https://idsa.confex.com/idsa/2015/webprogram/Handout/id3255/POSTER155_1153.pdf

Pregnancy as a risk factor for severe outcomes from influenza virus infection: A systematic review and meta-analysis of observational studies.

Management of Persistent Air Leaks.

Evaluation of Pulmonary Nodules: Clinical Practice Consensus Guidelines for Asia

Pneumothorax is an urgent situation that has to be treated immediately upon diagnosis. Pneumothorax is divided to primary and secondary. A primary pneumothorax is considered the one that occurs without an apparent cause and in the absence of significant lung disease. On the other hand secondary pneumothorax occurs in the presence of existing lung pathology. There is the case where an amount of air in the chest increases markedly and a one-way valve is formed leading to a tension pneumothorax. Unless reversed by effective treatment, this situation can progress and cause death. Pneumothorax can be caused by physical trauma to the chest or as a complication of medical or surgical intervention (biopsy). Symptoms typically include chest pain and shortness of breath. Diagnosis of a pneumothorax requires a chest X-ray or computed tomography (CT) scan. Small spontaneous pneumothoraces typically resolve without treatment and require only monitoring. In our current special issue we will present the definition, diagnosis and treatment of pneumothorax from different experts in the field, different countries and present different methods of treatment.

Pneumothorax: from definition to diagnosis and treatment

Molecular testing identifies patients with advanced non-small cell lung cancer (NSCLC) who may benefit from targeted therapy or immunotherapy (i.e., immune checkpoint inhibitor treatment for patients with high tumor mutational burden (TMB), microsatellite instability-high or mismatch repair-deficient tumors). Current guidelines state that molecular testing should be conducted at the time of initial diagnosis and tumor progression on targeted therapy. In real-world clinical practice in the United States (US), molecular testing is often not conducted or happens late in the diagnostic journey, resulting in delayed or inappropriate treatment. Herein, we review the rationale for molecular testing in advanced NSCLC, along with best-practice guidelines based on published recommendations and our own clinical experience, including a case study. We propose three strategies to optimize molecular testing in newly diagnosed patients with advanced NSCLC: (I) pulmonologists, interventional radiologists, or thoracic surgeons order molecular tests as soon as advanced NSCLC with an adenocarcinoma component is suspected; (II) liquid biopsies conducted early in the diagnostic pathway; and (III) pathologist-directed reflex testing, as conducted in other areas of oncology. To help facilitate these strategies, we outline our recommendations for optimal sample collection techniques and stewardship. In summary, we believe that implementation of these individual strategies will allow clinicians to effectively leverage available treatment options for advanced NSCLC, reducing the time to optimal treatment and improving patient outcomes.

Molecular testing strategies in non-small cell lung cancer: optimizing the diagnostic journey

Transthoracic needle biopsy (TTNB) is done with imaging guidance and most frequently by a radiologist, for the aim is to diagnose a defined mass. It is integral in the diagnosis and treatment of many thoracic diseases, and is an important alternative to more invasive surgical procedures. FNAC is a method of aspiration cytopathology, which with transthoracic biopsy ("core biopsy") is a group of percutaneous minimally invasive diagnostic procedures for exploration of lung lesions. Needle choice depends mostly upon lesion characteristics and location. A recent innovation in biopsy needles has been the introduction of automatic core biopsy needle devices that yield large specimens and improve the diagnostic accuracy of needle biopsy. Both computed tomography and ultrasound may be used as imaging guidance for TTNB, with CT being more commonly utilized. Common complications of TTNB include pneumothorax and hemoptysis. The incidence of pneumothorax in patients undergoing TTNB has been reported to be from 9-54%, according to reports published in the past ten years, with an average of around 20%. Which factors statistically correlate with the frequency of pneumothorax remain controversial, but most reports have suggested that lesion size, depth and the presence of emphysema are the main factors influencing the incidence of pneumothorax after CT-guided needle biopsy. On the contrary, gender, age, and the number of pleural passes have not been shown to correlate with the incidence of pneumothorax. The problem most responsible for complicating outpatient management, after needle biopsy was performed, is not the presence of the pneumothorax per se, but an increase in the size of the pneumothorax that requires chest tube placement and patient hospitalization. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications.

