Giant fluid-filled bulla treated by instillation of antibiotics after percutaneous drainage.

A 46-year-old man was admitted 3 years ago with symptoms of right chest discomfort. A chest X-ray and CT scan revealed an air-fluid level in a previously diagnosed giant bulla in his right upper lung field. Percutaneous drainage of the giant fluid-filled bulla using a pigtail catheter was performed. Instillation of antibiotics was performed twice and the catheter was removed. Two years later almost complete disappearance of the cavity was noted. Although immediate resolution of the giant fluid-filled bulla was not obtainable, the infection was controlled and an invasive procedure avoided.

Advanced glycation end products induce apoptosis and procoagulant activity in cultured human umbilical vein endothelial cells.

Hyperglycemia and the late products of non-enzymatic glycosylation, called advanced glycation end products (AGEs), play an important role in the development of microvascular complications in diabetes mellitus. Previous studies have reported that a high glucose environment triggered apoptotic changes in human umbilical vein endothelial cells (HUVECs). Therefore, we investigated whether AGEs contribute to the development of apoptosis and prothrombotic activity in HUVECs. After incubation of HUVECs with 0.2, 2.2, 22, 220 and 2200 nM of AGE-bovine serum albumin (BSA) from 6 to 48 h, we assayed the degree of apoptosis and procoagulant activity (PCA). There were no significant differences between HUVECs cultured for 48 h with 0.2, 2.2 or 22 nM of AGE-BSA and in controls in the proportion of apoptotic cells (3.5 +/- 0.8%, 3.9 +/- 1.5% and 5.2 +/- 1.1% vs. 2.5 +/- 0.6%). However, the proportion of apoptotic cells increased significantly to 36.7 +/- 9.8% in 220 nM of AGE-BSA, and 72.3 +/- 10.2% in 2200 nM of AGE-BSA (P < 0.001). PCA levels were 142 +/- 10 s after 6 h of exposure to 22 nM (P < 0.01), 131 +/- 5 s after 6 h of exposure to 220 nM (P < 0.001), and 106 +/- 4 s after 6 h of exposure to 2200 nM of AGE-BSA (P < 0.001). These values show that PCA was shortened significantly from the basal value of 161 +/- 6 s, and remained below the basal level until the end of the study. The amount of tissue factor was also significantly increased in 22 and 220 nM of AGE-BSA compared to the controls. In conclusion, this study showed that AGEs could induce apoptosis and increase procoagulant activity in cultured HUVECs. We suggest that AGEs can contribute to the development of microvascular complications through cell death of HUVECs and functional changes of the blood vessels.

Dumbbell shaped exophytic and endobronchial lipomatous hamartoma.

A 63-year-old man presented with a dumbbell-shaped mass obstructing his left upper lobe. He underwent a left upper lobectomy for suspected malignancy. An unexpected pathological diagnosis of endobronchial lipomatous hamartoma was made. Only 6 other cases have been reported in the English literature and only two cases were both endobronchial and exophytic.

Multiple cerebral aneurysms associated with cardiac myxoma in a patient with chronic renal failure: how can we resolve multiple cerebral aneurysms?

Left cardiac myxoma and consecutive embolization into the brain is well documented, whereas the association of myxoma with multiple fusiform cerebral aneurysms is rare. A 48-year old female with chronic renal failure had complained of syncope after receiving hemodialysis. An echocardiogram showed a 3 x 4 cm sized myxoma and brain MRI displayed multiple fusiform aneurysms. The myxoma was successfully removed. Postoperatively, she developed status epilepticus. Unfortunately, the patient did not recover and expired due to sepsis.