Current opinion in pulmonary medicine
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Exercise impairment and pulmonary hypertension are common features of interstitial lung disease. Antifibrotic therapies for interstitial lung disease remain unproved; therefore, some interest has been focused on treating the pulmonary vascular impairment these diseases. ⋯ Small case series have shown that some patients improve on receiving therapy for pulmonary hypertension secondary to interstitial lung disease. These findings suggest that larger treatment trials for medications targeting pulmonary hypertension in interstitial lung disease are warranted.
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To provide a timely and concise review of the most recent clinical data in the field of bridging (anticoagulation) therapy with heparin for the at-risk patient receiving long-term oral anticoagulation who requires temporary interruption for an elective invasive procedure or surgery. ⋯ Perioperative bridging therapy with heparin, either unfractionated heparin or low-molecular-weight heparin, appears to be safe and effective for patients, including those with mechanical heart valves, receiving long-term oral anticoagulation who require temporary interruption, especially for non-high-bleeding risk procedures such as minor surgery and invasive procedures. Further studies, including randomized double-blind placebo-controlled trials, are needed to optimize bridging therapy for specific patients and procedures.
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The pathogenesis of idiopathic pulmonary fibrosis as well as that of several other interstitial lung diseases is poorly understood. The role of autoimmunity in interstitial lung diseases associated with connective tissue disorders such as systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis as well as the vasculitides is well established. There is at least some evidence in the literature that supports the role of autoimmunity as one of the mechanisms of alveolar injury responsible for idiopathic pulmonary fibrosis. This review is an attempt to summarize the studies on this subject. ⋯ It might seem that the role of autoimmunity in interstitial lung disease has been underestimated or even underinvestigated. The subject requires further investigation, especially with regard to the problems of lung allograft rejection due to bronchiolitis obliterans of nonalloimmunity origin and the failure of patients with idiopathic pulmonary fibrosis to respond to most forms of currently available therapy.
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Bronchoscopy is a minimally invasive method for diagnosing lung diseases, but the technique has some limitations. In case of parabronchial lesions, the view is limited to the inner surface. Therefore, endobronchial ultrasound systems were developed. For obtaining biopsies of peripheral lung lesions, a new real-time guidance system shows promising results. In this review the authors assess the most important and interesting articles in both fields. ⋯ Endobronchial ultrasound proved to be useful in high-resolution imaging of the multilayer structures of the bronchial wall and the adjacent mediastinal structures at a distance of as much as 4 cm. Lymph nodes could be easily localized for transbronchial needle aspiration. In many instances it was superior for staging lung cancer and other pathologies. Real-time electromagnetic-guided bronchoscopy, coupled with computed tomography is a feasible and safe method for obtaining biopsies from peripheral lung lesions.
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The momentum for minimally invasive thoracic surgery has been growing. Thousands of video-assisted thoracoscopic surgery lobectomies have been performed since the first video-assisted thoracoscopic surgery lobectomy was performed in 1992, but currently most lobectomies are still performed via a thoracotomy. Although most lobectomies could be performed with video-assisted thoracoscopic surgery, less than 5% are currently performed that way. Compared with a thoracotomy, video-assisted thoracoscopic surgery offers patients a shorter length of stay, less pain, and a quicker recovery, without compromising the adequacy of the operation. The purpose of this review is to identify the current uses for minimally invasive procedures in thoracic surgery and to present the current data regarding these procedures. ⋯ Current data suggest that, compared with a thoracotomy, video-assisted thoracoscopic surgery has advantages for anatomic pulmonary resections.