Image-Assisted Pleural Needle Biopsy or Medical Thoracoscopy: Which Method for Which Patient? - A Randomized Controlled Trial.

BACKGROUND: Image-guided or assisted needle biopsies and the increasing use of medical thoracoscopy (MT) have increased the diagnostic accuracy of pleural diseases significantly. However, no consensus exists regarding which patients with pleural effusion should undergo MT and which patients should undergo image-guided or assisted needle biopsy as the first procedure to ensure greater diagnostic accuracy. RESEARCH QUESTION: Which biopsy method is more appropriate for which patient to provide the highest diagnostic accuracy in the diagnosis of pleural effusion? STUDY DESIGN AND METHODS: This prospective, randomized, parallel study included 228 patients with undiagnosed exudative pleural effusion. Patients were divided into two groups based on CT scan findings. Group 1 included patients with pleural effusion only. Group 2 included patients with pleural thickening or lesion in addition to pleural effusion. Patients in each group were assigned randomly to an image-assisted Abrams needle biopsy (IA-ANPB) or MT arm. The diagnostic sensitivity, reliability, and safety were determined for both groups. RESULTS: The false-negative rate was 30.3% for the IA-ANPB arm and 3.1% for the MT arm in group 1. The same rates were 11.9% for IA-ANPB and 4.7% for MT in group 2. In group 1, the sensitivity for the IA-ANPB arm was 69.7%, and the negative likelihood ratio was 0.30. The same rates for the MT arm were 96.9% and 0.03 (P = .009). In group 2, these values were 88.1% and 0.12 for the IA-ANPB arm and 95.4% and 0.05 for the MT arm (P = .207). The rate of complications between the two biopsy methods was not different (8.5% and 15.8%, respectively; P = .107). INTERPRETATION: MT showed a high diagnostic success in all patients with pleural fluid. However, IA-ANPB showed similar diagnostic success as MT in patients with pleural effusion and associated pleural thickening or lesions. Therefore, in the latter case, IA-ANPB could be preferable to MT. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT05428891; URL: www. CLINICALTRIALS: gov.

Correlation of Indeterminate Lesions of COVID-19 Pneumonia Detected on Computed Tomography with RT-PCR Results.

BACKGROUND: The typical findings of COVID-19 pneumonia include multilobar groundglass opacities and consolidation areas observed predominantly in the basal and peripheral parts of both lungs in computed tomography. OBJECTIVE: The current study aimed to correlate indeterminate lesions of COVID-19 pneumonia detected on computed tomography with the results of the reverse transcription-polymerase chain reaction (RT-PCR) test. METHODS: Patients with high-resolution computed tomography images that were reported to contain indeterminate lesions in terms of COVID-19 pneumonia were included retrospectively in the study. The lesions were categorized and the patterns were classified. The RT-PCR-positive and the RTPCR- negative patients were compared. P<0.05 was accepted as the statistical significance limit. RESULTS: The RT-PCR-positive patients exhibited a higher rate of peripheral lesions. Limited consolidation areas were not detected in the RT-PCR-positive patients. In the RT-PCR-negative patients, the rates of acinar nodules and the tree-in-bud pattern were significantly higher. The RTPCR- negative patients had higher nodular contour features and lesion coalescence. In the subgroup consisting of lesions with ground-glass opacities and/or ground-glass opacity around the nodule, the rate of nodular contour positivity was significantly higher in the RT-PCR- positive patients. CONCLUSION: COVID-19 pneumonia should be suspected when peripheral indeterminate lesions are detected. When indeterminate lesions, such as tree-in-bud pattern, acinar nodules and limited consolidation area are detected, alternative diagnoses should be considered first, even if there are ground glass opacities accompanying these lesions.

The effects of natural pollen exposure on inflammatory cytokines and their relationship with nonspecific bronchial hyperresponsiveness in seasonal allergic rhinitis.

