Internal medicine
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High-flow nasal cannula (HFNC) therapy is an oxygen delivery system. However, evidence regarding the clinical applications of HFNC is still emerging. We herein evaluated the clinical predictors of HFNC therapy success for adult patients with acute hypoxemic respiratory failure. ⋯ HFNC therapy showed a good compliance and the improvement of the physiologic parameters in an adult population. The failure to improve oxygenation within 24 hours was a useful predictor of intubation. Among the failure group, the vasopressor use and failed oxygenation improvement were associated with ICU mortality.
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Case Reports
Atypical progressive multifocal leukoencephalopathy in a patient with antisynthetase syndrome.
Antisynthetase syndrome is a disorder belonging to the dermatomyositis/polymyositis group, with high rates of morbidity and mortality. We herein present the case of a 71-year-old man who was diagnosed with antisynthetase syndrome and treated with rituximab. ⋯ The neuropathological diagnosis was progressive multifocal leukoencephalopathy. Treatment with rituximab for antisynthetase syndrome itself plays a fundamental role in the development of infectious complications.
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Bronchoscopy using radial-endobronchial ultrasound (R-EBUS) and virtual bronchoscopic navigation (VBN) is a promising method for diagnosing peripheral pulmonary lesions. We previously performed a randomized comparative trial (RCT) (i.e., VBN combined with EBUS RCT) involving patients with 30-mm or smaller peripheral pulmonary lesions and found that the addition of VBN to R-EBUS improved the diagnostic yield. In the present study, we performed a retrospective subanalysis in order to identify patients for whom VBN is useful. ⋯ VBN improves the diagnostic yield when combined with R-EBUS to assess lesions exhibiting involved bronchi on CT images.
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A 37-year-old woman gradually developed a gait disturbance due to sensory loss in the left lower extremity three years after being diagnosed with clinically isolated syndrome. Brain magnetic resonance imaging (MRI) demonstrated an incomplete ring-enhanced lesion with perifocal edema in the subcortex of the right parietal lobe. (11)C-methionine positron emission tomography (MET-PET) showed an insignificant uptake in the lesion. The patient was noninvasively diagnosed with tumefactive multiple sclerosis and treated with corticosteroids, and her neurological symptoms and MRI findings improved with treatment. The combination of MRI findings and insignificant uptake on MET-PET is useful for noninvasively differentiating tumefactive demyelinating lesions from brain tumors.
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The impact of the clustering of metabolic factors on chronic kidney disease (CKD) in non-obese individuals remains unclear. ⋯ Non-obese subjects with ≥3 metabolic factors, who are missed based on the essential criterion of obesity for metabolic syndrome, may have an equal or slightly higher risk of renal dysfunction than obese subjects with ≥3 metabolic factors.