The clinical respiratory journal
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Tumour necrosis factor-alpha (TNF-α) plays a crucial role in sarcoidosis. In severe disease, treatment with TNF-α inhibitors may be effective. ⋯ In sarcoidosis, treatment with adalimumab can reduce disease activity, as assessed by FDG-PET.
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Pirfenidone has been shown in three recently published trials to slow down the progression of the devastating interstitial lung disease, idiopathic pulmonary fibrosis (IPF). The precise mechanisms that initiate and perpetuate the histopathological process leading to lung fibrosis in IPF are still uncertain, but increased concentrations of reactive oxidative species and fibrogenetic factors have been observed in the pulmonary tissue of patients. ⋯ Along with the new ATS/ERS/JRS/ALAT 2011 statement for 'Evidence Based Guidelines for Diagnosis and Management', there is now a more profound basis for offering IPF patients an evidence-based evaluation and treatment. This review summarizes the background to the recommended use of pirfenidone for the treatment of IPF.
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Thoracoscopy is an invasive procedure that may be performed by physicians for the investigation of exudative pleural effusion using local anaesthesia, conscious sedation and a rigid thoracoscope. ⋯ Serious complications following thoracoscopy are rare. HAI is associated with malignancy and prolonged hospital stay. Benign histology may still confer significant morbidity.
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Risk stratification remains controversial in patients with normotensive pulmonary embolism (PE). The debate has recently focused right ventricular dysfunction detected by echocardiography or spiral computed tomography (CT) and cardiac biomarkers. ⋯ The PaO(2)/PaCO(2) measurement is a highly useful and practical measurement to predict prognosis in patients with acute PE. Moreover, it appears to be a more accurate predictor than RV/LV ratio and cTn-T levels in patients with normotensive PE.