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1.
Medicine (Baltimore) ; 103(30): e39094, 2024 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-39058830

RESUMO

RATIONALE: Extracorporeal membrane oxygenation (ECMO) is the last trump card for severe respiratory failure. The main complications of ECMO are bleeding and thrombosis, both of which can be life-threatening. Large blood clots can cause central airway obstruction (CAO) during ECMO, and CAO should be removed as soon as possible because of asphyxiation. However, there is no comprehensive reports on its frequency and management. The purpose of this study is to share therapeutic experiences for rare and serious conditions and provide valuable insights. PATIENT CONCERNS: We report 3 patients placed on ECMO for severe respiratory failure. DIAGNOSIS: CAO due to large blood clots occurred during ECMO in all 3 patients. INTERVENTIONS: Large blood clots were removed using flexible bronchoscopy, grasping forceps, and net retrieval devices in all 3 patients. OUTCOMES: In all 3 patients, large blood clots were removed multiple times during ECMO. The patients' respiratory conditions improved and they were eventually weaned off the ECMO. LESSONS: CAO due to large blood clots during ECMO is rare. The frequency of CAO requiring bronchoscopic removal was estimated to be approximately 1,5%. When this occurs, clots should be removed as soon as possible. Net retrieval devices are useful tools for the collection of large blood clots.


Assuntos
Obstrução das Vias Respiratórias , Oxigenação por Membrana Extracorpórea , Trombose , Humanos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/instrumentação , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Masculino , Trombose/etiologia , Feminino , Broncoscopia/métodos , Broncoscopia/efeitos adversos , Insuficiência Respiratória/terapia , Insuficiência Respiratória/etiologia , Pessoa de Meia-Idade , Adulto
2.
Thorac Cancer ; 14(25): 2618-2621, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37488715

RESUMO

Previously, cytotoxic drugs were the only option for patients with non-small cell lung cancer (NSCLC) and the prognosis was poor. However, molecularly targeted therapies and immune checkpoint inhibitors represent a breakthrough in the treatment of advanced NSCLC and have improved survival rates. In addition, advances in next-generation sequencing (NGS) have revealed the landscape of genomic alterations in patients with different cancers, aiding in the development of new molecularly targeted drugs. The patient reported here was a 54-year-old woman with left lower lung adenocarcinoma. The lung cancer was staged as T2aN3M1a stageIVA 11 years ago. She had received seven regimens of chemotherapy for 11 years. Among these, pemetrexed (PEM) regimens particularly showed long-term effects totaling more than 5 years. We performed NGS after disease progression of the seventh treatment. NGS revealed CD74-ROS1 fusion and she was treated with entrectinib. She has been taking entrectinib for over 20 months now. Herein, we report a rare case of CD74-ROS1-positive lung adenocarcinoma diagnosed by NGS that achieved long-term survival with cytotoxic drugs, especially PEM regimens. In patients showing favorable clinical response to PEM regimens, physicians should consider testing for ROS1/ALK rearrangement.


Assuntos
Adenocarcinoma de Pulmão , Antineoplásicos , Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Feminino , Humanos , Pessoa de Meia-Idade , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Pemetrexede , Proteínas Tirosina Quinases/genética , Proteínas Proto-Oncogênicas/genética , Adenocarcinoma de Pulmão/tratamento farmacológico , Antineoplásicos/uso terapêutico , Sequenciamento de Nucleotídeos em Larga Escala
3.
Clin Case Rep ; 10(12): e6754, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36567689

RESUMO

Coronavirus disease 2019 (COVID-19) has become a worldwide outbreak, and it can cause various symptoms and complications. However, pneumothorax secondary to COVID-19 is relatively uncommon. We herein report a 60-year-old man with bilateral refractory pneumothorax with severe COVID-19. In patients with poor general health and who are difficult to undergo surgery for pneumothorax post-COVID-19, internal treatments such as chest drainage, bronchial occlusion, and pleurodesis are essential to relieving refractory pneumothorax. It also indicates that autologous blood patch pleurodesis is a useful method in terms of efficacy and side effects.

4.
Respir Med Case Rep ; 31: 101266, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33134073

RESUMO

Immune checkpoint inhibitors (ICIs) improved the prognosis of patients with advanced lung cancers. The combination therapy of cytotoxic drugs and ICI is approved as first-line chemotherapy in non-small-cell lung cancer (NSCLC) and extensive disease small-cell lung cancer (ED-SCLC). It has been reported various immune-related adverse events (irAEs). We herein report a 65-year-old man with NSCLC who developed hepatitis and pancreatitis simultaneously during the combination immunochemotherapy. In the treatment of hepatitis and pancreatitis, the clinical course was different. In this report, the importance of accurate diagnosis through detailed examination and treatment priority depending on the severity of the symptoms is indicated.

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