Current opinion in pulmonary medicine
-
The clinical role of emerging imaging technologies for diagnosing cardiac sarcoidosis and other cardiomyopathies is evolving. An up-to-date review of the role of various imaging modalities in the evaluation of cardiac sarcoidosis and other cardiomyopathies is presented. ⋯ Clinical and subclinical cardiac involvement is common among patients with sarcoidosis. A structured clinical assessment incorporating advanced cardiac imaging with CMR and FDG-PET scanning is more sensitive than the established clinical criteria. CMR is an established imaging modality in the diagnosis of various other cardiomyopathies. Well designed prospective clinical trials are awaited to define the exact role of these imaging studies in the diagnosis and guidance of therapy.
-
Venous thromboembolism represents a potentially threatening complication in surgical and medical patients. Thromboprophylaxis showed a significant reduction of venous thromboembolic events, and low-molecular-weight heparins have been considered the standardized prophylactic regimen for a long time. The purpose of this review is to provide updated evidence on the use of low-molecular-weight heparins for prevention of venous thromboembolism after the publication of the latest American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on antithrombotic and thrombolytic therapy. ⋯ Low-molecular-weight heparins are expanding their application, but progressively they will be replaced by other new antithrombotics for the prophylaxis of venous thromboembolism. Surgical patients undergo a more concerted approach to thromboprophylaxis than medical patients. Future research should aim at improving prophylaxis in the latter setting in order to significantly reduce the rate of venous thromboembolic events.
-
Sampling the detachable cells and acellular lining secretions of the human respiratory tract by bronchoalveolar lavage (BAL) is a means of obtaining relevant components from the airways and alveolar areas for research use and clinical analysis in normals (controls) and patients with a wide spectrum of interstitial lung diseases (ILDs). This review attempts to discuss recent findings from BAL studies that provide insight into pathogenic mechanisms of ILDs and/or assist in diagnosing disease activity. ⋯ Whereas BAL findings continue to impact on understanding disease pathogenesis and this may be its major use now, BAL fluid components, cells in particular, are not correlated well with activity of disease nor for monitoring disease progress or response to treatment. For a few rarer ILDs, BAL fluid characteristics may strongly support a diagnosis.
-
The technique and clinical applications of medical thoracoscopy have substantially evolved in the last few decades. The recent development of a semirigid thoracoscope, which is handled similarly to a bronchoscope, has made this procedure more attractive to pulmonologists. We will review the latest data on clinical applications, recently developed techniques, and safety of medical thoracoscopy, focusing mainly on its role in thoracic malignancies. ⋯ Medical thoracoscopy is an excellent tool to establish diagnosis in patients with exudative pleural effusion of unclear origin. It is highly valuable in clarifying the origin of pleural effusions in patients with lung cancer, as the presence of a malignant pleural effusion is associated with poor survival and precludes the possibility of treatment with curative intention. Pleurodesis with talc poudrage is efficacious and well tolerated, especially with the use of large-particle talc.
-
Lung cancer is the leading cause of cancer death worldwide, and is diagnosed in the advanced stage in 70% of patients. This study will summarize the most up-to-date strategies in supportive care for patients with metastatic lung cancer. ⋯ Supportive care for the patient with advanced lung cancer should involve consideration and discussion of all therapeutic options that could provide benefit. Depending on the clinical situation, these could include chemotherapy or radiation, and should always include appropriate symptom management and family support. Research incorporating symptom and quality-of-life measures is challenging, but is also essential to inform excellent supportive care.