BackgroundPulmonary tuberculosis is caused by Mycobacterium tuberculosis and its manifestations may include parenchymal, airway, vascular, pleural, mediastinal and chest wall lesions. Hemoptysis is a common complication of the disease. Massive hemoptysis occurs in about 8 % of cases; with associated mortality ranging from 5 to 25 % Massive hemoptysis secondary to pulmonary artery aneurysm rupture is a rare phenomenon presenting unique challenges in airway management and stabilization of oxygenation, ventilation and blood pressure.Case historyWe present a case of a patient with necrotizing pulmonary tuberculosis complicated by a ruptured pulmonary artery “Rasmussen” aneurysm requiring emergent intubation and embolization.ConclusionMassive hemoptysis should be treated as a medical emergency requiring the coordinated care of multiple specialists including intensivists, interventional radiologists, anesthesiologists, and surgeons. Airway management and stabilization of cardiorespiratory status should be the highest priority, followed by timely diagnostic procedures to localize the site and cause of the bleeding.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1313-7) contains supplementary material, which is available to authorized users.
Cervicofacial actinomycosis is known to affect many soft tissues and bony structures in the head and neck. However to the authors' knowledge, actinomycosis of the post-cricoid region has not been previously reported. A case of a 74-year-old male who developed actinomycosis of the post-cricoid region after radiotherapy for a laryngeal carcinoma is presented. Actinomycosis should be considered in the differential diagnosis of dysphagia following radiotherapy for squamous cell carcinoma of the larynx, as early treatment is likely to result in a favourable outcome.
In a multivariable logistic analysis, African American pediatric patients were shown to have significantly higher odds of PRAEs when compared with the Caucasian group.
A case of spontaneous, isolated supraglottic haemorrhage in a patient recently started with warfarin sodium treatment is described. The symptoms of sore throat, dysphonia, stridor, dysphagia or a neck swelling in a patient taking anticoagulants should alert the clinician to the possibility of this rare but potentially fatal complication.
Introduction
The comparative efficacy and safety of valve‐in‐valve transcatheter aortic valve replacement (ViV‐TAVR) and redo‐surgical AVR (redo‐SAVR) in patients with degenerated bioprosthetic aortic valves remain unknown.
Method
Digital databases were searched to identify relevant articles. Unadjusted odds ratios for dichotomous outcomes were calculated using a random effect model. A total of 11 studies comprising 8326 patients (ViV‐TAVR = 4083 and redo‐SAVR = 4243) were included.
Results
The mean age of patients undergoing ViV‐TAVR was older, 76 years compared to 73 years for those undergoing SAVR. The baseline characteristics for patients in ViV‐TAVR vs. redo‐SAVR groups were comparable. At 30‐days, the odds of all‐cause mortality (OR 0.45, 95% CI 0.30–0.68, p = .0002), cardiovascular mortality (OR 0.44, 95% CI 0.26–0.73, p = .001) and major bleeding (OR 0.29, 95% CI 0.15–0.54, p = .0001) were significantly lower in patients undergoing ViV‐TAVR compared to redo‐SAVR. There were no significant differences in the odds of cerebrovascular accidents (OR 0.91, 95% CI 0.52–1.58, p = .74), myocardial infarction (OR 0.92, 95% CI 0.44–1.92, p = .83) and permanent pacemaker implantation (PPM) (OR 0.54, 95% CI 0.27–1.07, p = .08) between the two groups. During mid to long‐term follow up (6‐months to 5‐years), there were no significant differences between ViV‐TAVR and redo‐SAVR for all‐cause mortality, cardiovascular mortality and stroke. ViV‐TAVR was, however, associated with higher risk of prosthesis‐patient mismatch and greater transvalvular pressure gradient post‐implantation.
Conclusion
ViV‐TAVR compared to redo‐SAVR appears to be associated with significant improvement in short term mortality and major bleeding. For mid to long‐term follow up, the outcomes were similar for both groups.
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