A Thoracic Mass Discovered at Abdominal Imaging
Solitary fibrous tumor of the pleura (SFTP) is a rare primary pleural neoplasm arising from the submesothelial mesenchymal cell layer just beneath the mesothelial lining of the pleura. SFTPs consist of spindle cells embedded within variable amounts of connective tissue, typically staining positive for vimentin and antibodies to CD34. SFTPs are often attached to pleural surfaces through a pedicle. Histopathologic criteria for malignancy include high mitotic counts (>4 mitoses per 10 high-power fields), pleomorphism, hypercellularity, tumor giant cells, necrosis, and hemorrhage. Chest radiography in patients with SFTP shows ...
Source: Clinical Pulmonary Medicine - August 31, 2015 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
High-flow Nasal Cannula May Save Lives in Acute Hypoxemic Respiratory Failure
Synopsis: In patients with acute hypoxemic respiratory failure without an underlying lung disease, the use of high-flow nasal cannula did not lead to lower intubation rates at 28 days compared with standard oxygen therapy or noninvasive positive-pressure ventilation. However, there was evidence of reduced in-ICU and 90-day mortality.
Source: Frat J-P, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. Doi: 10.1056/NEJMoa1503326 (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - August 31, 2015 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Exercise Intolerance in Pulmonary Hypertension
Synopsis: Exercise intolerance and blunted cardiac output response to exercise in pulmonary hypertension is related to an impaired right ventricular exertional contractile reserve.
Source: Spruijt OA, Man FS, Groepenhoff H, et al. The effects of exercise on right ventricular contractility and right ventricular-arterial coupling in pulmonary hypertension. Am J Respir Crit Care Med. 2015; 191:1050-1057. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - August 31, 2015 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Myths and Legends: Vitamin K Antagonists Have a Better Safety Profile Than Direct Oral Anticoagulants in Patients Undergoing Bronchoscopic Procedures
Diagnostic bronchoscopy for obtaining tissue samples is a commonly performed procedure and is an extremely useful diagnostic tool for malignant and benign conditions. A significant proportion of patients who undergo these procedures are anticoagulated for conditions including atrial fibrillation, pulmonary embolism, and deep-vein thrombosis. With new classes of oral anticoagulants being prescribed more frequently, it is important that bronchoscopists are comfortable in the management of direct oral anticoagulants in the perioperative period. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - August 31, 2015 Category: Respiratory Medicine Tags: Clinical Myths & Evidence-based Medicine Source Type: research
Protein Repair: Cusp of a New Era in Cystic Fibrosis
Cystic fibrosis (CF) is a genetic disease caused by a variety of mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, which leads to either an absent or a dysfunctional CFTR protein. The specific mechanism of protein dysfunction is dependent on the specific underlying mutation, but can be broadly defined into 5 functional classes. Recent advances in CF therapeutics have focused on the development of drugs targeting the underlying CFTR protein defect to treat the disease (CFTR modulators). In particular, ivacaftor has successfully shown improvements in a subset of CF patients on a variety of cli...
Source: Clinical Pulmonary Medicine - August 31, 2015 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
A Review of Lung Transplantation for Patients With α-1 Antitrypsin Deficiency
α-1 antitrypsin deficiency (AATD) is an autosomal codominant condition that predisposes one to emphysema because of the lack of proteolytic defense in the lung. Emphysema leading to respiratory failure is the most common cause of death in AATD, and AATD is currently the fourth most common indication for lung transplantation (LT) in the United States. Although the intraoperative management of LT for AATD resembles that of usual (AAT replete) chronic obstructive pulmonary disease, several special circumstances regard the selection, pretransplant and posttransplant management, and outcomes after LT in AATD. The current revie...
