RESUMO
We present 3 cases of rapidly progressive interstitial pneumonia (RPIP) associated with clinically amyopathic dermatomyositis (C-ADM) that were treated with two courses of direct hemoperfusion with polymyxin B-immobilized fiber column (PMX-DHP). Despite initial treatment with high-dose corticosteroids, pulsed cyclophosphamide, and cyclosporine, the lung disease and hypoxemia deteriorated in all the patients. After PMX-DHP treatment, the PaO2/FiO2 ratio and serum LDH and KL-6 were improved, the abnormal shadows in chest high-resolution computed tomography (HRCT) scans gradually decreased, and, finally, all patients survived. These findings indicate that PMX-DHP treatment could be effective in the management of RPIP in patients with C-ADM in combination with conventional therapy.
Assuntos
Dermatomiosite/complicações , Doenças Pulmonares Intersticiais/terapia , Polimixina B/uso terapêutico , Idoso , Antibacterianos/uso terapêutico , Ciclofosfamida/uso terapêutico , Ciclosporina/uso terapêutico , Feminino , Hemoperfusão , Humanos , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/tratamento farmacológico , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: In December 2019, the coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), emerged in Wuhan, China, and has since spread throughout the world. This study aimed to investigate the association between the change in laboratory markers during the three days after pneumonia diagnosis and severe respiratory failure in COVID-19 patients. METHODS: Data of 23 COVID-19 patients with pneumonia, admitted to the Kumamoto City Hospital between February and April 2020 were retrospectively analyzed. RESULTS: Among the 23 patients, eight patients received mechanical ventilation (MV) (MV group), and the remaining 15 comprised the non-MV group. The levels of hemoglobin (Hb) and albumin (Alb) decreased in the MV group during the three days after pneumonia diagnosis more than in the non-MV group (median Hb: 1.40 vs. -0.10 g/dL, P = 0.015; median Alb: 0.85 vs. -0.30 g/dL, P = 0.020). Univariate logistic regression analysis showed that the decrease in Hb was associated with receiving MV care (odds ratio: 0.313, 95% confidence interval: 0.100-0.976, P = 0.045). Receiver operating characteristic curve analyses showed that the optimal cut-off value for the decrease in Hb level was -1.25 g/dL, with sensitivity and specificity values of 0.867 and 0.750, respectively. CONCLUSIONS: The decrease in Hb level during the short period after pneumonia diagnosis might be a predictor of worsening pneumonia in COVID-19 patients.
Assuntos
COVID-19/complicações , Hemoglobinas/análise , Pneumonia Viral/complicações , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , SARS-CoV-2 , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , COVID-19/terapia , COVID-19/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Valor Preditivo dos Testes , Respiração Artificial , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Risco , Albumina Sérica/análise , Índice de Gravidade de Doença , Fatores de Tempo , Adulto JovemRESUMO
A healthy 19-year-old man was referred to our hospital due to an elongated left heart border on chest radiograph. Transthoracic echocardiography showed a posteriorly deviated left ventricular apex, increased right ventricular dimension, and hypokinesis of the interventricular septum. Pulsed Doppler echocardiogram revealed a triphasic mitral inflow pattern. Myocardial longitudinal strain rate imaging revealed that the early diastolic strain rate abruptly decreased to a negative value and then became positive at the left ventricular apex. In this case of an absent pericardium, the triphasic mitral inflow pattern might have been caused by an early diastolic shortening and subsequent elongation at the apex.
Assuntos
Ventrículos do Coração/patologia , Valva Mitral/patologia , Pericárdio/anormalidades , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Adulto JovemRESUMO
Primary lung tumor tissue exhibiting numerous multinucleated osteoclast-like giant cells (OGCs) is an extremely rare histological type. In this study, we describe the case of an 82-year-old woman. Chest CT demonstrated an extensive crazy-paving appearance in both of the lung fields and a solid round mass in the right lower lobe. A pathological examination of the tumor revealed sarcomatoid carcinoma containing OGCs combined with diffused, invasive lepidic predominant adenocarcinoma. We herein present an extremely rare lung cancer, invasive lepidic predominant adenocarcinoma extensively involving the lung with areas of sarcomatoid carcinoma containing OGCs.