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Respiratory Investigation Nov 2021The prognosis of patients with connective tissue disease (CTD) has improved significantly in recent years, but interstitial lung disease (ILD) associated with connective... (Review)
Review
The prognosis of patients with connective tissue disease (CTD) has improved significantly in recent years, but interstitial lung disease (ILD) associated with connective tissue disease (CTD-ILD) remains a refractory condition, which is a leading cause of mortality. Because it is an important prognostic factor, many observational and interventional studies have been conducted to date. However, CTD is a heterogeneous group of conditions, which makes the clinical course, treatment responses, and prognosis of CTD-ILD extremely diverse. To summarize the current understanding and unsolved questions, the Japanese Respiratory Society and the Japan College of Rheumatology collaborated to publish the world's first guide focusing on CTD-ILD, based on the evidence and expert consensus of pulmonologists and rheumatologists, along with radiologists, pathologists, and dermatologists. The task force members proposed a total of 27 items, including 7 for general topics, 9 for disease-specific topics, 3 for complications, 4 for pharmacologic treatments, and 4 for non-pharmacologic therapies, with teams of 2-4 authors and reviewers for each item to prepare a consensus statement based on a systematic literature review. Subsequently, public opinions were collected from members of both societies, and a critical review was conducted by external reviewers. Finally, the task force finalized the guide upon discussion and consensus generation. This guide is expected to contribute to the standardization of CTD-ILD medical care and is also useful as a tool for promoting future research by clarifying unresolved issues.
Topics: Connective Tissue Diseases; Humans; Japan; Lung Diseases, Interstitial; Prognosis; Pulmonologists
PubMed: 34602377
DOI: 10.1016/j.resinv.2021.04.011 -
Clinics in Chest Medicine Jun 2024The pericardium comprises a double-walled fibrous-serosal sac that encloses the heart. Reflections of the serosal layer form sinuses and recesses. With advances in... (Review)
Review
The pericardium comprises a double-walled fibrous-serosal sac that encloses the heart. Reflections of the serosal layer form sinuses and recesses. With advances in multidetector computed tomography (CT) technology, pericardial recesses are frequently detected with thin-section CT. Knowledge of pericardial anatomy on imaging is crucial to avoid misinterpretation of fluid-filled pericardial sinuses and recesses as adenopathy/pericardial metastasis or aortic dissection, which can impact patient management and treatment decisions. The authors offer a comprehensive review of pericardial anatomy and its variations observed on CT, potential pitfalls in image interpretation, and implications for the pulmonologist with respect to unnecessary diagnostic procedures or interventions.
Topics: Humans; Pericardium; Tomography, X-Ray Computed; Pulmonologists; Multidetector Computed Tomography
PubMed: 38816085
DOI: 10.1016/j.ccm.2024.02.002 -
Integration of 3D printing and additive manufacturing in the interventional pulmonologist's toolbox.Respiratory Medicine Jan 2018New 3D technologies are rapidly entering into the surgical landscape, including in interventional pulmonology. The transition of 2D restricted data into a physical model... (Review)
Review
New 3D technologies are rapidly entering into the surgical landscape, including in interventional pulmonology. The transition of 2D restricted data into a physical model of pathological airways by three-dimensional printing (3DP) allows rapid prototyping and fabrication of complex and patient-specific shapes and can thus help the physician to plan and guide complex procedures. Furthermore, computer-assisted designed (CAD) patient-specific devices have already helped surgeons overcome several therapeutic impasses and are likely to rapidly cover a wider range of situations. We report herein with a special focus on our clinical experience: i) how additive manufacturing is progressively integrated into the management of complex central airways diseases; ii) the appealing future directions of these new technologies, including the potential of the emerging technique of bioprinting; iii) the main pitfalls that could delay its introduction into routine care.
