Hemorrhagic Malignant Pleural Effusion: Diagnosis, Survival Rate, and Response to Talc Pleurodesis.

Hemorrhagic malignant pleural effusion (HMPE) is diagnosed in 47-50% of all malignant pleural effusions (MPE). The aim of this study is to evaluate clinical, radiological, and morphological manifestations of HMPE and results of talc pleurodesis treatment. This is a retrospective review of the medical charts of 135 MPE patients which consists of HMPE group (42 patients) and simple MPE group (63 patients) (median age 67.9 years; 43 males, 62 females). In HMPE vs. simple MPE patients, pronounced dyspnea (100% vs. 88.9%, P = 0.024), chest pain (59.5% vs. 60.3%, P = 1), general deterioration (78.6% vs. 74.6%, P = 0.411) combined with large pleural effusion (81% vs. 50.8%, P = 0.001), and thickening of parietal pleura (73.8% vs. 68.3%, P = 0.349), all were more specific for HMPE. Cytological examination of HMPE showed more malignant pleural fluid cells (81% vs. 63.5%, P = 0.043). Histological examination revealed poorly differentiated types of tumors in 69.05% of HMPE (bronchogenic 33.33%, intestinal 16.67%, breast 14.3%) vs. 7.94% of simple MPE. In 19 HMPE vs. 0 simple MPE patients, thoracoscopy showed bleeding nodules (94.7%) on thickened parietal pleura (84.2%). Pleurodesis with talc by slurry (59%) and poudrage (41%) was less effective in HMPE than in simple MPE patients after 1 month (failed response; 33.3% vs. 21.6, P = 0.019), 3 months (42.9% vs. 25.7%, P = 0.017), and 6 months (42.9% vs. 21.7%, P = 0.035). Survival in HMPE was significantly lower (3.06 months vs. 5.37 months, P = 0.0005). HMPE has more severe clinical, laboratory, radiological, and endoscopic manifestations due to a more poorly differentiated malignant process. Talc pleurodesis was less effective in HMPE, and survival was poor.

Case Report: Surgical Management of Painful Manubriosternal Pseudoarthrosis.

A 31-year-old male amateur bodybuilder presented with a 2-year history of chronic pain over the sternum and a clicking sensation in the chest wall on movement. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) showed no cause for his symptoms. Dynamic ultrasound scan performed at a specialist sports center revealed pseudoarthrosis of the manubriosternal joint (MSJ). After a period of conservative management (rest and analgesia), he failed to improve and underwent debridement and fusion of the MSJ with plates and screws. At follow-up 23 months later, he remains pain-free and has returned to weight lifting and bodybuilding.

Rethinking SME default prediction: a systematic literature review and future perspectives.

Over the last dozen years, the topic of small and medium enterprise (SME) default prediction has developed into a relevant research domain that has grown for important reasons exponentially across multiple disciplines, including finance, management, accounting, and statistics. Motivated by the enormous toll on SMEs caused by the 2007-2009 global financial crisis as well as the recent COVID-19 crisis and the consequent need to develop new SME default predictors, this paper provides a systematic literature review, based on a statistical, bibliometric analysis, of over 100 peer-reviewed articles published on SME default prediction modelling over a 34-year period, 1986 to 2019. We identified, analysed and reviewed five streams of research and suggest a set of future research avenues to help scholars and practitioners address the new challenges and emerging issues in a changing economic environment. The research agenda proposes some new innovative approaches to capture and exploit new data sources using modern analytical techniques, like artificial intelligence, machine learning, and macro-data inputs, with the aim of providing enhanced predictive results.

Comparison of Ciaglia and Griggs Percutaneous Tracheostomy Techniques - A Biomechanical Animal Study.

