Pulmonary complications of liver transplantation: radiological appearance and statistical evaluation of risk factors in 300 cases
Rita GolfieriEmanuela GiampalmaAntonio Maria Morselli LabatePaola d'ArienzoElio JovineGian Luca GraziAlighieri MazziottiMonica MaffeiChiara MuzziS. TancioniC SamaAntonino CavallariGiampaolo Gavelli
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Atelectasis
Univariate analysis
Neuroradiology
Bacterial pneumonia
We studied the bactericidal capacity of the rat lung during the development of pneumococcal pneumonia. Pneumonia was produced in a lower lobe by the intrabronchial instillation of 10 4 Streptococcus pneumoniae cells in buffer. Lung bacterial counts progressively increased, reaching 10 7 per lung within 48 h, and the increase was associated with localized atelectasis and consolidation. Bacterial multiplication was inhibited with tetracycline at various intervals after infection, and the subsequent clearance of pneumococci was determined. Viable pneumococci were rapidly killed by lung defenses if bacterial multiplication was inhibited within 12 h of the onset of infection. No change occurred in the bacterial populationif tetracycline was delayed until 24 h after infection, indicating that pneumococcal killing by lung defenses had ceased. This effect could be reproduced with the addition of pneumococcal capsular polysaccharide to the inoculum, which produced a dose-related inhibition of pneumococcal clearance. The clearance of S. epidermidis was not impaired in the presence of pneumococcal pneumonia or by administration of exogenous capsular polysaccharide. These data indicate that pneumococcal pneumonia causes a marked impairment in lung antipneumococcal defenses within 24 h of the onset of infection. This acquired defect in antibacterial defenses may be due to the accumulation of pneumococcal capsular material in the lungs of infected animals.
Pneumococcal pneumonia
Bacterial pneumonia
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Pneumococcal infections
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Besides being one of the mechanisms responsible for ventilator-induced lung injury, atelectasis also seems to aggravate the course of experimental pneumonia. In this study, we examined the effect of reducing the degree of atelectasis by natural modified surfactant and/or open lung ventilation on bacterial growth and translocation in a piglet model of Group B streptococcal pneumonia. After creating surfactant deficiency by whole lung lavage, intratracheal instillation of bacteria induced severe pneumonia with bacterial translocation into the blood stream, resulting in a mortality rate of almost 80%. Treatment with 300 mg/kg of exogenous surfactant before instillation of streptococci attenuated both bacterial growth and translocation and prevented clinical deterioration. This goal was also achieved by reversing atelectasis in lavaged animals via open lung ventilation. Combining both exogenous surfactant and open lung ventilation prevented bacterial translocation completely, comparable to Group B streptococci instillation into healthy animals. We conclude that exogenous surfactant and open lung ventilation attenuate bacterial growth and translocation in experimental pneumonia and that this attenuation is at least in part mediated by a reduction in atelectasis. These findings suggest that minimizing alveolar collapse by exogenous surfactant and open lung ventilation may reduce the risk of pneumonia and subsequent sepsis in ventilated patients.
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Diffuse alveolar damage
Bacterial pneumonia
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Lung Ultrasound
Acute respiratory failure
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The case of a 6-year-old boy who developed complications following gastric interposition surgery for severe, recurrent esophageal stricture is reported. Investigation of his pleural effusion revealed a rare and unexpected complication.
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Acute respiratory failure
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Objective To explore the clinical features of plastic bronchitis in children with mycoplasma pneumoniae pneumonia and(or)bacterial pneumonia.Methods The study retrospectively reviewed the records of the children with plastic bronchitis who were admitted to Beijing Children's Hospital from January 2007 to March 2010.Subjects were divided into three groups based on the pathogen culture results:mycoplasma pneumoniae pneumonia group,mycoplasma pneumoniae pneumonia with bacterial infections group and bacterial pneumonia group.The data of the three groups such as clinical manifestations,roentgenographic findings,airway mucosal lesions seen through the bronchoscope and the histopathological findings of the bronchial cast were analyzed.Results Fifteen children with plastic bronchitis aged from 2 to 15 years were enrolled into the study.There were 5 cases in mycoplasma pneumoniae pneumonia group,6 cases in mycoplasma pneumoniae pneumonia with bacterial infections group and 4 cases in bacterial pneumonia group.The children in mycoplasma pneumoniae pneumonia group did not have dyspnea and the extrapulmonary positive signs.One case in mycoplasma pneumoniae pneumonia with bacterial infections group needed NCPAP treatment,and 1 case had extrapulmonary positive signs.Three cases in bacterial pneumonia group needed NCPAP or mechanical ventilation treatment,and 3 cases had extrapulmonary positive signs.Consolidation was the common finding in the CT scan of the lung in all the patients,and 1 case with atelectasis,3 cases with pleural effusion in mycoplasma pneumoniae pneumonia group;3 cases with atelectasis,5 cases with pleural effusion in mycoplasma pneumoniae pneumonia with bacterial infections group;3 cases with atelectasis,1 case with pleural effusion in bacterial pneumonia group.Bronchoscopy was performed in all the 15 cases and bronchial casts were removed.Under flexible bronchoscope,the most common mucosal lesions in the three groups were hyperemia and edema,and the severe mucosal lesions were found in children in mycoplasma pneumoniae pneumonia with bacterial infections group(2 cases with segmental bronchi dysventilation).All bronchial casts were typeⅠaccording to Seear's classification in histopathological findings.Conclusions In children,mycoplasma pneumoniae pneumonia may be complicated by plastic bronchitis,even if it did not have severe systemic inflammatory response.Bronchoscopy is suggested to be performed in time to improve the prognosis of the patients.
