A Case of Severe Respiratory Failure in a Patient with Sepsis From a Pressure Ulcer in Which Cooperation Among Many Professions Was Useful for Discharge From the Intensive Care Unit / 日本農村医学会雑誌

A woman in her 60s was being treated for diabetes and hypertension but had impaired activities of daily living (ADL) due to severe obesity (150 kg). She was transported to the emergency department because of disturbance of consciousness in August 201X. Imaging findings showed decreased permeability of the whole right lung field. She was intubated and started on ceftriaxone plus levofloxacin for severe infection with respiratory failure. Erysipelothrix rhusiopathiae was detected in blood cultures, leading to a diagnosis of sepsis due to a large pressure ulcer on the posterior aspect of the thigh. We switched levofloxacin to clindamycin and continued medical treatment, and she was extubated on the 10th day of illness. However, type 2 respiratory failure was prolonged because of alveolar hypoventilation due to obesity and she required noninvasive positive pressure ventilation. Also, she had difficulty getting out of bed due to obesity, disuse syndrome, and pressure ulcer. Cooperation among staff from many professions, including respiratory nursing, intensive care nursing, wound, ostomy and continence nursing, physical therapy, and nutrition management, led to improvement of ADL and weight loss (to 109 kg), allowing her to be transferred out of the intensive care unit.

Nontraumatic Hemopneumothorax Treated by Transcatheter Arterial Embolization / 日本農村医学会雑誌

From April 2009 to April 2017, we experienced on average 40 cases of spontaneous pneumothorax per year at our hospital, but we encountered only 2 cases of nontraumatic hemopneumothorax over the entire 8-year period. In one of these cases, we performed transcatheter artery embolization. Extravasation of contrast media was observed on CT near the apex of the lung, and angiography revealed the culprit vessel. We performed embolization and were able to achieve hemostasis and symptomatic improvement. However, hemopneumothorax recurred as a result of adhesion tear due to re-collapse of the lung and required surgical treatment. In this report, we describe our experience of this relatively rare condition and discuss the case with reference to the literature.

A Case of Papillary Lung Adenocarcinoma that was Difficult to Distinguish from Chronic Eosinophilic Pneumonia / 日本農村医学会雑誌

An 82 year-old-woman was referred to our hospital because of infiltrative shadow of the lingula in 201X. She was asymptomatic, so we followed up with imaging observation. After 1 year, the infiltrative shadow had progressed, so we performed bronchoscopy. Glandular epithelium with the mild aberrant type was detected, but did not lead to a definitive diagnosis. There was increased eosinophilic compartmentalization of immune response in the bronchoalveolar lavage, so we started treatment with corticosteroids for chronic eosinophilic pneumonia. However, there was no improvement of the shadow. Subsequent computed tomography-guided lung biopsy revealed evidence of papillary adenocarcinoma.

A Case of Mediastinal Abscess Requiring Surgical Management / 日本農村医学会雑誌

We report on an apparently healthy woman in her 50s who noticed pain in the left side of her neck anteriorly and was prescribed an antimicrobial agent at a nearby clinic. However, she developed hypotension and hypoxemia and was brought to our hospital. Laboratory investigations revealed evidence of inflammation, and imaging findings showed low-density areas corresponding to the left lobe of the thyroid gland. The low-density areas extended to the superior mediastinum, raising suspicion of a thyroid gland mediastinal abscess. We performed inferior mediastinal drainage with video-assisted thoracoscopic surgery and resection of the left lobe of the thyroid gland. Culture of mediastinal aspirate yielded Streptococcus viridans. Based on these findings, the final diagnosis was descent-related mediastinitis secondary to acute suppurative thyroiditis.