4 research outputs found
Benign Metastasizing Leiomyoma Presenting as Cavitating Lung Nodules
Benign metastasizing leiomyoma (BML) was initially used to describe
single or multiple pulmonary nodules composed of proliferating smooth
muscle cells (lacking cellular atypia) in premenopausal females 3 months
to 20 y after hysterectomy for uterine leiomyoma. The lung is the most
commonly involved site, thus including many malignant and benign
entities in the differential diagnosis. The present case refers to a
47-y-old premenopausal woman with a history of subtotal hysterectomy for
a uterine leiomyoma presenting with bilateral cavitating pulmonary
nodules. A number of nodules were resected by video-assisted
thoracoscopic surgery. The histological findings in correlation with the
immunohistochemical results were consistent with the diagnosis of BML. A
bilateral salpingooophorectomy was performed, combined with complete
removal of the remaining cervix. One year later, the subject remains
asymptomatic, and the pulmonary nodules are stable with regard to
number, size, location, and morphology
Surgical correction of acquired unilateral diaphragmatic paralysis by plication technique
Summary: Acquired diaphragmatic paralysis may compromise lung mechanics and cause dyspnoea and/or lead to respiratory failure in the long term. A 76 year-old female patient presented with progressive worsening of dyspnoea and spirometric indices, and imaging studies revealed elevation of the left hemidiaphragm. Surgical correction was carried out by diaphragmatic plication technique, through a mini-thoracotomy approach. Immediate alleviation (within days) of her symptoms was observed, while improvement of radiological and pulmonary function tests occurred some weeks later. Pneumon 2013,26(2
Comparison of advanced closed-loop ventilation modes with pressure support ventilation for weaning from mechanical ventilation in adults: A systematic review and meta-analysis
Purpose: To compare neurally adjusted ventilatory assist (NAVA),
proportional assist ventilation (PAV), adaptive support ventilation
(ASV) and Smartcare pressure support (Smartcare/PS) with standard
pressure support ventilation (PSV) regarding their effectiveness for
weaning critically ill adults from invasive mechanical ventilation
(IMV). Methods: Electronic databases were searched to identify
parallel-group randomized controlled trials (RCTs) comparing NAVA, PAV,
ASV, or Smartcare/PS with PSV, in adult patients under IMV through July
28, 2021. Primary outcome was weaning success. Secondary outcomes
included weaning time, total MV duration, reintubation or use of
non-invasive MV (NIMV) within 48 h after extubation, in-hospital and
intensive care unit (ICU) mortality, in-hospital and ICU length of stay
(LOS) (PROSPERO registration No:CRD42021270299). Results: Twenty RCTs
were finally included. Compared to PSV, NAVA was associated with
significantly lower risk for in-hospital and ICU death and lower
requirements for post-extubation NIMV. Moreover, PAV showed significant
advantage over PSV in terms of weaning rates, MV duration and ICU LOS.
No significant differences were found between ASV or Smart care/PS and
PSV. Conclusions: Moderate certainty evidence suggest that PAV increases
weaning success rates, shortens MV duration and ICU LOS compared to PSV.
It is also noteworthy that NAVA seems to improve in-hospital and ICU
survival. (c) 2021 Elsevier Inc. All rights reserved