Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Apr 2011
ReviewExtracorporeal membrane oxygenation for 2009 influenza A (H1N1)-associated acute respiratory distress syndrome.
The 2009 novel swine-origin influenza A (H1N1) virus was identified in April 2009 in Mexico, and the World Health Organization declared the first phase 6 global influenza pandemic of the century on June 11, 2009. The pandemic spread worldwide in just a few weeks. Most patients diagnosed with H1N1-2009 virus had a self-limited respiratory illness. ⋯ Despite attempts to optimize ventilator settings, some patients developed refractory hypoxemia or hypercapnia and received extracorporeal membrane oxygenation (ECMO) as a rescue therapy. In most of these cases, patients were retrieved from outside major cities and safely transported under ECMO to experienced tertiary centers through semiformal referral networks. However, whether the 25 to 50% mortality observed in the reported ECMO series was affected by the recourse to this technique could not be established.
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Lung carcinogenesis is a complex, stepwise process that involves the acquisition of genetic mutations and epigenetic changes that alter cellular processes, such as proliferation, differentiation, invasion, and metastasis. Here, we review some of the latest concepts in the pathogenesis of lung cancer and highlight the roles of inflammation, the "field of cancerization," and lung cancer stem cells in the initiation of the disease. Furthermore, we review how high throughput genomics, transcriptomics, epigenomics, and proteomics are advancing the study of lung carcinogenesis. Finally, we reflect on the potential of current in vitro and in vivo models of lung carcinogenesis to advance the field and on the areas of investigation where major breakthroughs will lead to the identification of novel chemoprevention strategies and therapies for lung cancer.
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Malignant pleural mesothelioma is an aggressive cancer principally attributable to asbestos. Although the incidence is now declining in the United States, it will continue to increase worldwide until all nations institute regulations limiting asbestos use and exposure. This is a heterogeneous disease, with three pathological subtypes that yield very different outcomes. ⋯ The reference chemotherapy regimen, pemetrexed-cisplatin, improves survival and quality of life. Key questions about maintenance therapy and the optimal regimens for elderly and frail patients remain to be answered. Although few other cytotoxic drugs have activity, a surprising number of novel agents are being investigated.
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Semin Respir Crit Care Med · Dec 2010
ReviewThe approach to the patient with a parapneumonic effusion.
Parapneumonic effusions are seen in up to 57% of patients with pneumonia. The majority of these effusions are noninfected and resolve with standard antibiotic treatment for the associated pneumonia. ⋯ Patients may present in a variety of ways from florid sepsis to weight loss and anorexia; such diversity mandates a high index of suspicion among physicians. The role of the combination of intrapleural deoxyribonuclease (DNase) and tissue plasminogen activator (t-PA) to aid fluid drainage shows promise but needs further assessment in large trials with surgery and mortality as primary end points.