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 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.