Closed thoracic drainage in elderly patients with chronic obstructive pulmonary disease complicated with spontaneous pneumothorax:A retrospective study

BACKGROUND Chronic obstructive pulmonary disease(COPD)combined with spontaneous pneumothorax,is characterized by significant decline in lung function,and even cause cardiopulmonary failure and hypoxia.AIM To evaluate the clinical effectiveness of central venous catheters and indwelling pleural catheters(IPC)in managing closed thoracic drainage in patients diagnosed with COPD with concomitant by spontaneous pneumothorax.METHODS Retrospective analysis was conducted on the clinical information of 60 elderly patients with COPD complicated by spontaneous pneumothorax admitted to the Shexian Branch of the second affiliated hospital of Zhejiang university school of medicine between March 2020 and March 2023.The clinical efficacy,complications,hospitalization duration,and costs were compared between patients with an indwelling thoracic catheter and those with a central venous catheter.Univariate logistic regression was used to analyze the causes of catheter displacement.RESULTS According to our findings,there were significant differences in the IPC group’s clinical efficacy,catheter operation time,and lung recruitment time(P<0.05).Comparing the complications after catheter treatment between the two groups revealed statistically significant variations in the incidence of postoperative analgesics,catheter abscission,catheter blockage,and subcutaneous emphysema in the IPC group(P<0.05).Univariate analysis demonstrated significant differences between patients with and without catheter dislodgement regarding duty nurse’s working years(less than three),Acute Physiology and Chronic Health Evaluation II(APACHE II)scores(less than 15),lack of catheter suture fixation,and the proportion of catheters not fixed twice(P<0.05).CONCLUSION Our results demonstrated that when treating elderly COPD patients with spontaneous pneumothorax,indwelling thoracic catheters are more effective than the central venous catheter group.Patients’catheter shedding is influenced by the primary nurse’s working years,APACHE II scores,and catheter fixation technique.

Young thoracic vertebra diffuse idiopathic skeletal hyperostosis with Scheuermann disease:A case report

BACKGROUND Diffuse idiopathic skeletal hyperostosis(DISH)is a disorder characterised by the calcification and ossification of ligaments and entheses.It is a frequent occurrence in elderly males,but rarely encountered in younger individuals.CASE SUMMARY A 24-year-old male was admitted to the hospital due to low back pain accompanied with numbness in both lower limbs for 10 d.Upon clinical examination and imaging tests,the patient was diagnosed with DISH with Scheuermann disease and thoracic spinal stenosis.Before the operation and medical treatment,the patient had hypoesthesia of the skin below the xiphoid process.Afterward,a standard laminectomy was conducted using ultrasonic bone curette and internal fixation was applied.Subsequently,the patient was given corticosteroids,neurotrophic drugs,hyperbaric oxygen and electric stimulation.As a result of the treatment,the patient’s sensory level decreased to the navel level and there was no major change in the muscle strength of the lower limbs.During follow-up,the patient’s skin sensation has returned to normal.CONCLUSION This case is a rare instance of DISH co-existing with Scheuermann’s disease in a young adult.This provides a valuable reference point for spine surgeons,as DISH is more commonly observed in middle-aged and elder adults.

Influence of Smoking Status and Body Mass Index on Serum Carcinoembryonic Antigen Concentration in Patients with Thoracic Diseases

BACKGROUND: Although the serum carcinoembryonic antigen (CEA) concentration is the well-known prognostic marker of non-small cell lung cancer (NSCLC), serum CEA concentration has been reported to be affected by smoking status and body mass index (BMI). There are no previous investigations that examined the relationship between BMI and serum CEA concentration in thoracic disease, including NSCLC. METHODS: Consecutive 384 NSCLC patients and 87 patients with benign thoracic disease were enrolled. The relationship between serum CEA concentration and smoking status and BMI in patients with benign thoracic benign disease and NSCLC was examined. RESULTS: In patients with benign thoracic disease, serum CEA concentration significantly increased with smoking status and Brinkman index. However, serum CEA concentration was not related with BMI. Serum CEA concentration of patients with NSCLC was significantly higher than those with benign disease. In NSCLC patients, the relationship between serum CEA concentration and smoking status was also found. A significant relationship between serum CEA concentration and smoking status was also found in patients with adenocarcinoma which is known to have weaker associations with smoking in carcinogenesis. On the other hand, we failed to find the relationship between serum CEA concentration and BMI in NSCLC patients. CONCLUSION: Serum CEA concentration may be affected by smoking status but not BMI in our Japanese patients with thoracic disease.

