Low serum prealbumin level in the perioperative period is associated with a poorer prognosis in NSCLC patients and could serve as a marker for identifying patients at high risk, even at an early clinical stage.
[Purpose] The purpose of this study was to clarify the benefits of early mobilization for
mechanically ventilated patients for their survival to discharge to home from the
hospital. [Subjects and Methods] Medical records were retrospectively analyzed of patients
who satisfied the following criteria: age ≥ 18 years; performance status 0–2 and
independent living at their home before admission; mechanical ventilation for more than 48
h; and survival after mechanical ventilation. Mechanically ventilated patients in the
early mobilization (EM) group (n = 48) received mobilization therapy, limb exercise and
chest physiotherapy, whereas those in the control group (n = 60) received bed rest alone.
Univariate and multivariate logistic regression analyses were performed to identify
clinical variables associated with discharge disposition. [Results] Early mobilization was
a positive independent factor and the presence of neurological deficits was a negative
factor contributing to discharge to home. Among patients surviving mechanical ventilation
without neurological deficits, the rate of discharge to home was significantly higher
among patients in the EM group that in the control group (76% vs. 40%). [Conclusion] Early
mobilization can improve the rate of discharge to home of patients requiring mechanical
ventilation because of non-neurological deficits.
Diaphragmatic ruptures after blunt trauma are rare life-threatening conditions. Most of them occur on the left-sided hemidiaphragm with herniation or associated organ injuries after a motor vehicle accident. We present an unusual case of blunt diaphragmatic rupture resulting in a delayed hemothorax. A 62-year-old man presented with acute dyspnea that initiated while straining to pass stool. He had a bruise on the lower back region of his right thorax after a slip-and-fall accident 7 days previously. Chest computed tomographic scans revealed a right-sided hemothorax without any evidence of herniation or associated organ injuries. Emergency surgery was performed through a video-assisted minithoracotomy. During surgery, we identified a diaphragmatic laceration with a severed blood vessel originating from the right superior phrenic artery. The lesion was repaired with interrupted horizontal mattress sutures. The total amount of bleeding was approximately 2000 mL. The patient had an uneventful recovery with no further bleeding episodes.
Castleman's disease is an uncommon lymphoproliferative disorder of unknown etiology, most often involving the mediastinum. It has 2 distinct clinical forms: unicentric and multicentric. Unicentric Castleman's disease arising from an intrapulmonary lymph node is rare, and establishing a preoperative diagnosis of this disease is very difficult mainly due to a lack of specific imaging features. We report a case of intrapulmonary unicentric Castleman's disease in an asymptomatic 19-year-old male patient who was accurately diagnosed by preoperative computed tomography (CT). The mass was incidentally found on a routine chest X-ray. A subsequent dynamic CT showed a well-defined, hypervascular, soft-tissue mass with small calcifications located in the perihilar area of the right lower lung. Three-dimensional CT (3D-CT) angiography indicated that the mass was receiving its blood supply through a vascular network at its surface that originated from 2 right bronchial arteries. The clinical history and CT findings were consistent with a diagnosis of unicentric Castleman's disease, and we safely and successfully removed the tumor via video-assisted thoracoscopic surgical lobectomy. This case shows that the imaging characteristics of these rare tumors on contrast-enhanced CT combined with 3D-CT angiography can be helpful in reliably establishing a correct preoperative diagnosis.
The coexistence of pulmonary fibrosis and emphysema on computed tomography images may represent a predictor of respiratory mortality in elderly chronic obstructive pulmonary disease patients with secondary spontaneous pneumothorax. Because of the potential risk of respiratory failure, we recommend nonsurgical treatment for secondary spontaneous pneumothorax in chronic obstructive pulmonary disease patients with these radiological features.
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