Pneumothorax: appearance on lateral chest radiographs

The appearance of pneumothorax on lateral radiographs obtained with the patient erect were reviewed in 100 patients (122 total examinations). A pneumothorax could be seen on the lateral projection in 89% of the examinations (109 of 122). The displaced pleural line was most frequently identified anteriorly or posteriorly and was less commonly identified at the lung apex or in a subpulmonic location. In 11 cases, an air-fluid level was the only recognizable finding of a pneumothorax on the lateral projection. Although in 27% of examinations (32 of 122) the pneumothorax was either not seen (11%) (n = 13) or was a subtle finding (16%) (n = 19), in 14% of examinations (17 of 122) the lateral projection provided helpful information to supplement the posteroanterior projection.     

Bronchial asthma and dermatitis due to spiramycin in a chick breeder.

A case of bronchial asthma and dermatitis due to spiramycin is described in a non-atopic woman who worked as a chick breeder and handling poultry feed containing antibiotic or chemoterapic drugs including spiramycin, chlortetracycline and sulfadimethoxine. Patch tests showed a vigorous delayed reaction to spiramycin. Inhalation challenge test with the chick feed containing spiramycin reproduced symptoms of late asthmatic response (FEV1 fell by 14% and FEF25-75 by 25% within the 4th and 6th hour) with leucocytosis. No significant modification of FEV1 and FEF25-75 was observed within 24 hours after challenge with chick feeds containing other antibiotic or chemotherapeutic agents but not spiramycin. On leaving her job, the patient had no further skin reactions or bronchial asthma episodes. This case suggests that allergic reactions to a chemical product may involve both type III and IV hypersensitivity.     

Massive Localized Lymphedema (MLL) in Bariatric Candidates

Background: Mild lymphedema of lower limbs and eventually abdomen is not exceedingly rare in morbid obesity. However, few large symptomatic masses have been reported. In a consecutive series of patients, all requiring resection of the lesion before bariatric treatment, clinical features and surgical findings are described, aiming to clarify the nature of this intricate problem. Methods: Subjects (n=4, 50% females, age 34.0±13.7 years (19-53), BMI 56.4±10.5 kg/m² (44.1-73.1) displayed lesions on the anteromedial aspect of the thigh (n=3) and hypogastrium (n=1). All reported episodes of intertrigo of local skin-folds in the preceding years, managed by local care and antibiotics. The mass was described as a serious nuisance, impairing walking, dressing and personal hygiene. Results: The mass was surgically removed without requirement for blood transfusion except in the case of one huge mass. Complications were relatively minor and consisted of partial skin dehiscence and lymph leakage for 2-3 weeks. Histologically, a complex pattern was observed including skin hypertrophy, edema, fibrosis, foci of microabscesses and dilated blood vessels, along with the pathognomonic lymphangiectasia. On follow-up to 6 months, improvement or restoration of the ability to walk occurred, with no additional skin infection and no recurrence. Conclusions: 1) Surgical treatment was effective. 2) Functional rehabilitation was achieved. 3) No recurrence was observed within the follow-up period.