Trans-facet joints approach to treat thoracic degenerative diseases with anterior compression

Objective To investigate the clinical outcomes of trans-facet joints approach to treat thoracic degenerative disease with anterior compression.Methods From January 2003 to December 2009,22 patients with thoracic myelopathy caused by

Infective endocarditis and thoracic aortic disease: A review on forgotten psychological aspects

AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, Pub Med and Psyc INFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS We found sixteen studies exploring psychological issues in patients with IE(six studies) and in TAD(ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE(four papers) and in TAD(eight papers). Depression and anxiety were analyzed in TAD only(five papers). Post-traumatic stress disorder was assessed in IE(one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.

Pulmonary and Orbital Bifocal IgG4 Disease: Case Report and Literature Review

Introduction: IgG4 disease is an orphan, fibro-inflammatory autoimmune disease of recent discovery whose thoracic involvement is rarer. We report a case of Pulmonary and orbital bifocal IgG4 disease with a review of the literature. Observation: This is a 71-year-old patient with a history of hypertension, dyslipidemia, smoking cessation at 15 PA, with progressive dyspnoea, weight loss of 4 kg with PS = 0 for 2 months. The thoracic CT scan revealed 3 pseudotumoral lung lesions of the LIG, LID and LM. The histology of the two CT-guided lung biopsies and the LIG wedge had objectified inflammatory lesions without signs of malignancy. The evolution was marked by the occurrence of a right orbital edema. The cerebral scanner found a voluminous right orbital inflammatory pseudotumor. Biopsy with histology found fibroinflammatory lesions with lymphoplasmacytic infiltrates and positive immunolabeling with anti-IgG4 antibodies. The PET scanner had objectified pulmonary and pleural parenchymal consolidations and moderately hypermetabolic mediastinal ADP with max SUV between 3 and 6. The patient was put on corticosteroid therapy with a favorable outcome. Conclusion: IgG4 disease is rare and difficult to diagnose despite well-defined and consensual diagnostic criteria and classification. The discovery of new biomarkers facilitates the diagnosis and monitoring of patients. Well-codified corticosteroid therapy is effective but possibility of recurrence. The current challenge remains the lack of data on the follow-up of these patients to assess the risk of neoplasia (lymphoma).

Hybrid Procedure for Thoracic Aortic Disease

Form 2008 to 2009, four patients with complex thoracic aortic disease, including aortic aneurysms and dissections, were successfully treated in our department with a new treatment approach:hybrid procedure.Combined open surgery and endovascular repair were performed in these patients without deep hypothermia or circulatory arrest.Compared to those who underwent traditional open surgery in the same period, time of mechanical ventilation and ICU stay was decreased in these four patients.All of them were discharged soon after operation without postoperative complications or death.The result suggests that this new approach could be an option for thoracic aortic disease, but long-term and large-population studies are still required to demonstrate the safety and validity.

Clinical features and surgical treatment of the coexistence of cervical,thoracic and lumber degenerative disease

Objective To discuss clinical features and surgical treatment of the coexistence of cervical,thoracic and lumber degenerative disease. Methods From January 2004 to December 2008,79 cases with the coexistence of cervical,thoracic

A Case of Thoracic Spinal Stenosis Secondary to Paget's Disease

PAGET'S disease,also called osteitis deformans,is a metabolic bone disorder.It is characterized by increased bone resorption and the compensatory formation of new bones.

¹⁸FDG-PET/CT Is a Useful Tool in Staging Procedure before Chemo-Radiotherapy in Patients with Limited Disease Small-Cell Lung Cancer. Pattern of Failure and Survival Is Analyzed

Background: The purpose of this study was to evaluate the use of 18FDG-PET/CT in staging procedure, the pattern of failure and survival in patients with small-cell lung cancer limited disease (LD-SCLC) undergoing chemo-radiotherapy. Methods: A total of 79 LD-SCLC patients were treated with a combination of chemotherapy and chest radiotherapy. Radiotherapy of the tumour and the pathological lymph nodes was performed either as 45 Gy twice-daily or 46 - 50 Gy once-daily. 18Fluro-2-deoxy-D-glucose (18FDG)-PET/CT was performed in 35 patients as part of the staging procedure. Results: With a median follow-up time of 17 months 6% developed isolated loco-regional failures while 57% developed distant metastases. No isolated regional failures were seen. Median overall survival was 22 months. Patients staged with a 18FDG-PET/CT had a significantly lower incidence of distant failures and a significantly improved overall survival compared with patients only staged with a CT scan (p = 0.03) (median overall survival of 34 versus 17 months, respectively). Conclusion: The pattern of failure showed a high risk of distant metastases but a low incidence of isolated loco-regional failures. Patients staged with an 18FDG-PET/CT had a significantly lower incidence of distant failures and better overall survival, indicating that 18FDG-PET could be beneficial in patients with LD-SCLC before deciding on treatment regimen.

