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Repeat Episodes of Massive Hemoptysis Due to an Anomalous Origin of the Right Bronchial Artery in a Patient with a History of Coccidioidomycosis 球虫病患者右支气管动脉异常起源引起的大咯血反复发作
Pub Date : 2021-09-01 DOI: 10.13175/swjpcc037-21
B. Asllanaj, E. Benge, Yi McWhworter, S. Bhatia
Anomalous bronchial arteries originate outside the space bound by the T5 and T6 vertebrae at the major bronchi. Here, we highlight a case of a 37-year-old man with a past medical history of coccidioidomycosis and who presented with massive hemoptysis. A bronchial angiogram showed the patient had a right bronchial artery originating anomalously from the left subclavian artery. The patient ultimately underwent a bronchial artery embolization, after which he achieved symptomatic remission.
异常支气管动脉起源于主支气管由T5和T6椎体结合的间隙外。在这里,我们强调一个37岁的男性病例,既往有球孢子菌病病史,并表现为大量咯血。支气管血管造影显示患者有右支气管动脉异常起源于左锁骨下动脉。患者最终接受了支气管动脉栓塞,之后症状缓解。
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引用次数: 0
CDC Warns of Increased Ivermectin Overdoses 美国疾病控制与预防中心警告伊维菌素过量使用增加
Pub Date : 2021-08-27 DOI: 10.13175/swjpcc038-21
R. Robbins, Phoenix Pulmonary
No abstract available. Article truncated after 150 words. The US Centers for Disease Control and Prevention (CDC) is warning of an increase in cases of ivermectin overdose due to people self-prescribing the drug in an effort to prevent or treat COVID-19 (1). Ivermectin is used to treat river blindness and intestinal roundworm infection in humans and to de-worm pets and livestock. A study published earlier this year showed that ivermectin killed SARS-CoV-2 in cells in vitro. The authors proposed that the medication be investigated as a cheap and easily available treatment for COVID-19. However, subsequent studies have failed to find any benefit in humans (3). In a new communication to its Health Alert Network, the CDC says cases of overdose and misuse are rising (1). More than 88,000 prescriptions were written for the drug ivermectin in the week ending August 13, an increase of 2400% over the weekly average prior to the COVID-19 pandemic (Figure 1). Unfortunately, the …
没有摘要。文章在150字后被删节。美国疾病控制与预防中心(CDC)警告称,由于人们为了预防或治疗COVID-19而自行开药,伊维菌素过量的病例有所增加(1)。伊维菌素用于治疗人类河盲症和肠道蛔虫感染,以及为宠物和牲畜除虫。今年早些时候发表的一项研究表明,伊维菌素在体外细胞中杀死了SARS-CoV-2。作者建议将这种药物作为一种廉价且容易获得的治疗COVID-19的药物进行研究。然而,随后的研究未能发现对人类有任何益处(3)。在与健康警报网络的最新通信中,疾病预防控制中心表示,过量和滥用的病例正在上升(1)。在截至8月13日的一周内,有超过88000张伊维菌素处方被开具,比COVID-19大流行之前的每周平均水平增加了2400%(图1)。
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引用次数: 0
A Case Series of Electronic or Vaping Induced Lung Injury 电子烟或电子烟致肺损伤病例系列
Pub Date : 2021-08-18 DOI: 10.13175/swjpcc032-21
R. Espinosa, Abdirahman Hussein, M. Sehring, M. Rachid, R. Dunn, D. Taneja
Introduction: Since their introduction, electronic cigarette use has increased and was even proposed as an alternative to traditional tobacco use. Recently, a series of patients with acute respiratory failure due electronic cigarette, or vaping, associated lung injury (EVALI) in 2019 has been described which has largely been attributed to tetrahydrocannabinol (THC) containing vaporizer itself, as well as vitamin E acetate. Several case series have been published regarding the acute presentation, diagnosis and management. In addition to diagnosis and management of EVALI, we sought to describe potential long-term effects of lung parenchyma in these patients. Methods: A retrospective review was performed on 16 patients with clinically diagnosed EVALI at OSF St Francis Medical Center between August 01 2019 and February 1 2020. Relevant demographic and clinical data were collected in patients diagnosed with EVALI. Results: Of the 16 patients in the study the median age (IQR) age was 25.25 (20-29) and 94% were male. The predominant presenting symptoms were dyspnea (94%), cough (56%), nausea 63%), vomiting (63%), abdominal pain (50%), diarrhea (50%), and fever (63%). 2 (13%) patients required endotracheal intubation. Common features of computerized tomography (CT) scan were bilateral diffuse ground glass opacity (93%), septal thickening (53%), and subpleural sparing (47%). Bronchoalveolar lavage (BAL) was obtained in 3 patients and all demonstrated neutrophil predominance of 69% (56-90). One BAL was significant for hemosiderin laden macrophages. Post hospital follow up pulmonary function tests were obtained in 3 and 2 of these were significant for obstructive lung disease. Conclusions: In this case series of patients diagnosed with vaping associated lung injury, obstructive lung disease may be seen on pulmonary function testing and surveillance of these patients should occur regardless of duration.
