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Battlefield Chemical Inhalation Injury
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
With mild exposure there is a reddened oropharynx with some endothelial inflammation extending peripherally to the level of the smaller airways. As exposure increases, the oropharynx becomes more intensely injected. There is edema of the epiglottis and larynx as well as the base of the tongue. A sharp line of demarcation may be seen separating the pharyngeal injection from the pale uninvolved esophagus. Pleural effusions may be seen in association with developing pulmonary edema. With even more severe exposures there are distended pulmonary lymphatics with a dense, heavy edematous consolidation of lung. Subcutaneous emphysema is common. A fibrinous exudate may be seen lining the bronchi at 1-2 days. There may be epithelial necrosis. With moderate exposures a purulent bronchitis may be seen with small areas of pneumonic consolidation that became larger with increasing severity of exposure. Infarction and gangrene have been reported by the French but is not a common finding in other pathologic reviews (Bunting, 1945c).
Correction of the Genetic Defect in Alpha-1 Antitrypsin Deficiency by Somatic Gene Therapy
Published in Kenneth L. Brigham, Gene Therapy for Diseases of the Lung, 2020
Randy C. Eisensmith, Savio L. C. Woo
Another major contributing factor that accelerates the development of pulmonary emphysema in deficient individuals is cigarette smoking. Not only will the particulate matter in cigarette smoke elicit a macrophage response and neutrophil migration to the lung, but the oxidants in the smoke can also inactivate hAAT by oxidation of the methionine residue at the active site (23). Patients with hAAT deficiency will generally develop emphysema in their 40s, and this development can be accelerated by 10 to 20 years in patients who smoke. Once emphysema occurs, deterioration of lung tissue will continue for several years until death, and there is no effective conventional therapy for this chronic condition.
The Tight-Skin (Tsk) Mutation, Chromosome 2
Published in John P. Sundberg, Handbook of Mouse Mutations with Skin and Hair Abnormalities, 2020
The heart of tight-skin mice increases dramatically with age as determined by gross observations as well as by wet and dry weight.12 This is associated with increases in hydroxyproline and CPK but not hexosamine content.12 There is an increased presence of collagen.13 Ultrastructural changes in the left ventricle of Tsk/+ mice include perivascular and intercellular edema, multiple foci of myocytolysis, and areas of moderate increases in interstitial collagen deposition.13 In a longitudinal study done to investigate the theory that right ventricular hypertrophy (RVH) was due to an increase in pulmonary vascular resistance secondary to capillary destruction, it was found that RVH developed late in life in Tsk/+ mice. There was a strong correlation between the severity of emphysema and this disease. However, no muscularized arterioles were observed in the mutant mice, indicating that in emphysema, RVH can develop in the absence of pulmonary vascular changes, and it is probably due to tissue destruction.14
Pembrolizumab related Guillain barre syndrome, a rare presentation in a patient with a history of lupus and bladder cancer
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Vikram Sangani, Mytri Pokal, Mamtha Balla, Ganesh Prasad Merugu, Sreedhar Adapa, Srikanth Naramala, Venu Madhav Konala
He is a former smoker, quits smoking 10 years ago, drinks alcohol occasionally, and reports no illicit drug use. There is no significant family history. Medication list includes apixaban, clopidogrel, levothyroxine, mycophenolate, atorvastatin, hydroxychloroquine, tamsulosin, finasteride, and omeprazole. On initial examination, his vitals are stable. Physical examination was significant for the patient in distress from back pain radiating to bilateral lower extremities associated with weakness. Also noted chronic macular darkening of leg. Neurological examination was significant for weakness in the lower extremities with a strength of 3 out of 5 bilaterally. There was no sensory loss. The patient did have a normal rectal tone. The rest of the physical examination was unremarkable. Patient’s urinalysis was negative. Portable chest x-ray revealed emphysema, no other acute findings. Patient’s admission labs are summarized in Table 1.
Microwave ablation of lung malignancies with coexisting severe emphysema: a retrospective analysis of safety and efficacy in 26 patients
Published in International Journal of Hyperthermia, 2021
Jinzhao Peng, Zhixin Bie, Yuanming Li, Bin Li, Runqi Guo, Chengen Wang, Xiaoguang Li
Emphysema is not only an independent risk factor for lung cancer but also a significant predictor of death from lung cancer [19,20]. The treatment of lung malignancies with concurrent severe emphysema remains a challenge. The scope of surgery and radiotherapy is limited in cases of severe emphysema. Previous studies have shown that severe emphysema is a poor prognostic predictor of long-term survival in lung cancer patients undergoing surgery. Moreover, coexisting emphysema increases the incidence of perioperative complications requiring treatment and mortality [2,3]. A study reported a high in-hospital mortality rate of 14% following anatomical lobectomy in patients with NSCLC and severe emphysema [21]. MWA can be an alternative treatment for lung malignancies in patients who are medically inoperable due to high-risk conditions or refuse to accept surgery. For patients with high-risk conditions, such as patients with a single lung after prior pneumonectomy, thermal ablation appeared to be a safe and effective option as demonstrated in several studies [10–12]. However, the safety and efficacy of MWA for primary lung cancer or metastases with coexisting severe emphysema have not been fully determined.
Endobronchial valve therapy for severe emphysema: an overview of valve-related complications and its management
Published in Expert Review of Respiratory Medicine, 2020
T. David Koster, Karin Klooster, Nick H. T. Ten Hacken, Marlies van Dijk, Dirk-Jan Slebos
Patients with severe emphysema are severely disabled and have very limited treatment options. Endobronchial lung volume reduction is an additional treatment for this patient group, and this treatment option is becoming more and more important as worldwide awareness and acceptance in the pulmonary field increases driven by solid science, guidelines, and reimbursement. Treatment with one-way valves is currently the most effective treatment, but only suitable in a small percentage of the patients. Careful patient selection is important to treat only patients that will benefit from the valves. However, even if successful, these patients need dedicated follow-up to monitor treatment effect, and in case of deterioration or complications, a critical reevaluation should be performed to try to regain the effect or treat the complication.