Cavitary Hodgkin Lymphoma of the Lung.

It has been shown that some cases of Hodgkin lymphoma (HL) may present with pulmonary parenchymal involvement usually in the form of multiple irregularly marginated pulmonary nodules. Other radiographic patterns such as consolidation, interstitial infiltrates, and cavitary lesions are less common. We present a case of HL, nodular sclerosis type, with pulmonary involvement presenting as a large cavitary consolidation and axillary and mediastinal lymphadenopathy. Initial diagnostic work-up including sputum culture, bronchoscopy, and a fine needle aspiration of lymph node was not conclusive favoring a reactive process with a presumptive diagnosis of cavitary pneumonia. A follow-up chest imaging revealed worsening right upper lung mass, axillary adenopathy, and new nodular satellite lesions, and a repeat bronchoscopy with multiple biopsies remained non-diagnostic requiring an excisional biopsy of the axillary lymph node confirming HL. Further transthoracic core biopsies of the cavitary lung lesion were consistent with pulmonary lymphoma involvement.

Pseudohypoglycemia: A Pitfall in Everyday Practice.

Hypoglycemia is a common clinical finding, especially in the inpatient setting. However, laboratory testing may show falsely low blood glucose levels. It is crucial for clinicians to recognize the existence of pseudohypo- glycemia and know when and how to test for it.

Evaluating dye recovery and reusability potential from dyebath effluent using forward osmosis membranes for minimum liquid discharge.

This study focuses on the evaluation of dye recovery and reuse potential from denim and polyester effluents using forward osmosis (FO). A cationic surfactant, tetraethylammonium bromide (TEAB), was used as the draw solution (DS). After optimizing the DS and feed solution (FS) concentrations and temperatures in batch experiments, a DS concentration of 0.75 M was selected at a 60 °C temperature for the semi-continuous mode. It generated a high flux of 18 L/m2/h and a low reverse solute flux (RSF) of 0.4 g/m2/h with 100% dye rejection. Dye reconcentration of 82-98% was achieved in the dyebath effluents. The unique property of surfactants to combine hundreds of monomers into micelle resulted in negligible RSF. Reversible fouling was observed on the membrane active layer, and NaOH and citric acid cleaning achieved about 95% of flux recovery. The functional groups on the membrane's active layer remained undisturbed due to foulant interactions showing its chemical stability against reactive dyes. Recovered dye characterization using 1D proton nuclear magnetic resonance (1HNMR) analysis depicted a 100% structural resemblance to the original dye. Hence, it can be reused for dyeing the next batch. Diluted TEAB solution can be used as fabric detergent and softener within the same textile industry in the finishing process. A minimum liquid and persistent pollutant (dyes) discharge is achieved by adopting the methodology proposed in this work with a strong potential of translating it to an industrial scale.

A novel approach to the analysis of spin-trapped free radicals using dimethyl sulfoxide and gas chromatography - mass spectrometry (GC-MS) with both solvent extraction and headspace solid phase microextraction (HS-SPME).

In this study, we have utilized a novel strategy based upon the use of dimethyl sulfoxide (DMSO) and gas chromatography-mass spectrometry (GC-MS) for the detection and identification of spin-trapped free radicals. Hydroxymethyl (.CH2OH) radicals, generated by Fenton-type chemistry, have been trapped by N-tert-butyl-α-phenylnitrone (PBN) or one of its derivatives in the presence of DMSO to form a 1,3-diadduct [PBN-(CH2OH)(CH3)], which may be detected directly in the reaction mixture following chloroform extraction or in the reaction vial headspace by sampling with SPME. Separation and identification have been carried out by capillary gas chromatography coupled to electron-ionization mass spectrometry (EI-MS). The results demonstrate that using DMSO aids GC-MS analysis of spin-trapped free radicals via the formation of radical-methyl di-adducts that are sufficiently volatile to be sampled both in the headspace or by an extracting solvent without the need for a derivatization step using silylating agents.

Optimization of nutrient rich solution for direct fertigation using novel side stream anaerobic forward osmosis process to treat textile wastewater.

