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Donuru A, Saul D, Parekh M, Kumaran M, Kandula V, Kharouf R. Gunshot-Related Pediatric Left Ventricular Apical Aneurysm. JACC Case Rep 2021; 3:26-30. [PMID: 34317463 PMCID: PMC8305065 DOI: 10.1016/j.jaccas.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022]
Abstract
Penetrating injuries of the thorax and abdomen, such as gunshot and stabbing, are rare in children. We present the case of a pediatric patient with a history of remote gunshot injury presenting with a late aneurysm in the left ventricle. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Achala Donuru
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
- Address for correspondence: Dr. Achala Donuru, Department of Radiology, Thomas Jefferson University Hospitals, 132 S. 10th Street, 1079 Main Building, Philadelphia, Pennsylvania 19107, USA.
| | - David Saul
- Department of Medical Imaging, A.I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Maansi Parekh
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Maruti Kumaran
- Department of Radiology, Temple University, Philadelphia, Pennsylvania, USA
| | - Vinay Kandula
- Department of Medical Imaging, A.I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Rami Kharouf
- Department of Cardiology, A.I. DuPont Hospital for Children, Wilmington, Delaware, USA
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Rozenbaum D, Shreve J, Radakovich N, Duggal A, Jehi L, Nazha A. Personalized Prediction of Hospital Mortality in COVID-19-Positive Patients. Mayo Clin Proc Innov Qual Outcomes 2021; 5:795-801. [PMID: 34002167 PMCID: PMC8114764 DOI: 10.1016/j.mayocpiqo.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To develop predictive models for in-hospital mortality and length of stay (LOS) for coronavirus disease 2019 (COVID-19)–positive patients. Patients and Methods We performed a multicenter retrospective cohort study of hospitalized COVID-19–positive patients. A total of 764 patients admitted to 14 different hospitals within the Cleveland Clinic from March 9, 2020, to May 20, 2020, who had reverse transcriptase-polymerase chain reaction–proven coronavirus infection were included. We used LightGBM, a machine learning algorithm, to predict in-hospital mortality at different time points (after 7, 14, and 30 days of hospitalization) and in-hospital LOS. Our final cohort was composed of 764 patients admitted to 14 different hospitals within our system. Results The median LOS was 5 (range, 1-44) days for patients admitted to the regular nursing floor and 10 (range, 1-38) days for patients admitted to the intensive care unit. Patients who died during hospitalization were older, initially admitted to the intensive care unit, and more likely to be white and have worse organ dysfunction compared with patients who survived their hospitalization. Using the 10 most important variables only, the final model’s area under the receiver operating characteristics curve was 0.86 for 7-day, 0.88 for 14-day, and 0.85 for 30-day mortality in the validation cohort. Conclusion We developed a decision tool that can provide explainable and patient-specific prediction of in-hospital mortality and LOS for COVID-19–positive patients. The model can aid health care systems in bed allocation and distribution of vital resources.
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Key Words
- ANC, absolute neutrophil count
- AST, aspartate aminotransferase
- BMI, body mass index
- CK, creatinine kinase
- COVID-19, coronavirus disease 2019
- CRP, C-reactive protein
- CXR, chest radiograph
- D1, day 1
- ICU, intensive care unit
- INR, international normalized ratio
- LDH, lactate dehydrogenase
- LOS, length of stay
- LightGBM, Light Gradient Boosting Machine
- NC, nasal cannula
- Nan, missing value
- PTT, partial thromboplastin time
- Q, quartile
- ROC AUC, area under the receiver operating characteristics curve
- SHAP, SHapley Additive exPlanations
- SUN, serum urea nitrogen
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Affiliation(s)
- Daniel Rozenbaum
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Jacob Shreve
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | | | - Abhijit Duggal
- Department of Critical Care, Cleveland Clinic, Cleveland, OH
| | - Lara Jehi
- Neurological Institute and Lerner College of Medicine, Cleveland, OH
| | - Aziz Nazha
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH.,Lerner College of Medicine, Cleveland, OH.,Center for Clinical Artificial Intelligence, Cleveland Clinic, Cleveland, OH
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Green PG, Herring N. Pneumopericardium and Pneumomediastinum After Implantation of a Cardiac Resynchronization Pacemaker. JACC Case Rep 2019; 1:381-384. [PMID: 31807734 PMCID: PMC6884155 DOI: 10.1016/j.jaccas.2019.07.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/25/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
Abstract
A patient with previous coronary artery bypass grafting developed an iatrogenic pneumothorax, along with pneumopericardium and pneumomediastinum, after elective implantation of a cardiac resynchronization therapy pacemaker. There was no evidence of lead perforation, and the patient remained well and was successfully managed conservatively. We hypothesize that air tracked from the pneumothorax via microscopic pleuropericardial fistulae. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Peregrine G Green
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Neil Herring
