Chest
-
Comparative Study
Lobe-Specific Mediastinal Nodal Dissection is Sufficient During Lobectomy by VATS or Thoracotomy for Early Stage Lung Cancer.
Lobectomy with complete mediastinal lymphadenectomy is considered standard for patients with early-stage non-small cell lung cancer (NSCLC). However, the benefits of complete lymphadenectomy are unproven. There is evidence suggesting a predictable pattern of mediastinal nodal drainage. This study analyzed the frequency and pattern of mediastinal nodal disease and its impact on outcome in patients with early-stage NSCLC. ⋯ Mediastinal N2 metastases follow predictable lobe-specific patterns in patients with negative preoperative CT scans and PET scans. Lobe-specific N2 nodal evaluation results in a recurrence rate similar to that of complete mediastinal evaluation. Lobe-specific mediastinal nodal evaluation appears acceptable in patients with early-stage NSCLC.
-
Comparative Study
Sleep-disordered-breathing in Ehlers-Danlos Syndrome (a genetic model of obstructive sleep apnea).
The objective of this study was to investigate the presence of sleep-disordered breathing (SDB) in patients with Ehlers-Danlos syndrome. Ehlers-Danlos syndrome is a genetic disorder characterized by cartilaginous defects, including nasal-maxillary cartilages. ⋯ In patients with Ehlers-Danlos syndrome, abnormal breathing during sleep is commonly unrecognized and is responsible for daytime fatigue and poor sleep. These patients are at particular risk for SDB because of genetically related cartilage defects that lead to the development of facial structures known to cause SDB. Ehlers-Danlos syndrome may be a genetic model for OSA because of abnormalities in oral-facial growth. Early recognition of SDB may allow treatment with orthodontics and myofacial reeducation.
-
Comparative Study
Do e-cigarettes have the potential to compete with conventional cigarettes? A survey of conventional cigarette smokers' experiences with e-cigarettes.
Electronic cigarettes (ECs) are becoming increasingly popular globally. If they were to replace conventional cigarettes, it could have a substantial impact on public health. To evaluate EC's potential for competing with conventional cigarettes as a consumer product, we report the first data, to our knowledge, on the proportion of smokers who try ECs and become regular users. ⋯ Almost one-fifth of smokers who try ECs once go on to become regular users. ECs may develop into a genuine competitor to conventional cigarettes. Government agencies preparing to regulate ECs need to ensure that such moves do not create a market monopoly for conventional cigarettes.
-
Comparative Study
Use of indwelling pleural catheters for cardiogenic pleural effusions.
Cardiogenic pleural effusions are rarely refractory to treatment of the underlying disease. Few options are available in these cases. Indwelling pleural catheter (IPC) insertion has been well described for the management of malignant pleural effusions. We present our experience with using IPCs for cardiogenic pleural effusion management. ⋯ IPC insertion for cardiogenic pleural effusion is a feasible option in carefully selected patients. Further research is needed to confirm the results and to assess the impact of IPC insertion on the quality of life of these patients.
-
Comparative Study
Identifying an Inciting Antigen is Associated with Improved Survival in Patients with Chronic Hypersensitivity Pneumonitis.
The cornerstone of hypersensitivity pneumonitis (HP) management is having patients avoid the inciting antigen (IA). Often, despite an exhaustive search, an IA cannot be found. The objective of this study was to examine whether identifying the IA impacts survival in patients with chronic HP. ⋯ Among patients with chronic HP, when adjusting for a number of potentially influential predictors, including the presence of fibrosis, the inability to identify an IA was independently associated with shortened survival.