The current study focused on the performance of a lab scale side stream anaerobic fertilizer drawn forward osmosis (An-FDFO) setup and optimization of nutrient rich solution to achieve sustainable water reuse from high strength synthetic textile wastewater. Three fertilizer draw solutes including Mono Ammonium Phosphate (MAP), Ammonium Sulphate (SOA) and Mono Potassium Phosphate (MKP) were blended in six different ratios with total molar concentration not exceeding 1 M. Among six blended draw solutions (DS), combination with high concentration of SOA have shown highest flux and combination with high concentration of MKP have shown highest reverse solute flux, while those with high concentration of MAP remain moderate both in flux and RSF. During long term runs, SOA: MKP (0.75: 0.25 M) showed longest filtration duration of 217 h in Run 1, with highest initial flux of 8.29 LMH and minimum dilution factor to achieve final nutrients concentration fit for direct fertigation, followed by Run 3 MAP: SOA: MKP (0.2: 0.6: 0.2 M) and then Run 2 MAP: MKP (0.75: 0.25). Moreover, deterioration of mixed liquor characteristics occurs in membrane tank due to high RSF. Similarly, the same inhibitory effect of reverse salt on biogas production was also assessed through Bio-Methane Potential experiments. However, Anaerobic Continuous Stirring Tank Reactor exhibited high performance efficacy, highlighting the importance of side stream submerged configuration in forward osmosis (FO) process.

Detection and identification of ethanal-derived spin-trapped free radicals using headspace thermal desorption gas chromatography-mass spectrometry (TD-GC-MS).

In this study, we demonstrate a novel approach to the detection and identification of the products of spin-trapped free radicals. Hydroxyl free radicals were generated by Fenton-based chemistry in the presence of ethanal and the spin-trapping agent N-tert-butyl-α-phenylnitrone (PBN). The resulting volatile compounds present in the reaction vial headspace were collected using thermal desorption (TD) and analysed by gas chromatography-mass spectrometry (GC-MS). Eleven compounds were detected in the headspace, and their identification was aided by using either a fluorinated or deuterated analogue of PBN as an alternative spin trap and/or deuterated ethanal (CD3CHO) as the secondary source of free radicals. The electron-ionisation (EI) mass spectra clearly demonstrate the "capture" of methyl radicals; two of the compounds detected were identified as containing one methyl group derived from ethanal, and four were shown to contain two methyl groups. This study demonstrates that sampling the reaction headspace using TD-GC-MS is a viable method for analysing products of free radical trapping, and potentially may be applied to a wide range of free radical systems.

Ketoacidosis associated with ketogenic diet in a non-diabetic lactating woman.

A 37-year-old woman who had 8 weeks post partum, breast feeding and on a low carbohydrate and high protein (ketogenic) diet, was admitted to the hospital with acute onset of nausea, vomiting and abdominal pain of 1-day duration. On admission, she was found to have high anion gap metabolic acidosis, elevated beta-hydroxybutyric acid level, normal glucose level and evidence of ketoacidosis. She was treated with lactated Ringer solution, along with dextrose 5% solution with the resolution of symptoms and metabolic derangement.

Acute COPD exacerbation presenting with pronounced intrabullous haemorrhage and haemoptysis.

A 54-year-old man with history of chronic obstructive pulmonary disease (COPD) presented with subacute onset of chest pain, shortness of breath, productive cough with haemoptysis and night sweats. There were no fever or recent weight loss reported. The chest radiograph showed right upper lobe bullae with adjacent opacification and an emphysematous lung. Due to worsening haemoptysis and persistent chest pain, CT of the chest with contrast was performed, which revealed moderate to severe emphysema and numerous blood-filled bullae. Cardiac work-up for chest pain was negative for myocardial ischaemia and for aortic dissection. Further infectious work-ups for mycobacterial and invasive fungal infection were negative. The patient was treated for acute COPD exacerbation and responded well to the antibiotics with the resolution of haemoptysis. Follow-up CT of the chest revealed the gradual resolution of the haemorrhage, while the patient remained asymptomatic.

Assessing Diaphragm Function in Chest Wall and Neuromuscular Diseases.

Diaphragm dysfunction is defined as the partial or complete loss of diaphragm muscle contractility. However, because the diaphragm is one of only a few skeletal muscles that is not amenable to direct examination, the tools available for the clinician to assess diaphragm function have been limited. Traditionally, measures of lung volume, inspiratory muscle strength, and radiographic techniques such as fluoroscopy have provided the major method to assess diaphragm function. Measurement of transdiaphragmatic pressure provides the most direct means of evaluating the diaphragm, but this technique is not readily available to clinicians. Diaprhragm ultrasonography is new method that allows for direct examination of the diaphragm.

Disorders of the Diaphragm.