/pdf/pneumothorax-after-transthoracic-needle-biopsy-of-lung-1v52pkdmrf.pdf

Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance

Currently there several diagnostic techniques that re used by radiologists and pulmonary physicians for lung cancer diagnostics. In several cases pneumothorax (PNTX) is induced and immediate action is needed. Both radiologists and pulmonary physicians can insert a chest tube for symptom relief. However; only pulmonary physicians and thoracic surgeons can provide a permanent solution for the patient. The final solution would be for a patient to undergo surgery for a final solution. In our current work we will provide all those diagnostic cases where PNTX is induced and treatment from the point of view of expert radiologists and pulmonary physicians.

/pdf/pneumothorax-after-transbronchial-needle-biopsy-32hq3rdbqj.pdf

Pneumothorax after transbronchial needle biopsy

Background/Aim. Influenza A (H1N1) re-emerged in the human population during
 2009. The aim of this study was to describe characteristics, laboratory
 findings, clinical presentation and treatment outcome among patients with
 influenza A (H1N1) infection. Methods. The study was performed at the
 Institute for Pulmonary Diseases of Vojvodina including all the patients
 hospitalized at the Intensive Care Unit or High Dependency Unit with
 confirmed, probable or suspected Influenza A (H1N1) infection between
 November 6th, 2009 and April 13th, 2010. Results. Among 64 patients Influenza
 A (H1N1) infection was confirmed by rt-PCR in 50, defined as probable in 7
 and as suspected in 6 patients. There was an equal number of male and female
 patients. Their mean age was 46 years (SD ± 12.1). None of the patients were
 vaccinated against influenza. Comorbidities were present in 37 (58%)
 patients. There were 29 (45%) obese patients. Three patients were pregnant.
 The median time from symptom onset to hospital admission was 5 days (IQR
 4-7). At admission, the median Modified Early Warning Score (MEWS) was 4 (IQR
 3-6). The most common presenting symptoms were cough (100%) and fever (89%).
 The mean oxygen saturation at admission was 85.3% (SD 9.0). Auscultatory
 finding of wheesing in the absence of a chronic lung disease was found in 10
 (15.6%) patients. Leukopenia was noted in 23 (35.9%) patients, and
 thrombocytopenia in 14 (21.9%) patients. Aspartate aminotransferase values
 were elevated in 41 (64.1%) patients, alanine aminotransferase in 32 (50%)
 patients, and creatine kinase in 36 (56.2%) patients. Opacities on an initial
 chest radiograph were predominantly patchy and the median number of the lung
 fields involved was 1 (IQR = 0-3). The non-survivors had statistically
 significantly higher MEWS at admission (p = 0.0001), lower oxygen saturation
 (p = 0.001), more lung fields involved on an initial chest radiograph (p =
 0.006), wheezing in the absence of chronic lung disease (p = 0.02) and
 elevated aspartat aminotransferase (p = 0.02) and creatine kinase (p = 0.03).
 Acute respiratory disstress developed in 21 (32.9%) patients, and mechanical
 ventilation was required in 23 (36.1%) patients. Septic shock developed in 12
 (18.7%) patients, and 19 (29.7%) patients had a multi-organ dysfunction. The
 overall hospital mortality was high - 20.3% (95% CI, 11.3%-32.2%; n = 13),
 and especially so among the patients who required mechanical ventilation -
 56.5% (95% CI, 36.8%-74.4%). Conclusion. Timely initiation of antiviral
 therapy and early recognition of critically ill are important factors for
 reducing mortality.

http://www.doiserbia.nb.rs/ft.aspx?id=0042-84501211951J

Tatjana Boskovic

Papers

Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance

Pneumothorax after transbronchial needle biopsy

Influenza A (H1N1)--past season's wonder flu in Vojvodina.