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Objectives. To highlight the possible complications of medical thoracoscopy (MT) and how to avoid them. Methods. A retrospective and prospective analysis of 127 patients undergoing MT in Nagoya Medical Center (NMC) and Toyota Kosei Hospital. The data about complications was obtained from the patients, notes on the computer system, and radiographs. Results. The median age was 71.0 (range, 33.0–92.0) years and 101 (79.5%) were males. The median time with chest drain after procedure was 7.0 (range, 0.0–47.0) days and cases with talc poudrage were 30 (23.6%). Malignant histology was reported in 69 (54.3%), including primary lung cancer in 35 (27.5), mesothelioma in 18 (14.2), and metastasis in 16 (12.6). 58 (45.7%) revealed benign pleural diseases and TB was diagnosed in 15 (11.8%). 21 (16.5%) patients suffered from complications including lung laceration in 3 (2.4%), fever in 5 (3.9%) (due to hospital acquired infection (HAI) in 2, talc poudrage in 2, and malignancy in 1), HAI in 2 (1.6%), prolonged air-leak in 14 (11.0%), and subcutaneous emphysema in 1 (0.8%). Conclusions. MT is generally a safe procedure. Lung laceration is the most serious complication and should be managed well. HAI is of low risk and can be controlled by medical treatment.

Background:Care of the patient with shock is one of the most challenging issues in emergency medicine and critical care. Use of thoracic ultrasonography has gained a wider ground in emergency medicine and intensive care. So, lung ultrasound is being a basic application, allowing the assessment of urgent diagnoses and therapeutic decisions. Aim of the work:This Study aimed to assess the value of chest ultrasound in differentiation between different types of shock for proper treatment. Materials and Methods:Our prospective study was conducted on 68 shocked patients, 39 were males(58%)and 29 were females (41%) their age ranged from 20 to 85years with mean age 58 years .All patients were admitted to the Respiratory Intensive Care Unit (RICU) of Chest Department at Assuit University Hospital during the period from November 2016 to April 2017 and were evaluated for the cause of shock.We performed early bed-side chest sonographic examination. Results:68 shocked patients were included in the study. 30 patients were septic shock, 19 patients were obstructive shock, 11 patients were cardiogenic shock,4 patients were hypovolemic shock,2 patients were mixed type of the shock, and 2 patients were not defined the causes of the shock. The study shows that there was a significant relationship between different types of shock and chest ultrasound finding (P= 0.04). 14 cases (46.7%) with septic shock had consolidation.14 cases (46.7%) with septic shock had pleural effusion and it was Para pneumonic. Also, we found 9 cases with pleural effusion (47.3%) in obstructive shock due to pulmonary embolism. We found B-lines in 45.5% in cardiogenic shocked patients.Also, there was a significant relationship between PH and PaCO2 different types of shock (P=0.04& 0.01 respectively). We found that combined respiratory Acidosis and metabolic alkalosis was more in patients with septic shock.Also, we found that patients with cardiogenic shock had both acidosis and alkalosis disorders in equal. Conclusion:We highlight the role of integrating chest ultrasound techniques in the physician resuscitation pathways to diagnose shock etiology, augment their clinical evaluation and guide resuscitation.

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Amyloidosis is the extracellular deposition of amyloid fibril protein in any tissue or organ. The clinical manifestations of pulmonary amyloidosis are variable and without specific symptoms. We report a rare case of diffuse alveolar septal amyloidosis which is an extremely rare pattern of involvement, with a very poor prognosis, to improve our understanding of the disease. CASE PRESENTATION:A 27-years-old man complained of shortness of breath and cyanosis. HRCT revealed diffuse groundglass opacifications with interlobular septal thickening in both lungs. The immune-histochemistry showed monoclonal lambda light chains. This case also showed nephrotic syndrome and cardiac arrhythmia, suggesting involvement of the kidney and the heart. Diagnosis: The diagnosis was finally established by transthoracic sonar guided lung biopsy (TSLB) and histological examination that revealed Congo Red-positive amorphous eosinophilic deposits in the alveolar Sept. Interventions: The patient was admitted to RICU and put on NIV then discharged on domiciliary oxygen therapy, and started treatment with chemotherapy melphalan 2mg daily plus prednisone 60 mg daily immediately after the result of histopathology. Outcomes: Three months after treatment, dyspnea and hypoxemia improved, and he continued treatment. The patient was in a good clinical condition after 10 months of follow-up, but he died suddenly.

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