Medical thoracoscopy with cryobiopsy as diagnostic tool for pleural metastatic in cutaneous squamous cell carcinoma: a rare case report.

Introduction: Distance metastasis of cutaneous squamous cell carcinoma (cSCC) to pleural is rarely reported, and meets difficulties in diagnosing due to quality of pleural biopsy sample. This case presented a novel technique by using cryobiopsy to obtain adequate sample and was first conducted in our hospital. Case presentation: A 62-years-old man admitted to hospital with dyspnoea due to massive right pleural effusion. Lung multi-sliced computed tomography showed right lung pleural effusion with compression atelectasis as well as collapse of medial lobe and upper lobe, multiple solitary nodules on mediastinal, costal antero-posterior and right diaphragm pleural part. Medical thoracoscopy was performed to obtain pleural samples by using cryobiopsy and forceps biopsy. Pathological analysis with Immunohistochemistry (IHC) revealed metastatic squamous cell carcinoma. Discussion: Recurrence rate of cSCC remains high even after treatment, with worse prognosis. Distant metastasis to pleural is rarely reported. Clinical approach for malignant pleural effusion by using medical thoracoscopy has 80% sensitivity with minimal complication. Pleural cryobiopsy is a novel technique used for obtaining sample from pleural biopsy with significant larger size of the specimen, less crush artefacts, fragmented and better tissue integrity, although the diagnostic yield and bleeding severity between cryobiopsy and conventional forceps biopsy are not significant. Conclusion: Medical thoracoscopy with cryobiopsy should be considered as a preferrable diagnostic tool for obtaining better sample specimen, especially for pleural metastatic.

The chest X-ray radiologic severity index as a determinant of the severity of COVID-19 pneumonia: study based on the duration of treatment and inpatient rooms.

Introduction: The chest X-ray examination is an imaging modality that is widely used in screening for COVID-19 pneumonia. The problems with treating COVID-19 pneumonia patients are the high incidence and severity of the disease and the limitations of treatment room facilities. The chest X-ray Radiologic Severity Index is expected to assist clinicians in obtaining the relationship between the extent of lesions on X-ray and the duration of treatment and hospitalization for COVID-19 pneumonia patients. Results: This study used an observational method using a retrospective approach. The research subjects were COVID-19 pneumonia patients from March 2020 to April 2021 who were hospitalized at Doctor Kariadi General Hospital Semarang. A total of 105 subjects confirmed positive RT-PCR and received serial X-ray examination services during treatment. The calculation of the RSI value was carried out on all X-ray chest X-rays and then statistically analyzed using the paired T test and Mann-Whitney methods. There was no significant relationship between the value of RSI1 and the duration of hospitalization with p = 0.566, as well as the value of RSI2 with the duration of hospitalization with p = 0.715. There is a significant relationship between the values of RSI1 and RSI2 with the use of the intensive care unit with p < 0.000, respectively. There was a significant relationship between the values of RSI1 and RSI2 with the use of ventilators in treatment, with p < 0.000. Furthermore RSI1 and RSI2 have a good result as predictor of intensive care and ventilator usage. Conclusion: The chest X-ray RSI has no significant relationship with the duration of hospitalization. The value of the chest X-ray RSI has a significant relationship with the use of intensive care rooms and the use of ventilators in treatment. The increase in the RSI value can describe the severity of the disease so that it plays a role in planning the treatment room.

Comparative estimation of pleural effusion volume based on lateral decubitus position of chest x-ray and CT scan imaging.

Previous study using thoracic phantom for estimating fluid volume has been obtained which represents the case of pleural effusion based on the size of the x-ray radiograph. The models are obtained in the form of three equations, the pleural effusion volume as a function of height, length times the height, and area of the radiograph image. The three models of estimation have high linearity with ratio value more than 0.988, higher than the modelling measurement using ultrasonography modality. The modelling is expected to give a contribution on developing method for helping clinicians estimate the pleural effusion volume as a basic for performing fluid aspiration and to monitor the therapy. However, because modelling is developed using phantoms, then to be applied clinically, further research is needed for its application to patients. The height function model yields correlation value of 0.966 and paired T-test value of 0.892. The height times length function model yields correlation value of 0.982 and paired T-test value of 0.611. The area function model yields correlation value of 0.997 and paired T-test value of 0.647. From the three equations, measurement of estimated pleural effusion volume using area function on chest x-ray lateral decubitus position is the most appropriate equation. Corresponding to the results of the measurement of gold standard using a CT scan. Height measurement is the measurement that is the fastest and easiest in the application. Limitation of the study is it only can be done in right lateral decubitus position of the patient, and also cannot be applied to patients with condition such as post lung surgery, massive subpulmonic/ supradiaphragmatic pleural effusion, empyema, an atypical pleural effusion such as septated, encapsulated, loculated pleural effusion and anatomical deformity, scoliosis, or abnormalities of thoracic cavity.

Viruses and Gram-negative bacilli dominate the etiology of community-acquired pneumonia in Indonesia, a cohort study.

OBJECTIVE: Knowledge about the etiology of community-acquired pneumonia (CAP) is essential for adequate management. Presently, few studies about CAP are available from Southeast Asia. This study aimed to investigate the etiology, severity, and outcome of CAP in the most populous Southeast Asia country, Indonesia. METHODS: From October 2007 to April 2009, adult patients admitted with CAP to two hospitals in Semarang, Indonesia, were included to detect the etiology of CAP using a full range of diagnostic methods. The severity of disease was classified according to the Pneumonia Severity Index (PSI). The outcome was assessed as 30-day mortality. RESULTS: In total, 148 consecutive patients with CAP were included. Influenza virus (18%), Klebsiella pneumoniae (14%), and Streptococcus pneumoniae (13%) were the most common agents identified. Other Gram-negative bacilli, Mycobacterium tuberculosis, Chlamydia pneumoniae each accounted for 5%. The bacteria presented wild type antibiotic susceptibility profiles. Forty-four percent of subjects were high-risk patients (PSI class IV-V). The mortality rate (30%) was significantly associated with disease severity score (P<0.001), and with failure to establish an etiological diagnosis (P=0.027). No associations were found between etiology and underlying diseases, PSI class, nor mortality. CONCLUSIONS: Viruses and Gram-negative bacilli are dominant causes of CAP in this region, more so than S. pneumoniae. Most of the bacteria have wild type susceptibility to antimicrobial agents. Patients with severe disease and those with unknown etiology have a higher mortality risk.