The exact mechanism of bronchial hyperresponsiveness (BHR) is not clear in allergic rhinitis (AR); an increase of BHR in pollen season suggests that natural pollen exposure causes airway inflammation in seasonal AR (SAR). This study was designed to investigate the effects of natural pollen exposure on inflammatory cytokines and their relationship with BHR. Sixty-six SAR patients with grass pollen sensitivity and 26 nonallergic rhinitis (NAR) patients were included. Peripheral blood samples for cytokine levels were taken and a nonspecific bronchial provocation test was performed during pollen season between May and August. The same measurements were repeated off-season between November and February. These measurements were done in NAR patients once. During the pollen season, SAR patients had significantly more increased levels of IL-13 than NAR patients (11.45 +/- 12.54 versus 5.19 +/- 4.02; p = 0.005). Blood eosinophil numbers were higher in those patients with BHR during pollen season than those without BHR (399.0 +/- 255.8 versus 278.9 +/- 193.2 mm(-3); p = 0.046). Blood eosinophil numbers during off-season were not different in those with and without BHR (respectively, 261.4 +/- 202.3 mm(-3) versus 205.9 +/- 116.9 mm(-3); p = 0.53). IL-10 levels were higher in the patients without BHR (n = 28) than those patients with BHR (n = 22) during off-season (8.12 +/- 13.1 versus 3.28 +/- 0.37; p = 0.04). Having higher levels of IL-10 than threshold value was more frequent in SAR patients without BHR than those patients with BHR during off-season (7/28 versus 1/22; chi(2) = 4.34; p = 0.04). IL-10 has a role in the continuation of BHR during off-season in SAR patients.

Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial.

BACKGROUND: In cases of pleural effusion, tissue samples can be obtained through Abrams needle pleural biopsy (ANPB), thoracoscopy, or cutting-needle pleural biopsy under the guidance of CT scan (CT-CNPB) for histopathologic analysis. This study aimed to compare the diagnostic efficiency and reliability of ANPB under CT scan guidance (CT-ANPB) with that of medical thoracoscopy in patients with pleural effusion. METHODS: Between January 2006 and January 2008, 124 patients with exudative pleural effusion that could not be diagnosed by cytologic analysis were included in the study. All patients were randomized after the CT scan was performed. Patients either underwent CT-ANPB or thoracoscopy. The two groups were compared in terms of diagnostic sensitivity and complications associated with the methods used. RESULTS: Of the 124 patients, malignant mesothelioma was diagnosed in 33, metastatic pleural disease in 47, benign pleural disease in 42, and two were of indeterminate origin. In the CT-ANPB group, the diagnostic sensitivity was 87.5%, as compared with 94.1% in the thoracoscopy group; the difference was not statistically significant (P = .252). No difference was identified between the sensitivities of the two methods based on the cause, the CT scan findings, and the degree of pleural thickening. Complication rates were low and acceptable. CONCLUSION: We recommend the use of CT-ANPB as the primary method of diagnosis in patients with pleural thickening or lesions observed by CT scan. In patients with only pleural fluid appearance on CT scan and in those who may have benign pleural pathologies other than TB, the primary method of diagnosis should be medical thoracoscopy. TRIAL REGISTRATION: clinicaltrials.gov; Identifier: NCT00720954.

Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study.

BACKGROUND: Several studies have already addressed the potential role of an increased fluorine 18 fluorodeoxyglucose (18F FDG) uptake in identification of pleural malignancy. In this pilot study, we investigate the role of 18F-FDG positron emission tomography/computed tomography (PET/CT) for differentiating asbestos-related benign pleural disease from malignant mesothelioma. MATERIALS AND METHODS: The study population comprised 31 consecutive patients (17 malignant mesotheliomas, nine benign asbestos pleurisies, and five diffuse pleural fibrosis) with a mean age of 61 years between January 2006 and December 2008. Thoracoscopy or image-guided pleural needle biopsy were systematically performed to reveal pathologic diagnosis and/or clinical follow-up for at least 3 years for presence or absence of malignant pleural effusion. ROCs analyses for standardized uptake value (SUV) adjusted to body weight were calculated between benign and malignant pleural diseases. RESULTS: 18F-FDG PET/CT imaging correctly detected the presence of malignancies in 15 of 17 patients with malignant mesothelioma for sensitivity, specificity, and overall accuracy of 88.2%, 92.9%, and 90.3%, respectively. 18F-FDG PET/CT imaging correctly identified 13 of 14 cases of benign pleural disease. The mean SUV values were 6.5 +/- 3.4 for malignant mesothelioma cases and 0.8 +/- 0.6 for benign pleural diseases (p < 0.001). When we compared the two groups of pleural disease, a cut-off value of 2.2 for SUV gave the best accuracy with 94.1%, 100%, 100%, and 93.3% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively. CONCLUSION: Preliminary results of this trial provide evidence that 18F-FDG PET/CT imaging is a highly accurate and reliable noninvasive test to decide for further investigation of differentiating malignant mesothelioma from benign pleural disease.

