Colonic metastasis from a primary adenocarcinoma of the lung presenting with acute abdominal pain: a case report.

Colonic metastasis from lung cancer is rare and generally asymptomatic. Here, we report a case with lung adenocarcinoma that presented with acute abdominal pain due to intestinal obstruction caused by the metastatic colon tumor. The patient underwent emergency colonoscopy and the pathologic report was adenocarcinoma, which was the same as that for a bronchoscopic biopsy from a large lung mass. Immunohistochemistry was positive for thyroid transcription factor-1 and cytokeratin 7, and negative for cytokeratin 20 and caudal-related homeobox transcription factor 2 on both lung biopsy and colon surgical specimens. Accordingly, we used immunohistochemistry for thyroid transcription factor-1, cytokeratin 7, cytokeratin 20 and caudal-related homeobox transcription factor-2 to diagnose primary adenocarcinoma of the lung with colonic metastasis.

Acupuncture therapy results in immediate bronchodilating effect in asthma patients.

BACKGROUND: According to previous data on asthma in the English literature, there are some results that show encouraging effects of acupuncture improving pulmonary function in asthma patients. We designed a prospective randomized crossover controlled study to determine the efficacy of acupuncture in asthma patients. METHODS: Eighteen asthma patients with bronchodilator response >20% improvement of forced expiratory volume in 1 second (FEV1) were initially randomly assigned to receive 1 performance of real acupuncture (RA) or sham acupuncture (SA) in a blinded manner. After a washout period, the patients were crossed over. Spirometry was done and recorded before and after acupuncture. RESULTS: Sixteen of 18 patients completed the study. The mean (+/-SD) FEV1 values before and after RA were 1.52 +/- 0.45L and 1.67 +/- 0.40L, respectively (p < 0.001). The mean (+/-SD) FEV1 values before and after SA were 1.49 +/- 0.40L and 1.49 +/- 0.41L, respectively (p = 0.838, not significant). The percentage change in FEV1 values after RA was better than after SA (RA, 11.57 +/- 8.11%; SA, 0.32 +/- 7.76%; p = 0.003), while the bronchodilator response of FEV1 from simple inhalation bronchodilator was better than that for RA (p < 0.001). CONCLUSION: In asthma patients, acupuncture treatment may result in immediate improvement of FEV1, but the degree of improvement is less than that from inhalation bronchodilator.

Tube thoracostomy-related necrotizing fasciitis: a case report.

Spontaneous pneumothorax is a serious complication of pulmonary tuberculosis that requires immediate treatment. Necrotizing fasciitis is a serious, rapidly progressive infection of the subcutaneous tissue and fascia, most related to trauma or surgery. Here, we report a case of pulmonary tuberculosis with spontaneous pneumothorax. A standard procedure of tube thoracostomy was performed for lung re-expansion. Two days after the tube was removed, necrotizing fasciitis developed from the puncture site. Computed tomography of the chest showed focal thickness with gas formation and loss of the fat plane over the chest wall, which is compatible with the diagnosis of necrotizing fasciitis. Aggressive treatment was given, including emergency fasciectomy and adequate systemic antibiotic and antituberculous treatment. The necrotizing fasciitis was successfully treated. The patient was discharged and sent home with maintenance antituberculous therapy.

Virtual bronchoscopy for diagnosis of recurrent respiratory papillomatosis.

Virtual bronchoscopy is a new method for viewing helical/spiral computed tomography (CT) images of the tracheobronchial trees. Using commercially available software to process the CT data, the tracheobronchial trees can be inspected through a series of three-dimensional images. Recently, this technique has been increasingly used to detect benign and malignant airway stenosis. We report the findings of virtual bronchoscopy in a 41-year-old man with recurrent respiratory papillomatosis (RRP). Several tiny nodules were evident in the lower trachea. Fiberoptic bronchoscopy was performed 1 month later during a planned surgery for laryngeal papillomas, and the findings were in agreement with virtual bronchoscopy. Detection of intrabronchial spreading in RRP is important since peripheral seeding of RRP can cause complications, including recurrent pneumonia, obstructive atelectasis, hemoptysis, and, rarely, may degenerate to squamous cell carcinoma. Virtual bronchoscopy is an alternative method for inspecting the tracheobronchial trees in patients with RRP when laryngeal papillomas impede fiberoptic bronchoscopy.

Endometriosis associated with hemothorax.

Bloody pleural effusion is rarely associated with endometriosis. To effectively treat this condition, it is important to differentiate the malady from other common diseases such as malignancy or tuberculosis. We describe the case of a 40-year-old multiparous female featuring right-sided hemothorax presenting with right shoulder pain and progressive shortness of breath for the preceding 2 months. Thoracoscopy disclosed grossly negative findings apart from multiple small pores in the right hemi-diaphragm with blood clots within them. Examination of the thoracoscopic biopsy specimens showed chronic pleuritis without evidence of malignancy or tuberculosis. Pelvic endometriosis was considered a possible diagnosis according to the results of abdominal computed tomography (CT) scan, transvaginal sonography, and the results of dilatation and curettage. Periodic episodes of symptoms concurrent with menstruation led to the suspicion of a relationship between these conditions in our patient. Despite the patient undergoing an abdominal total hysterectomy and adhesiolysis without salpingo-oophorectomy, recurrent right-sided bloody pleural effusion developed 1.5 months subsequent to surgery. As a consequence, danazol (400 mg/day) was maintained because of the endometriosis associated with pleural effusion. One year of regular follow-up later, there was no evidence of recurrent pleural effusion. We considered that the bloody pleural fluid arose via seepage from the pelvic endometriosis through the pores of the right hemi-diaphragm during menstruation.

Acupuncture resulting in immediate bronchodilating response in asthma patients.

There are some encouraging results in the English literature that show acupuncture resulting in an immediate improvement in pulmonary function, but there are also studies that have not demonstrated any benefit. We present 3 patients with persistent asthma who experienced immediate bronchodilatation after acupuncture without the use of any short-acting bronchodilator. After needle stimulation on selected acupoints, clinical symptoms such as dyspnea and wheezing improved. Pulmonary function test showed immediate improvement in forced expiratory volume in 1 second (FEV1), more than 20% as compared with baseline FEV1. Pulmonary function returned to baseline within 4 hours after acupuncture in 2 patients. From our observations of these 3 asthma patients, acupuncture may improve clinical dyspnea symptoms and performance on pulmonary function tests. Further large-scale controlled studies should be conducted to determine the effectiveness of acupuncture in the treatment of asthma.