导言:自推出以来,电子烟的使用有所增加,甚至被提议作为传统烟草使用的替代品。最近,2019年出现了一系列因电子烟或电子烟相关肺损伤(EVALI)而导致急性呼吸衰竭的患者,这在很大程度上归因于含有四氢大麻酚(THC)的蒸发器本身以及维生素E醋酸盐。关于急性表现、诊断和管理的几个病例系列已经发表。除了EVALI的诊断和治疗外,我们还试图描述这些患者肺实质的潜在长期影响。方法:回顾性分析2019年8月1日至2020年2月1日在OSF圣弗朗西斯医疗中心临床诊断为EVALI的16例患者。收集诊断为EVALI患者的相关人口学和临床资料。结果:16例患者中位年龄(IQR)年龄为25.25岁(20-29岁),94%为男性。主要表现为呼吸困难(94%)、咳嗽(56%)、恶心(63%)、呕吐(63%)、腹痛(50%)、腹泻(50%)和发烧(63%)。2例(13%)患者需要气管插管。计算机断层扫描(CT)的常见特征是双侧弥漫性磨玻璃不透明(93%),间隔增厚(53%)和胸膜下保留(47%)。3例患者行支气管肺泡灌洗(BAL),均显示中性粒细胞优势69%(56-90)。一个BAL对含铁血黄素的巨噬细胞有显著意义。住院后随访的肺功能测试中有3例,其中2例对阻塞性肺疾病有显著意义。结论:在本病例中,诊断为电子烟相关肺损伤的患者,肺功能检查可能会发现阻塞性肺疾病,无论持续时间长短,都应该对这些患者进行监测。
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引用次数: 0
Impact of In Situ Education on Management of Cardiac Arrest after Cardiac Surgery 现场教育对心脏手术后心脏骤停管理的影响
Pub Date : 2021-08-16 DOI: 10.13175/swjpcc028-21
B. Gali, G. Arteaga, Glen Au, V. Herasevich
Background: Advanced life support interventions have been modified for patients who have recently undergone sternotomy for cardiac surgery and have new suture lines. We aimed to determine whether the use of in-situ simulation increased adherence to the cardiac surgery unit-advanced life support algorithm (CSU-ALS) for patients with cardiac arrest after cardiac surgery (CAACS). Methods: This was a retrospective chart review of cardiac arrest management of patients who sustained CAACS before and after implementation of in-situ simulation scenarios utilizing CSU-ACLS in place of traditional advanced cardiac life support. We utilized classroom education of CSU-ACLS followed by in-situ high-fidelity simulated scenarios of patients with CAACS.. Interprofessional learners (n = 210) participated in 18 in-situ simulations of CAACS. Two groups of patients with CAACS were retrospectively compared before and after in situ training (preimplementation, n=22 vs postimplementation, n=38). Outcomes included adherence to CSU-ALS for resuscitation, delay in initiation of chest compressions, use of defibrillation and pacing before external cardiac massage, and time to initial medication. Results: Chest compressions were used less often in the postimplementation vs the preimplementation period (11/22 [29%] vs 13/38 [59%], P = 0.02). Time to initial medication administration, use of defibrillation and pacing, return to the operating room, and survival were similar between periods. Conclusion: In this pilot, adherence to a key component of the CSU-ALS algorithm—delaying initiation of chest compressions—improved
背景:高级生命支持干预措施已被修改,适用于最近接受心脏手术胸骨切开术并有新缝合线的患者。我们旨在确定原位模拟的使用是否增加了心脏手术后心脏骤停患者对心脏手术单元高级生命支持算法(CSU-ALS)的依从性。方法:这是一份回顾性图表,回顾了在使用CSU-ACLS代替传统的高级心脏生命支持实施现场模拟场景之前和之后,持续CAACS患者的心脏骤停管理。我们利用CSU-ACLS的课堂教育,然后对CAACS患者进行现场高保真模拟场景。。跨专业学习者(n=210)参与了CAACS的18个现场模拟。两组CAACS患者在原位训练前后进行了回顾性比较(实施前,n=22与实施后,n=38)。结果包括坚持CSU-ALS进行复苏、延迟开始胸外按压、在外部心脏按摩前使用除颤和起搏,以及首次用药时间。结果:实施后与实施前相比,胸外按压的使用频率较低(11/22[29%]vs 13/38[59%],P=0.02)。初始给药时间、除颤和起搏的使用、返回手术室的时间以及两个时期的生存率相似。结论:在这项试验中,对CSU-ALS算法的一个关键组成部分——延迟胸外按压的启动——的坚持得到了改善
