A Rare Presentation of Minimally Invasive Mesothelioma as a Large Tension Pneumothorax.

Development of mesothelioma is associated with asbestos exposure. Common presentations are with pleural-based plaques invading the chest wall and/or pleural effusion on chest imaging. The intent of this case report is to describe a rare presentation of mesothelioma, which presented atypically as a large tension pneumothorax. A 93-year-old male presented with a history of dyspnea that started after a coughing episode. On physical examination he was hemodynamically stable, but was hypoxic requiring 2L of supplemental oxygen. Computed tomography of the chest revealed a large right tension pneumothorax. A chest tube was placed and connected to suction (-20cmH20), but he continued to have an unresolving air leak over the following 2-week period. Upon video-assisted thoracotomy there were no blebs or adhesions seen. Right apical wedge resection and talc pleurodesis were performed. Pathologic examination revealed an atypical mesothelial cell proliferation with minimal, focal invasion into the pulmonary parenchyma. Tumor spread along the visceral pleura was thought to be the underlying cause of the pneumothorax. The surgical margins were uninvolved by the tumor, and the patient was later discharged home in stable condition. This was a rare presentation of what could best be described as minimally invasive mesothelioma arising in a background of probable mesothelioma in situ, which presented atypically as a large tension pneumothorax. This case highlighted the importance of establishing a pathologic diagnosis from pleural effusion cytology and/or pleural biopsy in persons presenting with spontaneous pneumothorax, and the difficulty in confirming a pathologic diagnosis of early mesothelial neoplasia.

Mental Health in Women.

Mental health illness has been increasing worldwide. The prevalence of mental illness and is higher among females than among males. It is estimated that one in 5 women experience a common mental health disorder. This article highlights gender disparities in the risk, prevalence, and presentation of different mental health disorders. Nearly all survivors of critical illness experience 1 or more domains of the post-intensive care syndrome. We review different mental health disorders including anxiety disorders, mood disorders, psychotic disorders, and post-intensive care syndrome, and medications used to manage these disorders. Delirium in the intensive care unit can be misdiagnosed as a primary psychiatric disorder and is important to distinguish from each other. We also highlight the inadequacy of surveillance and recognition of mental health disorders in the intensive care unit, leading to missed opportunities to properly manage these important psychiatric conditions.

Giant Cell Interstitial Pneumonia In Native, Transplanted And Re-Transplanted Lungs 8 Years Apart Without Known Hard Metal Exposure.

Pneumoconioses are a group of non-neoplastic pulmonary disorders caused by inhaled inorganic particles. Well-described pneumoconioses include asbestosis, silicosis, coal worker's pneumoconiosis, chronic beryllium disease, and hard metal lung disease. Giant cell interstitial pneumonia (GIP) is a distinctive and rare pneumoconiosis most frequently found in workers exposed to hard metals, primarily cobalt and tungsten carbide. The pathologic picture is considered virtually pathognomonic for hard metal lung disease, although this dogma has been questioned by a few reports of giant cell interstitial pneumonia in patients without apparent hard metal exposure. Giant cell interstitial pneumonia is even rarer in lung transplant recipients. Here, we present a patient without known hard metal exposure who was found to have persistent giant cell interstitial pneumonia in native, transplanted and re-transplanted lungs 8 years apart.

Lung cancer staging, the established role of bronchoscopy.

PURPOSE OF REVIEW: Lung cancer is the leading cause of cancer-related deaths worldwide. In the absence of distant metastases, accurate mediastinal nodal staging determines treatment approaches to achieve most favourable outcomes for patients. Mediastinal staging differentiates N0/N1 disease from N2/N3 in surgical candidates. Likewise, presence of nodal involvement in nonsurgical candidates who are being considered for stereotactic body radiation therapy is also critical. This review article seeks to discuss the current options available for mediastinal staging in nonsmall cell lung cancer (NSCLC), particularly the role of bronchoscopy. RECENT FINDINGS: Although several techniques are available to stage the mediastinum, bronchoscopy with EBUS-TBNA with or without EUS-FNA appears to be superior in most clinical situations based on its ability to concomitantly diagnose and stage at once, safety, accessibility to the widest array of lymph node stations, cost and low risk of complications. However, training and experience are required to achieve consistent diagnostic accuracy with EBUS-TBNA. SUMMARY: EBUS-TBNA with or without EUS-FNA is considered the modality of choice in the diagnosis and staging of NSCLC in both surgical and nonsurgical candidates.

Use of slide scrape lysates for polymerase chain reaction confirmation of disseminated Mycobacterium avium infection in a cat.

Disseminated mycobacteriosis in a 3-year-old domestic medium-haired cat was diagnosed on lymph node cytology. Slide scrape lysates from the cytology submission were used to confirm Mycobacterium avium by polymerase chain reaction (PCR) and sequencing and proved a simple technique that could be a valuable tool in veterinary diagnostics and research.

Utilisation d'un lysat de grattage de lame pour la confirmation par amplification en chaîne par la polymérase d'une infection disséminée à Mycobacterium avium chez un chat. Une mycobactériose disséminée chez un chat domestique à poil moyen âgé de 3 ans a été diagnostiquée à l'aide d'une cytologie des ganglions lymphatiques. La soumission d'un lysat de grattage d'une lame provenant de la soumission de cytologie a été utilisé pour confirmer Mycobacterium avium par amplification en chaîne par la (PCR) et séquençage et elle s'est avérée une technique simple qui pourrait être un outil utile dans les diagnostics et la recherche vétérinaires.(Traduit par Isabelle Vallières).

Lineup administrator influences on eyewitness identification decisions.

The present research examines how a lineup administrator may influence eyewitness identification decisions through different forms of influence, after providing the witness with standard, unbiased instructions. Participant-witnesses viewed a staged crime and were later shown a target-present or target-absent lineup. The lineup administrators either remained silent while the witness examined the lineup, made ostensibly cautionary statements to the witness, or prompted the witness to identify the person in the lineup who seemed most similar to the perpetrator. These two forms of influence, denoted as subtle-influence and similarity-influence conditions, led to different patterns of identification results. Results for the similarity-influence condition were generally consistent with criterion shift and relative judgment models of eyewitness decision making. Results for the subtle-influence condition, however, cannot be explained by alterations in the decision rule. A weighted matching model is outlined to explain results from the subtle-influence condition. Witnesses seemed generally unaware of the attempts by the lineup administrator to influence their decision, although some noted it, and the probative value of suspect identifications was lower for those who did note it. Implications for theory and policy are discussed.