Hemoptysis and thoracic fungal infections
Kapur S, Louie BE (Source: The Aspergillus Website - articles)
Sté Tunisienne des Maladies Respiratoires et d'Allergologie
Cercle des Bureaux - Appartement B 5-3 . 1082 Centre urbain Nord Tunis
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An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses
Conclusions:
More research should focus in the future on the management of breathlessness in respiratory diseases other than asthma and COPD. In addition, pharmacological treatments do not completely manage breathlessness and have an added burden of side effects. It is therefore important to focus more research on promising non-pharmacological interventions. (Source: BMC Pulmonary Medicine - Latest articles)
Music Relieves Stress Of Assisted Breathing
Patients who need assistance to breathe through mechanical ventilation may benefit from listening to music, a new review published in The Cochrane Library shows. The researchers found that music listening may relax patients, potentially resulting in fewer complications. Mechanical ventilation often causes major distress and anxiety in patients. The sensation of breathlessness, frequent suctioning, inability to talk, uncertainty regarding surroundings or condition, discomfort, isolation from others, and fear all contribute to high levels of anxiety... (Source: Health News from Medical News Today)
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Surgery of Uncomplicated Pulmonary Hydatid cysts: Capitonnage or Uncapitonnage?
The aim of this study is to compare two methods of capitonnage and uncapitonnage in the surgery of uncomplicated pulmonary hydatid cysts.
METHODS: 502 patients with pulmonary hydatid cysts who were managed surgically were evaluated retrospectively from 1994- 2007. The medical records and types of surgery of 234 patients with intact pulmonary hydatid cysts were collected. Patients were divided into two groups. Group 1 patients were operated using capitonnage and group 2 patients using uncapitonnage methods. Postoperative complications of two groups were compared.
RESULTS: 84 patients of group 1 with a mean age of 28.81± 9.37 years were operated using capitonnage method and 150 patients of group 2 with a mean age of 31.04± 8.62 years without capitonnage method. In the comparison of postoperative complications (pneumothrax, empyema and pneumonia) in two groups the results obtained from group 1 were significantly more advantageous over group 2 (P< 0.001). Total hospitalization time of group 1 was (5.2 ± 2.3) days and (5.9 ± 3.1) days for group 2 (P= 0.03). The duration of air leak was 2.1 ± 1.8 days for group 1, and 6.7 ± 3.5 days for group 2 (P< 0.001). There was significant statistical difference between two groups regarding the development of prolonged air leak and empyema. One and three cases of recurrence were observed in group1 and group 2 respectively. There was no significant difference regarding the rate of disease recurrence between two groups. No mortality was reported in both groups.
CONCLUSION: We conclude that the capitonnage method has more advantages in surgery of uncomplicated pulmonary hydatid cysts.
Is lung volume reduction surgery effective in the treatment of advanced emphysema?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether lung volume reduction surgery (LVRS) might be superior to medical treatment in the management of patients with severe emphysema. Overall 497 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question.
The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that LVRS produces superior patient outcomes compared to medical treatment in terms of exercise capacity, lung function, quality of life and long-term (>1 year postoperative) survival. A large proportion of the best evidence on this topic is based on analysis of the National Emphysema Treatment Trial (NETT). Seven studies compared LVRS to medical treatment alone (MTA) using data generated by the NETT trial. They found higher quality of life scores (45.3 vs. 27.5, P<0.001), improved maximum ventilation (32.8 vs. 29.6 l/min, P=0.001) and lower exacerbation rate per person-year (0.27 vs. 0.37%, P=0.0005) with LVRS than MTA. Mortality rates for LVRS were greater up to one year (P=0.01), equivalent by three years (P=0.15) and lower after four years (P=0.06) postoperative compared to MTA. Patients with upper-lobe-predominant disease and low exercise capacity (0.36 vs. 0.54, P=0.003) benefited the most from undergoing LVRS rather than MTA in terms of probability of death at five years compared to patients with non-upper-lobe disease (0.38 vs. 0.45, P=0.03) or upper-lobe-disease with high exercise capacity (0.33 vs. 0.38, P=0.32). Five studies compared LVRS to MTA using data independent from the NETT trial. They found greater six-minute walking distances (433 vs. 300 m, P<0.002), improved total lung capacity (18.8 vs. 7.9% predicted, P<0.02) and quality of life scores (47 vs. 23.2, P<0.05) with LVRS compared to MTA.
Even though LVRS has a much<greater cost per person over five years ($137,000 vs. $100,200, P<0.001), its improved lung function, greater exercise capacity and better quality of life scores make it a preferable treatment option to MTA, with particular indications for patients with upper-lobe-predominant disease and low exercise capacity.
Keywords: Lung volume reduction surgery; Emphysema; Medical management.