Ipsilateral Horner's syndrome as a rare complication of tube thoracostomy

BATF3 programs CD8+ T cell memory

Antiviral CD8⁺ T cell responses are characterized by an initial activation/priming of T lymphocytes followed by a massive proliferation, subset differentiation, population contraction and the development of a stable memory pool. The transcription factor BATF3 has been shown to play a central role in the development of conventional dendritic cells, which in turn are critical for optimal priming of CD8⁺ T cells. Here we show that BATF3 was expressed transiently within the first days after T cell priming and had long-lasting T cell-intrinsic effects. T cells that lacked Batf3 showed normal expansion and differentiation, yet succumbed to an aggravated contraction and had a diminished memory response. Vice versa, BATF3 overexpression in CD8⁺ T cells promoted their survival and transition to memory. Mechanistically, BATF3 regulated T cell apoptosis and longevity via the proapoptotic factor BIM. By programing CD8⁺ T cell survival and memory, BATF3 is a promising molecule to optimize adoptive T cell therapy in patients.

Horner's syndrome as a rare complication of tube thoracostomy: case reports and review of literature

Horner's Syndrome (HS), caused by the interruption of the oculosympathetic pathway, is a rare yet morbid complication of tube thoracostomy. However, literature regarding HS secondary to tube thoracostomy is limited to case reports, with little comprehensive information available. We report two cases and review all cases from the published literature to assess the outcome of this complication. HS secondary to tube thoracostomy leaves sequelae in 45.8% of patients. Immediate removal or repositioning of the tube does not affect prognosis. Therefore, precautions must be taken to avoid this complication.

Horner’s syndrome: A delayed complication after thoracostomy tube removal

PURPOSE

Description of a complication from tube thoracostomy.

METHODS

Case report from experience at an Air Force tertiary care hospital in a 50-year-old female smoker undergoing left upper lobectomy for lung cancer.

RESULTS

Horner's syndrome resulted 18 hours after removal of an apical thoracostomy tube.

CONCLUSIONS

Horner's syndrome caused by tube thoracostomy is a rare but real complication. One should avoid placing the tip of the tube in the medial thoracic apex with the intent of avoiding second-order sympathetic chain pathways. As evidenced by our patient with a delayed onset of presentation, malpositioned tubes should be repositioned before symptoms develop. Long-term prognosis is poor once Horner's syndrome develops.

[Claude Bernard-Horner syndrome and its opposite, Pourfour du Petit syndrome, in anesthesia and intensive care]

OBJECTIVE

To analyse cases of Horner's syndrome (HS) and its opposite, Pourfour du Petit's syndrome (PPS), occurring in anaesthesia and intensive therapy with consideration of the data of current literature.

DATA SOURCES

For this paper we have reviewed the French, English and German literature published in anaesthesia and intensive care journals using Medline search and the current textbooks.

STUDY SELECTION

All observational studies on these syndromes, whether clinical cases or letters to the editor, form the basis for this article.

DATA EXTRACTION

The articles were analysed mainly with regard to diagnosis, therapy and prognosis of syndromes due to iatrogenic causes.

DATA SYNTHESIS

HS is caused by a paralysis of the ipsilateral sympathetic cervical chain and includes a ptosis of the upper eyelid, a slight elevation of the lower lid, a sinking of the eyeball, a constriction of the pupil, a narowing of the palpebral fissure, a nasal stuffiness associated with anhidrosis, and flushing of the affected side of the face. Regional anaesthesia (intra-oral anaesthesia, brachial plexus block, epidural anaesthesia whether by thoracic, lumbar or caudal approach, as well as interpleural analgesia) is the main anaesthetic cause for HS. HS due to the effect of a local anaesthetic is transient, it can precede a high spinal block and a cardiovascular collapse. HS from puncture of the internal jugular vein is most often permanent. When transient, HS regresses within 3 months after puncture. Other causes of HS include intraoperative posture, pleural drain, neck surgery, neck trauma. A mydriatic collyrium, such as phenylephrine, resolves ptosis for less than 1 hour and results in blurred vision from pupillary dilation. Major ptosis requires surgery. PPS is the reciprocal HS and is caused by a stimulation of the ipsilateral sympathetic cervical chain. PPS can precede HS. It carries a risk for conjunctivitis, keratitis and epiphora in case of major exophthalmia. PPS is often reported as an unilateral mydriasis. PPS has the same causes as HS. Myotic collyriums are relatively inefficient. Major lid retraction requires a tarsorraphy, pomades and nocturnal lid occlusion. A part of HS and most PPS occurring in anaesthesia and intensive care remain unrecognized or are recognized with delay, especially if they remain minor and transient or when they occur in unconscious patients, in horizontal posture.

Chest tubes: indications, placement, management, and complications

Use of tube thoracostomy in intensive care units for evacuation of air or fluid from the pleural space has become commonplace. In addition to recognition of pathological states necessitating chest tube insertion, intensivists are frequently involved in placement, maintenance, troubleshooting, and discontinuation of chest tubes. Numerous advances have permitted safe use of tube thoracostomy for treatment of spontaneous or iatrogenic pneumothoracies and hydrothoracies following cardiothoracic surgery or trauma, or for drainage of pus, bile, or chylous effusions. We review current indications for chest tube placement, insertion techniques, and available equipment, including drainage systems. Guidelines for maintenance and discontinuation are also discussed. As with any surgical procedure, complications may arise. Appropriate training and competence in usage may reduce the incidence of complications.

Horner's syndrome caused by an intercostal chest drain

Horner's syndrome occurred in a young woman as a complication of the treatment of a traumatic pneumothorax with an intercostal drain. The nerve damage probably occurred when the lung had fully re-expanded, pressing the tip of the intercostal drain, lying at the apex of the pleural cavity, on to the sympathetic chain.

Shot in the neck in Spain (a rare cause of an isolated Horner's syndrome)

Horner's syndrome is rare. A bullet wound in the neck is a rare cause of the syndrome, and it is exceedingly uncommon for a Horner's syndrome to be the sole noteworthy clinical result of a gunshot wound of this part of the anatomy. Two cases of bullet injury of the neck are described wherein a permanent Horner's syndrome was the only important sequel.