Esophageal diagnosis of a malignant aspergilloma

A 59-year-old male patient developed a new 4 cm × 6 cm cavitary left upper lung lesion over a 2 months period. The patient had a prior history of a surgically resected Stage IA non-small cell lung cancer in the right upper lobe 3 years prior. He was treated for possible infection with radiographic improvement on subsequent imaging. Further imaging after 3 months revealed an oval soft tissue density within the cavity with air crescent sign. Bronchoscopy with transbronchial biopsies showed an acute and chronic granulomatous inflammation. Aspergillus fumigatus was noted on culture and voriconazole was initiated. Subsequent imaging showed initial improvement and then the stability of cavity size. However, 11 months later, the medial wall of the cavity showed increased thickness. Bronchoscopy showed no endobronchial lesions. Esophageal ultrasound-guided fine-needle aspiration using the endobronchial curvilinear endoscopic ultrasound bronchoscope was performed for a sampling of the cavity wall that was abutting the mediastinum. The aspirate showed squamous cell lung cancer and the patient was started on therapy after appropriate staging

Walbiri graphic art and sand drawing : a study in the iconography of a central Australian culture

189pThis study is based upon field work carried out amongst the Walbiri at Yuendumu Government Station in the Northern Territory from November 1956 to March 1957, and from June 1957 to January 1958; a brief period, August to September, 1956 was also spent amongst other Central Australian aborigines at the Bungalow near Alice Springs. This field work was made possible by a Fulbright grant which I held from 1955-1958, and was carried out under the auspices of the Department of Anthropology and Sociology of the Australian National University. Grateful acknowledgement is also made to the American Association of University Women for a grant to complete the writing of this thesis. The present study is a preliminary analysis of a few central problems in Walbiri graphic art. It is conceived as a 'trial analysis," a tentative exploration of an intricate and richly elaborated iconography. Central questions which are raised in this work are the interrelated ones of the internal structure of the graphic system, and the manner in which Walbiri graphs function as repositories of narrative 'story’ meaning. The problem of developing a technical terminology to cope with these problems has been one of the major difficulties besetting the analysis. The handful of terms which I have adopted, and which are explained in Chapter II, are not all equally satisfactory. The reader is asked to look upon them as first approximations. Illustrations of Walbiri graphs accompanying the text are derived from three kinds of data? 1. Sand drawings : various kinds of explanatory graphs drawn by Walbiri in the sand during storytelling and general conversation, or to demonstrate certain graphs associated with ancestors. Illustrations of these drawings are taken from my notebook copies made at the time. The sand stories told by women (see below, pp. 30 ff.) were recorded in the following manners initially, I concentrated upon learning the repertory of sand signs and their meanings; when I was familiar with the graphs, I concentrated upon recording the narratives, making notes only of those sand graphs which were especially interesting or novel. Most of the stories were recounted to me in or near the Walbiri camps— particularly the women’s camps--while women were sitting around in casual groups and indulging in their ordinary pursuits. There were few days at Yuendumu when I did not listen to at least one of these stories, although I sometimes recorded only a detail of a sand drawing, or the basic incidents of a plot. About fifteen women were my best informants for these stories, but I listened to the storytelling of many others. 2. Paper drawings. I supplied Walbiri with various sized papers, with pencil crayons, and (in the initial stages of my work) with charcoal and chalks. The pencil crayons worked out most satisfactorily% they particularly pleased Walbiri men, who liked working with sharp points and a range of colors. The majority of the drawings by Walbiri adults are the work of the men. Women on the whole did not respond well to the pencil and paper medium. Although there were about fifteen to twenty men who were my most regular informants, the work of many others is represented. Much of the drawing was done in or near the men’s camps or further out in the bush well away from the women. Often there were a few men working at the same time. I usually carried drawing materials with me each day, so that if the opportunity arose to obtain drawings, the materials were always at hand. When I did not have extra paper with me, Walbiri often drew in my notebooks. 3. Graphs painted during ritual, or observed on sacred boards and stones. Illustrations derived from these sources are from my photographs or sketches

