Pulmonary & Respiratory Medicine

Lung cancer is the leading cause of cancer-related death worldwide. Patients living with lung cancer often experience severe physical and psychological symptoms including dyspnea, fatigue, anxiety, decreased exercise tolerance, muscle weakness and compromised health-related quality of life as a direct consequence of the disease or as an indirect consequence of the cancer therapy itself. As both screening and treatment modalities improve, the number of people living with a diagnosis of lung cancer is increasing. Consequently, management of cancer-related symptoms as well as improvement of overall quality of life and functional status become critical issues in lung cancer patients. Thus, during the last decade, a wide range of exercise prescriptions and training modalities has been proposed and an emerging literature has addressed the effects of exercise-based rehabilitation programs along the continuum of the disease. The aim of this review is to address the latest literature regarding the feasibility and effectiveness of exercise-based rehabilitation for patients with lung cancer receiving treatments (perioperative, during chemotherapy/radiation therapy or following them) or for patients with advanced diseases. We also address how the use of new technologies or training modalities such as home-based telerehabilitation or neuromuscular electrical stimulation appears to be a promising approach to improve accessibility and participation in exercisebased rehabilitation programs. Evidence from our review suggests that pre and post-operative exercise-based rehabilitation appear to be safe and effective approaches to use with patients with lung cancer and for those with advanced disease receiving chemotherapy/radiation therapy. Larger randomized controlled trials are needed to confirm the efficacy of exercise interventions in this population.

Background: Each year in the United States an estimated 1.5 million people develop pleural effusions and approximately 178,000 thoracenteses (12%) are performed. While it has been established that malignant effusions are associated with increased mortality, the association between mortality and all-cause pleural effusions in a medical population has not been previously evaluated. Our objective was to evaluate associations between 30-day and 12-month all-cause mortality among patients with a pleural effusion.

Methods: All patients admitted to the medical service at Yale-New Haven Hospital during March 2011 were screened for pleural effusion. Pleural effusions were documented by the attending radiologist and the medical record was reviewed for admitting diagnosis, severity of illness and whether a thoracenteses was performed. The outcomes were 30-day and 12-month mortality after identification of the pleural effusion.

Results: One-hundred and four patients admitted to the medical service had pleural effusions documented by the attending radiologist. At 30-days, 15% of these patients had died and by 12-months mortality had increased to 32%. Eleven (10.6%) of the 104 patients underwent a thoracenteses. Severity of illness and malignancy were associated with 30-day mortality. For 12-month mortality, associations were found with age, severity of illness, malignancy, and diagnosis of pulmonary disease. Although sample size precluded statistical significance with mortality, the hazard ratio for thoracenteses and 30-day mortality was protective, suggesting a possible short term survival benefit.

Conclusions: In hospitalized medical patients with a pleural effusion, age, severity of illness and malignancy or pulmonary disease were associated with higher 12-month mortality. Thoracenteses may provide a protective effect in the first 30 days, but larger studies are needed to detect a short-term survival benefit. The presence of a pleural effusion indicates a high risk of death, with 15% of patients dying within 30 days and 32% dead within one-year of hospital admission.

Background: Resistin is an adipocytokine, associated with obesity and inflammation. Its exact role in insulin resistance and diabetes is still controversial, but there is now enough data, concerning its direct effects on myocardial cells. The relation between resistin plasma levels with risk of new onset heart failure in humans has been confirmed in several large studies.

Materials and methods: Resistin plasma levels were measured in 30 patients with obstructive sleep apnea and mild systolic dysfunction (ejection fraction 45, 7% ± 6, 17%), and compared to fifteen patients with obstructive sleep apnea and normal ejection fraction (ejection fraction 60, 3 ± 6, 3%). The effect of bilevel positive airway pressure therapy was evaluated during a three month follow-up in 19 patients. The dynamics of markers of haemodynamic stress – NT-pro-BNP was determined in addition. The association between resistin, obesity, insulin resistance and severity of obstructive sleep apnea was analysed.

Results: Resistin plasma levels were significantly higher in the group with mild systolic dysfunction in comparison to those with preserved ejection fraction (6, 92 ng/ml vs 2, 78 ng/ml). This difference lost significance after adjustment for confounders. In a linear regression analysis resistin levels were not associated with body mass index, obesity, homeostasis model assessment- index, systolic and diastolic blood pressure, or obstructive sleep apnea severity. Though not of statistical significance its plasma levels, decreased (8, 53 vs. 4, 16 ng/ml; p-0, 12) as a result of a three-month bilevel positive airway pressure therapy.

Conclusions: According to our data it is elusive to determine whether resistin plasma levels are associated with early myocardial damage. Its application for the monitoring of the effect of bilevel positive airway pressure therapy is tentative.

Mixed squamous and glandular papilloma of the lung is uncommon. Current literature demonstrates that there are less than 20 cases documented worldwide, though likely underreported. We present a case of a 58 y.o. female with history of COPD who was found to have mixed squamous and glandular papilloma, confirmed by histology. This case highlights an unusual etiology of endobronchial lesion that can mimic a malignancy. Clinicians should be aware of this entity because resection can be curative and prognosis is good.

Cyst is described on high-resolution computed tomography (HRCT) as focal round area of parenchymal hyperlucency with a well-defined interface with normal lung. A relatively small subset of lung diseases should be suspected when cystic pattern is seen on HRCT. In particular, the differential diagnosis of this pattern relies upon features such as: cranio-caudal distribution, cystic shape, and coexisting pulmonary or extra-pulmonary findings. Pulmonary Langerhans Cell Histocytosis (PLCH) is a smoke-related disease associated with cystic pattern. PLCH is characterized by infiltration of Langerhans cells in pulmonary interstitium with varying pathologic findings and depend on disease stage. The findings usually consist of a heterogeneous combination of lung nodules and cysts with upper lobes predominance. Notably, the HRCT pattern of PLCH is often striking and usually suggests confident diagnosis. Nevertheless, cases with atypical features can be seen. This case report describes the ambiguous imaging findings of a biopsy-proven PLCH.