Pathologic processes that involve the central nervous system, phrenic nerve, neuromuscular junction, and skeletal muscle can impair diaphragm function. When these processes are of sufficient severity to cause diaphragm dysfunction, respiratory failure may be a consequence. This article reviews basic diaphragm anatomy and physiology and then discusses diagnostic and therapeutic approaches to disorders that result in unilateral or bilateral diaphragm dysfunction. This discussion provides a context in which disorders of the diaphragm and their implications on respiratory function can be better appreciated.

Sleep duration and risk of lung cancer in the physicians' health study.

BACKGROUND: Lung cancer is the most common cancer and cancer related cause of death worldwide. However, the association between sleep duration and incident lung cancer has not been investigated in a prospective cohort study. METHODS: We prospectively examined the association between sleep duration and incident lung cancer in a cohort of 21,026 United States (US) male physicians. Self-reported sleep duration was ascertained during 2002 annual follow-up questionnaire. Incident lung cancer was ascertained through yearly follow-up questionnaires. Cox regression was used to estimate relative risk of incident lung cancer. RESULTS: The average age at baseline was 68.3±8.8 yr. During a mean follow up of 7.5 (±2.2) yr, 150 cases of lung cancer occurred. Using 7 h of sleep as the reference group, multivariable adjusted hazard ratios (95%CI) for lung cancer were 1.18 (0.77-1.82), 1.0 (ref), and 0.97 (0.67-1.41) from lowest to the highest category of sleep duration (P for quadratic trend 0.697), respectively. In a secondary analysis, smoking status did not modify the sleep duration-lung cancer association (P=0.78). There was no evidence for an interaction between sleep duration and sleep apnea on the risk of lung cancer either (P=0.65). CONCLUSIONS: Our data failed to show a higher risk of lung cancer in association with altered sleep duration among US male physicians.

Recurrent life-threatening hyperkalemia without typical electrocardiographic changes.

Hyperkalemia is generally associated with electrocardiographic (ECG) changes and these changes have been used to follow the effects of high serum potassium (K+) levels on the heart. It is known that chronic renal impairment may diminish the toxic effects of hyperkalemia on ECG abnormality formation. (1-3) Here, we report a case of recurrent severe hyperkalemia without any significant ECG changes in a patient with normal baseline renal function.

Long-term efficacy of deferasirox in preventing cardiovascular complications in the iron-overloaded gerbil.

Iron-induced cardiovascular disease is the leading cause of death in iron-overloaded patients. Deferasirox is a novel tridentate oral chelator that exhibits a half-life suitable for once-daily dosing; however, little is known regarding the effectiveness of this agent in preventing iron-induced cardiovascular disease. Adult male Mongolian gerbils were randomly divided into 3 groups: control, iron overload, and iron overload followed by deferasirox treatment. Iron-overloaded animals received iron dextran 100 mg/kg intraperitoneally (ip)/5 days for 10 weeks, while deferasirox was given 100 mg/kg per d orally (po) for 9 months post iron loading. Cardiac and aortic iron levels were determined by inductively coupled plasma atomic emission spectrometry. Gerbil electro- and echocardiograms were obtained in anesthetized animals at regular intervals. Compared to control animals, iron concentration was 3.3- and 2.4-fold higher in iron-overloaded heart and aorta, respectively (P < .05). Deferasirox treatment reduced cardiac and aortic iron levels by 32% and 35%, respectively (P < .05). These results were consistent with the decrease in cellular iron deposition observed with Prussian Blue iron staining. Iron-overloaded gerbils were found to exhibit frequent arrhythmias including premature ventricular contractions, supraventricular tachycardia, and recurrent ventricular tachycardia. In addition, echocardiographic assessment demonstrated iron overload-associated increase in left ventricular dimensions including left ventricular posterior wall dimension (LVPWd: 49%), left ventricular internal dimension (LVIDd: 26%), and left ventricular septum thickness (LVSd: 42%). These parameters were significantly reduced with deferasirox treatment (LVPWd: 23%, LVIDd: 24%, and LVSd: 27%). Iron overload was also associated with reduced ejection fraction (EF: by 30%) and fractional shortening (FS: by 23%) in comparison with controls (P < .05). With deferasirox treatment, these values were higher (EF: by 30%, FS: by 28%) compared to iron-overloaded group. These findings suggest that deferasirox may be useful for attenuating iron-induced changes in cardiac structure and function.

Thoracic splenosis: know it--avoid unnecessary investigations, interventions, and thoracotomy.

Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. Most cases of TS are asymptomatic and are diagnosed during the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive workup and unnecessary invasive diagnostic procedures including thoracotomy. Multiple, asymptomatic, left-sided pleura-based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert one to suspect TS, which can then simply be confirmed with a (99m)Tcsulfa colloid radionuclide scan. If TS is suspected and radionuclide imaging studies are performed, further extensive investigations, such as bronchoscopy, biopsy, thoracoscopy, and thoracotomy, are not required as the radionuclide scan is definitive for diagnosis. Most cases are asymptomatic, so further treatment is rarely required; all cases are managed conservatively. We emphasize that all physicians, radiologists, pathologists, and interventionalists should recognize key features that suggest the diagnosis of TS, order appropriate imaging when it is suspected, and avoid unnecessary invasive diagnostic procedures including thoracotomy.

Chronic acetaminophen attenuates age-associated increases in cardiac ROS and apoptosis in the Fischer Brown Norway rat.

There is a growing need for pharmacological agents to manage cardiovascular disease in the rapidly growing elderly population. Here, we determine if acetaminophen is efficacious in decreasing age-related increases in cardiac reactive oxygen species (ROS) and apoptosis in aging Fischer 344 X Brown Norway rats. Compared to 6-month control animals, indices of oxidative (superoxide anion [O2( *-)] and 4-hydroxy-2-nonenal [4-HNE]) and nitrosative (protein nitrotyrosylation) stress were markedly increased in 33-month-old rat hearts. 33-month animals that had been treated with acetaminophen (30 mg/kg/day p.o. for 6 months) exhibited diminished age-related increases in cardiac ROS levels and TUNEL positive nuclei and these changes were accompanied by improvements in the Bax/Bcl2 ratio, diminished evidence of caspase-3 activation and increased phosphorylation of protein kinase B, ERK1/2, p70S6K and GSK-3beta. Taken together these results suggests that acetaminophen may attenuate the age-associated increases in the cardiomyocyte apoptosis, possibly via diminishing age associated elevation in ROS production.

Possible molecular mechanisms underlying age-related cardiomyocyte apoptosis in the F344XBN rat heart.

Despite advances in treatment, age-related cardiac dysfunction still remains a leading cause of cardiovascular death. Recent data have suggested that increases in cardiomyocyte apoptosis may be involved in the pathological remodeling of heart. Here, we examine the effects of aging on cardiomyocyte apoptosis in 6-, 30-, and 36-month-old Fischer344 x Brown Norway F1 hybrid rats (F344XBN). Compared with 6-month hearts, aged hearts exhibited increased TdT-mediated dUTP nick end labeling-positive nuclei, caspase-3 activation, caspase-dependent cleavage of alpha-fodrin and diminished phosphorylation of protein kinase B/Akt (Thr 308). These age-dependent increases in cardiomyocyte apoptosis were associated with alterations in the composition of the cardiac dystrophin glycoprotein complex and elevated cytoplasmic IgG and albumin immunoreactivity. Immunohistochemical analysis confirmed these data and demonstrated qualitative differences in localization of dystrophin-glycoprotein complex (DGC) molecules with aging. Taken together, these data suggest that aging-related increases in cardiac apoptotic activity model may be due, at least in part, to age-associated changes in DGC structure.

Lyme carditis: sequential electrocardiographic changes in response to antibiotic therapy.

Lyme disease is a tick-borne spirochetal infection that may involve heart. The cardiac manifestations of Lyme disease including varying degrees of atrioventricular heart block occur within weeks to months of the infecting tick bite. This report describes a 43 year-old man with Lyme carditis who presented with complete heart block. The heart block resolved with ceftriaxone therapy. Lyme carditis should be considered in the differential diagnosis in patients who present with new onset advanced heart block.

Thoracic splenosis: A diagnosis by history and imaging.

Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. The majority of cases of TS are asymptomatic and are diagnosed in the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive work-up and unnecessary invasive diagnostic procedures including thoracotomy. This case report describes a 40-year-old man, who was diagnosed incidentally with TS, several years after the initial injury. Multiple, asymptomatic, left-sided pleural based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert suspicion of TS, which can then simply be confirmed by a Tc-99m sulphur colloid radionuclide scan. Most patients are treated conservatively unless they are symptomatic. Physicians must recognize the key features suggesting a diagnosis of TS, order appropriate imaging studies and avoid unnecessary invasive diagnostic procedures.