BACKGROUND AND AIMS: The two most common commercial percutaneous dilation tracheotomy (PDT) sets apply different techniques. Our aim was to investigate the biomechanical properties of these two techniques on an animal model, that simulate a human trachea. MATERIALS AND METHODS: Biomechanical properties of the different steps of the Ciaglia Blue Rhino® and Griggs Portex® techniques were measured on 20 pig cadavers. RESULTS: We found that the use of the two different devices created equal sized openings in the trachea (p >0.05). The force needed to insert the Griggs forceps was 1.8 kg average compared to 2.51 kg using the Ciaglia dilator (p <0.00001). The calculated total energy expenditure in the Ciaglia Blue Rhino® kit was 1.46 times greater than the Griggs Portex® kit (p <0.0001). This was mainly due to the amount of energy required during the final dilator stage, which was 4 times more using the Ciaglia Blue Rhino® dilator than the Portex® Griggs-dilator forceps. CONCLUSION: We conducted a series of biomechanical properties experiments on an animal model of PDT using two popular commercial kits - Griggs Portex® guidewire dilating forceps by Smiths Medical and Ciaglia Blue-Rhino® by Cook Medical. The Ciaglia technique required almost 50% more energy to perform a PDT (p <0.0001), mainly because of the force exerted during the final dilator insertion stage compared to the Griggs forceps. Further research is needed to examine if these properties are related to some of the PDT complications. HOW TO CITE THIS ARTICLE: Ronen O, Rosin I, Taitelman UZ, Altman E. Comparison of Ciaglia and Griggs Percutaneous Tracheostomy Techniques - A Biomechanical Animal Study. Indian J Crit Care Med 2019;23(6):247-250.

Percutaneous Dilatational Tracheostomy Using Tube Exchanger.

We describe a modified technique for percutaneous dilatational tracheostomy using a 15F tube exchanger or Eschmann catheter. A retrospective review of 1180 procedures using this modified technique demonstrated it to be effective with a failure rate of only 0.25% (3 patients). Moreover, it provides an additional safeguard with the ability to rapidly reintroduce the endotracheal tube into the trachea guided by the exchange catheter in the event of accidental extubation during the procedure. This technique needs no additional special devices or equipment (eg, a bronchoscope). However, a prospective study is needed to better define its complication rate.

Solitary fibrous tumour: a rare tumour of the pleural cavity.

Solitary fibrous tumours are a rare group of tumours that originate from connective tissues such as the pleura and mediastinum. When growing within the thoracic cavity these tumours exert pressure on vital organs and large vessels. We have successfully operated on two patients with large solitary fibrous tumours and managed the pathophysiological changes manifested as superior vena cava syndrome resulting from these tumours.

Tension pyopneumothorax.

Tension pyopneumothorax is a rare complication of pneumonia and subpleural abscess eroding into the pleural space. We present a case of tension pyopneumothorax in a drug addict. Successful treatment consisted of pleural drainage and parenteral antibiotics. The presence of an air-fluid level accompanying tension pneumothorax on chest radiograph should alert the physician to the possibility of this emergency condition.

Emergency percutaneous tracheostomy in trauma patients: an early experience.

BACKGROUND: In recent years, percutaneous tracheostomy (PCT) has become a routine practice in many hospitals. In the early publications, most authors considered adverse conditions such as short or fat neck or obesity as relative contraindications, whereas cervical injury and emergency were regarded as absolute contraindications. More recently, several reports demonstrated the safety and feasibility of PCT in patients with some of the above contraindications. We, like many others, gradually reduced the contraindications and expanded the indications for PCT. In this paper, we report our early experience with emergency PCT in trauma patients. METHODS: Ten adult patients suffering from multiple injuries after motor vehicle accident (7) or severe head and neck burns (3) required emergency surgical airway control after failure to accomplish orotracheal intubation. A modified Griggs' technique was used by experienced thoracic surgeons. Recorded data included patient demographics, clinical and anatomic conditions, length of procedure, and complications. Short-term follow-up was performed in the hospital by thoracic staff surgeons. Long-term follow-up was carried out in the outpatient clinic. RESULTS: Six male and 4 female patients underwent emergency PCT. The mean time from skin incision to intubation was 5.5 minutes including the oxygen insufflation period. There was no failure, no procedure-related complication, and no conversion to open technique. Five patients survived and underwent uneventful decannulation. In approximately 1 year of follow-up, there were no clinical symptoms or signs of complications related to the tracheostomy. CONCLUSIONS: Emergency PCT using a modified Griggs' technique is feasible and safe. In experienced hands, it might be even easier and faster than the open surgical tracheostomy.