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Sharan LA, Price TP, Hehn B, Manoff D, Cowan SW. A 22-year-old man with pleural tuberculosis associated hydropneumothorax: Case report and literature review. Respir Med Case Rep 2016; 18:27-30. [PMID: 27144114 PMCID: PMC4840424 DOI: 10.1016/j.rmcr.2016.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 11/25/2022] Open
Abstract
A 22-year-old Asian male presented with fever, non-productive cough, right-sided pleuritic chest pain and was found to have a large right hydropneumothorax. A chest tube was placed. Pleural fluid analysis revealed a lymphocytic predominant exudate and he was subsequently started on four-drug daily anti-tuberculosis therapy (isoniazid, ethambutol, rifampin, pyrazinamide). Pleural biopsy revealed acid-fast bacilli. Given his persistent pleural effusion, he was given four doses of intrapleural tissue plasminogen activator (tPA) and dornase alpha (DNase) via his chest tube over a period of 6 days resulting in clinical and radiologic improvement. Pleural biopsy and pleural fluid culture specimens later revealed Mycobacterium tuberculosis. Intrapleural tPA-DNase therapy has demonstrated improved resolution of infections and shortened hospitalizations for parapneumonic infectious effusions. However, there is little literature on the use of intrapleural fibrinolytics specifically for pleural tuberculosis associated effusions. Furthermore, the American Thoracic Society does not comment on therapeutic thoracentesis or intrapleural fibrinolytic therapy in their recommendations for treatment of pleural tuberculosis. In our case of pleural TB-associated hydropneumothorax, the use of intrapleural tPA-DNase therapy facilitated pleural fluid drainage and resulted in near-complete resolution of the effusion.
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Key Words
- ADA, adenosine deaminase
- AFB, acid fast bacilli
- CT, chest tube
- CXR, chest radiograph
- EMB, ethambutol
- Fibrinolytic therapy
- HD, hospital day
- INH, isoniazid
- PZA, pyrazinamide
- Pleural effusion
- Pleural tuberculosis
- RIF, rifampin
- TB, tuberculosis
- Tuberculosis
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Affiliation(s)
- Lauren A. Sharan
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thea P. Price
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Boyd Hehn
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Manoff
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott W. Cowan
- Department of Surgery, Division of Thoracic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- Corresponding author. Thoracic Surgery, Thomas Jefferson University Hospital, 1025 Walnut Street, Suite 607, Philadelphia, PA 19107, USA.Thoracic SurgeryThomas Jefferson University Hospital1025 Walnut StreetSuite 607PhiladelphiaPA19107USA
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Mehta KK, Ahmad SQ, Shah V, Lee H. Postobstructive pulmonary edema after biopsy of a nasopharyngeal mass. Respir Med Case Rep 2015; 16:166-8. [PMID: 26744691 PMCID: PMC4682000 DOI: 10.1016/j.rmcr.2015.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022] Open
Abstract
We describe a case of 17 year-old male with a nasopharyngeal rhabdomyosarcoma who developed postobstructive pulmonary edema (POPE) after removing the endotracheal tube following biopsy. He developed muffled voice, rhinorrhea, dysphagia, odynophagia, and difficulty breathing through nose and weight loss of 20 pounds in the preceding 2 months. A nasopharyngoscopy revealed a fleshy nasopharyngeal mass compressing the soft and hard palate. Head and neck MRI revealed a large mass in the nasopharynx extending into the bilateral choana and oropharynx. Biopsy of the mass was taken under general anesthesia with endotracheal intubation. Immediately after extubation he developed oxygen desaturation, which did not improve with bag mask ventilation with 100% of oxygen, but improved after a dose of succinylcholine. He was re-intubated and pink, frothy fluid was suctioned from the endotracheal tube. Chest radiograph (CXR) was suggestive of an acute pulmonary edema. He improved with mechanical ventilation and intravenous furosemide. His pulmonary edema resolved over the next 24 h. POPE is a rare but serious complication associated with upper airway obstruction. The pathophysiology of POPE involves hemodynamic changes occurring in the lung and the heart during forceful inspiration against a closed airway due to an acute or chronic airway obstruction. This case illustrates the importance of considering the development of POPE with general anesthesia, laryngospasm and removal of endotracheal tube to make prompt diagnosis and to initiate appropriate management.
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Key Words
- ARDS, acute respiratory distress syndrome
- CPAP, Continuous positive airway pressure
- CXR, chest radiograph
- FiO2, fraction of inspired oxygen
- LV, left ventricle
- MRI, magnetic resonance imaging
- NPPE, negative pressure pulmonary edema
- Nasopharyngeal tumor
- PEEP, positive end expiratory pressure
- POPE (postobstructive pulmonary edema)
- POPE, postobstructive pulmonary edema
- Pulmonary edema
- RV, right ventricle
- Rhabdomyosarcoma
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Affiliation(s)
- Keyur Kamlesh Mehta
- SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203, United States
| | - Sabina Qureshi Ahmad
- SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203, United States
| | - Vikas Shah
- SUNY Downstate, Pediatric Intensivist Kings County Hospital Center, 451 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Haesoon Lee
- SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203, United States
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