Respiration; international review of thoracic diseases
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Case Reports
Progressive overlap syndrome due to small cell lung cancer as a paraneoplastic syndrome.
The association between rheumatic diseases and malignancy has been documented in many studies. Polymyositis and especially dermatomyositis are associated with a higher risk of malignant disease. Furthermore, lung cancer usually develops in patients with a prolonged history of systemic sclerosis accompanied by pulmonary fibrosis. Though overlap syndrome is rarely reported in the associated cancer, this is the first report describing progressive overlap syndrome in small cell lung cancer as a paraneoplastic syndrome.
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Bronchoalveolar lavage (BAL) is an established diagnostic tool in interstitial lung diseases. BAL frequently yields findings of diagnostic value and at times even confirmatory diagnostic results. ⋯ The recovery rate hardly affected the cellular and non-cellular constituents of BAL at a lower limit of 30% of the instilled volume.
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The transition from medical resident to subspecialty fellow is a critical time period in fellowship training that has not been well described. The current practices of fellow orientation in pulmonary and critical care training programs are not known. ⋯ This survey demonstrated that early fellow training differs across programs in both time spent and clinical and procedural topics covered. An early, standardized approach to clinical and procedural training can assure appropriate exposure that cannot be guaranteed by on the job training. To provide justification for such an approach, clinical outcomes need to be correlated with training methods.
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Comment Letter Case Reports
Sirolimus-associated desquamative interstitial pneumonia.
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Lung injury associated with the acute respiratory distress syndrome can be exacerbated by improper mechanical ventilation creating a secondary injury known as ventilator-induced lung injury (VILI). We hypothesized that VILI could be caused in part by alveolar recruitment/derecruitment resulting in gross tearing of the alveolus. ⋯ We demonstrated that alveolar instability induced by injurous ventilation does not cause gross alveolar tears, suggesting that the tissue injury in this animal VILI model is due to a mechanism other than gross rupture of the alveolus.