Fibrosing Alveolitis
K. Gupta, P. Carmichael, A. Zumla in 100 Short Cases for the MRCP, 2020
To establish the severity of the condition, he requires: A chest X-ray.An ECG.A FBC. Pulmonary function tests.Arterial blood gases whilst breathing air and oxygen. From a diagnostic point of view he requires the following investigations: 6. A bronchoscopy with lavage and biopsy.7. A lung gallium scan.8. A CT of his thorax.9. Other tests include: an ESR, serum auto-antibodies,SACE level, serum precipitins and immunoglobulin levels.
Toxicity of Antineoplastic Chemotherapy in Children
Sam Kacew in Drug Toxicity and Metabolism in Pediatrics, 1990
A variety of tests have been proposed to predict bleomycin lung toxicity or to detect it in its earliest stages.102 Clinical signs may not be present until significant fibrosis has occurred, and the chest X-ray may lag behind progression of the disease. Pulmonary function testing is usually performed before onset of therapy in order to provide a baseline for further evaluation. Two tests seem to be most sensitive to the toxic changes of bleomycin lung, namely, carbon monoxide diffusing capacity (DLCO) and forced vital capacity. It has been proposed that bleomycin be discontinued when the DLCO falls to 40% of the patient’s normal value, but even this will not guarantee that the patient will not progress to clinically significant toxicity.
Left thoracic subtotal esophagectomy
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
In addition to the effects of thoracotomy on pulmonary function, the intrathoracic stomach takes up room in the thorax after esophagectomy, and this adversely affects pulmonary function. Thus, pulmonary function should be meticulously assessed before resection of the esophagus. Pulmonary complications, including retained secretions, atelectasis, pneumonia, and respiratory failure, are the most severe problems following thoracic surgical procedures. Patients who are heavy smokers have a significantly increased risk of postoperative complications. The ability to cough is important because cough helps avoid postoperative atelectasis. Preoperative pulmonary function testing is undertaken routinely. The tests range from the simplest medical assessment (history taking, particularly of past pulmonary disease; physical examination; and stair climbing) to the most sophisticated exercise testing, and even analysis of blood gases. After deep inspiration, the ability to breath hold for more than 30 seconds suggests normal lung function. A value less than 20 seconds implies a high risk for thoracotomy. After climbing stairs of three stories, a pulse rate of more than 120 beats per minute indicates a high risk for esophagectomy. In my experience, a patient with a maximum volume ventilation (MVV) and vital capacity (VC) more than 70% of predicted values will tolerate a transthoracic esophagectomy; however, if the MVV and VC are less than 50% of predicted values, forced expiratory volume in 1 second (FEV1)/forced vital capacity less than 60%, and oxygen saturation (SO2) less than 90% after exercise, surgery is contraindicated.
Acute fibrinous and organizing pneumonia following the COVID-19 mRNA-1273 vaccine
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Stephanie Nevison, David Hwang, Anastasia Oikonomou, Lee Fidler
Bronchoscopy with lavage and transbronchial biopsies showed significant lymphocytosis (62.7% of cell count) without eosinophils observed. Bronchoscopy and bronchoalveolar lavage (BAL) cultures were negative for COVID-19, bacteria, mycobacteria, and fungus. Biopsies cultured Streptococcus constellatus (suspected contaminant, not grown in washings). Histopathology demonstrated acute fibrinous and organizing pneumonia (AFOP), without eosinophils or hyaline membranes identified (Figure 2). The case was reviewed at a multidisciplinary discussion, resulting in a provisional diagnosis of AFOP secondary to mRNA-1273 vaccination. He was treated with corticosteroids and experienced rapid improvement of symptoms and imaging. Pulmonary function testing was normal within 6 weeks of starting treatment.
Robotic totally endoscopic coronary artery bypass grafting: current status and future prospects
Published in Expert Review of Medical Devices, 2020
Johannes Bonatti, Stephanie Wallner, Bernhard Winkler, Martin Grabenwöger
Currently any patient with a clear indication for surgical coronary revascularization can be considered. Table 1 lists the most important contraindications. The surgeon should pay attention to any pathology restricting the space inside the chest because it may compromise free movement of the robotic camera and the instruments. Preoperative workup includes all exams performed for regular CABG; in addition a CT angiogram of chest abdomen pelvis is carried out in order to assess space available as well as general, cardiovascular, and pulmonary pathology. Other valuable information can be obtained from the preoperative CT angiography such as location of the coronary targets and an intramyocardial course. We have previously described findings and measurements on these CT scans which can guide the surgeon to a safe indication for the procedure and should be seen as mandatory preoperative step [10]. Pulmonary function tests are part of the routine preoperative workup. As reported by Kitahara and coworkers even morbid obesity does not appear to be an absolute contraindication to the procedure [11].
Feasibility of hypofractionated radiotherapy in inoperable node-positive NSCLC patients with poor prognostic factors and limited pulmonary reserve: a prospective observational study
Published in Acta Oncologica, 2021
Chukwuka Eze, Julian Taugner, Nina Sophie Schmidt-Hegemann, Lukas Käsmann, Julian Elias Guggenberger, Olarn Roengvoraphoj, Maurice Dantes, Arteda Gjika, Minglun Li, Claus Belka, Farkhad Manapov
Patients were assessed prior to treatment, twice per week during the course of treatment to monitor toxicity and 4–6 weeks after completion of treatment. A pulmonary function test was performed 4–6 weeks after initial treatment and on follow-up if indicated. A physical examination and whole-body PET/CT or CT of the chest/upper abdomen were performed every 3 months for the first 2 years, every 6 months for years 3/4, and annually thereafter. Non-haematological toxicity was classified per common terminology criteria for adverse events (CTCAE) version 5.0 assessed twice per week during treatment, 6 weeks after completion, and every three months for the first 2 years following Hypo-IGRT. Treatment response was assessed on the first follow-up imaging per RECIST 1.1.
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