Pneumothorax from bronchopleural or alveolo-pleural fistulae can be complicated by prolonged air leak (AL). This can occur in a variety of clinical settings. Examples include structural lung disease, such as bronchiectasis, and cavitary lung disorders. Prolonged AL is associated with prolonged hospital stay, atelectasis, pneumonia, and thromboembolic disease. Endobronchial valves (EBVs) have been recently introduced to manage such situations. The global experience in this novel therapeutic modality is still evolving. We report our preliminary experience with managing persistent AL treated successfully with EBVs and review the current literature on this subject. Our experience shows that EBVs are an effective tool for the management of prolonged AL from persistent bronchopleural or alveolo-pleural fistulae. It is a minimally invasive procedure recommended as an option, particularly in patients not fit for surgical repair.
Schistosomiasis is an uncommon waterborne helminthic infection that infects humans. Although it is not prevalent in India, many cases are reported due to contact with infested water bodies. Schistosomiasis primarily involves the lower urinary tract and colorectal region. Pulmonary schistosomiasis, although very unusual, has been described with the systemic manifestation of the disease; however, pleural involvement with schistosomiasis has never been described before in the literature. We report this first case of pleural schistosomiasis masquerading as tuberculosis, which posed a diagnostic challenge and later a new learning point in the presentation of the disease.
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The risk of cancer among end stage renal disease patients is higher than general population. Types of malignancy, age of patients, comorbid condition and functional status can influence management of cancer. The data regarding cancer among hemodialysis patients in Middle East area is rarely reported. We aim to study the types of cancers in hemodialysis patients in a tertiary oncology center in United Arab Emirate. Methods: Ethical approval was obtained to conduct a retrospective chart review study at Tawam Hospital from January 2009 to August 2019. We included end stage renal disease adult patients (age >18) with diagnosis of cancer after initiation of hemodialysis. Laboratory data and Clinical outcomes were analyzed using descriptive analysis. Results: A total of 1708 patients required hemodialysis during study period and 203 patients had diagnosis of cancer. 68 hemodialysis patients fulfilled the inclusion criteria (cancer after initiation of HD). The mean age was 68.8 years, and male to female ratio (2:1). National patients were 32 (47%). The duration of hemodialysis prior to cancer diagnosis was ranging from 0.5 to 10 years. Majority of patients had arteriovenous fistula (48) as access for HD and 20 patients had tunneled HD catheters. The comorbid conditions in our cohort were hypertension (61 [89.7%]), diabetes mellitus (50 [73.5%]), ischemic heart disease (33 [48.5%]), stroke (13 [19.1%]) and peripheral vascular disease (14[ 20.5%]). The most common type of cancers was urogenital 18 (26.4%)(renal cell carcinoma (7), bladder cancer (6), prostate cancer(5)). Hematological malignancies were as the following multiple myeloma (6), leukemia (chronic myeloid CML (1), plasma cell leukemia (1)), and lymphoma (3). Breast cancer has been identified in 5 HD female patients while ovarian cancer andcervical cancer were identified in 1.4 %. Lung cancer was found only in two HD patients with positive smoking history. Gastrointestinal cancers diagnosed in our cohort were colon cancer (7), gastric (3), esophageal cancer (3), liver cancer (2) and pancreatic cancer (2). Skin cancers were identified in patient who failed renal transplant (Basal cell carcinoma and Squamous cell carcinoma). 23 patients (33.8%) had metastatic disease at time of diagnosis. 23 patients (33.8%) had metastatic disease at time of diagnosis. Majority of patient received chemotherapy (29 [42.6%]). Oncology surgery and radiotherapy were done in selected patients (33.8%). The mortality rate was high especially with metastatic disease andfew patients opted for palliative care. Conclusions: The incidence of cancer in our hemodialysis patients over 10 years is low with predominance of urogenital cancers. Patients with metastatic disease had poor prognosis and palliative care is essential.
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