Experience with indwelling pleural catheters in the treatment of recurrent pleural effusions.

Recurrent pleural effusions are frequently encountered in clinical practice. Whether malignant or nonmalignant, they often pose a challenge to the practicing clinician. When they recur, despite optimum medical therapy of the underlying condition and repeated thoracenteses, more invasive definitive approaches are usually required. Since its introduction in 1997, the PleurX catheter became the preferred method to treat recurrent malignant pleural effusions. Since then, a number of publications have documented its utility in managing recurrent nonmalignant pleural effusions. The purpose of this paper is to review the use of the PleurX catheter in recurrent pleural effusions.

A sanguineous pleuro pericardial effusion in a patient recently treated with Dabigatran.

Dabigatran, a direct thrombin inhibitor, is one of the new oral anticoagulants. As more patients receive treatment with Dabigatran, and as the clinical indications for Dabigatran use expand, reporting serious adverse effects is fundamental to future safety assessment. Although patients taking Dabigatran had fewer life-threatening bleeds when compared to Coumadin, those events continue to be reported. We describe, in the same patient, a sanguineous pleuro pericardial effusion that was diagnosed incidentally on a pre-ablation cardiac CT angiography. The diagnosis was made approximately two months after initiating Dabigatran treatment for non-valvular atrial fibrillation in a 63-year-old patient.

Hemidiaphragm paresis and granulomatous pneumonitis associated with adalimumab: a case report.

Adalimumab is a fully human monoclonal anti-TNF-alpha antibody. Reported adverse effects have raised a number of safety concerns associated with their prolonged use. A case of granulomatous pneumonitis and hemidiaphragm paresis associated with adalimumab therapy for rheumatoid arthritis is described. In May 2012, a 57 year old male presented with dry cough, dyspnea and orthopnea after 4 months of treatment with adalimumab for rheumatoid arthritis. The patient received adalimumab from November 2011 to February 2012. A right hemidiaphragm elevation was shown on chest radiograph. A right hemidiaphragm paresis was shown on chest fluoroscopy. Bilateral lower lobe interstitial disease was shown on the chest HRCT scan. Open lung biopsy of the right lower lobe showed subacute granulomatous pneumonitis. In July 2013, the patient's respiratory symptoms and the previous restrictive pattern on PFTs resolved. In a same patient, a rare association of hemidiaphragm paresis and granulomatous pneumonitis with adalimumab treatment is herein reported.

The use of botox in the treatment of post cardiac surgery paradoxical vocal cord movement.

Paradoxical vocal cord movement (PVCM) is a laryngeal disorder characterised by paradoxical adduction of the vocal cords during inspiration, expiration, or both. In severe cases patients can present with acute respiratory failure requiring intubation and mechanical ventilation. Paradoxical vocal cord movement can be due to different conditions including central nervous system injury, conversion disorders, psychological stress, inhaled irritants, and true laryngeal dystonias. Paradoxical vocal cord movement has also been described in association with cardiac surgery. Most cases of mild PVCM are successfully treated with a combination of speech therapy, patient education, and psychotherapy. In severe cases, patients might require tracheostomy. We report a case of a 65 year-old man who developed severe PVCM post coronary artery bypass surgery requiring tracheostomy for six months. He was successfully treated with bronchoscopic injection of Botulinum toxin type A into his vocal cords. He was decannulated one week after the injection, and was doing well at six weeks follow up.