Airway management for a patient with tracheobronchomegaly undergoing lobectomy: a case report
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ABSTRACT:
SUBMITTER: Wang S
PROVIDER: S-EPMC10621132 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:In a 68-year-old male patient with cholangitis microabscess in the liver, cavitary lung cancer of the right lower lobe was incidentally diagnosed. The patient's medical history comprised totally laparoscopic distal gastrectomy (TLDG) and cholecystectomy 9 years ago. Before TLDG, endoscopic retrograde cholangiopancreatography (ERCP) was performed because of a common bile duct stone and cholangitis. Three months ago, he was readmitted with cholangitic microabscess, and a cavitary lesion of right lower lobe was detected incidentally. Hepatobiliary microabscess was improved with ERCP and antibiotic treatment. Video-assisted thoracoscopic surgery (VATS) right lower lobectomy and mediastinal lymph node dissection were undergone uneventfully. Pneumonic infiltration in the right lower lung field and hydropneumothorax on the right side were developed on postoperative day 10. Chest computed tomography showed pneumobilia and micro-bronchopleural fistula (BPF) was suspected with bronchoscopic examination. Despite antibiotics usage and thoracic suction, air leakage could not be improved. VATS Talc pleurodesis was performed on postoperative day 38. Contralateral pneumonia developed 1 week following talc pleurodesis. Furthermore, bilirubin was detected in the repeated bronchial washing and pleural fluid and they showed the same color and nature. Though ERCP and endoscopic nasobiliary drainage, the patient's condition deteriorated and the patient passed away on postoperative day 60. Bronchopleurobiliary fistula is an extremely rare complication after thoracic surgery for which surgical treatment is challenging, early recognition of a developing fistula and the aggressive treatment at an early stage can reduce the associated morbidity and mortality from the sequelae of this rare disease entity.
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Project description:We report clinical and genetic findings of a 14-year-old male with T-cell acute lymphoblastic leukemia with low-hypodiploidy. The medical history included neck pain for a month, facial nerve palsy on the right side for 6 days, fever, drowsiness, and weakness for 3 days, vomiting, diarrhea for 1 day. The physical examination presented features of hypovolemia, palsy of the facial nerve on the right side, enlarged lymph nodes, hepatosplenomegaly, sore throat, and petechiae of the skin. Radiological images indicated lesions of different organs. Bone marrow biopsy confirmed precursor T-ALL. In the FISH tests, KMT2A and BCR/ABL1 rearrangements were not observed. GTG banding revealed 3 cell clones, which confirmed the hypodiploidy. Multiplex RT-qPCR was performed. STIL/TAL1 (del1p32) gene rearrangement was found in the blast cells. Additional tests were performed using the CytoScan HD microarray technique. Molecular karyotype did not reveal hypodiploidy, but identified other abnormalities such as duplication of chromosomal regions: 4q25q35.2, 6p23.3p11.1 and 8p23.3q24.21, and the loss of heterozygosity of short arm chromosome 9. In two regions of the chromosome biallelic deletions were found at 9p21.3, including the CDKN2A, CDKN2B, IFNA1, MTAP genes and at 10q23.31, containing PTEN. The child died 9 days after diagnosis. Bone marrow biopsy, GTG banding, FISH techniques, and molecular karyotyping were used to make an accurate diagnosis. This case documents a rapid progression of the disease and unfavorable results of T-cell acute lymphoblastic leukemia with hypodiploidy.
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Project description:BackgroundCOVID-19 is usually a time-limited disease. However, prolonged infections and reinfections can occur among immunocompromised patients. It can be difficult to distinguish a prolonged infection from a new one, especially when reinfection occurs early.MethodsWe report the case of a 57-year-old man infected with SARS-CoV-2 while undergoing chemotherapy for follicular lymphoma. He experienced prolonged symptomatic infection for 3 months despite a 5-day course of remdesivir and eventually deteriorated and died.ResultsViral genome sequencing showed that his final deterioration was most likely due to reinfection. Serologic studies confirmed that the patient did not seroconvert.ConclusionsThis case report highlights that reinfection can occur rapidly (62-67 d) among immunocompromised patients after a prolonged disease. We provide substantial proof of prolonged infection through repeated nucleic acid amplification tests and positive viral culture at day 56 of the disease course, and we put forward evidence of reinfection with viral genome sequencing.
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