Current opinion in pulmonary medicine
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This paper reviews several studies that have concentrated on the diagnostic and prognostic information that can be obtained with high-resolution computed tomography (HRCT) and that show how this information can be used and interpreted in conjunction with the clinical and the pathologic information. ⋯ HRCT plays an important role in the detection, diagnosis and follow-up of diffuse parenchymal and interstitial lung disease and may be very helpful in predicting prognosis. In patients in whom typical CT features are present, diagnosis can often be suggested, whereas signs of fibrosis have important prognostic implications. However, in order to increase the chance of a correct diagnosis, a formal multidisciplinary approach is necessary.
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Considerable advances in genomics, transcriptomics and proteomics have in the recent years transformed our understanding of the molecular mechanisms involved in the pathogenesis of lung cancer and are in the process of revolutionizing our approach to its diagnosis and treatment. Although these techniques have traditionally been described in the context of large volume biopsies from surgically resected tumors, significant technical advances allow their application to smaller samples obtained bronchoscopically, often the only samples available in advanced lung cancer. ⋯ Molecular biology techniques are increasingly applied to smaller biopsy specimens obtained via bronchoscopy, allowing for their use in advanced, unresectable nonsmall cell lung cancer. Although these techniques have not yet entered the clinical practice arena, they will likely become an unavoidable complement to conventional morphologic examinations and allow for individualized diagnostic and therapeutic approach to lung-cancer patients.
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Review
Training for endobronchial ultrasound: methods for proper training in new bronchoscopic techniques.
The field of pulmonary medicine has experienced a rapid growth in innovative new technologies aimed at both diagnosis and treatment of airway, mediastinal and parenchymal disorders. Endobronchial ultrasound (EBUS) has emerged as an extremely useful tool in real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures. A growing body of evidence has demonstrated the efficacy of EBUS-TBNA in the diagnosis and staging of lung cancer, as well as the diagnosis of benign causes of mediastinal and hilar lymphadenopathy. This has increased the demand for EBUS among general pulmonologists and thoracic surgeons and is presenting a challenge in establishing teaching venues and training guidelines to gain competence in EBUS. ⋯ Evidence-based protocols for teaching EBUS-guided TBNA and other advanced bronchoscopic procedures are necessary as these technologies continue to expand into general pulmonary practice. Ongoing research in bronchoscopy education promises to guide proper and effective training of clinicians to achieve learners' satisfaction and optimal patient outcomes.
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The aim of this review is to highlight recent reports (2009) concerning empyema and the heptavalent pneumococcal conjugate vaccine. ⋯ A new generation of conjugate vaccines that include new serotypes and a wider spectrum of coverage, and the protein-based vaccines that may prevent invasion and preserve colonization, should help us to achieve a positive long-term impact of pneumococcal vaccination.
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Secondary spontaneous pneumothorax (SSP) can occur in patients who are suffering from diffuse lung disease. The main cause of SSP is chronic obstructive pulmonary disease (COPD). In contrast to primary spontaneous pneumothorax, SSP is a potentially life-threatening condition because patients with SSP also have limited cardiopulmonary reserve. Prompt diagnosis and treatment of SSP are mandatory. In this review, thoracoscopy, a less invasive surgical treatment for SSP, is discussed from the viewpoint of postoperative morbidity, mortality, and recurrence of SSP. ⋯ Thoracoscopic surgery for the treatment of SSP should be less invasive to reduce postoperative morbidity, and it should also be more effective to reduce the recurrence of pneumothorax.