The effects of urokinase instillation therapy via percutaneous transthoracic catheter in loculated tuberculous pleural effusion: a randomized prospective study.

The purpose of this study was to propose that intrapleural urokinase (UK) instillation could reduce pleural thickening in the treatment of loculated tuberculous pleural effusion. Forty- three patients who were initially diagnosed as having loculated tuberculous pleural effusion were assigned at random to receive either the combined treatment of UK instillation including anti-tuberculosis agents (UK group, 21 patients) or strictly the unaccompanied anti-tuberculous agents (control group, 22 patients). The UK group received 100,000 IU of UK dissolved in 150 ml of normal saline daily, introduced into the pleural cavity via a pig-tail catheter. The control group was treated with anti-tuberculous agents, excepting diagnostic thoracentesis. After the cessation of treatment, residual pleural thickening (RPT) was compared between the two groups. Clinical characteristics and pleural fluid biochemistry were also evaluated. The RPT (4.59 +/- 5.93 mm) of the UK group was significantly lower than that (18.6 +/- 26.37 mm) of the control group (p < 0.05). The interval of symptoms observed prior to treatment of patients with RPT > or = 10 mm (6.0 +/- 3.4 wks) was detected to be significantly longer than in those with RPT < 10 mm (2.1 +/- 1.2 wks) in the control group (p < 0.05). However, there were no discernible differences were seen in the pleural fluid parameter in patients with RPT > or = 10 mm, as compared to patients with RPT < 10 mm in the UK group. These results indicate that the treatment of loculated tuberculous pleural effusion with UK instillation via percutaneous transthoracic catheter can cause a successful reduction in pleural thickening.

A Case of Septic Azygos Vein Embolism Caused by Staphylococcus aureus Bacteremia.

A Septic embolism is a type of embolism infected with bacteria containing pus. These may become dangerous if dislodged from their original location. Embolisms of this type in the azygos vein are potentially fatal. The diagnosis of septic azygos vein embolism is difficult, so rapid diagnosis and treatment is important to avoid complications. Generally, treatment is enough for appropriate antibiotic therapy without anticoagulant therapy. We report a case of staphylococcal septic embolism in the azygos vein, which was discovered in a 51-year-old man exhibiting chest pain, dyspnea and fever. The patient was treated with antibiotic therapy alone without the use of anticoagulants.

Various computed tomography findings of 2009 H1N1 influenza in 17 patients with relatively mild illness.

PURPOSE: We retrospectively analyzed the computed tomography (CT) findings of H1N1 virus infection in 17 patients with relatively mild illness. MATERIALS AND METHODS: From September 2009 to January 2010, a total of 17 patients with confirmed H1N1 infection were included in the study (mean age 30.7 years). All patients were managed as outpatients or required short hospitalization without ventilation assistance. The CT scans were assessed for the presence of nodules, ground glass opacity (GGO), consolidation, bronchial wall thickening, reticulation, effusion, and lymph node enlargement. Location and distribution were evaluated. RESULTS: The most frequent manifestation was a mixture of nodules, consolidation, and GGO (5/17, 29.4%). In one case there was a focal area of bronchiolitis (centrilobular nodules with tree-in-bud appearance), and 10 of 17 cases (58.8%) showed bronchial wall thickening (findings of bronchitis/peribronchitis) and/or other abnormalities. In 16 of the 17 cases (94.1%) there were CT abnormalities with bilateral and random distribution without zonal predominance. Pleural effusions were seen in eight cases (47.1%). CONCLUSION: In contrast to several reports so far, CT findings of H1N1 virus infection in patients with mild illness are variable, including suggestive findings of inflammation involving large and/or small airways. This study showed various CT findings overlapping with other viral, atypical, or bacterial pneumonia and even cryptogenic organizing pneumonia.

Sonographically guided excisional biopsy of small abdominal wall masses using vacuum-assisted biopsy device.

We report the case of a 37-year-old man who underwent excision of small benign abdominal wall masses using a vacuum-assisted biopsy device designed for breast biopsy (Mammotome). To our knowledge, this is the first application of such a device to remove a soft tissue mass other than a breast lesion.

Acute bilateral basal ganglia lesions in diabetic uraemia: diffusion-weighted MRI.

METHODS: We studied four patients with diabetes mellitus and chronic renal failure who developed sudden choreic movement disorders. The clinical manifestations, laboratory findings, MR imaging findings, and clinical outcome in each patient were evaluated. RESULTS: All four patients had long-term diabetes mellitus and severe azotaemia. Brain MR findings consisted of bilateral symmetric basal ganglia lesions, with decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. All three patients who underwent diffusion-weighted MR imaging (DWI) showed signal intensities similar to those of the surroundings in regions corresponding to increased signal intensity on T2-weighted images, with slightly increased apparent diffusion coefficient (ADC) values. Two of the patients showed small focal areas of restricted diffusion within the basal ganglia lesions. After haemodialysis, follow-up MR imaging in all patients demonstrated that the basal ganglia lesions had regressed markedly, with some residual changes. The movement disorders also improved in all patients. CONCLUSION: A syndrome associated with acute bilateral basal ganglia lesions in diabetic uraemic patients is rare, with reversible changes demonstrated by clinical and imaging findings. DWI showed that the bilateral basal ganglia lesions in this syndrome were primarily vasogenic in origin, although there were small foci of cytotoxic oedema within the lesions.

Radiologic findings of peripheral primitive neuroectodermal tumor arising in the retroperitoneum.

OBJECTIVE: The purpose of this article is to present the radiological findings of peripheral primitive neuroectodermal tumors that arise in the retroperitoneum. CONCLUSION: Peripheral primitive neuroectodermal tumors (PNETs) arising in the retroperitoneum tend to be large and aggressive. Although the imaging appearance of peripheral PNETs is nonspecific, these tumors should be considered in the differential diagnosis when one encounters a large retroperitoneal mass with aggressive features.

Foreign body-induced actinomycosis mimicking bronchogenic carcinoma.

Actinomycosis is a slowly progressive infectious disease caused by an anaerobic and microaerophilic bacteria that colonizes the face, neck, lung, pleura and the ileocecal region. There have been a few cases of this disease which have involved in the lung but one very rare case has been reported. We report a case of foreign body-induced endobronchial actinomycosis mimicking bronchogenic carcinoma in a 69-year-old man. On admission, the patient presented with weight loss, cough and hemoptysis. The fiberoptic bronchoscopy revealed a soft tissue mass, with a partial occlusion of the left upper bronchus, which resembled bronchogenic carcinoma. Contrary to the first impression, the biopsy of the bronchus revealed the mass lesion to be an actinomycotic infection involving the bronchus. After the confirmation of the lesion, treatment with penicillin was initiated. The follow-up bronchoscopy revealed an aspirated fish bone at the site of infection. The foreign body was safely removed.