Topics: Bioprinting; Computer-Aided Design; Humans; Models, Anatomic; Patient-Specific Modeling; Printing, Three-Dimensional; Respiratory Tract Diseases; Stents
PubMed: 29413501
DOI: 10.1016/j.rmed.2017.11.019 -
Seminars in Thoracic and Cardiovascular... Jul 2002The pulmonologist's goal in managing a patient with a solitary pulmonary nodule is to distinguish the benign from malignant nodule and, where malignancy is either... (Review)
Review
The pulmonologist's goal in managing a patient with a solitary pulmonary nodule is to distinguish the benign from malignant nodule and, where malignancy is either confirmed or strongly suspected, to expedite resection. By using established clinical features (eg, age, smoking status) and radiographic findings (eg, calcification, growth rate, size), a probability of malignancy can be determined. If necessary, noninvasive or adjuvant invasive testing is used to alter the probability to one that permits observation or demands resection. The proper use of these tests mandates knowledge about their performance characteristics. Decision-analytic approaches, using Bayesian analysis, may assist with the calculation of probability. These models have not consistently outperformed the clinician or adjuvant testing. The use of low-dose computed tomography (CT) scanning as a screening tool has led to the discovery of many small, indeterminate nodules. Management decisions for these nodules are influenced by their low prevalence of malignancy and small size. Future advances will add to our ability to effectively meet our stated goal.
Topics: Decision Making; Humans; Lung Neoplasms; Pulmonary Medicine; Radiographic Image Enhancement; Solitary Pulmonary Nodule; Tomography, X-Ray Computed
PubMed: 12232866
DOI: 10.1053/stcs.2002.33154 -
Clinics in Chest Medicine Mar 2020Therapeutic bronchoscopy for both endobronchial tumors and peripheral lung cancer is rapidly evolving. The expected increase in early stage lung cancer detection and... (Review)
Review
Therapeutic bronchoscopy for both endobronchial tumors and peripheral lung cancer is rapidly evolving. The expected increase in early stage lung cancer detection and significant improvement in near real-time imaging for diagnostic bronchoscopy has led to the development of bronchoscopy-delivered ablative technologies. Therapies targeting obstructing central airway tumors for palliation and as a method of local disease control, patient selection and patient-centered outcomes have been areas of ongoing research. This review focuses on patient selection when considering therapeutic bronchoscopy and new and developing technologies for endobronchial tumors and reviews the status of bronchoscopy-delivered ablative tools for peripheral lung cancers.
Topics: Bronchoscopy; Humans; Lung Neoplasms; Pulmonologists
PubMed: 32008626
DOI: 10.1016/j.ccm.2019.11.003 -
Respiratory Medicine 2021Hematopoietic stem cell transplantation (HSCT) is used for treatment of a myriad of both malignant and non-malignant disorders. However, despite many advances over the... (Review)
Review
Hematopoietic stem cell transplantation (HSCT) is used for treatment of a myriad of both malignant and non-malignant disorders. However, despite many advances over the years which have resulted in improved patient mortality, this subset of patients remains at risk for a variety of post-transplant complications. Pulmonary complications of HSCT are categorized into infectious and non-infectious and occur in up to one-third of patients undergoing HSCT. Infectious etiologies include bacterial, viral and fungal infections, each of which can have significant mortality if not identified and treated early in the course of infection. Advances in the diagnosis and management of infectious complications highlight the importance of non-infectious pulmonary complications related to chemoradiation toxicities, immunosuppressive drugs toxicities, and graft-versus-host disease. This report aims to serve as a guide and clinical update of pulmonary complications following HSCT for the general pulmonologist who may be involved in the care of these patients.
Topics: Clinical Competence; Female; Health Knowledge, Attitudes, Practice; Hematopoietic Stem Cell Transplantation; Humans; Infection Control; Infections; Male; Patient Care; Postoperative Complications; Pulmonologists; Risk
PubMed: 34107323
DOI: 10.1016/j.rmed.2021.106493 -
La Radiologia Medica Apr 2018To apply the Delphi exercise with iterative involvement of radiologists and pulmonologists with the aim of defining a structured reporting template for high-resolution...
OBJECTIVES
To apply the Delphi exercise with iterative involvement of radiologists and pulmonologists with the aim of defining a structured reporting template for high-resolution computed tomography (HRCT) of patients with fibrosing lung disease (FLD).