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Bacterial pneumonia
Mycoplasma pneumonia
Mycoplasmataceae
Atypical pneumonia
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Abstract Introduction We conducted an ultrasound study to investigate echocardiographic artifacts in mechanically ventilated patients with lung pathology. Methods A total of 205 mechanically ventilated patients who exhibited lung atelectasis and/or pleural effusion were included in this 36-month study. The patients underwent lung echography and transthoracic echocardiography, with a linear 5 to 10 MHz and with a 1.5 to 3.6 MHz wide-angle phased-array transducer, respectively. Patients were examined by two experienced observers who were blinded to each other's interpretation. Results A total of 124 patients (60,48%) were hospitalized because of multiple trauma; 60 patients (29,26%) because of respiratory insufficiency, and 21 (10,24%) because of recent postoperative surgery. The mean duration ( ± standard deviation) of hospitalization was 35 ± 27 days. An intracardiac artifact was documented in 17 out of 205 patients (8.29%) by echocardiography. It was visible only in the apical views, whereas subsequent transesophageal echocardiography revealed no abnormalities. The artifact consisted of a mobile component that exhibited, on M-mode, a pattern of respiratory variation similar to the lung 'sinusoid sign'. Lung echography revealed lung atelectasis and/or pleural effusion adjacent to the heart, and a similar M-mode pattern was observed. The artifact was recorded within the left cardiac chambers in 11 cases and within the right cardiac chambers in six. Conclusions Lung atelectasis and/or pleural effusion may create a mirror image, intracardiac artifact in mechanically ventilated patients. The latter was named the 'cardiac-lung mass' artifact to underline the important diagnostic role of both echocardiography and lung echography in these patients. Trial registration This trial is ISRCTN registered: ISRCTN 49216096.
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Lung Ultrasound
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Lung Ultrasound
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To analyze occurrence, prevention and treatment of the complications of thoracoscopic assisted spine surgery.Retrospective review of 182 patients who underwent standard thoracoscopic technique or video-assisted thoracic surgical procedure from October 1998 to August 2004. The treatment of thoracic diseases included debridement, decompression with (or) reconstruction. The total number of complications were recorded, and its mechanism, prevention and treatment were analyzed.Complications occurred in 16 patients, 12 cases of perioperative complications included 3 patients suffered from pneumonia, 3 pulmonary atelectasis, 2 patients' lung injured by trocar, 1 patient obtained transient monoplegia, 2 suffered from transient intercostal nerve pain and 1 had superficial incision infection. Long-term complications occurred in 4 cases: spinal tuberculosis relapsed 2 cases (one who had diabetes obtained relapse in 8 months of post-operation and another relapsed with complex spinal tuberculosis in 4 weeks postoperation), 2 patients suffered from kyphosis deformity and pain.The type and incidence of complications with thoracoscopic spine surgery mainly depend on indication, operation procedures and anesthesia, only by limit surgical indication, ameliorate technique, obey surgical principle and consummate perioperative treatment can we obtain mini-invasive effect by thoracoscopic assisted spine surgery.
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Introduction: Spontaneous pneumothorax is a rare complication of COVID-19 pneumonia (only 1–2% of patients). The aim of this research is to present this pathological entity as a complication of COVID-19 pneumonia. Patients and Methods: We present 18 patients (hospitalized from August to December 2020) with spontaneous pneumothorax as a complication of COVID-19 pneumonia [sex: men -11(61,1 %); mean age – 67,83, range: 33 ÷ 88 years].Imagine methods (X-Ray and computed tomography) were used to determine COVID-19 pneumonia and pneumothorax. Pneumothorax was treated by chest tube insertion. Results: Right-sided pneumothorax was established in 10 patients (55,6%), left-sided – in 6 (33,3 %) and bilateral – in 2. In 13 patients there was a connection between pneumothorax and mechanical ventilation: in nine of the patients pneumothorax was presented during the ventilation and for the rest four cases after patient's extubation - as a late sequel of COVID-19 pneumonia. In five of the cases, spontaneous pneumothorax wasn't related with mechanical ventilation. The cumulative death rate was 72,22 % (in 13 patients): 11 of them - from the group with mechanical ventilation and in 2 cases - without intubation. Conclusion: With this research we present one relatively rare complication of COVID-19 pneumonia – spontaneous pneumothorax. Our results demonstrate the role of mechanical ventilation as a precipitating factor for spontaneous pneumothorax in COVID-19 patients. In spite of the limited number of reported cases, this study presents mechanical ventilation as a risk factor for patient's death in COVID-19 pneumonia complicated with spontaneous pneumothorax.
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