Prognostic factors according to the treatment schedule in malignant pleural mesothelioma.

OBJECTIVES: In this study, we aimed to investigate the factors affecting the survival of patients with malignant pleural mesothelioma (MPM) according to their treatment schedules, including those treated with best supportive care, chemotherapy, and multimodality therapy. METHODS: We evaluated 235 patients with MPM. The patients were classified into three groups according to their treatment schedules: the best supportive care group, the chemotherapy group, and the multimodality therapy group. Prognostic factors were determined for all patients and for the three groups by univariate and multivariate analyses. However, the effectiveness of treatment schedules as a prognostic factor was not evaluated in this study. RESULTS: After adjusting for therapy in a Cox model, a Karnofsky Performance Status (KPS) < or = 70, a right side tumor, serum lactate dehydrogenase >500 IU(-1), a nonepithelial subtype, and stage 3 to 4 disease were determined by multivariate analyses to be unfavorable prognostic factors for all the patients. A KPS < or = 70, serum lactate dehydrogenase >500 IU(-1), a nonepithelial subtype, and stage 3 to 4 disease were associated with a poor prognosis for the best supportive care group. The single unfavorable prognostic factor for the chemotherapy group was a KPS < or = 70. A right side tumor and a nonepithelial subtype were associated with a poor prognosis for the multimodality therapy group. CONCLUSIONS: The patients with an epithelial subtype, a good KPS, and an early-stage tumor had a good prognosis, even if they did not receive any treatment. The only prognostic factor for the chemotherapy group was KPS. The histologic subtype and stage of the tumor were not related to the prognosis in this group. A mixed subtype and a right side tumor were unfavorable prognostic factors for the multimodality therapy group. These findings may be useful in counseling patients and in planning further studies.

Pleurodesis in follow-up and treatment of malignant pleural mesothelioma patients.

We analyzed the necessity of pleurodesis in the follow-up of the patients with malignant pleural mesothelioma (MPM), and how much it contributes to the survival period by determining the indications, efficiency, and reliability of the pleurodesis application. 191 patients were assessed retrospectively and 69 (36%) of them were established with a pleurodesis indication. In 42 patients accepting pleurodesis, the pleurodesis success was evaluated. Factors affecting the success of pleurodesis and the effect of pleurodesis on survival were assessed. Pleurodesis was a success in 26 (62%) of the 42 patients. In the group in which the pleurodesis process was a success, it was observed that KPS and pleural fluid pH were higher (p= 0.030, p= 0.032, respectively). In case of KPS > or = 80, the sensitivity was: 76.9%, specificity: 50.0%, PPV: 71.4%, and NPV was established as 57.1%. In case of pleural fluid pH > 7.27, the sensitivity was: 92.9%, specificity: 50.0%, PPV: 76.5%, and NPV was observed as 80.0%. In the group in which pleurodesis was a success, the median survival was longer (Log-rank: 11.2; p= 0.0008). Independently from chemotherapy, the chance of living longer for patients whose pleurodesis was a success was 2.6 times higher. A severe complication concerning the process was not observed. Pleurodesis is performed less frequently than it is assumed on patients with MPM. In patients with KPS > or = 80, pleural fluid pH > 7.27, and with indication, pleurodesis must be administered. In feasible patients, a successful pleurodesis with talc increases the survival of patients with MPM, and it can be safely administered.

Characteristics of lung cancer patients with asbestos-related radiological findings.

The purpose of the current study was to compare the characteristics of lung cancer patients who had exposure to asbestos and asbestos-related radiological findings (ARRF) to the characteristics of patients who had no exposure. Of the 766 lung cancer patients evaluated, 607 had no exposure to asbestos and no ARRF, 88 had ARRF and a history of exposure, remaining 71 patients had no exposure to asbestos occupationally and no ARRF, but we could not obtain environmental exposure history from them. So we excluded these 71 patients' data. The study patients were compared with respect to age, gender, smoking history, duration and nature of symptoms, findings on physical examination, tumor histological types, chest X-ray (CXR) findings, tumor site and stage, and survival. Lung cancer patients with ARRF were more often males, former smokers, and older than patients with no history of exposure to asbestos. There were no differences between the groups of patients in terms of the duration of symptoms, the distribution of symptoms, the findings on physical examination, tumor histological type, and the CXR findings. There was no difference between the two groups of patients in the distribution among tumor stages and median survival. The anatomic site of origin of the tumor in the group with ARRF was peripheral and in the lower zone of the lung. We suggest that specific attention should be given to the peripheral and lower zones of the lungs on CRX during the evaluation of the patients with ARRF for lung cancer.