METHODS
The writing committee selected the HRCT criteria-the Delphi items-for rating from both radiology panelists (RP) and pulmonology panelists (PP). The Delphi items were first rated by RPs as "essential", "optional", or "not relevant". The items rated "essential" by < 80% of the RP were selected for the PP rating. The format of reporting was rated by both RP and PP.
RESULTS
A total of 42 RPs and 12 PPs participated to the survey. In both Delphi round 1 and 2, 10/27 (37.7%) items were rated "essential" by more than 80% of RP. The remaining 17/27 (63.3%) items were rated by the PP in round 3, with 2/17 items (11.7%) rated "essential" by the PP. PP proposed additional items for conclusion domain, which were rated by RPs in the fourth round. Poor consensus was observed for the format of reporting.
CONCLUSIONS
This study provides a template for structured report of FLD that features essential items as agreed by expert thoracic radiologists and pulmonologists.
Topics: Adult; Aged; Delphi Technique; Female; Humans; Male; Middle Aged; Models, Theoretical; Prospective Studies; Pulmonary Fibrosis; Pulmonary Medicine; Radiology; Research Report; Tomography, X-Ray Computed
PubMed: 29230680
DOI: 10.1007/s11547-017-0835-6 -
The Role of the Pulmonologist in a Pulmonary Embolism Response Team (PERT): A Time to Come on Stage.Archivos de Bronconeumologia Jan 2019
Topics: Anticoagulants; Hospital Rapid Response Team; Humans; Mechanical Thrombolysis; Physician's Role; Pulmonary Embolism; Pulmonologists; Risk Assessment; Spain; Thrombolytic Therapy
PubMed: 29789172
DOI: 10.1016/j.arbres.2018.04.002 -
The Korean Journal of Internal Medicine Jul 2017Interstitial lung disease (ILD) occurs in 15% of patients with collagen vascular disease (CVD), referred to as connective tissue disease (CTD). Despite advances in... (Review)
Review
Interstitial lung disease (ILD) occurs in 15% of patients with collagen vascular disease (CVD), referred to as connective tissue disease (CTD). Despite advances in management strategies, ILD continues to be a significant cause of mortality in patients with CVD-associated ILD (CTD-ILD). There is a lack of randomized, clinical trials assessing pharmacological agents for CTD-ILD, except in cases of ILD-associated systemic sclerosis (SSc). This may be due to the lack of CTD cases available, the difficulty of histological confirmation of ILD, and the various types of CTD and ILD. As a result, evidence-based pharmacological treatment of CTD-ILD is not yet well established. CTD-ILD presents with varying degrees of histology, from inflammation to fibrosis, and a wide spectrum of clinical manifestations, from minimal symptoms to respiratory failure. This renders it difficult for clinicians to make decisions regarding treatment options, observational strategies, optimal timing for interventions, and the appropriateness of pharmacological agents for treatment. There is no specific treatment for reversing fibrosis-like idiopathic pulmonary fibrosis in a clinical setting. This review describes pharmacological interventions for SSc-ILD described in randomized control trials, and presents an overview of recent advances of CTD-ILD-dependent treatments based on the types of CTD.
Topics: Connective Tissue Diseases; Humans; Immunologic Factors; Lung Diseases, Interstitial; Prevalence; Pulmonologists
PubMed: 28704913
DOI: 10.3904/kjim.2016.212 -
Pediatric Pulmonology Oct 2020Pediatric pulmonologists have been involved in the care of adult COVID-19 patients in a variety of ways, particularly in areas with a high concentration of cases. This...
Pediatric pulmonologists have been involved in the care of adult COVID-19 patients in a variety of ways, particularly in areas with a high concentration of cases. This invited commentary is a series of questions to Dr Mikhail Kazachkov, a pediatric pulmonologist at New York University, about his experiences to date in a major COVID-19 "hotspot" and his thoughts about how other pediatric pulmonologists facing this situation can best support their colleagues.
Topics: Adult; COVID-19; Child; Emotions; Hospitals, Pediatric; Humans; Infection Control; Pandemics; Patient Care Team; Pediatrics; Professional Role; Pulmonary Medicine; Pulmonologists; SARS-CoV-2
PubMed: 32761974
DOI: 10.1002/ppul.25010