feasible and safe, but no firm conclusions should be drawn from our limited resources. We report the feasibility of concomitant bilateral VATS plication of the diaphragm in two adults, and this was not previously reported in the adult population. There is a need for further good quality, prospective studies, and randomized controlled studies evaluating efficacy of VATS diaphragmatic plication.

scholarly journals Mediastinal teratoma presenting as huge tumor shadow associated with prominent mediastinal shift on chest X-ray examination; a case report.

1992 ◽  
Vol 6 (7) ◽  
pp. 825-831
Author(s):  
Hisayuki Aoyagi ◽  
Yutaka Yamaguchi ◽  
Mitsutoshi Shiba ◽  
Michio Fujino ◽  
Yasuo Sekine ◽  
...  
Keyword(s):  
Case Report ◽  
X Ray ◽  
Mediastinal Teratoma ◽  
Mediastinal Shift ◽  
Chest X Ray

Intensive therapy of multiple fatty embolism of the microvascular bed of vital organs

2021 ◽  
Vol 87 (1) ◽  
pp. 59-62
Author(s):  
M.V. Chepelyanskaya ◽  
◽  
V. V. Unzhakov ◽  
A.S. Doloka ◽  
S.N. Berezutsky ◽  
...  
Keyword(s):  
Intensive Therapy ◽  
Interdisciplinary Approach ◽  
Lung Ventilation ◽  
Fat Embolism ◽  
Multiple Organ ◽  
Acid Base Balance ◽  
Artificial Lung Ventilation ◽  
Base Balance ◽  
Cardiovascular Medications ◽  
Complications And Mortality

The article presents a clinical case of successful treatment of a patient with polytrauma complicated by multiple fatty embolism. Complications were manifested in the form of a syndrome of multiple organ failure: cerebral, cardiovascular and respiratory failure. According to the protocols and recommendations for providing assistance to patients with polytrauma, the tactics of management and intensive therapy were determined, with the obligatory consideration of recommendations for the treatment of patients with fat embolism. The patient underwent neuroprotection, which included one of the modern drugs, such as celex, artificial lung ventilation, maintenance of hemodynamics by cardiovascular medications, correction of the water, electrolyte and acid-base balance with positive dynamics. Despite the difficulties of diagnosis and treatment, a high percentage of disability, complications and mortality, the difficulty of preventing complications, a favorable outcome for patients with associated trauma is possible. An interdisciplinary approach ensures the success of the treatment and rehabilitation of these patients.

scholarly journals Vitamin K Deficiency Presenting in an Infant with an Anterior Mediastinal Mass: A Case Report and Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Mauricio A. Palau ◽  
Amanda Winters ◽  
Xiayuan Liang ◽  
Rachelle Nuss ◽  
Susan Niermeyer ◽  
...  
Keyword(s):  
Vitamin K ◽  
Mediastinal Mass ◽  
Anterior Mediastinum ◽  
Medical Attention ◽  
Anterior Mediastinal Mass ◽  
Vitamin K Deficiency ◽  
K Deficiency ◽  
Chest X Ray ◽  
Work Up

We report a case of a 1-month-old infant with spontaneous thymic hemorrhage secondary to severe vitamin K deficiency. He was brought to medical attention due to scrotal bruising and during evaluation was noted to be tachypneic and hypoxemic. Chest X-ray revealed an enlarged cardiothymic silhouette, and a follow-up echocardiogram revealed a mass in the anterior mediastinum. Routine laboratory work-up revealed severe coagulopathy. Further questioning revealed the patient had not received prophylactic vitamin K at birth. The coagulopathy resolved with administration of vitamin K, and a biopsy confirmed the anterior mediastinal mass was due to spontaneous thymic hemorrhage.

scholarly journals Pharmacological correction of intrarenal hemodynamic disorders in acute kidney injury (part 2)

2018 ◽  
Vol 4 (2) ◽  
pp. 95-104
Author(s):  
Katherine K. Shramenko ◽  
Georgiy A. Gorodnik ◽  
Valentina P. Shano ◽  
Irina V. Kuznetsova ◽  
Aleksandr P. Grigorenko ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intensive Therapy ◽  
Kidney Injury ◽  
Lung Ventilation ◽  
Results Of Treatment ◽  
Therapeutic Measures ◽  
Pharmacological Correction ◽  
Clinically Significant

