Severe thoracic trauma caused left pneumonectomy complicated by right traumatic wet lung, reversed by extracorporeal membrane oxygenation support-a case report.

BACKGROUND: Double lumen intubation and one-lung ventilation should be applied without delay in cases of traumatic main bronchial rupture. In most cases, when the patients' vital signs have been stabilized, the repair can be performed. However, when one-lung ventilation is complicated by traumatic wet lung, the mortality rate is likely to be much higher. CASE PRESENTATION: In this case, the patient experienced a left main bronchial rupture, bilateral traumatic wet lung, and acute respiratory distress syndrome (ARDS) because of severe thoracic trauma. Though the patient was treated with intubation and mechanical ventilation (MV), his oxygenation was still not stable. Thus, veno-venous extracorporeal membrane oxygenation (V-V ECMO) was initiated; upon improvement of oxygenation, the patient received an exploratory thoracotomy. Unfortunately, the rupture proved to be irreparable, resulting in a total left pneumonectomy. As there was severe ARDS caused by trauma, ECMO and ultra-low tidal volume (VT) MV strategy (3 ml/kg) were utilized for lung protection post-op. ECMO was sustained up to the 10th day, and MV until the 20th day, post-operation. With the support of MV, ECMO and other comprehensive measures, the patient made a recovery. CONCLUSION: V-V ECMO and ultra-low VT MV helped this thoracic trauma patient survive the lung edema period and prevented ventilator associated pneumonia (VAP). In extreme situations, with the support of ECMO, the tidal volume may be lowered to 3 ml/kg.

[The characteristics of Parkinson's disease with dementia and Alzheimer's disease with impaired cognitive function].

OBJECTIVE: To analyze the characterization of cognitive function in Parkinson's disease with dementia and Alzheimer's disease. METHODS: Cognitive function was examined in Parkinson's disease with dementia (PDD) patients (n = 30), Alzheimer's disease (AD) patients (n = 30) and healthy elderly control subjects (n = 60). Neuropsychological evaluation contained semantic fluency test, phonemic fluency test, action fluency test, objective and action naming tests. RESULTS: In PDD group, the score of semantic fluency test is 9.33 ± 2.78, 6.17 ± 1.67 of phonemic fluency test and 7.03 ± 2.34 of action fluency test, it is 6.90 ± 2.47, 7.87 ± 2.01, 8.30 ± 3.17 of AD group. The score of objective and action naming tests is 36.33 ± 3.39, 17.63 ± 2.17 in PDD group, while AD patients is 33.23 ± 3.56 and 22.33 ± 2.37. The verbal fluency tests and naming tests were impaired in PDD and AD patients compared with the healthy elderly control group (P < 0.01), phonemic fluency, action fluency and action naming were more impaired in PDD patients compared with the AD group, while semantic fluency and objective naming were more impaired in AD patients (P < 0.01). CONCLUSIONS: Executive function deficit and naming impairment are found in PDD and AD patients, it shows that PDD is characterized by the addition of cortical dysfunction upon a predominant and progressive fronto-subcortical impairment. There is subcortical dysfunction in AD patients.