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Drug-Resistant Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Keertan Dheda, Aliasgar Esmail, Anzaan Dippenaar, Robin Warren, Jennifer Furin, Christoph Lange
The decision for a thoracosurgical intervention should be made by a multidisciplinary team of experts and the procedure should be performed in a center with experience in MDR-TB thoracic surgery.185 Surgery should be considered in patients with localized pulmonary disease that cannot be cured by medical treatment alone (e.g., non-culture conversion after 6 months of adequate medical treatment, especially when there are large cavities) or when there are life-threatening complications, e.g., pulmonary hemorrhage, non-resolving pleural empyema, or extensive necrosis. The best treatment outcomes are achieved with partial unilateral lung resections though this likely reflects a selection bias.186 Patients considered for pneumonectomy must be carefully selected. A recent meta-analysis on the role of surgery for patients with MDR-TB found no overall benefit of extensive surgical procedures though there were many confounders.186
The thorax
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Pneumonectomy is removal of a whole lung and has a higher mortality rate (5–8%). The surgeon must be satisfied that the patient is fit to tolerate this procedure from the preoperative work-up. This procedure is reserved for either centrally placed tumours involving the main bronchus or those that straddle the fissure. At thoracotomy, inspection of the lung and direct palpation of the mass will determine resectability and lymph node spread. Fixation of the tumour to the aorta, heart or oesophagus implies irresectability. Involvement of the mediastinal lymph node chain is associated with a poor prognosis. With modern preoperative imaging, resection is abandoned in only about 3% of cases.
Multiple choice questions (MCQs)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
A 50-year-old patient is admitted with shortness of breath. CXR shows marked opacification of the right hemithorax with mediastinal shift towards that side. Which of the following should be considered in the differential diagnosis? Pleural effusion.Consolidation.Central obstructing tumour.Previous pneumonectomy.Mesothelioma.
XIST/miR-34a-5p/PDL1 axis regulated the development of lung cancer cells and the immune function of CD8+ T cells
Published in Journal of Receptors and Signal Transduction, 2022
Jing Li, Liyan Che, Chang Xu, Dongdong Lu, Yan Xu, Mengru Liu, Wenshu Chai
Lung cancer is the most common malignant tumor worldwide, with an annual incidence of 18 million and an annual death toll of 16 million [1]. Risk factors for lung cancer include smoking and passive smoking, indoor fuel, and oil fume pollution, radon pollution, and family history of lung cancer [2]. Anatomical pneumonectomy is the main treatment for early and mid-stage lung cancer, but it is easy to induce respiratory and cardiovascular complications after surgery [3]. Radiotherapy and chemotherapy are also common methods to treat lung cancer, but cancer cells are easily resistant to radiotherapy and chemotherapy [4]. In recent years, immunotherapy represented by immune checkpoint inhibitors has made gratifying progress [5]. Immune checkpoints broadly include costimulatory molecules represented by CD28, ICOS, and HVEN, and inhibitory molecules represented by programmed cell death 1 (PD-1), T-cell immunoglobulin and mucin domain 3 (TIM3), and lymphocyte-activation gene 3 (LAG3). They are like accelerators or brakes of the immune system and act a crucial part in the stimulation and suppression of the immune system [6,7]. Therefore, the development of preparations or drugs that target immune checkpoints has become the key to the treatment of lung cancer [8].
Bioengineering lungs — current status and future prospects
Published in Expert Opinion on Biological Therapy, 2021
Vishal Swaminathan, Barry R. Bryant, Vakhtang Tchantchaleishvili, Taufiek Konrad Rajab
Seemingly, one of the most clinically applicable end goals of the transplantation of bioengineered lungs would be in the setting of oncologic thoracic surgery; more specifically, the potential for heterologous self-cell seeded lung replacement post-pneumonectomy in the setting of bronchogenic cancer. Unfortunately, lung transplantation in those with a recent history of cancer, in some instances as long as a five-year disease-free interval, is an absolute contraindication due to the chance of recurrence post-transplantation [56]. Lungs utilized for conventional transplants are also a scarce resource. However, if a donor lung is reseeded with the recipient’s own cells transplanted, the chance of immunological insult may be averted and it provides a rich and potentially unlimited source of organs for transplantation. Such research is currently being done in animal models, with the hopes of human clinical translation [57]. This could potentially increase the scope of curative pneumonectomy or lobectomy in the setting of bronchogenic cancer, with less of a worry about whether the patient would have enough lung tissue remaining to survive. This makes it so that artificial lung transplantation post-pneumonectomy in the setting of cancer remission might be the earliest clinical application of this technology.
Efficacy and safety of percutaneous tube drainage in lung abscess: a systematic review and meta-analysis
Published in Expert Review of Respiratory Medicine, 2020
Qibin Lin, Minli Jin, Yacan Luo, Meixi Zhou, Chang Cai
In the pre-antibiotic era, 30–40% of patients with lung abscess would die, and the other third of patients would survive with sequelae, such as chronic lung abscess [4,5]. However, with the introduction of antibiotics, 80–90% of lung abscesses were successfully treated [2]. In recent years, however, the bacterial resistance rate has increased markedly due to antibiotic abuse, coupled with the aging of the population, host secondary immunodeficiency, such as acquired immunodeficiency syndrome (AIDS) and other factors; consequently, the treatment of lung abscess constantly faces new challenges [6]. When medical treatment fails, pneumonectomy is usually recommended. However, even with surgery, the mortality rate for lung abscesses ranges from 15% to 20% [7]. Another treatment option is abscess drainage.