The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Background: This document provides clinical recommendations for the diagnosis of idiopathic pulmonary fibrosis (IPF). It represents a collaborative effort between the American Thoracic Society, Eur...

https://www.atsjournals.org/doi/pdf/10.1164/rccm.201807-1255ST

Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline.

The operative treatment of pectus excavatum.

Background: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociacion Latinoamericana del Torax.Methods: Systematic reviews were performed for six questions. The evidence was discussed, and then recommendations were formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.Results: The guideline committee defined HP, and clinical, radiographic, and pathological features were described. HP was classified into nonfibrotic and fibrotic phenotypes. There was limited evidence that was directly applicable to all questions. The need for a thorough history and a validated questionnaire to identify potential exposures was agreed on. Serum IgG testing against potential antigens associated with HP was suggested to identify potential exposures. For patients with nonfibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis, and suggestions for transbronchial lung biopsy and surgical lung biopsy were also made. For patients with fibrotic HP, suggestions were made in favor of obtaining BAL for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy. Diagnostic criteria were established, and a diagnostic algorithm was created by expert consensus. Knowledge gaps were identified as future research directions.Conclusions: The guideline committee developed a systematic approach to the diagnosis of HP. The approach should be reevaluated as new evidence accumulates.

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Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline.

The pride in British medicine that was established by this flagship-the first edition of the Oxford textbook of medicine-is rekindled by the second edition. Some rearrangement and expansion of sections have occurred. The first edition indicated that the book was intended for anyone studying or practising clinical medicine (as a first reference source for general practitioners and specialists) and this new edition amply fulfils that challenge. A section on primary care brings this discipline into its rightful place in such a textbook and helps to break down any artificial barrier that may exist between hospital and family practice medicine. One looks for updating between the two editions and apart from increase in size there are 'improvements' throughout-almost completely new and recent references in the section on pituitary and hypothalmic disorders, an account of CT scanning in pituitary and adrenal disease, developments such as magnetic resonance imaging included in the cardiovascular disease section. The section on respiratory disease has illuminating descriptions of the pathophysiology of the airways and gas exchange. The clinical section on asthma is updated to modern concepts. Rheumatology and connective tissue disorders is expanded from eight to 15 subsections. AIDS, dealt with in only three pages, may (one hopes) be in the end a true perspective or, alternatively, this field is changing so rapidly that we can await a major assessment of this condition in a third edition.

Oxford textbook of medicine

Accuracy of sentinel node biopsy in the staging of non-small cell lung carcinomas: systematic review and meta-analysis of the literature.

INTRODUCTION Carcinoid tumors are a type of neuroendocrine tumors which usually involve the upper airways and the patients most often complain of cough and hemoptysis. MATERIALS AND METHODS This study was performed from 1990 through 2007 on 40 patients with carcinoid tumor who had been followed up for at least 3 years. The statistical analysis were based on tumor epidemiology, treatment and the 3-year survival. The factors influencing the survival were analyzed using SPSS and exact Fisher test. RESULTS M/F was 16/24 with mean age 34 years. Their most common symptoms were coughing (90%) . The left main bronchus was the most common site of involvement (25%). 95% of all the cases underwent surgery and 5% of the patients underwent chemoradiotherapy due to distant metastasis . The most common surgical procedure was lobectomy or biloectomy (57.8%). Bronchial sleeve resection was performed on 10.4% of the patients. The most common pathology was the typical form (90%) and 5% of the madiastinal lymph nodes were involvd all of the atypical type. Carcinoid syndrome was seen in one patient (2.5%) and post operative adjuvant treatment was done in 5% of the patients after surgery because of mediastinal lymph node involvement. Post operative recurrence occurred in one patient (2.6%) of the atypical form with mediastinal lymph nodes involvement. The most common complication of surgery was a long- term air leakage (10.4%) and the surgical death rate was 0%. 3-year survival was 92.5%. The factors influencing the survival included the pathological type, distant metastasis and mediastinal lymph node involvement. CONCLUSION Carcinoid tumors have mostly been responsive to surgical intervention, resulting in a long term survival.

