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.

/pdf/diagnosis-of-hypersensitivity-pneumonitis-in-adults-an-51yggqalis.pdf

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

### How should the diagnosis of bronchiectasis be determined?

#### Recommendations – Imaging

#### Good practice points

CT imaging protocol 

CT features of bronchiectasis 

General 

### In whom should the diagnosis of bronchiectasis be suspected?

#### Recommendations

https://thorax.bmj.com/content/thoraxjnl/74/Suppl_1/1.full.pdf

British Thoracic Society Guideline for bronchiectasis in adults

This chapter primarily deals with one of the classic four terrible “T’s” in the differential diagnosis of anterior mediastinal masses, namely, thymic epithelial tumors. Given the rarity of these malignancies, with an estimated 390 cases per year in the USA, management of these entities is primarily guided by several retrospective analyses. This chapter focuses on the clinical presentation, associated autoimmune disease, staging, and role of radiation in the management of thymoma and thymic carcinoma.

Tumors of the Mediastinum

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

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.

/pdf/primary-malignant-chest-wall-tumors-analysis-of-40-patients-189g1grxhe.pdf

Primary malignant chest wall tumors: analysis of 40 patients

BACKGROUND: Bronchiectasis is a permanent irreversible dilatation of the bronchial wall, often arising from inadequate treatment of a pulmonary infection. In recent years, the incidence of bronchiectasis has decreased mainly due to improved medical treatment of respiratory infections. However, the disease still constitutes a health problem in developing countries. METHOD: We reviewed 277 patients with bronchiectasis who underwent pulmonary resection in the Ghaem & Omid hospitals affiliated to Mashhad University of Medical Sciences in Iran from 1985 to 2008. The patients were evaluated for age, sex, clinical features, etiology, type of surgical procedure, morbidity, mortality and treatment outcomes. RESULTS: A total of 277 patients were enrolled in this study [200 males (72.2 %) and 77 females (27.7 %)]. Mean patient age was 34.7 years. The most common symptom was productive cough (79.4 %). The most common etiology was pulmonary infection (77.6 %). The disease was bilateral in 62 cases (22.3 %) and the most common site of involvement was the left lower lobe (55 %). The most common surgical technique for the unilateral form was lobectomy (42.2 %) and one-sided lobectomy with segmentectomy of the other side in 25 patients with bilateral bronchiectasis. Mortality and morbidity rates were 0.7 % and 15.8 %, respectively. The most common complication was wound infection (5.7 %). The mean follow-up was 4.5 years. 68.5 % of patients were symptom-free at the last postoperative evaluation, 23.8 % had an improvement in their symptoms, and 7.5 % of patients showed no improvement. Statistically, complete resection had a better outcome. CONCLUSION: In conclusion, surgery is an acceptable treatment in bronchiectasis and has low mortality and morbidity rates. The best outcomes were observed after complete resection. In selected bilateral cases, resection was used with acceptable outcomes.

Surgical management of bronchiectasis: analysis of 277 patients.

BackgroundEsophageal cancer is among the most common gastrointestinal cancers for which the main treatment is surgery. This study was undertaken to analyze the results of Botox injection in preventing gastric stasis in these patients.Patients and methods60 patients with esophageal cancer in the middle and lower third parts were included in our study between 2010 and 2011, and were randomly divided into two groups. In group A, 30 patients underwent pyloroplasty, and in group B, injection of botulinum toxin into the pyloric sphincter muscle was used in 30 patients.ResultsThe mean age of these patients was 61 ± 10.7 years and the male/female ratio was 33:27. Isotope scans 3 weeks after surgery showed that 5 patients in group A and 3 in group B had delayed gastric emptying; there was no significant difference between the 2 groups, and the success rate of Botox injection was 90%.ConclusionConsidering the fact that there was no significant difference between pyloroplasty and Botox injection on gastric emptying ...

Botulinum toxin for prevention of delayed gastric emptying after esophagectomy.

Introduction: Pleural malignant mesothelioma is an uncommon but extremely invasive tumor which originates from mesothelial cells and usually occurs after prolonged exposure to asbestos. Different types of surgical and oncological therapeutic methods have been used resulting in various outcomes. The aim of this study was to evaluate, clinicopathologically, 40 patients with pleural malignant mesothelioma and the main factors influencing their prognosis. Methods: In this study, 40 patients with a definitive diagnosis, who had been followed up for at least 3 years were studied according to these: epidemiologic factors, stage and pathological types, treatment method and complications, and by using factors that influence patients survival, we evaluated them statistically. Results: The M/F ratio was l3/1 with an average age of 55 years. Chest pain was the most common symptom. In 55% of patients, the lesions were localized in the left site and most were in Buchart stage I or II. The epithelial form was the most common pathological pattern (62.5%). 47.5% of patients only received radiotherapy and chemotherapy. Of patients who underwent decortication and pleurectomy with adjuvant therapy, extrapleural was performed in 20% of patients, and pneumonectomy, in 17.5%; and 15% refused any type of treatment. One patient died from the surgery. The most common surgical complication was wound infection. The average survival was 10.5 months, and the main factors influencing the survival were physiologic status, pathological form of disease, stage of disease and the pattern of pleural involvement. Conclusion: Because of the low survival after multimodality invasive treatments in mesothelioma, aggressive therapeutic methods were recommended in patients with good physiological status and early clinical stage with a good pathology type.

Seyed Ziaollah Haghi

Papers

Pulmonary hydatid cyst : analysis of 1024 cases

Primary malignant chest wall tumors: analysis of 40 patients

Surgical management of bronchiectasis: analysis of 277 patients.

Botulinum toxin for prevention of delayed gastric emptying after esophagectomy.

malignant pleural mesothelioma clinicopathologic and survival characteristic in a Consecutive Series of 40 Patients