Asunto(s)
Enfermedades Pulmonares/microbiología , Nocardiosis/patología , Nódulo Pulmonar Solitario/microbiología , Anciano , Humanos , Enfermedades Pulmonares/patología , Masculino , Nocardia/genética , Nocardia/aislamiento & purificación , Tomografía de Emisión de Positrones , Nódulo Pulmonar Solitario/patología , Tomografía Computarizada por Rayos XRESUMEN
Effective surgical treatment for spontaneous pneumothorax requires control of the postoperative recurrent bulla. Currently, a covering method using an absorbable sheet is a well-recognized form of operative procedure to prevent recurrence. However, the technique used in covering methods appears to be complicated. Here, we present a simple covering method. Using a suture as a guide, we can easily and correctly induce the sheet to the targeting area. Fixation is made at only 1 point at the center of the sheet. To date, we have applied this covering method to 57 patients. Recurrence was recognized in 3 patients( 5.3%) over a mean follow-up period of 12 months.
Asunto(s)
Implantes Absorbibles , Neumotórax/cirugía , Adolescente , Adulto , Anciano , Femenino , Adhesivo de Tejido de Fibrina , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Procedimientos Quirúrgicos Torácicos/métodos , Resultado del TratamientoRESUMEN
There are few reported cases of intrathoracic Ewing's sarcoma, a very rare malignant neoplasm. We report a surgical case of extraskeletal Ewing's sarcoma that had been followed-up as a stable sized tumour for many years, which then grew rapidly within a year. A 27-year old female patient with a rapidly growing abnormal shadow on chest roentgenogram was admitted to our department. She had undergone periodic examinations including chest computed tomography (CT) scans for 6 years since a small nodule in her chest had been pointed out by chest roentgenogram. The initial CT demonstrated a solitary nodule with a diameter of 20 mm on the parietal pleura that covered the V rib of the posterior chest wall. For 5 years the tumour's size did not change noticeably but it suddenly grew to about 90 mm diameter in a year. The tumour volume doubling time was calculated to be 17 days.
Asunto(s)
Sarcoma de Ewing/diagnóstico , Neoplasias Torácicas/diagnóstico , Toracoscopía/métodos , Adulto , Diagnóstico Diferencial , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Estadificación de Neoplasias , Neumonectomía , Tomografía de Emisión de Positrones , Sarcoma de Ewing/cirugía , Neoplasias Torácicas/cirugía , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Clostridium difficile is an important cause of antibiotic-associated diarrhoea. The simultaneous presence of different strains in individual faecal samples has not yet been established, but is important for epidemiological studies. Recurrences of Clostridium difficile-associated diarrhoea (CDAD) are observed in 15-20 % of patients and have been reported as relapses or reinfections with a new strain. In a period of 1 year, 28 faecal samples from 23 patients with a first episode of CDAD were collected at the Leiden University Medical Centre. In addition, 52 faecal samples from 23 patients, from three different hospitals, with one (n = 19), two (n = 2) or three (n = 2) recurrences were studied. PCR-ribotyping was applied as the standard typing method for the isolates. The toxinogenic and clindamycin-resistance profiles of the isolates was determined by PCR. Of 23 patients with a first episode of CDAD, two (8.7 %) harboured two different types, with no differences in toxinogenicity or clindamycin resistance, within one faecal sample. One of these 23 patients showed two types in three faecal samples from the same episode. Of the 23 patients with recurrences, six (26 %) showed a different strain type isolated in a recurrent episode. The number of cases of multiple C. difficile strains in faecal samples from patients with a first episode of CDAD did not differ significantly from the number of different strains present in recurrent episodes (chi-square test, P < or = 0.2). This observation limits the application of typing methods for studying the epidemiology of CDAD.