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引用次数: 0
Arizona Thoracic Society Supports Mandatory Vaccination of Healthcare Workers 亚利桑那州胸科学会支持医护人员强制接种疫苗
Pub Date : 2021-08-05 DOI: 10.13175/swjpcc033-21
R. Robbins
No abstract available. Article truncated after 150 words. I watched much of the past year and a half of the COVID-19 pandemic in horror listening to the TV pundits and politicians argue against wearing masks, receiving vaccinations, and in general, undermining the safety and freedoms of all Americans. Nothing is done to regulate commentator or politician disinformation under the excuse that these pundits have the right of free speech as a fundamental liberty. Fundamental liberties are freedoms the population is entitled to fully enjoy without government intrusion. Nevertheless, the proper exercise of these liberties, taken in conjunction with the need for public order, national security, the preservation of moral values, as well as respect for the rights of one’s fellowman—all of this necessarily entails that some restrictions be placed upon these liberties (1). Only the freedom of thought, conscience and opinion are subject to no real restriction. Each and every person is free to think what he …
没有可用的摘要。文章在150字后被截断。在过去一年半的时间里,我惊恐地看着新冠肺炎大流行的大部分时间,听着电视专家和政客们反对戴口罩、接种疫苗,总的来说,这会破坏所有美国人的安全和自由。没有采取任何措施来监管评论员或政客的虚假信息,借口是这些评论员有言论自由这一基本自由的权利。基本自由是指人民有权在不受政府干预的情况下充分享有的自由。然而,这些自由的适当行使,与公共秩序、国家安全、维护道德价值观以及尊重同胞权利的需要相结合——所有这些都必然要求对这些自由施加一些限制(1)。只有思想、良心和意见的自由不受真正的限制。每个人都可以自由思考他…
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引用次数: 0
Month: Unilateral Peripheral Lung Opacity » Medical Image of the Month: Bleomycin-Induced Pulmonary Fibrosis in a Patient with Lymphoma 本月医学影像:博莱霉素诱导的淋巴瘤患者肺纤维化
Pub Date : 2021-08-02 DOI: 10.13175/swjpcc024-21
M. Dufwenberg
Interstitial pulmonary fibrosis is the most feared complication of bleomycin therapy and occurs in up to ten percent of patients that receive the drug. The risk of bleomycin-induced pulmonary fibrosis is related to the age of the patient, the dose of medication given, the patient’s kidney function, and whether the patient smokes cigarettes. Current screening guidelines for bleomycin-induced lung injury are limited, but most clinicians screen high risk and symptomatic patients with pulmonary function testing. This case report is of a patient with lymphoma who received bleomycin as a part of his chemotherapy regimen, and later developed pulmonary fibrosis complicated by bouts of eosinophilic multifocal pneumonia. The case highlights the importance of close monitoring of patients taking bleomycin for signs and symptoms of pulmonary fibrosis and the need for major medical societies to issue concrete screening guidelines.
