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Respiratory Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Ian Pavord, Nayia Petousi, Nick Talbot
This usually manifests over months, with malaise, weight loss, anorexia, night sweats and productive cough. There may be haemoptysis, breathlessness and chest pain, with or without pleural effusion. Some patients present with tender, enlarged cervical lymph nodes, usually in the anterior triangle, which may be the only manifestation of post-primary disease.
Pulmonary Oedema, Lymphangitis Carcinomatosa and ARDS.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
This is often a rapidly progressive lethal condition, leading to severe dyspnoea and anoxia, but a few patients may have more slowly progressive disease and live for a few or several months. In many cases little can be done except for the removal of an accompanying pleural effusion, but some amelioration may be produced by steroids and/or diuretics. Some cases, due to breast, ovarian or prostatic neoplasm may respond to chemotherapy or hormones. Diagnosis may be established by biopsy of the lung or accompanying enlarged nodes or from a knowledge of proven gradually spreading neoplasm. In some cases sputum cytology will be positive and in others fibre-optic bronchoscopy can be carried out to aspirate secretions, but this may be quite hazardous in view of the severe dyspnoea. Aspiration of concomitant pleural fluid (which is often present) is likely to produce positive cytology. In a few cases examined by the author with isotope lung scans, one has been able to observe linear branching perfusion defects running alongside the lines of the vessels (Illus. LYMPHANGITIS, Pt. 37a-c). In the case illustrated, the deposits were mainly perivenous, and the patient died about 24 hours later - she also had gross bony deposits from her breast carcinoma.
Chylothorax
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Although pleurodesis can be performed as a stand-alone operation to treat a refractory chylothorax, the procedure is more commonly employed in combination with thoracic duct ligation, particularly if no focal leak is identified. Once access to the parietal pleura is obtained either by thoracotomy or thoracoscopy, the entire parietal pleura of the lower thorax adjacent to the thoracic duct is mechanically abraded with a surgical sponge, peanut, or cautery scratch pad. An alternative approach to pleurodesis is to instill a chemical agent such as bleomycin, doxycycline, or talc, all of which are known to facilitate significant pleural inflammation. Chemical pleurodesis is generally reserved for treatment in older children and in patients with congenital lymphangiomatosis. A chest tube should be left in place after pleurodesis.
Pharmacokinetics of antibiotics for pleural infection
Published in Expert Review of Respiratory Medicine, 2022
Estee P M Lau, Calvinjit Sidhu, Natalia D Popowicz, Y. C. Gary Lee
There are no clinical features that can differentiate pleural infection from pneumonia. Pleuritic chest pain, if present, should raise suspicion of pleural inflammation. Patients with chronic pleural infection often have constitutional symptoms such as fever and raised systemic inflammatory markers. Imaging (radiography, ultrasound and computerized tomography (CT)) helps establish extent of fluid collections and loculations, as well as underlying associated infective features (e.g. pneumonia, abscesses and lymphadenopathy etc.) [8], Figure 1. Organisms are only cultured in 20–30% of patients using conventional pleural fluid microbiological testing but the yield can be increased using blood culture bottles to transport the fluid samples and by obtaining pleural tissue biopsies [9]. Despite that, no microbes are identified in almost half of all the patients and choice of antibiotics therapy is empirical.
Transdiaphragmatic cardiophrenic lymph node resection in a patient with an advanced-stage ovarian cancer
Published in Journal of Obstetrics and Gynaecology, 2022
Osman Turkmen, Fatih Kilic, Burak Ersak, Gunsu Kimyon Comert, Sevgi Ayhan, Mustafa Ozdemir, Taner Turan
Two surgical techniques have been described for CPLN resection: video-assisted thoracic surgery (VATS) and transdiaphragmatic. In a report of nine cases who underwent metastatic CPLN resection through a 2-cm incision in the fifth intercostal space, Lim et al. (2009) reported no increase in the amount of haemorrhage, complication rate, and no delay in adjuvant therapy. In a report of 11 cases who underwent transdiaphragmatic CPLN resection, Yoo et al. (2013) reported some advantages of transdiaphragmatic route over VATS, such as the lack of need of changing patient’s position, the applicability by gynaecologic oncologists, and the lack of need for inserting a thoracic tube. Using transdiaphragmatic CPLN resection, LaFargue et al. (2016) reported a mean operation time of 385 min, blood loss of 564 mL, and postoperative hospital stay of 7 days. In these studies, CPLN resection was described as a procedure with low complication and morbidity rate. Pleural effusion, pneumothorax, and pneumonia are the most commonly observed complications (Yoo et al. 2013; Prader et al. 2016).
Transmembrane protein 88 inhibits transforming growth factor-β1-induced-extracellular matrix accumulation and epithelial-mesenchymal transition program in human pleural mesothelial cells through modulating TGF-β1/Smad pathway
Published in Journal of Receptors and Signal Transduction, 2022
Zhongmin Sun, Qian Ning, Hong Li, Tinghua Hu, Ling Tang, Qing Wen, Liangrong Shen
Pleural fibrosis is a pathological process occurred in the development of several lung diseases. Pleural fibrosis is defined as an excessive deposition of extracellular matrix (ECM) components, which finally leads to the destruction of normal pleural tissue architecture and compromised function [1]. It is generally considered that the pathogenesis of pleural fibrosis is associated with inflammatory cells, profibrotic mediators and coagulation, and fibrinolytic pathways are integral to pleural remodeling and fibrosis [2,3]. The pleura is lined by a monolayer of mesothelial cells that rest on a thin basement membrane [4]. Increasing evidence suggests that pleural mesothelial cells (PMCs) play a significant role in the pathogenesis of this condition through initiating inflammatory responses and producing ECM components [5,6]. Targeting PMCs may be adequate therapy and can be developed to prevent pleural fibrosis from occurring.