Current opinion in pulmonary medicine
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Pleural effusions have a major impact on the cardiorespiratory system. This article reviews the pathophysiological effects of pleural effusions and pleural drainage, their relationship with breathlessness, and highlights key knowledge gaps. ⋯ Pleural effusions are associated with abnormalities in gas exchange, respiratory mechanics, respiratory muscle function and hemodynamics, but the association between these abnormalities and breathlessness remains unclear. Prospective studies should aim to identify the key mechanisms of effusion-related breathlessness and predictors of improvement following pleural drainage.
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In the last decade, video-assisted thoracoscopic surgery (VATS) has become a popular method in diagnosis and treatment of acute chest injuries. Except for patients with unstable vital signs who require larger surgical incisions to check bleeding, this endoscopic surgery could be employed in the majority of thoracic injury patients with stable vital signs. ⋯ Retained hemothorax derived from blunt chest trauma should be managed carefully and rapidly. Early VATS intervention is a well tolerated and reliable procedure that can be applied to manage this complication cost effectively.
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Review Comparative Study
Comparison of mesothelin and fibulin-3 in pleural fluid and serum as markers in malignant mesothelioma.
Malignant mesothelioma is an asbestos-induced, aggressive tumour, which frequently presents with pleural effusion. There are over 60 reported causes that can result in the development of a pleural effusion. Currently, there are no tumour biomarkers in widespread clinical use for the differential diagnosis of mesothelioma from other diseases. With the incidence of mesothelioma expected to continue to increase, it is timely to review the current status of effusion-based biomarkers for mesothelioma diagnosis. ⋯ To date, soluble mesothelin remains the best available biomarker for mesothelioma and a positive result is clinically useful in patients with pleural effusions in whom the diagnosis is uncertain.
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To discuss the imaging of interstitial lung disease believed to be caused by smoking. ⋯ It is now accepted that cigarette smoking can cause lung diseases other than lung cancer, chronic bronchitis and emphysema. Indeed, the hypothesis that tobacco smoke can cause interstitial lung disease - and, specifically, pulmonary fibrosis - dates back to the 1960s. The list of interstitial lung disease, in which smoking is believed to have an etiologic role, includes Langerhans' cell histiocytosis, respiratory bronchiolitis/respiratory bronchiolitis-interstitial lung disease and desquamative interstitial pneumonia. More recently, there is emerging evidence which suggests that smoking may be associated with other patterns of pulmonary fibrosis (e.g. nonspecific interstitial pneumonia and smoking-related interstitial fibrosis). In the present review we discuss the imaging of the interstitial lung disease known to be caused by smoking; the typical appearances and some of the diagnostic difficulties are discussed.