Spontaneous bilobar torsion managed with pneumopexy.
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ABSTRACT:
SUBMITTER: Qaqish TR
PROVIDER: S-EPMC8311547 | biostudies-literature | 2021 Jun
REPOSITORIES: biostudies-literature
Publications
Spontaneous bilobar torsion managed with pneumopexy.
Qaqish T Robert TR Chainani Abby A Batchelor Elizabeth E Thanawala Ruchi R Jonsdottir Hildur H Krishnan Sundar S Gross Thomas T Arshava Evgeny V EV
JTCVS techniques 20210128
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Project description:ObjectiveLobar torsion is a rare occurrence in which a portion of the lung is twisted on its bronchovascular pedicle. The vast majority are observed in the acute postoperative period often following right upper lobectomy. Spontaneous middle lobe torsion independent of pulmonary resection is exceptionally rarer; fewer than 15 cases have been recorded. We present an institutional case series of 2 patients postorthotopic liver transplantation who developed spontaneous middle lobe torsion due to large pleural effusions.MethodsWe provide the medical course as well as intraoperative techniques for our 2 patients along with a review of the literature.ResultsBoth patients in this case series underwent orthotopic liver transplant complicated postoperatively by a large pulmonary effusion. Patient one developed an abdominal hematoma requiring evacuation and repair, after which he developed progressive shortness of breath. Bronchoscopy revealed a right middle lobe obstruction; upon thoracotomy, 180-degree torsion with widespread necrosis was evident and the middle lobe was removed. He is doing well to date. Patient 2 experienced postoperative pleural effusion and mucus plugging; computed tomography revealed abrupt middle lobe arterial occlusion prompting urgent operative intervention. Again, the middle lobe was grossly ischemic and dissection revealed a 360-degree torsion around the pedicle. It was resected. He is doing well to date.ConclusionsAs the result of its rarity, radiographic and clinical diagnosis of spontaneous pulmonary lobar torsion is challenging; a high index of suspicion for spontaneous middle lobe torsion must be maintained to avoid delays in diagnosis. Prompt surgical intervention is essential to improve patient outcomes.
| S-EPMC10405155 | biostudies-literature
Project description: Not available
| S-EPMC10580048 | biostudies-literature
Project description:The management of spontaneous coronary artery dissection (SCAD) presents challenges and uncertainties. We present a case of a 54-year-old woman who developed SCAD in the three primary coronary artery territories including the distal left anterior descending artery (LAD), a diagonal branch, the first and second obtuse marginals (OMs), and the midright coronary artery (RCA). She was managed conservatively without procedural intervention, and follow-up coronary angiography demonstrated complete recovery.
| S-EPMC11671644 | biostudies-literature
Project description: Not available
| S-EPMC10859645 | biostudies-literature
Project description:ObjectivesThe aim of the study was to identify the characteristics associated with spontaneous labor onset in pregnant patients undergoing expectant management at greater than 39 weeks' gestation and delineate perinatal outcomes associated with spontaneous labor compared with labor induction.Study designThis was a retrospective cohort study of singleton pregnancies at ≥390/7 weeks' gestation delivered at a single center in 2013. The exclusion criteria were elective induction, cesarean delivery or presence of a medical indication for delivery at 39 weeks, more than one prior cesarean delivery, and fetal anomaly or demise. We evaluated prenatally available maternal characteristics as potential predictors of the primary outcome-spontaneous labor onset. Multivariable logistic regression was used to generate two parsimonious models: one with and one without third trimester cervical dilation. We also performed sensitivity analysis by parity and timing of cervical examination, and compared the mode of delivery and other secondary outcomes between patients who went into spontaneous labor and those who did not.ResultsOf 707 eligible patients, 536 (75.8%) attained spontaneous labor and 171 (24.2%) did not. In the first model, maternal body mass index (BMI), parity, and substance use were identified as the most predictive factors. Overall, the model did not predict spontaneous labor (area under the curve [AUC]: 0.65; 95% confidence interval [CI]: 0.61-0.70) with high accuracy. The addition of third trimester cervical dilation in the second model did not significantly improve labor prediction (AUC: 0.66; 95% CI: 0.61-0.70; p = 0.76). These results did not differ by timing of cervical examination or parity. Patients admitted in spontaneous labor had lower odds of cesarean delivery (odds ratio [OR]: 0.33; 95% CI: 0.21-0.53) and neonatal intensive care unit (NICU) admission (OR: 0.38; 95% CI: 0.15-0.94). Other perinatal outcomes were similar between the groups.ConclusionMaternal characteristics did not predict spontaneous labor onset at ≥39 weeks' gestation with high accuracy. Patients should be counseled on the challenges of labor prediction regardless of parity and cervical examination, outcomes if spontaneous labor does not occur, and benefits of labor induction.Key points· Majority of patients will attain spontaneous labor at ≥39 weeks.. · Maternal characteristics do not predict labor at ≥39 weeks.. · Spontaneous labor has associated lower perinatal risks.. · A shared decision model should be utilized in counseling patients who may choose expectant management..