Acute Thoracic Syndrome in Sickle Cell Children at the Pediatrics Department of Donka National Hospital

Introduction: Acute thoracic syndrome is the appearance of a new pulmonary infiltrate on radiology associated with fever, desaturation or respiratory signs. It is the second leading cause of hospitalization and the first cause of death in sickle cell patients. It is an acute pulmonary complication whose pathophysiological mechanisms are still poorly understood. This study aims to study the epidemiological, clinical, therapeutic and evolutionary aspects of Acute Chest Syndrome in children at the Pediatrics Department of Donka National Hospital. Method: This is a prospective study of descriptive type for a period of 6 months from February 19 to August 19, 2019 on patients with sickle cell disease who developed an ATS in the pediatrics department of Donka National Hospital. Epidemiological, clinical, therapeutic and evolutionary data were studied and proportionate data were calculated. Results: The frequency of ATS was 39%. The mean age of our patients was 9.83 years with the extremes of 4 and 16 years. The age group from 6 to 10 years with a frequency of 66.7% was the most affected. Fever was the main clinical manifestation, followed by hepatomegaly. All our patients were homozygous SS and undergoing folic acid prophylaxis. 96% of our patients did not receive any specific vaccine. Antibiotic therapy, hyperhydration and analgesics were administered to all our patients. 96% of our patients were transfused with red blood cell concentrate. 96% of our patients were transfused with packed red blood cells. 96% of our patients were transfused with packed red blood cells and 96% of them had a favorable outcome. Conclusion: ATS is an acute complication of sickle cell disease responsible for significant mortality and morbidity in the pediatric population. Its treatment is symptomatic and must be started early. Emphasis must be placed on prevention to prevent or limit its occurrence.

Thoracic Air Leak Syndrome: A Rare and Fatal Complication of Allogeneic Stem Cell Transplant

Thoracic air leak syndrome (TALS) is a rare complication of allogeneic stem cell transplant (Allo-SCT) and is associated with a poor prognosis. We report a case of a 67-year-old male, after 20 months of Allo-SCT for acute myeloid leukemia, who presented with fever and acute worsening dyspnea on a background of a 4-month history of slowly progressive dyspnea. He was initially diagnosed with parainfluenza pneumonia and later developed TALS as a result of bronchiolitis obliterans (BO) caused by chronic graft-versus-host disease (cGVHD). Herein, we highlight the importance of early recognition and treatment of non-infectious pulmonary complications of Allo-SCT.

Current knowledge and contemporary management of non-A non-B aortic dissections

Non-A non-B aortic dissection(AAD)is an infrequently documented condition,comprising of only a small proportion of all AADs.The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD,have led to an ongoing controversy around the topic.It seems that the clinical progression of acute non-A non-B AAD diverges from the typical type A and B dissections,frequently leading to serious complications and thus mandating early intervention.Currently,the available treatment methods in the surgical armamentarium are conventional open,endovascular techniques and combined hybrid methods.The optimum approach is tailored in every individual case and may be determined by the dissection’s location,extent,the aortic diameter,the associated complications and the patient’s status.The management of non-A non-B dissections still remains challenging and a unanimous consensus defining the gold standard treatment has yet to be reached.In an attempt to provide further insight into this perplexing entity,we performed a minireview of the literature,aiming to elucidate the epidemiology,clinical course and the optimal treatment modality.