Tracheobronchopulmonary carcinoid tumors: analysis of 40 patients.

Purpose
Pulmonary hydatid cyst, a parasitic disease, is a health care problem in developing countries. In this study, we evaluated outcomes of patients with pulmonary hydatid disease who were treated in our department.

Pulmonary hydatid cyst : analysis of 1024 cases

The use of sentinel node surgery for esophageal carcinoma is still under investigation. We evaluated the data available in the literature on this topic, and herein present the results in a systematic review format. PUBMED, SCOPUS, the ISI web of knowledge and the information from the annual meetings of the Japan Esophageal Society were searched using the search terms: "(esophagus OR esophageal) AND sentinel". The outcomes of interest were the detection rate and sensitivity. Overall, 18 studies were included. The pooled detection rate was 89.2% [82.6-93.5]. Patients with T1 and two tumors had a 17% higher detection rate compared to those with T3 and four tumors. The pooled sensitivity was 84% [78-88%]. The sensitivity was higher for adenocarcinoma compared to squamous cell carcinoma (SCC) (91 vs. 81%). In the SCC patients, there was a trend toward decreased sensitivity associated with an increasing tumor depth (T1:88%, T2:76%, T3:50%). Our analysis indicated that sentinel node biopsy is useful in adenocarcinoma patients. For SCC patients, including only cN0 patients (preferably T1 and 2) would increase the detection rate and sensitivity. Due to the limited number of high-quality studies, drawing any more definite conclusions is impossible. Large cohort studies with a standardized and consistent design will be needed in the future.

Accuracy of sentinel node biopsy in esophageal carcinoma: a systematic review and meta-analysis of the pertinent literature

Primary chest wall tumors originate from different constructions of thoracic wall. We report our multidisciplinary experience on primary thoracic tumor resection and thoracic reconstruction, the need to additional therapy and evaluating prognostic factors affecting survival. We performed a retrospective review of our prospectively maintained database of 40 patients treated for malignant primary chest wall tumor from 1989 to 2009. Patients were evaluated in terms of age, sex, clinical presentation, type of imaging, tissue diagnosis methods, pathology, surgical technique, early complications, hospital mortality, prevalence of recurrence and distant metastases, additional treatment, 3 years survival and factors affecting survival. Male/Female (F/M) = 1, with median age of 43.72 years. Mass was the most common symptoms and the soft tissue sarcoma was the most common pathology. Resection without reconstruction was performed in 5 patients and Thirty-five patients (87.5%) had extensive resection and reconstruction with rotatory muscular flap, prosthetic mesh and/or cement. Overall, 12.5% (5/40) of patients received neoadjuvant therapy and 75% (30/40) of patients were treated with adjuvant therapy. The 3-year survival rate was 65%. Recurrences occurred in 24 patients (60%), 14 developed local recurrences, and 10 developed distant metastases. The primary treatment modality for both local and distant recurrences was surgical resection; among them, 10 underwent repeated resection, 9 adjuvant therapy and 5 were treated with lung metastasectomy. The most common site of distant metastasis was lung (n = 7). Factors that affected survival were type of pathology and evidence of distant metastasis. Surgery with wide margin is the safe and good technique for treatment of primary chest wall tumors with acceptable morbidity and mortality.

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Reza Bagheri

Papers

Accuracy of sentinel node biopsy in the staging of non-small cell lung carcinomas: systematic review and meta-analysis of the literature.

Tracheobronchopulmonary carcinoid tumors: analysis of 40 patients.

Pulmonary hydatid cyst : analysis of 1024 cases

Accuracy of sentinel node biopsy in esophageal carcinoma: a systematic review and meta-analysis of the pertinent literature

Primary malignant chest wall tumors: analysis of 40 patients