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Open-lung biopsy in patients with undiagnosed lung lesions referred at a tertiary cancer center is safe and reveals noncancerous, noninfectious entities as the most common diagnoses.

Eur J Clin Microbiol Infect Dis. 2012 Aug 16;

Authors: Georgiadou SP, Sampsonas FL, Rice D, Granger JM, Swisher S, Kontoyiannis DP

Abstract
We evaluated the diagnostic yield of open-lung biopsies (OLBs) in a large tertiary cancer center to determine the role of infectious diseases as causes of undiagnosed pulmonary lesions. All consecutive adult patients with either single or multiple pulmonary nodules or masses who underwent a diagnostic OLB over a period of 10 years (1998-2007) were retrospectively identified. Their risk factors for malignancy and clinical and radiological characteristics were reviewed, and their postoperative complications were assessed. We evaluated 155 patients with a median age of 57 years (range, 19-83 years). We identified infectious etiologies in 29 patients (19 %). The most common diagnosis in this group was histoplasmosis (12 [41 %]), followed by nontuberculous mycobacterial infection (7 [24 %]) and aspergillosis (4 [14 %]). The majority of the 126 remaining patients had nonmalignant diagnoses, the most prevalent being nonspecific granuloma (26 %), whereas only 17 % had malignant diagnoses. We observed no significant differences among the patients with infectious, malignant, or both noninfectious and nonmalignant final diagnoses regarding their demographic, laboratory, and clinical characteristics. Six percent of the patients had at least one post-OLB complication, and the post-OLB mortality rate was 1 %. OLB is a safe diagnostic procedure which frequently identifies a wide variety of infectious and inflammatory diseases.

PMID: 22895891 [PubMed - as supplied by publisher]

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Particulate emissions: health effects and labour market consequences.

J Environ Public Health. 2012;2012:130502

Authors: Kruse M, Sætterstrøm B, Bønløkke J, Brønnum-Hansen H, Flachs EM, Sørensen J

Abstract
The objective of this study was to analyse the productivity cost savings associated with mitigation of particulate emissions, as an input to a cost-benefit analysis. Reduced emissions of particulate matter (PM(2.5)) may reduce the incidence of diseases related to air pollution and potentially increase productivity as a result of better health. Based on data from epidemiological studies, we modelled the impact of air pollution on four different diseases: coronary heart disease, stroke, lung cancer, and chronic obstructive pulmonary disease. We identified individuals with these diseases and modelled changes in disease incidence as an expression of exposure. The labour market affiliation and development in wages over time for exposed individuals was compared to that of a reference group of individuals matched on a number of sociodemographic variables, comorbidity, and predicted smoking status. We identified a productivity cost of about 1.8 million EURO per 100,000 population aged 50-70 in the first year, following an increase in PM(2.5) emissions. We have illustrated how the potential impact of air pollution may influence social production by application of a matched study design that renders a study population similar to that of a trial. The result suggests that there may be a productivity gain associated with mitigation efforts.

PMID: 22899943 [PubMed - in process]

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Lung cancer and interstitial lung diseases: a systematic review.

Pulm Med. 2012;2012:315918

Authors: Archontogeorgis K, Steiropoulos P, Tzouvelekis A, Nena E, Bouros D

Abstract
Interstitial lung diseases (ILDs) represent a heterogeneous group of more than two hundred diseases of either known or unknown etiology with different pathogenesis and prognosis. Lung cancer, which is the major cause of cancer death in the developed countries, is mainly attributed to cigarette smoking and exposure to inhaled carcinogens. Different studies suggest a link between ILDs and lung cancer, through different pathogenetic mechanisms, such as inflammation, coagulation, dysregulated apoptosis, focal hypoxia, activation, and accumulation of myofibroblasts as well as extracellular matrix accumulation. This paper reviews current evidence on the association between lung cancer and interstitial lung diseases such as idiopathic pulmonary fibrosis, sarcoidosis, systemic sclerosis, dermatomyositis/polymyositis, rheumatoid arthritis, systemic lupus erythematosus, and pneumoconiosis.

PMID: 22900168 [PubMed]

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Why Do Patients With Interstitial Lung Diseases Fail in the ICU? A Two-Center Cohort Study.

Respir Care. 2012 Aug 16;

Authors: Güngör G, Tatar D, Saltürk C, Cimen P, Karakurt Z, Kιraklι C, Adιgüzel N, Ediboglu O, Yιlmaz H, Moçin OY, Balcι M, Yιlmaz A

Abstract
BACKGROUND: Admitting patients with interstitial lung disease (ILD) to the intensive care unit (ICU) is controversial due to their associated high mortality, when they require invasive mechanical ventilation. We aimed to determine the risk factors for mortality in ILD patients requiring ICU support due to acute respiratory failure (ARF). METHODS: An observational cohort study was performed in two chest diseases teaching hospitals. We included all ILD patients with ARF admitted between 2008-2010. Patient demographics, non-invasive and invasive mechanical ventilation (NIV and IMV) use, and mortality were obtained from medical records. Patients receiving NIV were divided based on their continuous or non-continuous demand for NIV. NIV failure was defined as intubation for IMV, or death during NIV. Cox regression analysis was used to determine the hazard ratio (HR) for NIV failure. RESULTS: One hundred and twenty patients (71 male, median age of 66 years) were enrolled in the study. Types of ILD were idiopathic pulmonary fibrosis (N = 96), collagen vascular disease (N = 10), silicosis (N = 9), drug induced (N = 3), and eosinophilic pneumonia (N = 2). Median APACHE II score was 24 (19-31), and 75 (62.5%) patients received NIV on ICU admission, 28 (37.3%) of whom needed continuous NIV. The NIV failure rate was 49.3% (N = 37). The mortality rates of continuous NIV, non-continuous NIV, IMV and total ICU were, 61.7% (29/47), 10.7% (3/28), 89.7% (61/68), 60% (72/120) respectively. APACHE II > or = 20 and continuous NIV demand indicated significant risk for NIV failure (HR and 95% confidence interval [CI]; 2.77 [1.19-6.45], p = 0.019, and 5.12, [1.44-18.19], p = 0.012, respectively). CONCLUSION: Because of higher mortality, physicians should consider IMV cautiously in the ICU management of ILD patients with ARF. Non-invasive ventilation may be an option in less severe patients with APACHE II score less than 20.

PMID: 22906309 [PubMed - as supplied by publisher]