间质性肺纤维化是博来霉素治疗最可怕的并发症,在接受该药治疗的患者中发生率高达10%。博莱霉素诱发肺纤维化的风险与患者的年龄、给药剂量、患者的肾功能以及患者是否吸烟有关。目前博莱霉素引起的肺损伤的筛查指南是有限的,但大多数临床医生通过肺功能测试筛查高风险和有症状的患者。本病例报告是一个淋巴瘤患者接受博来霉素作为其化疗方案的一部分,后来发展为肺纤维化并伴有嗜酸性多灶性肺炎。该病例强调了密切监测服用博来霉素的患者肺纤维化体征和症状的重要性,以及主要医学协会发布具体筛查指南的必要性。
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引用次数: 1
Impact of Recent Job Loss on Sleep, Energy Consumption and Diet. 近期失业对睡眠、能量消耗和饮食的影响。
Pub Date : 2021-08-01 Epub Date: 2021-11-16 DOI: 10.13175/swjpcc045-21
Salma Batool-Anwar, Candace Mayer, Patricia L Haynes, Yilin Liu, Cynthia A Thomson, Stuart F Quan

To examine how sleep quality and sleep duration affect caloric intake among those experiencing involuntary job loss.

Methods: Adequate sleep and self reported dietary recall data from the Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study was analysed. Primary sleep indices used were total sleep time, time spent in bed after final awakening, and sleep quality as measured by the Daily Sleep Diary (DSD). Mean Energy consumption (MEC) was the primary nutritional index. Secondary indices included diet quality using the Health Eating Index 2015 (HEI), and self-reported intake of protein, carbohydrates and fats.

Results: The study participants were comprised mainly of women (61%) and non-Hispanic white. The participants had at least 2 years of college education and mean body mass index of 30.2±8.08 (kg/m 2). The average time in bed was 541.8 (9.0 hrs) ±77.55 minutes and total sleep time was 461.1 (7.6 hrs) ±56.49 minutes. Mean sleep efficiency was 91±6%, self-reported sleep quality was 2.40±0.57 (0-4 scale, 4 = very good), and minutes earlier than planned morning awakening were 14.36±24.15. Mean HEI score was 47.41±10.92. Although the MEC was below national average for both men and women, male sex was associated with higher MEC. In a fully adjusted model sleep quality was positively associated with MEC.

Conclusion: Daily overall assessments of sleep quality among recently unemployed persons were positively associated with mean energy consumption. Additionally, the diet quality of unemployed persons was found to be unhealthier than the average American and consistent with the relationship between poor socioeconomic status and lower diet quality.

研究那些经历非自愿失业的人的睡眠质量和睡眠时间是如何影响热量摄入的。方法:通过职业转换评估日常活动模式(ADAPT)研究分析充足睡眠和自我报告的饮食回忆数据。使用的主要睡眠指标是总睡眠时间、最终醒来后在床上度过的时间以及通过每日睡眠日记(DSD)测量的睡眠质量。平均能量消耗(MEC)是主要营养指标。二级指标包括使用2015年健康饮食指数(HEI)的饮食质量,以及自我报告的蛋白质、碳水化合物和脂肪摄入量。结果:研究参与者主要由女性(61%)和非西班牙裔白人组成。参与者至少受过2年大学教育,平均体重指数为30.2±8.08 (kg/ m2),平均卧床时间为541.8(9.0小时)±77.55分钟,总睡眠时间为461.1(7.6小时)±56.49分钟。平均睡眠效率为91±6%,自我报告睡眠质量为2.40±0.57(0-4评分,4 =非常好),比计划早醒14.36±24.15分钟。平均HEI评分为47.41±10.92。尽管男性和女性的MEC都低于全国平均水平,但男性的MEC较高。在完全调整模型中,睡眠质量与MEC呈正相关。结论:最近失业人员的每日总体睡眠质量评估与平均能量消耗呈正相关。此外,失业人员的饮食质量比普通美国人更不健康,这与社会经济地位差与饮食质量差之间的关系是一致的。
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引用次数: 0
August 2021 Imaging Case of the Month: Unilateral Peripheral Lung Opacity 本月影像病例:单侧周围性肺不透明
Pub Date : 2021-08-01 DOI: 10.13175/swjpcc031-21
M. Gotway
