Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Aug 2008
ReviewPleural interventions: management of acute and chronic pneumothorax.
Pneumothorax is a common clinical entity that may present to a wide variety of medical specialties. Primary pneumothorax (in the presence of no known underlying lung disease) and secondary pneumothorax (in known lung disease) are distinct entities with varied etiology, treatment, and prognosis. ⋯ The etiology of pneumothorax will often inform the clinician whether a more conservative or more invasive approach is required. Radiological intervention techniques are valuable in the treatment of complicated pneumothoraces and in certain clinical situations.
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Malignant pleural effusions (MPEs) are commonly seen as complications of advanced malignancy, especially in lung cancer and breast cancer. The management will depend on the performance status of the patient, severity of the symptoms, and the primary tumor's response to systemic therapy. Thoracentesis is usually the first step for both diagnostic and therapeutic reasons. ⋯ Additional advantages are the ability to treat trapped lung, large loculated effusions, and bilateral effusions simultaneously, as well as lower charges. Spontaneous pleurodesis can occur in up to 50% of the patients. Tunneled catheters should be considered in all patients with MPE and particularly those who have a reasonable expectancy of being outpatient.
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Semin Respir Crit Care Med · Jun 2008
ReviewWho is at high risk for lung cancer? Population-level and individual-level perspectives.
Lung cancer is the leading cause of cancer death in the world. However, there is large geographic variation internationally and within nations. Despite the fact that many causes of lung cancer have been established, cigarette smoking is the principal cause. ⋯ Many lung cancer risk factors have been identified, but active cigarette smoking is the predominant cause of lung cancer and the principal marker of both high-risk populations and high-risk individuals. In the absence of cigarette smoking, lung cancer would be a rare disease. Strategies that effectively prevent youths from starting to smoke and that promote cessation among dependent smokers can transform populations from high risk to low risk.
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Prognosis of lung cancer is markedly improved when cancers are resected in early stages (particularly in stage I). Previous investigations failed to show benefit with use of chest radiographs or sputum cytologies to screen for lung cancer among high-risk populations. ⋯ However, whether screening CT reduces death from lung cancer has not been clarified. This review examines the problem presented by lung cancer, the issues presented by screening, and the results of past and recent studies of lung cancer screening.
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Semin Respir Crit Care Med · Jun 2008
ReviewBronchoscopy for the diagnosis and staging of lung cancer.
Bronchoscopy is an invaluable tool utilized for the diagnosis, staging, and management of lung cancer. Advancements in computer technology and engineering have allowed for the emergence of newer modalities to evaluate endobronchial, parenchymal, and mediastinal pathology. Established techniques such as white light video bronchoscopy and its ancillary procedures (forceps biopsy, brush biopsy, bronchoalveolar lavage, bronchial washings, and transbronchial needle aspiration) are discussed here, with their accuracy described in relation to tumor location, size, and type. ⋯ Special emphasis has been placed on their role in the early detection and staging of lung cancer. Some technology requires further study to delineate its role in the disease, whereas other modalities are emerging as the new gold standard in evaluation of lung cancer. The future holds great promise with further miniaturization of equipment and improvements in computer processing power that may allow for in vivo pathological evaluation of abnormal tissue.