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A systematic review of lung function testing in asthmatic young children

Asthma diagnosis is difficult in young children being mainly based on clinical signs and parents' history, which is sometimes difficult to obtain. Lung function testing may improve asthma diagnosis by objectively assessing its main features, airway obstruction, spontaneously reversible or after use of a bronchodilator drug, ventilation inhomogeneity during an acute bronchoconstriction and airway hyperresponsiveness. In young children that cannot cope with classical tests, it is important to use and develop simple, short lasting methods, made ​​in spontaneous ventilation without active cooperation. Such techniques are a measurement of respiratory resistance by forced oscillations or the interrupter technique, of specific airway resistance by plethysmography and capnography. All these parameters are sensitive to the presence of an airway obstruction and to a bronchodilator or bronchoconstrictor agent, but their cutoff values in differentiating between asthmatic and healthy children as well as their specific indications in asthma management remain to be established.
Keywords: asthma, child, forced oscillations technique, interrupter technique, specific airway resistance, capnography.

Paraneoplastic syndromes: the way to an early diagnosis of lung cancer

Pulmonary malignancies are the leading cause of cancer mortality around the world. The late diagnosis of lung cancer, in advanced stages, is mainly due to atypical clinical presentation. Paraneoplastic syndromes have been first described in 1825, as a group of symptoms related to a malignant disease, which are not the effect of the primary neither of the metastatic tumor. The paraneoplastic syndromes have been reported in all types of lung cancer, but more frequently in small cell lung cancer, due to its origin in neuroendocrine cell precursors. The most frequent associated syndromes described in the literature are neurological and endocrine. In most patients paraneoplastic syndromes occur prior to other symptoms of malignancy. The presence or the severity of these syndromes is not correlated with the stage of cancer. Most of the paraneoplastic syndromes disappear once the primary tumor is removed and reappear in case of cancer recurrence or metastasis. This paper is a review of paraneoplastic syndromes in lung cancer.
Keywords: lung cancer, paraneoplastic syndrome

Pulmonary metastasectomy general issues

Pulmonary metastasectomy has been widely accepted by thoracic surgeons and is applied to the treatment of a variety of histologies, but the evidence that the patient may benefit from lung metastasectomy is not yet elucidated and the best way of integrating oncologic therapies (induction or adjuvant chemotherapy or radiotherapy) with surgical resection are still unknown. When there is no good clinical alternative, the resection of pulmonary metastases can give some patients long-lasting disease free intervals. Patients should be carefully selected on the basis of clinical staging with defined prognostic indicators. In order to obtain suitable results the management of these patients should be based on a multidisciplinary team decision.
Keywords: pulmonary metastasectomy, oncologic therapy, multidisciplinary team

Endobronchial ultrasound ebus a new method for the diagnosis and staging of lung cancer

In this paper we present a new method, endobronchial ultrasound (EBUS), which appeared recently among the tools of the pulmonologist for the diagnosis and staging of lung cancer. Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) provides the opportunity for obtaining tissue samples required for the histologic and cytologic diagnosis of lung cancer. The advantages of EBUS have to be made popular as it is a minimally invasive method, safe, simple, fast, also with a superior cost/benefit ratio compared to any previously used methods.