| S-EPMC10615796 | biostudies-literature
Project description: Not available
| S-EPMC4017395 | biostudies-literature
Project description:BackgroundManagement of spontaneous pneumothorax (SP) is still subject to debate. Although encouraging results of recent studies about outpatient management with chest drains fitted with a one-way valve, no data exist concerning application of this strategy in real life conditions. We assessed how SP are managed in Emergency departments (EDs), in particular the role of outpatient management, the types of interventions and the specialty of the physicians who perform these interventions.MethodsFrom June 2009 to May 2013, all cases of spontaneous primary (PSP) and spontaneous secondary pneumothorax (SSP) from EDs of 14 hospitals in France were retrospectively included. First line treatment (observation, aspiration, thoracic drainage or surgery), type of management (admitted, discharged to home directly from the ED, outpatient management) and the specialty of the physicians were collected from the medical files of the ED.ResultsAmong 1868 SP included, an outpatient management strategy was chosen in 179 PSP (10%) and 38 SSP (2%), mostly when no intervention was performed. Only 25 PSP (1%) were treated by aspiration and discharged to home after ED admission. Observation was the chosen strategy for 985 patients (53%). In 883 patients with an intervention (47%), it was performed by emergency physicians in 71% of cases and thoracic drainage was the most frequent choice (670 patients, 76%).ConclusionsOur study showed the low level of implementation of outpatient management for PS in France. Despite encouraging results of studies concerning outpatient management, chest tube drainage and hospitalization remain preponderant in the treatment of SP.
| S-EPMC6329130 | biostudies-literature
Project description:BackgroundExpectant management is an alternative for curettage in women with a miscarriage.AimTo assess the pattern of vaginal bleeding and pain in expectantly managed women with a miscarriage, and to analyse the factors predictive of a relatively quick spontaneous loss of pregnancy.Design of studyPart of a study comparing expectant management with surgical evacuation.SettingTwo hospitals in Amsterdam.MethodIn expectantly managed women with a miscarriage, the pattern of vaginal bleeding and pain and the probability of a spontaneous loss of pregnancy was analysed.ResultsOf the 188 expectantly managed women 95 (51%) experienced a spontaneous loss of their pregnancy. In women with bleeding at inclusion, 52% had a completed miscarriage loss, while of the women without bleeding but with a coincidentally diagnosed non-viable pregnancy during routine ultrasonographic examination, 46% had a completed miscarriage. In the multivariate analysis an increasing bleeding pattern at inclusion was predictive of a relatively quick spontaneous loss of pregnancy. The median daily levels of bleeding and pain were the most prominent during the first 8 days after the start of the bleeding and decreased thereafter.ConclusionsExpectant management is effective in 51% of unselected women with a miscarriage. An increasing bleeding pattern is predictive of a relatively quick spontaneous loss of pregnancy in first-trimester miscarriages. The graphical representation of our findings can be used to inform women about the natural course of miscarriages and a well-informed treatment choice.
| S-EPMC1314693 | biostudies-literature
Project description:In cells, RNA polymerase (RNAP) must transcribe supercoiled DNA, whose torsional state is constantly changing, but how RNAP deals with DNA supercoiling remains elusive. We report direct measurements of individual Escherichia coli RNAPs as they transcribed supercoiled DNA. We found that a resisting torque slowed RNAP and increased its pause frequency and duration. RNAP was able to generate 11 ± 4 piconewton-nanometers (mean ± standard deviation) of torque before stalling, an amount sufficient to melt DNA of arbitrary sequence and establish RNAP as a more potent torsional motor than previously known. A stalled RNAP was able to resume transcription upon torque relaxation, and transcribing RNAP was resilient to transient torque fluctuations. These results provide a quantitative framework for understanding how dynamic modification of DNA supercoiling regulates transcription.
| S-EPMC5657242 | biostudies-literature
Project description:Introductionand importance: We reported a case of secondary spontaneous pneumothorax (SSP) in a 70-years-old male with acute exacerbation of COPD (AE COPD) managed with improvised chest tube drain (ICD).Case presentationHe presented with sudden onset breathlessness and oxygen saturation of 78%. With prolonged expiration on auscultation, he was treated as AE COPD with oxygen therapy, nebulization with albuterol/ipratropium, and injectable antibiotics and steroids. The patient was not improving with treatment on third day, and non-critical respiratory distress continued. Considering the alternative diagnosis, the chest X-ray was done which revealed right sided spontaneous pneumothorax and COPD. Due to his reluctancy to go to higher center for chest tube insertion during ongoing COVID-19 pandemic, we inserted ICD (intravenous set put in saline bottle) at our primary care. Following drainage, breathlessness improved and saturation increased. Then inpatient symptomatic treatment for COPD was continued for three more days. He was discharged on inhalers after fifth day and asked for follow up after 10 days. He came after 1 month and on repeat chest X-ray, his right sided pneumothorax resolved completely and COPD was in control with inhaled medications. There was no recurrence of pneumothorax in five months follow up.Clinical discussionICD is a safe, and an alternative option in resource limited setting. However, the guidelines recommend chest tube insertion as appropriate treatment.ConclusionThis would remind the physicians to anticipate the alternative possibility, and to re-examine those with AE COPD who are not improving as expected with oxygen and nebulization therapy.
| S-EPMC9289406 | biostudies-literature