Introduction: Treatment of acute kidney injury (AKI) is a complex current problem. Mortality in this pathology is over 50%. One of the areas of correction therapy in AKI patients is the improvement of diagnostics and the earliest identification of the underlying cause of AKI. The second promising direction in reducing mortality is prevention of AKI progression (nephroprotection) and resulting multi-organ disorders by individual pharmacological and non-pharmacological intensive therapy. Objectives: to evaluate the possibilities of individual pharmacological correction and intensive care of patients with AKI of different origin. Materials and methods: A prospective nonrandomized study. Inclusion criteria: patients with prerenal, renal and subrenal AKI module in stage of oligoanuria and restoration of diuresis. Exclusion criteria: AKI in patients after cardiosurgery and operations on large vessels. Individual pharmacological and non-pharmacological correction (renoprotection) was performed in 250 ICU patients with prerenal (130), renal (81) and subrenal (39) AKI. The effectiveness of individual nephroprotection was assessed by the duration of the oligoanuria stage (indicator of AKI severity). Results and discussion: The basis of intensive therapy in AKI patients was renal replacement therapy and peridialysis care. Peridialisys support was presented by a complex of therapeutic measures aimed at preventing the progression of AKI (nephroprotection) and the prevention of multi-organ complications. Individual pharmacological and non-pharmacological peridialysis intensive therapy was performed, including: removal of the main cause of forming AKI; maintenance of normal circulation blood volume and effective cardiac output; maintenance of adequate lung ventilation (correction of hypoxia, timely ventilation); correction of hypertension, hypotension, and clinically significant arrhythmia; improvement of renal blood flow and stimulation of diuresis; stopping bleeding and correction of anemia; targeted antibiotic therapy; removal or adequate drainage of the intoxication focus (purulent focus); use of alternative ways of detoxication and efferent methods. It was proved that individual pharmacological and non-pharmacological nephroprotection made it possible to improve the results of treatment. The duration of the oligoanuria stage significantly (p < 0.05) decreased to 14.3±0.9 days in the main group (22.6±1.2 days in the comparison group). Conclusions: The medical technology of individual intensive therapy with renal replacement therapy and peridialysis care has been developed, including: a diagnostic stage with determination of peculiarities of renal hemodynamic disorders and pharmacological and instrumental (stenting, drainage, etc.) correction of the real cause and manifestations of AKI. Improving AKI diagnostics and carrying out individual pharmacological and non-pharmacological correction improves the results of AKI treatment.

scholarly journals Case Report Mediastinal Teratoma Resembling Vascular Tumor with Rapid Growth Accompanied by Vena Cava Superior Syndrome and Bilateral Paramalignant Pleural Effusion

2020 ◽  
Vol 2 (1) ◽  
pp. 68-75
Author(s):  
Ni Rini ◽  
◽  
Suryanti Pratiwi ◽  
Imam Bayuadi ◽  
Dini Erawati ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Mediastinal Tumor ◽  
Vena Cava ◽  
Vascular Tumor ◽  
Vascular Lesions ◽  
X Ray ◽  
Mediastinal Teratoma ◽  
Vena Cava Superior ◽  
Chest X Ray

Background: Teratomas are tumors originate from germ cells, consist of well differentiated tissue from more than one of three layers of embryonic cells: ectoderm, mesoderm and endoderm. Teratomas are generally slow-growing and asymptomatic. Mediastinal teratoma is the most common extra-gonadal germ cell tumor. Superior vena cava syndrome and bilateral paramaligant pleural effusion are complications which can occur in mediastinal teratomas. Case: We report a 37-year-old woman presented with shortness of breath since 1 month before admission, chest pain, cough, weight loss, swolen of face, neck, and right arm. Chest x-ray showed mediastinal tumor. However, no mediastinal tumor had been detected by chest x-ray to examine her heart disease 3 years earlier. Chest computed tomography scan showed anterosuperior mediastinal tumor surrounding great blood vessels and bilateral pleural effusion. Computed tomography guided transthoracic fine needle aspiration biopsy revealed tumor containing mature squamous epithelial component. Patient underwent open biopsy by sternotomy and histological assessment confirmed the diagnosis as mediastinal teratoma with vascular lesions predominantly resembling vascular tumor. Conclusion: Establishing the diagnosis of mediastinal teratoma is challenging and it requires multi modality approaches.

scholarly journals Primary small cell neuroendocrine carcinoma of the anterior mediastinum presenting with trepopnea

