We conducted a study to examine the effect of COVID-19 on the acute exacerbation of interstitial lung disease (AE-ILD) early in the COVID-19 epidemic (January 1–April 30, 2020). An online questionnaire survey was conducted, which was completed by 134 hospitals. During this period, 854 patients with AE-ILD (including 12 cases of COVID-AE-idiopathic pulmonary fibrosis were hospitalized at 128 hospitals. In comparison, the total number of AE-ILD hospitalizations during the same period in 2019 was 894. The number of hospitalizations increased at 17 hospitals, decreased at 27, and remained the same at 88 hospitals in 2020 compared to the same period in 2019. In 2020, COVID-19-related acute exacerbations had a significantly worse prognosis than non-COVID-19-related acute exacerbations in both 30-day and 90-day mortality. Because the prognosis of AE-ILD associated with COVID-19 is extremely poor, prevention of COVID-19 is especially important for patients with ILD.
We present a rare case of a tuberculous retropharyngeal abscess (RPA)
Lesions were made by electrical coagulation in the base of the hypothalamus of rats, 20 to 24 h after birth. Subsequent growth of the hypophysis was examined volumetrically and histologically on the 40th and 60th days after the operation, paying special attention to the pars intermedia. Growth retardation of the hypophysis was noticeable after 60 days in rats with lesions of the hypophysial stalk (groups 1 and 2) and the posterior portion of the median eminence (group 4), especially in animals in which the stalk was completely (group 1) or almost completely (group 2) transected. Notwithstanding the growth retardation of the hypophysis, the ratios of the volume of the pars anterior to that of the whole hypophysis in groups 1 and 2 were not significantly different from those in group 3 (animals with a lesion of the anterior portion of the median eminence), groups 4 and 5 (animals with a lesion in the hypothalamus elsewhere than the stalk and median eminence), and normal controls of the same age (group 6). In contrast to this, the ratio of the volume of the pars nervosa to the total gland in group 3, and more especially in groups 1 and 2, had considerably diminished, and that of the pars intermedia in groups 1 and 2 had markedly increased, after 60 days in comparison with those in groups 3, 4, 5, and 6. These results indicate that the pars intermedia of animals in groups 1 and 2 was hypertrophic compared with the pars anterior and pars nervosa. These volumetric data seem to correspond with the finding that neurosecretory material was not present in the pars nervosa in groups 1 and 2, but was abundant in groups 3, 4, 5, and 6. After 60 days, the pars intermedia of group 1 consisted chiefly of well-developed cells, as in normal adult rats. On electron microscopic examination, however, they were found to differ from normal mature cells in the following three points: (1) most of the secretory granules were vesicular with little or no opacity; (2) the endoplasmic reticulum frequently showed cisternae; (3) nerve terminals were not encountered at the surface of the glandular cells. The former two points suggest that these cells are functionally active, an observation that agrees with the results of volumetric findings. It is concluded from these data that, in the absence of hypothalamic control, the pars intermedia of the hypophysis in rats grows actively after birth, while the anterior hypophysis seems to be inactive and atrophic [unpublished].
Medio-basal hypothalamic lesions were made by electric coagulation in Sprague-Dawley strain rats 20-24 hours after birth. Testicular development in these animals was examined 20,40 and 60-70 days after birth. Transection (Group 1) or severe lesion (Group 2) of the pituitary stalk caused arrest of both spermatogenesis and testicular development. In these animals, on the 40th and 60th day after birth, the seminiferous tubules were very small in diameter and no spermatids or spermatozoa were found in the lumen. The seminiferous epithelium was very thin, and spermatogenesis was arrested in the premeiotic stage. Lesion of the posterior part of the median eminence, including the stalk (Group 4), also induced testicular atrophy, but spermatogenesis was not disturbed. Damage of the anterior portion of the median eminence (Group 3) did not cause testicular atrophy. When the median eminence and the stalk were intact, lesions of the hypothalamus, including the subthalamus, mamillary body and half the hypothalamus (Group 5), did not depress spermatogenesis. The hypophysis did not show any degeneration in all cases examined, although the size was very small in Groups 1 and 2. These findings suggest that development of testiculotropic function of the hypophysis is dependent on the hypothalamus, especially on the posterior medio-basal hypothalamus, even though the hypophysis grows independently of hypothalamic control.
Background: Despite improved surgical techniques and perioperative management, anastomotic leakage (AL) after esophageal cancer surgery remains a potential complication. In most cases, spontaneous healing upon proper drainage is observed, but sometimes, AL results in intractable enterocutaneous fistulas. We here report a case of intractable enterocutaneous fistula caused by post-esophagectomy AL and successfully treated by scopolamine ointment and negative pressure wound therapy (NPWT). Case presentation: A 77-year-old man underwent thoracoscopic subtotal esophagectomy with 3-field lymph node dissection, followed by gastric tube reconstruction through the posterior mediastinal route. On the 6th postoperative day, AL was identified, forming an enterocutaneous fistula. Initially, conservative treatment was performed, but the fistula failed to close. We hypothesized that the substantial amount of exudate might be hampering fistula closure. Scopolamine ointment was used to reduce the amount of fluid. NPWT was also initiated to promote wound healing. Approximately 3 weeks after the beginning of the treatment, the fistula closed; oral intake became possible, and the patient was discharged from the hospital without any symptoms. Conclusions: The combination of scopolamine ointment and NPWT may be regarded as one effective treatment option for intractable enterocutaneous fistula due to AL after esophagectomy.
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