- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Pneumothorax is a principal diagnosis for emergency management services (EMS) providers to make because it is a potentially life-threatening condition that is commonly associated with complaints such...
Pneumothorax is a principal diagnosis for emergency management services (EMS) providers to make because it is a potentially life-threatening condition that is commonly associated with complaints such as chest pain, shortness of breath, and trauma. The condition spans all age groups, and EMS providers should, therefore, maintain a high index of suspicion for pneumothorax for any patient with a sudden onset of acute respiratory distress and ipsilateral chest pain. Pneumothorax is the entry of air into the potential space between the parietal and visceral pleura. Air can enter the chest cavity from a rupture in the lung tissue or trauma to the pleura. Lung tissue can burst spontaneously in patients with risk factors such as tobacco use, Marfan’s syndrome, underwater diving, airplane travel, and male gender. It can also occur secondarily as a part of a chronic lung disease such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, or pneumocystis pneumonia (PCP) due to the destruction of lung tissue. EMS providers may also encounter several different mechanisms of injury that violate the pleura creating a pneumothorax, such as penetrating trauma to the chest or blunt trauma with a rib fracture. EMS providers may be called to the outpatient setting where medical/holistic procedures involving the chest or neck may cause an iatrogenic pneumothorax, such as central venous catheter placement, thoracentesis, and lung biopsies. EMS providers are challenged in making the diagnosis for several reasons. They do not have access to emergency department tools such as chest radiographs and point of care thoracic ultrasound which may clinch the diagnosis. Many patients will have comorbid conditions that may mimic a pneumothorax including COPD/asthma, congestive heart failure (CHF), and pleural effusions, which may have decreased breath sounds during acute exacerbations and acute dyspnea. A hemothorax will have a similar presentation as a hemothorax such as dyspnea, hypoxia, decreased breath sounds, and chest pain. A key clinical finding that separates these two is that a pneumothorax will have hyper-resonance to percussion, but a hemothorax will have a hypo-resonance to percussion. Both of these will need a chest tube, but only a tension pneumothorax will require needle decompression. Ambient noise in the field may drown out differences in lateralized breath sounds. Low light, body fluid, and other environmental factors may make otherwise obvious chest wall openings unapparent in emergencies. In the appropriate clinical setting of acute dyspnea, but equivocal breath sounds, EMS providers may percuss the thorax for unilateral hyper-resonance and asymmetric tactile fremitus in making the diagnosis.
- Lung cancer risk stratification using methylation profile in the oral epithelium. [Journal Article]
- ACAsian Cardiovasc Thorac Ann 2018 Nov 11; :218492318813443
- CONCLUSIONS: The results of this study indicate that specific gene methylation in the oral epithelium might be a promising biomarker for lung cancer risk assessment, especially among smokers. Risk stratification through the analysis of DNA methylation profiles in the oral epithelium may be a useful and less invasive first-step approach in an efficient two-step lung cancer screening strategy.
- Repertoire of bacterial species cultured from the human oral cavity and respiratory tract. [Journal Article]
- FMFuture Microbiol 2018 Nov 12
- While the gut microbiota is currently in the spotlight, the airway microbiome has been recently associated with several pulmonary diseases and carcinogenesis. As there are several biases associated w...
While the gut microbiota is currently in the spotlight, the airway microbiome has been recently associated with several pulmonary diseases and carcinogenesis. As there are several biases associated with high-throughput sequencing methods, cultivation techniques are crucial for the investigation of the human microbiome. We thus aimed to build an exhaustive database, including a list of microbes isolated by culture from respiratory specimens, by performing a review of the literature. Herein, we have listed a total of 756 species cultured from the human respiratory tract. This represents 27.23% of the overall bacterial richness captured from human being by culture methods. This repertoire could be valuable for the elucidation of the interactions between the respiratory microbiome and human health.
- Application of the "continuous suture dividing and equal suture tightening" method in video-assisted thoracoscopic surgery sleeve lobectomy. [Journal Article]
- JTJ Thorac Dis 2018; 10(9):5199-5207
- CONCLUSIONS: The continuous suture dividing and equal suture tightening method is convenient, feasible, and safe for bronchial anastomosis in VATS sleeve lobectomy. It can effectively avoid the entanglement of the suture threads, thereby enabling the widespread adoption of VATS sleeve lobectomy.
- Innate Lymphoid Cells in the Maternal and Fetal Compartments. [Review]
- FIFront Immunol 2018; 9:2396
- Pregnancy success is orchestrated by the complex balance between the maternal and fetal immune systems. Herein, we summarize the potential role of innate lymphoid cells (ILCs) in the maternal and fet...