Severe Pneumomediastinum Complicating EBUS-TBNA

Pneumomediastinum infrequently complicates diagnostic bronchoscopy. Increased airway or alveolar pressure results in air leaks to the mediastinum through existing or induced defects. Excessive cough, recurrent episodes of increased abdominal pressure, vomiting, or sneezing can all induce spontaneous pneumomediastinum. Less commonly it has been documented with lung or neck infections, esophageal or tracheal tears, and rapid increases in altitude such as during plane flights or scuba diving, with mechanical ventilation, substance abuse, and after bronchoscopy. Pneumomediastinum may be, but is not always, associated with pneumothorax

Massive hemoptysis due to recurrence of bronchial to pulmonary vascular malformation: A case report

Bronchial dieulafoy lesions are quite rare with relatively few case reports in the literature. Symptoms may vary but the lesion is often associated with hemoptysis and may present as massive hemoptysis. We present a case of a 69-year-old male with a recurrent episode of hemoptysis three years after treatment for a bronchial dieulafoy lesion. The bronchoscopy done three years prior during an initial episode of hemoptysis showed a visible dieulafoy deep within a subsegmental branch of the right lower lobe. This case is unique because there are no other reports within the literature of a delayed recurrence several years after previous treatment of a bronchial dieulafoy lesion, which in our case was due to bronchial to pulmonary vascular malformation. Bronchial arteriography revealed a bronchial artery to pulmonary artery vascular malformation, which was successfully treated with coil embolization

Case report: Steroid responsive mesothelioma-related pleural effusion

Malignant pleural mesothelioma (MPM) is an asbestos-related tumor arising in the pleural cavity. Symptoms reflect extension of disease and include shortness of breath and chest pain. Unexplained pleural effusion and pleural pain in patients exposed to asbestos should raise the suspicion of MPM. The most common radiologic presentation is ipsilateral pleural effusion with or without pleural thickening or a mass. Thoracoscopic biopsy remains the most appropriate procedure for definitive diagnosis of mesothelioma. Despite advancement in diagnostic procedures and biomolecular research, this tumor nevertheless has poor prognosis. Mesothelioma remains a diagnostic and therapeutic challenge and is likely to remain one in the years to come. Here we present the first reported case of steroid treatment responsive pleural effusion in a 72 year-old-male that initially was misdiagnosed as rheumatoid related effusion. However, Pleuroscopy with biopsy revealed mesothelioma

The role and safety of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and management of infected bronchogenic mediastinal cysts in adults

Bronchogenic and other duplication cysts are congenital abnormalities that can present at any age including adulthood years. They are usually asymptomatic and discovered incidentally on radiological imaging of the chest. They are commonly treated by surgical resection. Recently, endobronchial ultrasound has been used to assist in diagnosis when radiologic imaging is not definitive. Endobronchial ultrasound has been used rarely to drain infected cysts, a rare complication of the bronchogenic cyst. We present a unique case of an infected large bronchogenic cyst treated with endobronchial ultrasound drainage combined with conservative medical therapy. We also review the scarce available literature describing such an approach and its potential complications and add recommendations based on our experience in managing these anomalies

Reflecting on loss in Papua New Guinea

This article takes up the conundrum of conducting anthropological fieldwork with people who claim that they have 'lost their culture,' as is the case with Suau people in the Massim region of Papua New Guinea. But rather than claiming culture loss as a process of dispossession, Suau claim it as a consequence of their own attempts to engage with colonial interests. Suau appear to have responded to missionization and their close proximity to the colonial-era capital by jettisoning many of the practices characteristic of Massim societies, now identified as 'kastom.' The rejection of kastom in order to facilitate their relations with Europeans during colonialism, followed by the mourning for kastom after independence, both invite consideration of a kind of reflexivity that requires action based on the presumed perspective of another

Your Trash Is Someone's Treasure The Politics of Value at a Michigan Landfill

This article discusses scavenging and dumping as alternative approaches to deriving value from rubbish at a large Michigan landfill. Both practices are attuned to the indeterminacy and power of abandoned things, but in different ways. Whereas scavenging relies on acquiring familiarity with an object by getting to know its particular qualities, landfilling and other forms of mass disposal make discards fungible and manipulable by stripping them of their former identities. By way of examining the different ways in which people become invested in the politics of value at the landfill, whether as part of expressions of gender and class or for personal enjoyment, different comportments toward materiality are revealed to have underlying social and moral implications. In particular, it is argued that different approaches to the evaluation of rubbish involve competing understandings of human and material potential