RESUMO
A 60-year-old man had a medical examination because of fever in the emergency hospital and had a diagnosis of pneumonia and was treated, but he was admitted to our hospital 2 days later because there was not the improvement of his symptom. The chest computed tomography(CT)image showed multilocular pleural effusions and lower lobe atelectasis with the air bronchogram on the left side. We diagnosed the case as empyema and inserted a catheter, but drainage was very few and injected 60,000 urokinase units for 3 days from the next day. We removed a drain 2 days after the 3rd infusion, and the pleural thickening became mild, and atelectasis was gradually improved in the chest CT image, and the inflammatory reaction was reduced, too. The intrathoracic washing with urokinase was thought to be effective for empyema with atelectasis.
Assuntos
Empiema Pleural/terapia , Atelectasia Pulmonar/complicações , Irrigação Terapêutica/métodos , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Drenagem , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Perioperative COVID-19 infections in patients suffering from end-stage renal disease (ESRD) are more likely to become severe, with a high mortality rate, than those in other patients. For such patients, corticosteroid therapy is one of the limited number of treatment options. We experienced a case of ESRD in which COVID-19 infection immediately followed arteriovenous graft surgery. Although the respiratory condition deteriorated following dexamethasone administration, requiring invasive mechanical ventilation, intravenous methylprednisolone pulse therapy (pulse therapy) improved it dramatically, suggesting that pulse therapy may be effective against severe COVID-19 infection in patients suffering from ESRD.
RESUMO
The patient was 81-year-old woman diagnosed with lung cancer who underwent upper right lobectomy in January 2002. Computed tomography (CT) of the thorax showed a mass shadow presenting rapid-growing in the left S3 in August, 2008. The size of the mass shadow in the left S3 increased on day 16 after hospitalization, and a nodular shadow appeared in the left S(1+2). The bronchial washing specimen showed acid-fast bacilli identified as Mycobacterium intracellulare by deoxyribonucleic acid (DNA) -DNA hybridization (DDH). The patient showed radiological improvement following combination chemotherapy with rifampicin, ethambutol and clarithromycin.
Assuntos
Infecção por Mycobacterium avium-intracellulare/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagem , Idoso de 80 Anos ou mais , Feminino , Humanos , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The patient was a 61-year-old woman diagnosed with lung cancer who underwent lower right lobectomy in March 2003. Brochopleural fistula developed in the 3rd postoperative month and subsequent chest drainage stopped the air leak. Chest X-ray on follow-up in August 2006, revealed nodular shadows in the lower right field and computed tomography of the thorax showed clusters of small nodules in the right S2. The bronchial washing specimen showed acid-fast bacilli, which was identified as Mycobacterium intracellulare by DNA-DNA hybridization. The patient showed radiological improvement following combination therapy with rifampicin, ethambutol, clarithromycin, and streptomycin.
Assuntos
Adenocarcinoma/cirurgia , Pneumopatias/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Pneumonectomia , Complicações Pós-Operatórias , Feminino , Humanos , Pneumopatias/etiologia , Pessoa de Meia-Idade , Infecção por Mycobacterium avium-intracellulare/etiologiaRESUMO
A case was 56 years old woman, and she did not have any subjective symptom. She received multiphasic health screening, and abnormal shadow was detected on her chest radiograph. Chest radiography revealed infiltrations in the middle lobe. Computed tomography (CT) of the thorax showed clusters of small nodules in the middle lobe. The bronchial washing specimen showed acid-fast bacilli identified as Mycobacterium intracellulare by DNA-DNA hybridization (DDH) method. This case was diagnosed as Mycobacterium intracellulare lung disease. The patient received combination therapy with rifampicin, ethambutol, and clarithromycin for one year with radiological improvement. CT findings were characteristic and useful for the early diagnosis of MAC infection, which led to cure of the disease by chemotherapy.
Assuntos
Antituberculosos/administração & dosagem , Pneumopatias/tratamento farmacológico , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Claritromicina/administração & dosagem , Esquema de Medicação , Quimioterapia Combinada , Etambutol/administração & dosagem , Feminino , Humanos , Pneumopatias/diagnóstico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Rifampina/administração & dosagem , Tomografia Computadorizada por Raios XRESUMO
We report 2 cases of thymomatous myasthenia gravis associated with postoperative crisis and medicated with steroid therapy using prednisolone without primary dose escalation. Two women, a 38 years old and the other 64 years old, underwent extended thymectomy under the diagnosis of myasthenia gravis associated with invasive thymoma. Bulbar symptoms in both were severe despite preoperative anticholinesterase medication. Myasthenic crises with an antiacetylcholine receptor antibody (anti-AchR Ab) elevation were encountered in the postoperative clinical course. Daily administrations of a large amount of prednisolone without primary dose escalation and the subsequent tapering therapy effectively improved myasthenic symptoms and decreased their anti-AchR Ab titer. We also discuss difficulties in treatment in these cases.