Successful treatment of refractory empyema using dual sheet covering

Managing thoracic empyema with massive air leakage can be challenging. We present a case with thoracic empyema with multiple bronchopleural fistulae and extensive lung parenchymal necrosis due to drain injury. Emergency surgery was performed for respiratory distress due to massive air leakage. As direct sutures could not be achieved due to extensive parenchymal necrosis, polyglycolic acid and oxidized regenerated cellulose sheets were packed into the lesion. Although open-window thoracostomy was required for bronchopleural fistulae, the stoma closure was achieved via vacuum-assisted closure therapy. The dual sheet coverings contributed to the successful recovery by resolving multiple bronchopleural fistulae.

A preliminary study of quantitative analysis of tissue perfusion using contrast-enhanced ultrasound in the evaluation of the severity of acute pancreatitis

Background Acute pancreatitis (AP) is a lethal disease with high mortality. Early diagnosis and evaluation of the severity of pancreatitis is crucial for the prevention a treatment of AP. The clinical value of contrast-enhanced ultrasound (CEUS) in evaluating the severity of acute pancreatitis by quantitative analysis of the tissue perfusion and the areas of pancreatic parenchymal necrosis is little known. Methods 60 acute pancreatitis patients (AP group) and 30 volunteer (control group) were selected, the AP group was further divided into subgroup, the mild acute pancreatitis (MAP) group and the severe acute pancreatitis (SAP) group. All received CEUS examination, the differences of the parameters of time-intensity curve (TIC) between group AP and Control were analyzed. The receiver operating characteristics (ROC) curve of CEUS in diagnosing AP and SAP were drew, then calculated the best cut-off point of CEUS for the diagnosis of AP. Results Compared to group Control, there was a marked increase in AT and TTP, while a dramatic decrease in PI and AUC in group AP (all P < 0.05), no significant difference of WT and S was observed. After analysis of PI and AUC of those two subgroup AP patients, it was much higher in MAP group than SAP group, in contrast, the TTP decreased markedly(all P < 0.05), no significant difference of AT,WT and S was found. Next, we found that the sensitivity, specificity and diagnostic coincidence rate were 96.7%, 73.3% and 85.0% respectively, when the AUC ≤ 727.2dBs was used as the standard for the diagnosis of AP; and the sensitivity, specificity and diagnostic coincidence rate were 93.3%, 73.3%, and 83.3%, respectively when PI ≤ 11.41 dB was used as the standard for the diagnosis of SAP. Finally, we found that there was no significant difference in the detection of pancreatic parenchymal necrosis between CEUS and contrast-enhanced computed tomography (CECT). Conclusions CEUS could provide an objective and powerful basis for the early diagnosis of SAP, and also detect necrotic areas of pancreatic parenchyma early, quickly and accurately, which provide an available tool for clinic to early detection and assessment of the severity of acute pancreatitis.

Experimental model in rats of penumbra area using implemented baloon in caudate nucleus volume dependent and time dependent

The study aims to determine whether early removal of an experimental intracerebral mass alters neurological function. In four experimental series, 0.6mL and 0.8mL balloons were implanted by stereotaxis and inflated into the right caudate nucleus of rats. After 1hour of insufflation, the brains were removed and studied by histopathological analysis. Immunohistochemical was included with protein S-100, marker of neuronal destruction. Four groups were formed (1A, 1B, 2A, 2B) and the variables: time and balloon volume was analyzed. In each series of the time variable, half of the animals had a 0.8mL balloon inflated for three minutes (Group 1A), and the other half had a 0.8mL balloon inflated for ten minutes (Group 2A). In the variable balloon volume series, half of the animals had a 0.6mL balloon inflated for 6 minutes (Group 1B), while the other half had a 0.8mL balloon inflated for 6minutes (Group 2B). In the qualitative and quantitative analysis of the parameters, the shortest group (group 1A), either there was no lesion, or there was partial loss of nervous tissue, while the longest group (group 2A) presented edema and cerebral parenchymal necrosis, reaching 35% of nuclear pyknosis. In the volume dependent groups (groups 1B and 2B), the findings were similar, both with about 30% of pyknotic nuclei. Thus, time was the major determinant of injury, reiterating the prognostic importance of early removal of a spontaneous intracerebral mass.

Pneumonia by Cryptococcus neoformans in a goat in the Southern region of Brazil

ABSTRACT: This report describes the clinical, pathological, and molecular aspects of a pneumonia by Cryptococcus neoformans in a goat in the Southern region of Brazil. A goat with a history of prolonged transportation presented dyspnea, nasal discharge and cough, and was subjected to necropsy, histopathology, and mycological evaluation. Grossly, cranio-ventral pulmonary consolidation was observed, characterized by firm and grayish areas interspersed with dark red foci. Histopathology of the lungs showed areas of parenchymal necrosis, containing blastoconidia with a slightly basophilic central cell, surrounded by an unstained capsule. It was associated with moderate granulomatous inflammatory infiltrate and peripheral fibrosis. The capsule and fungus cell exhibited marked Alcian Blue and periodic acid-Schiff staining, respectively. Diagnosis of fungal pneumonia by C. neoformans was based on clinical, pathological, and molecular findings.