Soft tissue sarcoma metastatic to pleura.

Almost all cancers can cause distant pleural metastases. However, pleural metastases of soft tissue sarcoma that constitute less than 1% of adult solid malignancy are extremely rare. It is very difficult to distinguish them form sarcomatous malignant mesothelioma on histopathological features. We report a 57 year-old man who presented to us with left chest pain and progressive dyspnea and was diagnosed to have a pleural metastases of soft tissue sarcoma by thoracoscopic biopsy.

Predictors of talc pleurodesis outcome in patients with malignant pleural effusions.

OBJECTIVE: Chemical pleurodesis is an accepted palliative therapy for patients with recurrent, symptomatic, malignant pleural effusions (MPE). The purpose of the study was to determine the factors that have an effect on successful pleurodesis for MPE. PATIENTS AND INTERVENTIONS: Eighty-four consecutive patients with biopsy-proven malignant pleural disease and recurrent, symptomatic MPE were eligible to participate in this study. Five grams of talc mixed in 150ml of normal saline were administered via tube thoracostomy or small-bore catheters after complete drainage of the pleural effusion. RESULTS: Seven patients did not return for their 30-day follow-up visit and were excluded from further analysis. Successful pleurodesis was achieved in 63 of 77 eligible patients (81.8%) with MPE. In the univariate analysis, female gender, Karnofsky performance status, pleural fluid pH, cholesterol, and adenosine deaminase level showed a significant association with the probability of success. Multivariate logistic regression analysis showed that pleural fluid pH and ADA levels were independent predictors of talc pleurodesis outcome. CONCLUSION: Our results show that pleurodesis using talc as the sclerosing agent is a simple and acceptable procedure with high efficacy for controlling MPE, especially when used in appropriate patients.

Local recurrence of tumor at sites of intervention in malignant pleural mesothelioma.

In malignant pleural mesothelioma (MPM) patients, local dissemination (LD) of the tumor is frequently observed at the sites of intervention where diagnosis/treatment are performed. We evaluate the factors affecting LD frequency and discuss the use of PR in MPM patients. Histopathologically diagnosed 212 MPM patients who had not received PR were evaluated in terms of development of LD. Of the 212 patients, 29 received supportive therapy, 157 received chemotherapy and 26 received multi-modal therapy. The LD frequency was 13.2% for all patients. The median survival rate was 9 or 10 months in patients with or without LD, respectively. A higher LD frequency was observed in patients receiving thoracotomy. The LD appearance time in supportive care is short. The LD frequency in patients treated with chemotherapy that revealed progressive disease was higher than the patients who revealed stable disease or objective response. LD developed in 2 months in patients with sarcomatous and mixed cell type, and the survival rate was low. LD was not associated with the stage of the disease. The most suitable candidate groups for PR are patients receiving supportive therapy, thoracotomy without multi-modal therapy or patients with sarcomatous and mixed cell type tumors.

Epidemiology of pleural mesothelioma in a population with non-occupational asbestos exposure.

BACKGROUND AND OBJECTIVE: This study describes the epidemiology of malignant pleural mesothelioma (MPM) in a rural population with environmental asbestos exposure. METHODS: Patients with diagnosed MPM were recruited and their relevant demographic and exposure data were analysed. RESULTS: A total of 131 patients with MPM (59 men, 72 women) were studied. The patients' mean age was 57.8 years and the mean exposure duration was 28.9 years. The cumulative fibre count of the villagers ranged from 0.19 to 14.61 fibre/mL-years. Of the 131 patients, 85 had epithelial cell type, 20 had mixed, and eight had sarcomatous pleural mesothelioma. No significant relationship was found between asbestos fibre type and age, exposure period, or cellular type of MPM; similarly, no significant relationship could be found between the cellular type and age or exposure period. Patients with sarcomatous mesotheliomas were considerably older. Only five of 131 (3.8%) patients had a family history of mesothelioma. CONCLUSIONS: Environmental exposure to asbestos begins at birth and this may be important in the age of disease onset, if a threshold model for cancer initiation is operative. Both men and women had an excess risk of mesothelioma. Given that a family history of MPM was not common in this relatively homogenous patient group, a genetic predisposition to mesothelioma appears unlikely.

Increased pleural fluid adenosine deaminase levels in patients with malignant pleural effusions: a potential predictor of talc pleurodesis outcome.