2018 ◽  
Vol 11 (1) ◽  
pp. e225014
Author(s):  
Mohamed Iliyas ◽  
Das Dona ◽  
Uma Devi ◽  
Naseem Noorunnisa
Keyword(s):  
Neuroendocrine Carcinoma ◽  
Outpatient Care ◽  
Delayed Diagnosis ◽  
Anterior Mediastinum ◽  
Small Cell ◽  
Common Symptom ◽  
Small Cell Neuroendocrine Carcinoma ◽  
X Ray ◽  
Chest X Ray ◽  
Slow Growing

We report the case of an elderly man who had visited many physicians with breathlessness and was treated in an outpatient care. The cause of breathlessness was not evaluated, which turned out to be a slow-growing tumour in the mediastinum. Later, we diagnosed it to be a case of neuroendocrine carcinoma arising from the anterior mediastinum. The patient had succumbed to death because of the delayed diagnosis. A simple chest X-ray could have helped to make an early diagnosis. This case is reported with the intention to bring into light the effect of delayed diagnosis of a rare disease presenting with a very common symptom.

scholarly journals Peri-operative anaesthesia challenges in large anterior mediastinal mass - A case report

2021 ◽  
Vol 8 (4) ◽  
pp. 604-607
Author(s):  
Rachna Wadhwa ◽  
Varun Sharma ◽  
Pallavi Ahluwalia ◽  
Vishnu Datt
Keyword(s):  
Anterior Mediastinum ◽  
Anterior Mediastinal Mass ◽  
Unknown Etiology ◽  
Ct Guided ◽  
Airway Compression ◽  
X Ray ◽  
Airway Collapse ◽  
Ct Guided Biopsy ◽  
Residual Capacity ◽  
Chest X Ray

Thymic mass is a rare tumor in the anterior mediastinum. They are usually of unknown etiology. About 50% of patients are diagnosed incidentally on chest radiographs. A 45 years, BMI-28, male patient presented to cardiac outpatient department with breathlessness and persistent cough for past three months. He also complained of generalized fatigue and nonspecific chest pain. On chest x-ray (PA view), there were diffuse opacities in middle and lower zone and no tracheal compression or deviation. Lateral neck X-ray also ruled out any airway compression. Computed tomography thorax revealed a huge mass occupying the prevascular compartment of mediastinum and insinuating the visceral compartment bilaterally with extension upto bilateral cardiophrenic and anterior costophrenic angles. CT-guided biopsy was consistent with thymolipoma which was surgically resected.Thymolipomas usually present with nonspecific symptoms. They pose a huge anaesthetic challenge during the peri-operative period in terms of difficult intubation, co-existing airway compression requiring reinforced tubes and fiberoptic guidance, the possibility of sudden airway collapse post-induction, risk of hypoxemia secondary to reduced functional residual capacity (FRC) and haemodynamic disturbances during and after removal of huge mass.

scholarly journals Fetal Presentation of Mediastinal Immature Teratoma: Ultrasound, Autopsy and Cytogenetic Findings

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1543
Author(s):  
Maria Paola Bonasoni ◽  
Giuseppina Comitini ◽  
Veronica Barbieri ◽  
Andrea Palicelli ◽  
Nunzio Salfi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Fetal Monitoring ◽  
Surgical Excision ◽  
Fetal Outcome ◽  
Anterior Mediastinum ◽  
Therapeutic Strategies ◽  
Cystic Mass ◽  
Immature Teratoma ◽  
Adequate Treatment ◽  
Mediastinal Teratoma

Teratomas are the most common congenital tumors, occurring along the midline or paraxial sites, or uncommonly, the mediastinum. Teratomas are classified as mature, containing only differentiated tissues from the three germinal layers; and immature, which also present with neuroectodermal elements, ependymal rosettes, and immature mesenchyme. Herein, we describe a new case of fetal mediastinal immature teratoma detected at 21 weeks of gestational age (wga) + 1 day with thorough cytogenetic analysis. Ultrasound (US) showed a solid and cystic mass located in the anterior mediastinum, measuring 1.8 × 1.3 cm with no signs of hydrops. At 22 wga, US showed a mass of 2.4 cm in diameter and moderate pericardial effusions. Although the prenatal risks and available therapeutic strategies were explained to the parents, they opted for termination of pregnancy. Histology showed an immature teratoma, Norris grade 2. Karyotype on the fetus and tumor exhibited a chromosomal asset of 46,XX. The fetal outcome in the case of mediastinal teratoma relies on the development of hydrops due to mass compression of vessels and heart failure. Prenatal US diagnosis and close fetal monitoring are paramount in planning adequate treatment, such as in utero surgery, ex utero intrapartum therapy (EXIT) procedure, and surgical excision after birth.

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