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Weekly Hospital-Based Pulmonary Rehabilitation for Chronic Obstructive Airway Disease Maintains Exercise Capacity and Reduces Hospitalization

Introduction: This retrospective study aimed to evaluate the effects of a supervised, weekly, hospital-based pulmonary rehabilitation (PR) program on exercise capacity and clinical outcome in patients with chronic obstructive airway diseases (COAD) in a tertiary-care hospital in Taiwan. Methods: Eighty-four COAD patients were divided into PR (n=42) or non-PR (n=42) groups. Subjects in the PR group regularly took part in a once-a-week rehabilitation program in the hospital for a period of 12 months. Pulmonary function was measured and 6-minute walk tests were given every 3 months. Total duration and time of hospitalization and emergency room (ER) consultation were analyzed. Results: There was no demographic difference between the 2 groups. During the study period, the 6-minute walk distance increased in the PR group (from 402.5±18.3 to 410.4±17.8 meters), but significantly decreased in the non-PR group (from 430.7±12.8 to 376.0±24.9 meters, p＜0.05). Forced vital capacity was significantly higher in the PR group at 6 and 12 months, compared to the non-PR group. Hospital admissions and length of stay were significantly decreased in the PR group compared to the non-PR group (0.29±0.55 vs. 0.64±1.02 visits and 1.88±4.16 vs. 6.71±14.82 days, respectively, p＜0.05). Subjects in the PR group also had a lower rate and duration of ER visits than those in the non-PR group (0.24±0.53 vs. 0.93±1.67 visits and 0.36±0.88 vs. 2.12±4.17 days, respectively, p＜0.05). Conclusion: Weekly hospital-based PR can maintain functional exercise capacity and improve pulmonary function in COAD patients. Hospital and ER visits and length of stay were also reduced.

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Tuberculous Abscess of the Anterior Chest Wall: Report of 2 Cases

Tuberculosis (TB) usually involves the lungs, which is the site of about 90% of mycobacterial infection. TB of the chest wall is a rare entity. Herein, we reported 2 cases of TB of the chest wall presenting as an abscess without intrapulmonary involvement. Computerized tomography of the thorax showed anterior chest wall abscess without evidence of underlying lung or pleural disease. Sputum examination revealed negative acid-fast bacilli in the smear and TB culture. Both patients were diagnosed by surgical pathology and tissue culture, and were treated with complete resection combined with anti-tuberculous therapy.

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Tracheal Diverticulum Presentinged as Long-Term Hoarseness: Case Report and Literature Review

Tracheal diverticulum is a rare disease entity, usually found in asymptomatic patients, or those presenting with cough, dyspnea, and sometimes, dysphagia. Tracheal diverticula are classified as congenital or acquired based on their anatomic position and characteristics. Congenital diverticula are usually smaller, located 4 or 5 cm below the vocal cord. The acquired form is larger, presents in adulthood, typically protrudes from the right posterolateral wall of the trachea, and has a wider opening, if any. On histologic examination, tracheal diverticula have respiratory mucosa only, without components of cartilage or smooth muscle. The association between chronic obstructive pulmonary disease and tracheal diverticula is still being debated. Cases of recurrent laryngeal nerve paralysis and hoarseness caused by tracheal diverticula, with full recovery after resection, have been reported previously. If medical treatment of patients with symptomatic tracheal diverticulum fails, surgical resection is a feasible option. We report a rare case of tracheal diverticulum that presented with hoarseness, and review related published articles. Although relatively rare, tracheal diverticulum should be included in the differential diagnosis of hoarseness.

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Fatal Salmonella-Infected Aneurysm of the Aortic Arch: A Case Report

An infected arterial aneurysm is often caused by Staphylococcus aureus or Salmonella species, and involvement of the aorta is a rare but life-threatening condition. The mortality rate is very high in those without surgical treatment. The typical presentation of an infected aneurysm is based on its location, whether it is in a superficial location (e.g., common femoral artery, a painful, pulsatile mass with fever) or is a deeper vessel (e.g., aorta, fever with or without blood-tinged sputum). Because of the insidious onset, symptoms and signs could occur after rupture of the aneurysm. Here, we describe a fatal case of infected aneurysm of the aortic arch mimicking pneumonia and caused by Salmonella group D.

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Three Metachronous Primary Malignancies: A Case Report and Literature Review

A 63-year-old male who had been diagnosed as having esophageal squamous cell carcinoma (T1N0Mx post- endoscopic submucosal dissection) in 2011 presented with a left soft palate mass in 2012. Biopsy of the oral mucosa was performed and the pathology showed well-differentiated squamous cell carcinoma. This patient presented to Chang Gung Memorial Hospital in 2014 with blood-tinged sputum and progressive dyspnea. Initial chest x-ray showed right upper lobe consolidation. Chest CT examination revealed right upper lobe consolidation with a suspicious 6cm infiltrative mass invading the right hilum and mediastinum. Multiple liver nodules and masses in both lobes of the liver were also noted. Bronchoscopy examination with tissue biopsy for pathologic study revealed small cell carcinoma of the bronchus. Echo-guided fine needle aspiration for the right liver lobe tumor was performed and the pathology study showed small cell carcinoma, metastatic. The initial approach to patients with suspected lung cancer is based on the study results of patients with non-small cell lung cancer. In general a few things need to be considered, including selecting a biopsy site and obtaining an adequate sample for microscopic examination. Immunohistochemical and genetic analyses are necessary for confirmation of the diagnosis. Aggressive tissue biopsy for pathology study may increase the rate of diagnosis for double, or even triple primary malignancies. More precise diagnosis will provide more treatment choices.

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A Rare Case of Cold Abscess in the Anterior Chest Wall

Primary tuberculous abscesses (also called “cold abscesses”) of the chest wall are rare and constitute less than 10% of skeletal extrapulmonary tuberculosis cases. Tuberculosis of the chest wall usually presents as an enlarged and occasionally painful mass in the chest wall. Cases of tuberculous abscess of the anterior chest wall are rarely reported in the literature. We reported a rare case of tuberculous abscess of the anterior chest wall in a 64-yearold man who presented with painful swelling in the left chest region. Physical, imaging, and histological examinations led to a diagnosis of tuberculous chest wall lesion. Complete excision of the cold abscess and partial resection of the left 6th rib were performed. During surgery, 150 mL of purulent fluid was found in the cyst. The patient was stable postoperatively and received anti-tuberculosis medication. Cold abscess of the anterior chest wall is difficult to diagnose preoperatively and may be confused with secondary bone metastasis, pyogenic abscess, chondroma, multiple myeloma, lymphoma, or infectious diseases such as actinomycosis. Complete excision of the abscess of the chest wall and of the invaded structures is our preferred approach to achieve en bloc resection. When a chest wall tumor with a cystic lesion and homogenous fluid content is encountered, cold abscess should be suspected.