Current opinion in pulmonary medicine
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To examine recent advancements in the clinical characteristics, treatment and prognosis of diffuse parenchymal disease and pulmonary hypertension due to idiopathic pulmonary fibrosis, scleroderma and sarcoidosis. ⋯ Lung fibrosis by any cause can be a debilitating disease. Not all current medical options are equally effective under randomized-controlled trials. Further studies with novel therapies are needed to control symptoms. The compounding presence of pulmonary hypertension will further limit the patient activity, quality of life and survival. As it has been reviewed, not all pulmonary hypertension-specific agents effectively work in these three subset groups.
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Increased familial occurrences as well as different disease modes in different ethnic groups suggest a genetic influence in sarcoidosis. Also, genetic analyses have revealed a number of chromosomal regions and specific genes associated with sarcoidosis. This review brings up some recent discoveries on the genetic contribution to sarcoidosis. ⋯ Sarcoidosis is a complex disease which is influenced by a multitude of genes and environmental factors. The strongest genetic associations are found within the human leucocyte antigen region, in which several specific human leucocyte antigen alleles clearly associate with disease risk and phenotype, but additional genes in the same region may turn out to be important as well. Future studies on large, clinically well defined patient cohorts will help to elucidate the genetic impact on sarcoidosis.
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Though lobectomy remains the standard of care for resection of nonsmall cell lung cancer, a number of studies have been published in the last 24 months exploring the role of sublobar resection in the treatment of stage I nonsmall cell lung cancer. ⋯ Sublobar resection is an alternative therapy for stage I nonsmall cell lung cancer for patients with physiologic impairment unable to undergo lobectomy. The literature also suggests a role for patients with prior lung resection, bronchoalveolar carcinoma, peripheral tumors less than 2 cm, and for the elderly.
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To summarize the best clinical evidence published in the last year and regarding the functional evaluation and the residual quality of life after lung resection in patients with lung cancer. ⋯ Carbon monoxide lung diffusion capacity and stair-climbing test should be performed routinely in all lung-resection candidates. In those with poor exercise tolerance in stair-climbing test or exercise oxygen desaturation, or candidates to pneumonectomy, the measurement of VO2max is recommended. Quality of life should always be assessed through specific instruments and not inferred by traditional functional tests.