Arjun Saradna

Strongyloides Hyperinfection and Miliary Tuberculosis Presenting with Syndrome of Inappropriate Antidiuretic Hormone Secretion in a Malnourished Patient

Strongyloides stercoralis (S. stercoralis) is an intestinal nematode endemic to tropical regions. An accelerated infection, known as a hyperinfection, occurs in immunocompromised patients, most commonly those treated chronically with glucocorticoids or those who have human T cell leukemia virus-1 (HTLV-1) infection. We describe a 67-year-old Hispanic female who presented with complaints of decreased oral intake and fatigue since three months. Hyponatremia on initial presentation was attributed to syndrome of inappropriate antidiuretic hormone (SIADH) secretion and managed with fluid restriction. Computed tomography (CT) of the chest revealed multiple pulmonary nodules suggestive of miliary tuberculosis, however, sputum acid-fast bacilli (AFB) smears were negative. Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) was performed and specimens sent for AFB testing. A concurrent endoscopy with biopsy was done to evaluate dysphagia. Both respiratory and gastrointestinal (GI) specimens were positive for Strongyloides stercoralis. Treatment with ivermectin and prophylactic antibiotics was started. The patient developed septic shock and had multiple episodes of gastrointestinal bleeding. Despite aggressive management, she expired. Subsequently, cultures for Mycobacterium tuberculosis (MTB) were positive and the autopsy demonstrated evidence of MTB infection in the lungs, liver, and lymph nodes. This case illustrates the importance of considering co-infection with Strongyloides stercoralis in patients with MTB, both associated with depressed cellular immunity.

Solitary Fibrous Tumor of Pleura Invading into the Left Atrium via Pulmonary Vein

A 67-year-old woman came to the hospital because of difficulty in breathing. After an initial clinical assessment, contrast-enhanced computerized tomography (CT) of the chest revealed a well-circumscribed heterogeneous mass arising from the pleura adjacent to the superior and medial left pulmonary artery. The mass was invading the pulmonary vein and entering the left atrium. Histopathology of the biopsy of the mass was suggestive of solitary fibrous tumor (SFT) of the pleura. The patient underwent pneumonectomy and resection of the left atrial mass with pericardial patch repair of the left atrium.

122: EBSTENOID ANOMALY

Learning Objectives: To investigate the learning curve of transesophageal echocardiography (TEE) applied in mechanically ventilated patients in ICU. Methods: A prospective observation study was conducted. A total of 60 consecutive patients with TEE examination admitted to Department of SICU of First Affiliated Hospital of Sun Yat-Sen University from December 2016 to June 2017 were enrolled. According to the date of TEE examination, the patients were divided into five groups(A, B, C, D, E), with 12 patients in each group.The TEE examination scores,duration and complication among five groups were compared, with learning curve established. The examination scores including the quality of the 20-TEE views, color doppler flow imaging and hemodynamics were assessed by TEE expert. Results: There were no significant differences in gender composition, age, acute physiology and chronic health evaluation II (APACH II), primary disease and prognosis among five groups, which showed the baseline was equivalent and comparable. There were statistically significant differences in TEE examination scores (F = 15.934, P = 0.000) and duration (F = 16.011, P = 0.000) among five groups. The examination scores of group A and group B were (23.67 ± 9.70) and (30.00 ± 11.42) respectively (P > 0.05), while the scores of group C, group D and group E were (40.08 ± 7.27), (41.75 ± 5.62) and (46.17 ± 3.41) respectively (P> 0.05). The scores of group A and group B were significantly lower than that of group C, D and E(P < 0.05). The learning curve showed an upward trend, and the scores gradually tended to be stable after the group C. The examination duration of group A [(58.22 ± 14.19)min] was the longest and fluctuated most(P < 0.05).The duration of group B and group C was (43.33 ± 4.64) min and (39.97 ± 6.67) min respectively (P > 0.05), while the duration of group D and group E was (31.04 ± 7.84) min and (31.50 ± 4.82) min respectively (P > 0.05). The examination duration of group A,B and C were significantly longer than that of group D and group E (P < 0.05). The learning curve showed a downward trend, and the duration was stable after group D. There were no significant differences in complications of TEE examination among five groups (P> 0.05). Conclusions: The learning curve of performing TEE examination is approximately 36-48 cases for mechanically ventilated patients in ICU. With the completion of 36 performances, one can basically grasp this technique, and may reach full mastery after 48 performances.

ETIOLOGY AND PREDICTORS OF 30-DAY UNPLANNED READMISSION RATES AFTER LEFT VENTRICULAR ASSIST DEVICE PLACEMENT

Background: Mechanical circulatory support with Left Ventricular Assist Device (LVAD) placement is an important therapy for advanced heart failure. Although these patients are likely vulnerable to increased hospitalizations, there are limited data on a national level about incidence and reasons for