Pregnancy success is orchestrated by the complex balance between the maternal and fetal immune systems. Herein, we summarize the potential role of innate lymphoid cells (ILCs) in the maternal and fetal compartments. We reviewed published literature describing different ILC subsets [ILC1s, ILC2s, ILC3s, and lymphoid tissue inducer (LTi) cells] in the uterus, decidua, fetal tissues [liver, secondary lymphoid organs (SLO), intestine, and lung] and amniotic cavity. ILC1s, ILC2s, and ILC3s are present in the murine uterus prior to and during pregnancy but have only been detected in the non-pregnant endometrium in humans. Specifically, ILC2s reside in the murine uterus from mid-pregnancy to term, ILC1s increase throughout gestation, and ILC3s remain constant. Yet, LTi cells have only been detected in the non-pregnant murine uterus. In the human decidua, ILC1s, ILC3s, and LTi-like cells are more abundant during early gestation, whereas ILC2s increase at the end of pregnancy. Decidual ILC1s were also detected during mid-gestation in mice. Interestingly, functional decidual ILC2s and ILC3s increased in women who underwent spontaneous preterm labor, indicating the involvement of such cells in this pregnancy complication. Fetal ILCs exist in the liver, SLO, intestine, lung, and amniotic cavity. The fetal liver is thought to be the source of ILC progenitors since the differentiation of these cells from hematopoietic stem cells occurs at this site, and mature ILC subsets can be found in this compartment as well. The interaction between LTi cells and specialized stromal cells is important during the formation of SLO. Mature ILCs are found at the mucosal surfaces of the lung and intestine, from where they can extravasate into the amniotic cavity. Amniotic fluid ILCs express high levels of RORγt, CD161, and CD103, hallmarks of ILC3s. Such cells are more abundant in the second trimester than later in gestation. Although amniotic fluid ILC3s produce IL-17A and TNFα, indicating their functionality, their numbers in patients with intra-amniotic infection/inflammation remain unchanged compared to those without this pregnancy complication. Collectively, these findings suggest that maternal (uterine and decidual) ILCs play central roles in both the initiation and maintenance of pregnancy, and fetal ILCs participate in the development of immunity.
- Inflammatory Myofibroblastic Tumors in Paranasal Sinus and Nasopharynx: A Clinical Retrospective Study of 13 Cases. [Journal Article]
- BRBiomed Res Int 2018; 2018:7928241
- CONCLUSIONS: IMT is an intermediate tumor that often mimics malignancy. We are not sure if IMTs in the nasal cavity are more aggressive because of the biology or if the location and local therapy in the head region is more complicated. Radiologic findings help know the extent of the lesion. For unresectable nasal IMT, combined therapy with glucocorticoids, chemotherapy, and radiotherapy is sometimes a better choice. Glucocorticoids are especially recommended as a basic part of the integrated therapy. However, the standard treatment needs further research.
- Neoplastic cerebral aneurysm from metastatic lung adenocarcinoma with neuroendocrine features. [Journal Article]
- WNWorld Neurosurg 2018 Nov 03
- CONCLUSIONS: NCAs are rare, and there is insufficient data to support specific guidelines for management. This case is novel as the patient received adjuvant stereotactic radiosurgery to the operative bed as well as systemic chemotherapy and has maintained good functional status as of last follow-up at 6 months.
- Giant solitary fibrous tumor of the pleura. [Journal Article]
- JSJ Surg Case Rep 2018; 2018(11):rjy270
- CONCLUSIONS: SFTP are a rare pathology of the pleural cavity, which most of the time develop from submesothelial fibroblasts of the visceral pleura. Due to their non-characteristic clinical picture, SFTP are usually diagnosed in the later stages of the development. A significant issue in the management of giant SFTP is radical resection of the tumor to relieve compression of the lung parenchyma and other mediastinal structures.SFTP are rare neoplasms that fortunately are benign 80% of the time. Only a few cases of giant SFTP that cover almost the entire pleural space are described in the literature. This report represents one of the largest resected SFTP reports in the literature.
- Structural biology of intraepithelial neuroendocrine cells in the larynx: Literature review. [Review]
- PRPathol Res Pract 2018 Oct 24
- Current knowledge of laryngeal neuroendocrine cells in man and other vertebrates is reviewed. Particular attention is paid to differences in the distribution of neuroendocrine cells between squamous ...
Current knowledge of laryngeal neuroendocrine cells in man and other vertebrates is reviewed. Particular attention is paid to differences in the distribution of neuroendocrine cells between squamous and respiratory laryngeal mucosa, foetal versus post-natal spatial arrangements, relation to the laryngeal cavity and nerve fibres, and immunoreactivities of these cells. Methodological deficiencies and gaps in knowledge are outlined. Comparisons with neuroendocrine cells in lung and gut are drawn, caution with regard to existing histogenetic models of laryngeal neuroendocrine neoplasia is advised and lines of future research are suggested.
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- Surveillance for Cancers Associated with Tobacco Use - United States, 2010-2014. [Journal Article]
- MSMMWR Surveill Summ 2018 11 02; 67(12):1-42
- Tobacco use is the leading preventable cause of cancer, contributing to at least 12 types of cancer, including acute myeloid leukemia (AML) and cancers of the oral cavity and pharynx; esophagus; stom...
Tobacco use is the leading preventable cause of cancer, contributing to at least 12 types of cancer, including acute myeloid leukemia (AML) and cancers of the oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; and cervix. This report provides a comprehensive assessment of recent tobacco-associated cancer incidence for each cancer type by sex, age, race/ethnicity, metropolitan county classification, tumor characteristics, U.S. census region, and state. These data are important for initiation, monitoring, and evaluation of tobacco prevention and control measures.