An integrated approach to diagnosis and management of severe haemoptysis in patients admitted to the intensive care unit: a case series from a referral centre

BACKGROUND: Limited data are available concerning patients admitted to the intensive care unit (ICU) for severe haemoptysis. We reviewed a large series of patients managed in a uniform way to describe the clinical spectrum and outcome of haemoptysis in this setting, and better define the indications for bronchial artery embolisation (BAE). METHODS: A retrospective chart review of 196 patients referred for severe haemoptysis to a respiratory intermediate care ward and ICU between January 1999 and December 2001. A follow-up by telephone interview or a visit. RESULTS: Patients (148 males) were aged 51 (± sd, 16) years, with a median cumulated amount of bleeding averaging 200 ml on admission. Bronchiectasis, lung cancer, tuberculosis and mycetoma were the main underlying causes. In 21 patients (11%), no cause was identified. A first-line bronchial arteriography was attempted in 147 patients (75%), whereas 46 (23%) received conservative treatment. Patients who underwent BAE had a higher respiratory rate, greater amount of bleeding, persistent bloody sputum and/or evidence of active bleeding on fiberoptic bronchoscopy. When completed (n = 131/147), BAE controlled haemoptysis in 80% of patients, both in the short and long (> 30 days) terms. Surgery was mostly performed when bronchial arteriography had failed and/or bleeding recurred early after completed BAE. Bleeding was controlled by conservative measures alone in 44 patients. The ICU mortality rate was low (4%). CONCLUSION: Patients with evidence of more severe or persistent haemoptysis were more likely to receive BAE rather than conservative management. The procedure was effective and safe in most patients with severe haemoptysis, and surgery was mostly reserved to failure of arteriography and/or early recurrences after BAE

Approach to diagnosis and pathological examination in bronchial Dieulafoy disease: a case series

<p>Abstract</p> <p>Background</p> <p>There are limited series concerning Dieulafoy disease of the bronchus. We describe the clinical presentation of a series of 7 patients diagnosed with Dieulafoy disease of the bronchus and provide information about the pathological diagnosis approach.</p> <p>Patients and methods</p> <p>A retrospective review of patients who underwent surgery for massive and unexplained recurrent hemoptysis in a referral center during a 11-year period.</p> <p>Results</p> <p>Seven heavy smoker (49 pack years) patients (5 males) mean aged 54 years experienced a massive hemoptysis (350–1000 ml) unrelated to a known lung disease and frequently recurrent. Bronchial contrast extravasation was observed in 3 patients, combining both CT scan and bronchial arteriography. Efficacy of bronchial artery embolization was achieved in 40% of cases before surgery. Pathological examination demonstrated a minute defect in 3 cases and a large and dysplasic superficial bronchial artery in the submucosa in all cases.</p> <p>Conclusion</p> <p>Dieulafoy disease should be suspected in patients with massive and unexplained episodes of recurrent hemoptysis, in order to avoid hazardous endoscopic biopsies and to alert the pathologist if surgery is performed.</p

Emergence of multidrug resistant, extended-spectrum β-lactamase and metallo-β-lactamase strain of Acinetobacter baumannii in ICU ward of Kashan Beheshti Hospital during 2013-14

Background: Acinetobacter baumannii (A .baumannii) is a nosocomial opportunistic pathogen especially in intensive care unit (ICU) patients with innate resistance to many antibiotics. The aims of this study were to determine the antibiotic resistance patterns, the frequency of extended-spectrum &amp;beta;-lactamase (ESBL) and metallo-&amp;beta;-lactamase (MBL) enzymes among the A. baumannii isolated from tracheal tubes of hospitalized patients in ICU ward of Beheshti hospital (Kashan, Iran) during 2013-2014. Materials and Methods: A descriptive cross-sectional study was performed on 40 isolates of A .baumannii. Antibiotic susceptibility test for seventeen antimicrobial agents was performed according to the CLSIs guidelines. ESBL and MBL producing isolates were confirmed by double-disk diffusion test. The presence of blaOXA51 gene was investigated using PCR. Results: All of A. baumannii isolates were resistant to Piperacillin, Piperacillin-Tazo&shy;bactam, Ceftazidime, Cefepime, Cefotaxime, Ceftriaxone, Meropenem, Imipenem, Ciprofloxacin, Levofloxacin, and Trimethoprim-Sulfamethoxazole; 100 of the isolates were multi-drug resistant (MDR). Two (5) and 26 (65) strains were ESBL- and MBL-positive, respectively. All isolates were positive for blaOXA-51 gene. Conclusions: The study emphasizes the high frequency of MDR in Kashan Shahid Beheshti hospital. Since the resistance genes are located on mobile elements, to prevent further spread of the infection, rapid identification of the mentioned strains is essential

In-Situ Infrared Thermographic Inspection for Local Powder Layer Thickness Measurement in Laser Powder Bed Fusion

The laser powder bed fusion (LPBF) process is strongly influenced by the characteristics of the powder layer, including its thickness and thermal transport properties. This paper investigates in-situ characterization of the powder layer using thermographic inspection. A thermal camera monitors the temperature history of the powder surface immediately after a layer of new powder is deposited by the recoating system. During this process, thermal energy diffuses from the underlying solid part, eventually raising the temperature of the above powder layer. Guided by 1D modeling of this heat-up process, experiments show how the parameterized thermal history can be correlated with powder layer thickness and its thermal conductivity. A neural network, based on the parameterized thermal history, further improves the correlation after training. It is used to predict the part distortion for an unsupported structure. This method detects serious part distortion several layers before the part breaks through the powder layer and interacts with the recoater. This approach can be automated to prevent catastrophic recoater crashes or abrasion of soft wipers and has the potential to monitor local properties of the powder layer in-situ

Dieulafoy’s disease of the bronchus: a possible mistake

<p>Abstract</p> <p>We present a case of a 57 year old woman who suffered from massive hemoptysis; she was sent to our Department for a suspect neoformant lesion. We assumed it might be a Dielafoy’s disease and proceeded with an imaging study that confirmed the diagnosis. After embolization the patient no longer showed signs of bleeding. In brief, we concluded that whenever there is a suspect of Dielafoy’s disease, the biopsy has to be avoided.</p