Current opinion in pulmonary medicine
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Sleep is characterized by many changes in the respiratory system, including a reduction in respiratory motor output associated with the loss of wakefulness, increased upper airway resistance, and blunted protective reflexes (such as load compensation), that result in reduced alveolar ventilation. The development of carbon dioxide retention appears to be linked to the exaggeration of sleep-related changes on ventilation by coexistent respiratory system disorders. ⋯ Concurrent obstructive sleep apnea syndrome may further compromise nocturnal ventilation, thereby contributing to the development of acute or chronic respiratory failure. The use of noninvasive nocturnal ventilation at night has resulted in significant improvements in symptoms of hypoventilation and daytime carbon dioxide retention in various clinical settings, yet important questions remain about implementation of this modality.
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Lymphoid interstitial pneumonitis (LIP) involves a clinicopathologic pattern of pulmonary disease characterized by diffuse interstitial reactive lymphoid infiltrates. In adults, it occurs most commonly in autoimmune diseases, such as Sjögren's syndrome (0.9% of these patients) and primary biliary cirrhosis, whereas in children it is usually seen in HIV infection. Dysproteinemias (hyper- and hypogammaglobulinemia) are found in more than 60% of patients. ⋯ These patterns may be difficult to differentiate from each other. It appears that LIP sometimes evolves to lymphoma; the frequency of this evolution is probably low but is difficult to assess because low-grade lymphomas may mimic LIP. A relatively high frequency of LIP patients have Epstein-Barr virus DNA in their lungs but not all patients with LIP show this finding, suggesting other possible etiologies.
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Chemotherapy has produced only modest survival benefits in patients with advanced non-small cell lung cancer. Several new chemotherapeutic agents developed in the past few years have shown promising activity in non-small cell lung cancer. ⋯ Chemotherapy has made a much stronger impact in small cell lung cancer, but the majority of patients still die from disease. The new chemotherapeutic agents may also contribute to improved survival of patients with small cell lung cancer, especially when used in combination with thoracic radiotherapy in those who present with limited disease.
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The diagnosis, staging, and follow-up of lung cancer is a clinical and therapeutic challenge. Recent radiographic advances are critical to the management of patients with lung cancer. This review focuses on state-of-the-art chest imaging modalities, including plain radiography, computed tomography; magnetic resonance imaging, as well as the newest technique, positron-emission tomography, and discusses the current literature.
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The use of lasers in the diagnosis and treatment of lung neoplasms has just surpassed a 20-year experience. This paper reviews recent developments in the use of lasers in the palliative treatment of advanced tracheobronchial tumors and pleural mesothelioma. The role of bronchoscopic laser therapy relative to other endobronchial treatment modalities such as stent placement and brachytherapy is presented. Finally, the potential use of lasers in photodetection and curative treatment of early lung cancer is discussed.