Acute Respiratory Distress Syndrome: A Rare Manifestation of Rhinovirus Infection.

Human rhinovirus (HRV) is a common cause of respiratory infections. HRV-related lower respiratory tract infections, including community-acquired pneumonia, are seldom seen in the clinical setting, and progression to acute respiratory distress syndrome (ARDS) is even rarer. We report on a case of a young immunosuppressed host who presented to the hospital for respiratory distress. She was diagnosed with HRV-related pneumonia, which rapidly progressed to ARDS based on clinical examination. After orotracheal intubation and mechanical ventilation with a low tidal volume strategy, she made a rapid recovery. This case highlights the importance of understanding that HRV may be an etiology of community-acquired pneumonia in immunosuppressed hosts and that ARDS may be a complication of this infection. Rapid recognition and clinical suspicion are important to the care of these patients, as ARDS has a high mortality rate.

Marijuana-Induced Lung Injury: A Case Report and a Review of the Literature.

Marijuana is a commonly abused illicit substance around the world, and lung injury related to its use has seldom been cited in the literature. Most cases describe marijuana-induced lung injury via vaping and the use of butane hash oil; however, no cases, to our knowledge, have associated lung injury related to marijuana smoke in the form of rolled "blunts" or cigarettes. We describe the case of a patient who presented to the hospital due to chest computed tomography findings demonstrating diffuse bilateral opacifications without signs of systemic inflammatory response syndrome. Bronchoscopy with bronchoalveolar lavage and sputum cultures failed to identify an infectious etiology, and serologies were negative for autoimmune etiologies. We aim to contribute to the limited body of literature describing marijuana-induced lung injury.

BRCA1/2 Mutations in Vietnamese Patients with Hereditary Breast and Ovarian Cancer Syndrome.

(1) Background: Individuals with BRCA1/2 gene mutations are at increased risk of breast and ovarian cancer. The prevalence of BRCA1/2 mutations varies by race and ethnicity, and the prevalence and the risks associated with most BRCA1/2 mutations has not been unknown in the Vietnamese population. We herein screen the entire BRCA1 and BRCA2 genes for breast and ovarian cancer patients with a family history of breast cancer and ovarian cancer, thereby, suggesting a risk score associated with carrier status and history for aiding personalized treatment; (2) Methods: Between December 2017 and December 2019, Vietnamese patients who had a pathological diagnosis of breast and epithelial ovarian cancer were followed up, prospectively, after treatment from two large institutions in Vietnam. Blood samples from 33 Vietnamese patients with hereditary breast and ovarian cancers (HBOC) syndrome were collected and analyzed using Next Generation Sequencing; (3) Results: Eleven types of mutations in both BRCA1 (in nine patients) and BRCA2 (in three patients) were detected, two of which (BRCA1:p.Tyr1666Ter and BRCA2:p.Ser1341Ter) have not been previously documented in the literature. Seven out of 19 patient's relatives had BRCA1/2 gene mutations. All selected patients were counselled about the likelihood of cancer rising and prophylactic screening and procedures. The study established a risk score associated with the cohorts based on carrier status and family history; (4) Conclusions: Our findings suggested the implications for the planning of a screening programme for BRCA1 and BRCA2 genes testing in breast and ovarian cancer patients and genetic screening in their relatives. BRCA1/2 mutation carriers without cancer should have early and regular cancer screening, and prophylactic measures. This study could be beneficial for a diverse group in a large population-specific cohort, related to HBOC Syndrome.

Use of single-staged transmetatarsal trimmed great toe transfer for reconstruction of a thumb amputation at the carpometacarpal joint.

BACKGROUND: Reconstruction for proximal thumb amputation at the carpometacarpal (CMC) joint level is extremely challenging. All thenar muscles are lost and other fingers might be lost or injured. Transmetatarsal trimmed great toe (TGT) transfer may be an option in such cases. METHODS: Between 2012 and 2018, 11 patients who had amputation of the thumb at the CMC joint level were reconstructed by transmetatarsal TGT transfer in a single stage. There were seven cases in which the right hand was affected and four cases in which the left hand was affected. Three cases involved a contracture scar at the thumb stump and required web space reconstruction. Average follow-up was 33.9 months (range: 12-76 months) RESULTS: All toe transfers survived. The average of static two-point discrimination (S2PD) was 14.6 mm; the average scores of the Quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ) were 18.6 and 73.8, respectively. Two cases did not achieve opposition due to mispositioning of the neothumb. In nine cases achieving opposition, the Kapandji score ranged from 4 to 9, pinch ranged from 3 to 11 lbs, and grip ranged from 15 to 86 lbs. In the donor foot, three patients had neuroma and two had a new callus on the palmar side of the second and third metatarsal heads. The average foot and ankle disability index score was 91.6. CONCLUSION: Single-staged transmetatarsal TGT transfer is safe and useful for thumb reconstruction at the CMC joint level. This reconstructive method is suitable for manual workers, especially in the developing countries.

A simple approach to thumb amputation reconstruction at metacarpal base with toe transfer, two case reports.

INTRODUCTION: Reconstruction for thumb amputation at the metacarpal base by toe transfer is challenging. To restore a thumb with normal or near-normal length, the reconstruction plan usually involves a complicated and challenging process either in two stages (stage 1: resolving soft tissue and bone defect; stage 2: toe transfer) or a single stage by using two free flaps (one free soft tissue flap and one toe flap). However, is it necessary to restore the full length of the thumb for functional and aesthetic achievement? PRESENTATION OF CASES: Two male patients (21 and 22 years old) had a thumb amputation at the metacarpal base. We accepted the shortened metacarpal length and performed reconstruction in one stage by trimmed great toe flap, at the level of the metatarsophalangeal joint. The first phalanx of toe flap was fused with the first metacarpal base. On long-term follow-up, both patients were able to return to daily activities, work and had a good cosmesis. DISCUSSION: With our reconstruction technique, two reconstructed thumbs were functionally similar to a thumb amputation group 1 of Campbell-Reid. Using trimmed great toe flap, the tip of our reconstructed thumbs looks like that of a normal thumb. Both patients were satisfied. CONCLUSION: Accepting length shortening, the reconstruction for thumb amputation at the metacarpal base by toe transfer could be done more easily and simply in a single stage.

The experiences drawn from 139 cases of free flap transference for covering lower extremity defects

138 patients (102 males, 36 females) aged 3-71 years old with 139 deficiencies of various causes in inferior limbs underwent a surgery of free flap transfer with 144 free flaps. Survived rate reached 134/144 flaps (93.05%), full necrosis in 10/144 flaps (6.95%). All cases were sucessfully operated exculding 5/10 cases of second time transfer. Near possible complications such as obstruction of the arterial connection of 4 flap-connect sites, obstruction of the venous connection of 6 flap sites, obstruction of venous-arterial connection of 2 sites, necrotic infection in 1 flap.