No abstract available. Article truncated after 150 words. Clinical History: A 56-year-old post-menopausal woman was referred to endocrinology after a routine screening bone densitometry scan suggested osteoporosis. She had undergone this testing after she developed back pain following a pulled muscle for which she saw a chiropractor. The patient had no significant past medical history and she was actively involved in exercise. She denied use of alcohol, drugs, and smoking. She had no allergies and was not taking any medications. Her past surgical history included Lasik surgery, breast augmentation 15 years earlier, and surgery for a deviated septum. Physical examination showed a thin patient, afebrile, with a largely normal physical exam, although her pulse was intermittently irregular. Her blood pressure was 130 / 80 mmHg with a normal respiratory rate. Pulse oximetry showed a room air saturation of 98%. When asked about her irregular pulse, the patient recalled that she had episodes of “heart racing” for which she …
没有可用的摘要。文章在150字后被截断。临床病史:一名56岁的绝经后妇女在常规筛查骨密度扫描提示骨质疏松后被转诊至内分泌科。她在肌肉拉伤后出现背痛,为此她去看了脊椎按摩师,之后她接受了这项测试。患者既往无明显病史,且积极参与运动。她否认酗酒、吸毒和吸烟。她没有过敏,也没有服用任何药物。她过去的手术史包括激光手术、15年前的隆胸手术和鼻中隔偏曲手术。体格检查显示,一名瘦瘦的患者没有发烧,尽管她的脉搏间歇性不规则,但体格检查基本正常。她的血压为130/80毫米汞柱,呼吸频率正常。脉搏血氧计显示房间空气饱和度为98%。当被问及她的脉搏不规则时,这位患者回忆说,她有“心跳加速”的症状,为此她…
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引用次数: 0
Impact of Recent Job Loss on Sleep, Energy Consumption and Diet 近期失业对睡眠、能量消耗和饮食的影响
Pub Date : 2021-08-01 DOI: 10.1101/2021.10.11.21264815
S. Batool-Anwar, C. Mayer, P. Haynes, Y. Liu, C. Thomson, S. Quan
To examine how sleep quality and sleep duration affect caloric intake among those experiencing involuntary job loss. Methods; Adequate sleep and self reported dietary recall data from the Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study was analyzed. Primary sleep indices used were total sleep time, time spent in bed after final awakening, and sleep quality as measured by the Daily Sleep Diary (DSD). Mean Energy consumption (MEC) was the primary nutritional index. Secondary indices included diet quality using the Health Eating Index 2015 (HEI), and self-reported intake of protein, carbohydrates and fats. Results The study participants were comprised mainly of women (61%) and non-Hispanic white. The participants had at least 2 years of college education and mean body mass index of 30.2 {+/-} 8.08 (kg/m 2 ). The average time in bed was 541.8 {+/-} 77.55 minutes and total sleep time was 461.1 {+/-}56.49 minutes. Mean sleep efficiency was 91 {+/-} 6%, self-reported sleep quality was 2.40 {+/-}0.57 (0-4 scale, 4 = very good), and minutes earlier than planned morning awakening were 14.36 {+/-}24.15. Mean HEI score was 47.41 {+/-} 10.92. Although the MEC was below national average for both men and women, male sex was associated with higher MEC. In a fully adjusted model sleep quality was positively associated with MEC. Conclusion Daily overall assessments of sleep quality among recently unemployed persons were positively associated with mean energy consumption. Additionally, the diet quality of unemployed persons was found to unhealthier than the average American and consistent with the relationship between poor socioeconomic status and lower diet quality.
