Giant neurofibroma arising from the intercostal nerve: a rare case report

Neurofibroma is a benign nerve sheath tumor of the peripheral nervous system. A young male presented with complaints of gradually increasing breathlessness and heaviness on the right side of the chest, and percussion notes over the chest were impaired all over the right lung fields except the basal zone. Contrast-enhanced computed tomography scan of the thorax revealed a large heterogeneous mass occupying most of the right hemithorax. Intraoperatively, the huge mass measuring about 18 cm?×?13 cm?×?12 cm was seemed to arise from the right fourth intercostal space. Histopathology revealed a neurofibroma. Giant intrathoracic neurofibroma is very uncommon and its malignant potential should be evaluated.     

Combustion-related organic species in temporally resolved urban airborne particulate matter

Accurate characterization of the chemical composition of particulate matter (PM) is essential for improved understanding of source attribution and resultant health impacts. To explore this, we conducted ambient monitoring of a suite of 15 combustion-related organic species in temporally resolved PM_2.5 samples during an ongoing animal exposure study in a near source environment in Detroit, MI. All of the 15 species detected were above the method detection limit in 8 h samples. This study focused on two molecular classes: polycyclic aromatic hydrocarbons (PAHs) and hopanes measured in samples. Of the 12 PAHs studied, benzo[b]fluoranthene (169 pg m^?3), benzo[g,h,i]perylene (124 pg m^?3), and benzo[e]pyrene (118 pg m^?3) exhibited the three highest mean concentrations while 17α(H),21β(H)-hopane (189 pg m^?3) and 17α(H),21β(H)-30-norhopane (145 pg m^?3) had the highest mean concentrations of the three hopanes analyzed in samples. Ratios of individual compound concentrations to total compound concentrations (∑15 compounds) showed the greatest daily variation for 17α(H),21β(H)-hopane (11–28%) and 17α(H),21β(H)-30-norhopane (8–20%). Diagnostic PAH concentration ratios ([IP]/[IP + BP] (range 0.30–0.45), [BaP]/[BaP + BeP] (range 0.26–0.44), [BaP]/[BP] (range 0.41–0.82), [Bb]/[Bk] (range 2.07–2.66)) in samples reflected impacts from a mixture of combustion sources consistent with greater prevalence of petroleum combustion source emissions (gasoline, diesel, kerosene, and crude oil) compared to coal or wood combustion emissions impacts at this urban site. Results from this study demonstrate that short-duration sampling for organic speciation provides temporally relevant exposure information.     

Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction

We aimed to characterize the independent predictors of LVT following STEMI and the association with outcomes. The clinical predictors of left ventricular thrombus (LVT) formation after ST-segment elevation myocardial infarction (STEMI) are not well-defined in the contemporary era. We performed a retrospective analysis of STEMI patients at Duke from 2000 to 2011 who had a transthoracic echocardiogram within 90 days post-STEMI and compared patients with and without LVT (LVT+ vs. LVT?). Univariate Cox proportional hazards regression models of baseline characteristics were examined and significant variables were used in a multivariable model to assess adjusted relationships with LVT. A multivariable Cox PH survival model with covariate adjustments was used for assessment of LVT and long-term mortality. Of all eligible patients, 1734 patients met inclusion criteria and 4.3 % (N = 74) had a LVT. LVT+ patients tended to have a history of heart failure (HF) and higher initial troponin compared to LVT- patients. After adjustment, higher heart rate, non-white race, HF severity, and presence of left anterior descending artery (LAD) disease were independent predictors of LVT. There was a trend toward an association between LVT and increased all-cause mortality (HR 1.36; 95 % CI 0.84–2.21, P = 0.22), however this was not statistically significant. LVT was seen in over 4 % of this contemporary post-STEMI population. Several baseline characteristics were independently associated with LVT: Heart rate, HF severity, LAD disease, and non-white race. Prospective studies are warranted to determine whether anticoagulation in patients at increased risk for LVT improves outcomes.