Over a 3-year period, all patients referred for barium enema examination had a double-contrast barium enema and flexible sigmoidoscopy performed on the same day. A total of 462 joint examinations were performed. Abnormalities were found in 193 patients by the use of barium enema, 164 patients by using sigmoidoscopy and 294 by the use of both methods of investigation. Sigmoidoscopy was superior to barium enema in the detection of polyps and inflammatory bowel disease but barium enema was more sensitive for diverticular disease. The presenting symptoms had no predictive value in distinguishing carcinoma, polyps and diverticular disease. Diverticular disease did not reduce the sensitivity of barium enema examination to polyps in the sigmoid colon. Fibreoptic sigmoidoscopy immediately before barium enema was well tolerated by patients. The investigations were complementary in the diagnosis of colonic polyps, inflammatory bowel disease and diverticular disease.
Anti-thyroid medications can cause a variety of adverse reactions. There are only a small amount of reported cases associating the thioamides with pleural effusions [1,2,3]. None of these were associated with trapped lung. We present a case of a trapped lung with unclear etiology associated with methimazole and hypothyroidism. CASE PRESENTATION: A 36-year-old male with a history of Type 1 diabetes and Graves' disease status post radio-iodine ablation on methimazole presented to the hospital after one month of shortness of breath and cough with no associated fevers, chills, or night sweats. The patient was found to have a large right pleural effusion with mediastinal shift to the left with a completely collapsed lung. He subsequently had a chest tube placed with four liters fluid drained. Pleural fluid showed an exudative effusion by Light's Criteria with fluid and serum protein of 4.6 g/dL and 8.6 g/dL respectively. Fluid and protein lactate dehydrogenase (LDH) were 120 U/L and 320 U/L respectively. Pleural glucose was 95 mg/dL and pH was 7.75. Gram stain and cultures were unremarkable. Cytology was non-diagnostic for malignancy. After drainage, the patient's right lung remained collapsed with quickly reaccumulated effusion. Serum sedimentation rate, quantiferon gold, fluid adenosine deaminase, and fluid amylase were all negative. He was found to be hypothyroid with a thyroid stimulating hormone level of 20.7 IU/mL and free T4 of 0.31 ng/mL and his methimazole was stopped. An autoimmune panel was negative. Due to concern for trapped lung, the patient underwent a video-assisted thorascopic surgery converted to thoracotomy for decortication of the right upper, middle, and lower lobes. After decortication, the patient had increased aeration of the lung with no evidence of consolidation or mass. He was ultimately discharged home with resolution of the hypothyroidism and placed back on methimazole. He has only had recurrence of a mild asymptomatic effusion.
Perioperative digoxin concentrations were measured in 20 unselected adult patients undergoing coronary surgery. None of the patients were receiving treatment with digoxin. A digoxin-like immunoreactive substance was found in 16 patients postoperatively. This substance, if pharmacologically active, may have important clinical implications in the management of patients after open heart surgery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.