研究那些经历非自愿失业的人的睡眠质量和睡眠时间是如何影响热量摄入的。方法;通过职业转换评估日常活动模式(ADAPT)研究分析充足睡眠和自我报告的饮食回忆数据。使用的主要睡眠指标是总睡眠时间、最终醒来后在床上度过的时间以及通过每日睡眠日记(DSD)测量的睡眠质量。平均能量消耗(MEC)是主要营养指标。二级指标包括使用2015年健康饮食指数(HEI)的饮食质量,以及自我报告的蛋白质、碳水化合物和脂肪摄入量。结果研究参与者主要由女性(61%)和非西班牙裔白人组成。参与者至少受过2年大学教育,平均体重指数为30.2 {+/-}8.08 (kg/ m2)。平均卧床时间为541.8{+/-}77.55分钟,总睡眠时间为461.1{+/-}56.49分钟。平均睡眠效率为91{+/-}6%,自我报告的睡眠质量为2.40{+/-}0.57(0-4量表,4 =非常好),比计划早醒14.36{+/-}24.15分钟。平均HEI评分为47.41{+/-}10.92。尽管男性和女性的MEC都低于全国平均水平,但男性的MEC较高。在完全调整模型中,睡眠质量与MEC呈正相关。结论近期失业人员每日睡眠质量总体评价与平均能量消耗呈正相关。此外,失业人员的饮食质量比普通美国人更不健康,这与社会经济地位差与饮食质量差之间的关系是一致的。
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引用次数: 1
A Case and Brief Review of Bilious Ascites and Abdominal Compartment Syndrome from Pancreatitis-Induced Post-Roux-En-Y Gastric Remnant Leak 鲁氏-恩氏术后残胃漏致胰腺炎并发胆汁性腹水和腹腔隔室综合征1例
Pub Date : 2021-07-11 DOI: 10.13175/swjpcc018-21
Marissa Martin, Michael Lee, A. Neumeier, T. Huie
This is a case of a 55-year-old man with Roux-en-Y gastric bypass surgery 15 years prior who presented with acute pancreatitis and developed distributive shock, bacteremia, acute respiratory distress syndrome, anuric acute renal failure, and a distended abdomen with increasing ascitic fluid on imaging. An elevated bladder pressure, lactic acidosis, and anuria raised concern for abdominal compartment syndrome. Paracentesis was done and four liters of bilious ascitic fluid were drained. Intra-abdominal pressure was measured and improved from 27 cmH2O to 13 cmH2O with paracentesis. Mean arterial pressure and urine output also improved. The patient developed recurrent loculated intra-abdominal fluid collections, though ultrasound, CT scans with and without contrast, MRCP, ERCP, upper GI fluoroscopy, and small bowel enteroscopy failed to reveal a source of the bilious output. Ultimately, a gastrostomy tube was placed and delivery of contrast material through the tube revealed active extravasation from the remnant stomach. This case underscores the importance of considering post-surgical leak regardless of how remotely a Roux-en-Y surgery took place, confirms the importance of pursuing early gastrostomy tube placement and contrast administration when post-Roux-en-Y gastric remnant leaks are suspected, and demonstrates the role of paracentesis in critically ill patients with abdominal compartment syndrome.
这是一例55岁男性患者,15年前行Roux-en-Y胃旁路手术,表现为急性胰腺炎,并发分布性休克、菌血症、急性呼吸窘迫综合征、无尿急性肾衰竭,影像学显示腹部膨胀伴腹水增多。膀胱压力升高、乳酸性酸中毒和无尿引起了对腹腔隔室综合征的关注。做了穿刺,排出了四升胆汁腹水。测量腹内压,穿刺后腹内压由27 cmH2O降至13 cmH2O。平均动脉压和尿量也有所改善。患者出现反复的腹腔积液,尽管超声、带或不带造影剂的CT扫描、MRCP、ERCP、上消化道透视和小肠肠镜检查均未发现胆汁输出的来源。最后,放置胃造口管,通过管输送造影剂,发现残胃有活跃的外渗。该病例强调了考虑术后泄漏的重要性,无论Roux-en-Y手术发生的距离有多远,证实了怀疑Roux-en-Y术后胃残余泄漏时早期胃造口管放置和造影剂的重要性,并证明了穿刺在腹膜间室综合征危重患者中的作用。
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引用次数: 0
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Southwest journal of pulmonary & critical care
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