Source: Clinical Pulmonary Medicine - August 31, 2015 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Pulmonary Complications After Hematopoietic Stem Cell Transplantation
This report provides an updated review on the pulmonary complications after HSCT, including their incidence, clinical presentation, diagnosis, and management. It also provides an overview of the diagnostic approach to these complications. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - August 31, 2015 Category: Respiratory Medicine Tags: Colleagues in Respiratory Medicine Source Type: research
Decreasing Failure-to-rescue Events in the Era of Rapid Response Systems
In-hospital medical emergencies including in-hospital cardiac arrests, unplanned ICU admissions, and unexpected deaths occur frequently and represent, in many of the cases, failure of the health care system to recognize and respond promptly to signs of deterioration. Rapid response systems are an intervention for this problem, but benefits remain uncertain. In this review, we discuss the epidemiology of in-hospital medical emergencies, the different components of the response system, and potential improvements to decrease failure-to-rescue events. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - August 31, 2015 Category: Respiratory Medicine Tags: Clinical Practice Management Source Type: research
Corticosteroids in the Critically Ill Patient: Benefits and Risks for Hospital-acquired Pneumonia/Ventilator-associated Pneumonia
Corticosteroids are among the most commonly prescribed medications. Because of their wide use and vast influence on various aspects of homeostasis, it is not surprising that steroids may be beneficial in some clinical scenarios and deleterious in others. The interplay between nosocomial pneumonias and steroids represents one of the most remarkable intersections between a drug and a disease. Corticosteroids may influence the risk of a hospitalized patient developing pneumonia, but they may ultimately be necessary if a patient develops catecholamine-resistant septic shock or if overt bronchospasm is present. In addition, pro...
Source: Clinical Pulmonary Medicine - August 31, 2015 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Current Pharmacological Treatment of Pulmonary Aspergillosis
Invasive aspergillosis (IA) is a severe condition with high mortality rates that typically occurs among immunocompromised patients, mostly those affected by hematological malignancies. In the past few years, an increasing number of cases have been reported among patients without classic risk factors. Although the current guidelines report voriconazole as the first-line therapy for IA, the increase in the rates of Aspergillus fumigatus resistant to azoles represents an emerging problem and requires the introduction of new therapeutic options. For these reasons, alternative antifungal therapies may be used in selected scenar...
Source: Clinical Pulmonary Medicine - August 31, 2015 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
The Subsolid Pulmonary Nodule—Approaching a Distinct Entity
Synopsis: Based on the natural history of subsolid pulmonary nodules, an approach of computed tomography monitoring instead of resection may be appropriate.
Source: Scholten ET, de Jong PA, de Hoop B, et al. Towards a close computed tomography monitoring approach for screen detected subsolid pulmonary nodules? Eur Respir J. 2015;45:765–773. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - June 24, 2015 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Volatile Organic Compounds in the Intensive Care Unit: On the Scent of Something Big?
Synopsis: Specific patterns of exhaled breath metabolites are associated with the presence of lower respiratory tract pathogens.
Source: Fowler SJ, Basanta-Sanchez M, Xu Y, et al. Surveillance for lower airway pathogens in mechanically ventilated patients by metabolomics analysis of exhaled breath: a case-control study. Thorax. 2015;70:320–325. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - June 24, 2015 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
“Corner Shot”: An Incidentally Detected Thoracic Lesion at Abdominal Imaging
Bronchial carcinoid tumors are uncommon thoracic neuroendocrine neoplasms that, although malignant, usually exhibit indolent biological behavior. Bronchial carcinoid tumors are often subdivided into “typical” and “atypical” varieties, the latter more frequently associated with somewhat more aggressive behavior, advanced local disease, and lymphadenopathy. Bronchial carcinoid tumors present on chest radiography as central or hilar masses, often associated with postobstructive effects. Thoracic computed tomography often shows a central lesion, occasionally with calcification, and a clear relationship to an airway, of...
Source: Clinical Pulmonary Medicine - June 24, 2015 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Empirical Antibiotic Treatment for Community-acquired Pneumonia: New Perspectives
This article reviews current international guidelines, recent evidence, and investigates new perspectives on the issue of empirical antibiotic prescribing for community-acquired pneumonia. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - June 24, 2015 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Biomarker Kinetics in VAP
Patients under mechanical ventilation are at risk for several problems and complications, in particular ventilator-associated pneumonia (VAP). The diagnosis of VAP results from a combination of radiologic findings, signs, and symptoms of lower-respiratory-tract infection, and microbiologic criteria. It is consensual that the definition of VAP is neither valid nor reliable. Several criteria are recognized as being inaccurate and subjective. With this scenario, there is need for improvement, and serum biomarkers, namely their, could bring additional information to improve the diagnosis and the management of VAP. Changes in b...
Source: Clinical Pulmonary Medicine - June 24, 2015 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