《金匮要略》“支饮”病名含义考释

支饮病是《金匮要略》的重要组成部分。但对于其疾病命名含义,长期以来充满争议。后世医家或从医理角度、或从临床实践角度,对这一疾病命名含义作出训释,而基于文字学角度进行探讨者却较为罕见。通过对“支”字形字义之考证,同时结合对张仲景原文记载之分析,“支饮”之“支”当为“支撑”之义,“支饮”病名含义为“支撑于胸膈之水饮”。支撑于胸膈间之支饮,与位于人体腹部之痰饮、四肢之溢饮、胸胁之悬饮,涵盖了人体之大部,与“水在心”“水在肺”等“水在五脏”条文互为羽翼,从不同角度构建了仲景痰饮证治理论体系。

名老中医于作盈教授治疗胸痹学术思想探析

冠状动脉粥样硬化性心脏病(以下简称为“冠心病”)属于中医“胸痹”范畴。随着现代社会生活节奏的加快,冠心病发病率逐年升高,严重地影响了人们的生活质量,给社会和家庭带来了沉重的负担。国家名老中医于作盈教授50余年来,对胸痹进行了深入研究,积累了丰富的临床经验,并通过中医药系统治疗有效控制了冠心病的进展,减少了冠状动脉介入治疗。文章对于作盈教授治疗“胸痹”的经验和学术思想进行了总结探析,拓宽了临床治疗思路和方法。

针灸治疗冠心病心绞痛研究进展

冠状动脉粥样硬化性心脏病(以下简称“冠心病”)属于中医学“胸痹”“心悸”“真心痛”等范畴。近年来针灸在治疗冠心病心绞痛方面取得了良好的效果,其主要作用机制是影响血小板活性、改善心肌组织损伤、促进血液循环、促进血管活性物质释放、抗氧自由基等。随着针灸治疗冠心病心绞痛机制研究的不断深入,针灸也被越来越多地应用于该疾病的治疗中。此文针对目前关于针灸治疗冠心病心绞痛的相关研究资料,进行了回顾性分析,将在针灸作用机制和治疗方法上加以论述总结。

桂枝汤治疗心血管疾病的研究进展

心血管疾病依然是当今世界严重威胁人类生命安全的主要疾病,现代医学通过成熟完备的心脏介入技术及各类新型的药物,极大地降低了心血管相关死亡事件,但尽管如此,新技术及新药物依然伴随着众多不良反应的存在,同样影响着患者的生存率及生存质量,桂枝汤作为《伤寒论》的经典名方,经过前人的经验总结,不仅对于太阳表证相关疾病拥有着良好的疗效,尤其对于心血管疾病也同样拥有良好的疗效,现代药理学研究也证实了这一观点,文章以期总结近5年国内外桂枝汤相关研究,对于桂枝汤在治疗心血管疾病方面的进展进行综述,旨在聚焦现代研究热点,把握研究方向,为进一步开展相关研究提供借鉴。

基于痰浊血瘀理论浅谈冠心病的发病机制及中医治疗策略

冠状动脉粥样硬化性心脏病简称冠心病,属于中医学胸痹范畴,是全球致死率最高的疾病之一。冠心病的病因病机复杂多样,痰浊血瘀是其常见分型。痰浊血瘀型冠心病病机典型,临床分期复杂,治疗方法多样。文章从痰瘀互结理论探讨冠心病的中西医发病机制,同时也对近年来针对冠心病的临床治疗及实验室研究的治疗策略进行综述。

老年冠心病合并缺铁性贫血的中西医研究进展

冠状动脉粥样硬化性心脏病即冠心病(CHD)和缺铁性贫血(IDA)是威胁老年人健康的两种主要疾患。CHD患者常伴随着IDA,合并IDA的CHD患者临床病变更严重,且以老年人群最为明显,其5年生存率下降往往超过20%。我国CHD合并IDA的发病率较高。二者在流行病学、病因、病理等方面有许多共同点,且作用机制可相互影响,对患者预后产生不利影响。传统中医认为老年CHD和IDA多属本虚标实、虚实夹杂之证,皆与正气虚弱、脾肾虚衰关系密切。

基于Citespace对健脾法治疗冠心病可视化分析

目的 分析中医药健脾法治疗冠心病的研究现状及热点,探索研究新趋势。方法 检索中国知网近23年收录的健脾法治疗冠心病相关文献,应用CiteSpace 6.2.4.msi软件绘制作者、机构、关键词知识图谱。结果 共纳入文献257篇。自2000年以来,中医药健脾法治疗冠心病的研究总体呈上升趋势。存在2个合作紧密的研究团队,分别以杨关林、张军平为代表;最主要研究机构为辽宁中医药大学;关键词共现分析频次居前3位的为“冠心病”“胸痹”“从脾论治”。结论 基于病证结合的中医药治疗冠心病分子机制研究是目前的研究热点,研究趋势从临床观察拓展到实验研究,未来该领域研究方向更多趋向于健脾祛痰化瘀法,从基因、蛋白直至关键病理环节的成链式、系统式研究。