A Rare Complication: Development of an Aspergilloma after Endobronchial Coil Placement in a COPD Patient.

Endobronchial coils are a relatively novel endoscopic lung volume reduction modality that aims to increase functional capacity in chronic obstructive pulmonary disease (COPD) patients. Two major trials have studied the safety and efficacy of this therapy, but long-term safety has not been studied. Adverse events reported are mainly periprocedural pneumothoraces and early bacterial infectious complications. We report the case of a patient with severe emphysema (Global Initiative for Chronic Obstructive Lung Disease stage IV COPD) who developed endobronchial coil-associated aspergillomas 3 years after coil placement.

Body Composition in Very Preterm Infants: Role of Neonatal Characteristics and Nutrition in Achieving Growth Similar to Term Infants.

BACKGROUND: The identification of factors involved in the postnatal growth of preterm infants will help achieve growth similar to that of term infants. OBJECTIVES: As per protocol: to compare body composition in very preterm infants at term-corrected age (TCA) with that in term infants, and to explore relationships between neonatal characteristics and body composition in preterm infants. METHODS: Anthropometry, nutritional characteristics, and neonatal outcomes were prospectively collected in 26 preterm (<29 weeks) and 33 term (37-40 weeks) infants. Body composition using dual-energy X-ray absorptiometry (DXA) was measured at TCA in preterm infants and between days 7 and 10 in term infants. RESULTS: Parenteral nutrition in preterm infants provided a mean of 2.9 ± 0.2 and 2.1 ± 0.5 g/kg/day of intravenous amino acids and lipids, respectively, during the first week of life. The mean weight gain velocity from birth to DXA assessment was 12.1 ± 1.4 g/kg/day. Compared with term infants, preterm infants at TCA were shorter and lighter, with a smaller head circumference, a lower weight estimated by DXA (2,960 ± 552 vs. 3,843 ± 377 g), and increased skinfold thicknesses. Fat mass percent (13.9 ± 5.4%) and lean mass percent (84.7 ± 5.6%) in preterm infants were similar to those in term infants (14.7 ± 3.5 and 83.5 ± 3.6%, respectively). Neonatal weight gain velocity in preterm infants was positively associated with lean mass (grams). CONCLUSION: Subcutaneous fat is increased in preterm infants. Higher protein intake in preterm infants might increase weight gain velocity and achieve a lean mass comparable to that of term infants.

Breast-related CSF shunt complications: literature review with illustrative case.

In this article, we discuss and classify breast-related ventriculoperitoneal (VP) cerebrospinal fluid (CSF) shunt complications, and provide a literature review. Shunt complications related to pre-existing breast implants comprise nearly half of the breast-related shunt complications reported thus far. We present a complication of shunt failure in a 61-year-old woman who had previously undergone mastectomies for breast cancer with implant reconstruction. Following shunting, she developed headaches, fever, and right-sided breast swelling and erythma consequent to breast implant rupture, distal shunt migration, and CSF pseudocyst. This case is unique in that it involved rupture of a breast implant from VP shunt insertion. For complication avoidance, neurosurgeons should be aware of the potential pitfalls in shunting patients with breast implants.

Gliomas: advances in molecular analysis and characterization.

BACKGROUND: Gliomas represent the most common primary brain tumor. Despite recent advances in diagnostic imaging, neurosurgical technique, radiation therapy, and chemotherapy, significant advances in accurate prognosis and improved survival have not been achieved. Nevertheless, new developments in molecular biology could have potential impact on the clinical management of patients with these brain tumors. This review will describe the technological advances being used to enrich the classification of gliomas, present specific studies that have successfully used the new technologies to identify molecular subtypes of glioblastoma, and discuss the implications of such enhanced classification and molecular characterizations for the prediction of therapeutic response and the design of future brain tumor therapies. RESULTS: Innovative techniques using complementary DNA and oligonucleotide microarrays (gene chips), tissue microarrays (tissue chips), and differential immunoabsorption have provided high throughput and potentially comprehensive approaches for the molecular characterization of human gliomas. Alterations of several tumor suppressor genes and oncogenes have already been identified as being critical to glioma transformation and progression. These approaches have led to the subclassification of glioblastoma multiforme into distinct subtypes based on the molecular signatures of the tumors. CONCLUSIONS: Classifications of gliomas can now be enhanced with new techniques for comprehensive molecular characterization. Improved and efficient molecular profiling of brain tumors is advancing diagnosis/prognosis and identifying targets for novel and rational therapeutic approaches. Neurosurgeons and neuro-oncologists should be aware of these new developments so they can better advise and treat their patients.