Chemical pleurodesis using various sclerosing agents is accepted palliative therapy for patients with recurrent, symptomatic, malignant pleural effusions (MPE). However, the utility of various clinical and biochemical parameters in predicting pleurodesis outcome is still controversial. The objective of this study was to investigate the relationship between pleural fluid adenosine deaminase (Pf-ADA) levels and talc pleurodesis outcomes, and to compare Pf-ADA levels to various other biochemical variables with respect to predicting talc pleurodesis outcome in patients with MPE. In this prospective trial, 60 consecutive patients with MPE were enrolled; 35 had malignant mesothelioma (MM) and 25 had metastatic pleural carcinoma (MPC). A complete response was achieved in 49 of 60 MPE patients (81.7%). The Pf-ADA, pH, and albumin levels in patients with successful pleurodesis were significantly higher than in those with unsuccessful pleurodesis (p values < 0.001, 0.036, 0.027, respectively). ROC curve analysis revealed that optimal differentiation between successful and unsuccessful pleurodesis could be achieved with cutoff points of 17.5 U/L for Pf-ADA (area under the curve = 0.873; sensitivity = 77.6%; specificity = 90.9%); >2.5 g/dl for albumin (area under the curve = 0.715; sensitivity = 85.4%; specificity = 54.5%); and >7.26 for pleural fluid pH (area under the curve = 0.703; sensitivity = 83.7%; specificity = 54.5%). In analysis of the subgroup, Pf-ADA were found to be a good marker for discrimination between successful and unsuccessful pleurodesis in patients with MM (p < 0.001) but not in the MPC group (p = 0.068). These results indicate that Pf-ADA levels could be considered predictors of the outcome of pleurodesis, especially in patient with MM. Furthermore, the present study also demonstrated that Pf-ADA level is a superior test to predict the outcome of pleurodesis compared to pleural fluid pH and albumin level.

Lung cancer in individuals less than 50 years of age.

The aim of this study was to compare the epidemiologic, clinical, and laboratory characteristics and survival rates of younger and older patients with lung cancer. We studied 1340 patients who were histopathologically diagnosed as having lung cancer from 1990 to 2005. Based on prior reports, we defined "younger" as individuals less than 50 years old. The patients were classified into two groups: <50 years (the younger group) and >/=50 years (the older group). Of the 1340 patients, 179 (13.4%) were in the younger group and 1161 were in the older group. In the younger group, exposure to occupational risk factors was a risk factor for lung cancer, while in the older group, smoking was a risk factor. At the time of diagnosis, chest pain was more common in the younger group, while in the older group, cough, dyspnea, and hilar enlargement on chest X-ray were more frequent. The incidence of adenocarcinoma and small-cell carcinoma was greater in the younger group, while squamous cell carcinoma was more common in the older group. Metastasis rates were significantly different between the two age groups: 52.0% of the younger group presented with stage IV disease compared with 43.5% of the older group. Although fewer younger than older patients were not able to receive or rejected anticancer therapy, the overall survival was similar in both groups. These data indicate that lung cancer had different etiopathogenetic characteristics in younger patients, which may have clinical implications. By planning preventive measures based on these characteristics, more efficient use of resources can be achieved.

Detecting extrathoracic metastases in patients with non-small cell lung cancer: Is routine scanning necessary?

There is controversy over whether to scan extrathoracic sites for metastases in patients with non-small cell lung cancer (NSCLC). We tested the efficiency of clinical factors to determine whether metastasis has occurred, and whether routine scanning for NSCLC is required. Nine hundred and forty five patients scanned for extrathoracic metasates were included. Clinical factors indicating metastasis were determined using multivariate analysis. Of the 945 cases, 377 (39.9%) had metastasis. Bone metastases were determined by focal skeleton pains, elevated serum alkaline phosphatase levels, adenocarcinoma, KPS500 IU, a N2 or N3 case, KPS

A retrospective analysis of malignant pleural mesothelioma patients treated either with chemotherapy or best supportive care between 1990 and 2005 A single institution experience.

The aim of this study was to investigate the efficacy and safety profile of chemotherapy (CT) compared to best supportive care (BSC) in patients with histopathologically confirmed diffuse malignant pleural mesothelioma (DMPM). A total of 161 patients between 1990 and 2004 treated either with CT (109 patients) or BSC (52 patients) depending on patients choice were evaluated in this analyses. Chemotherapy protocols included a combination of cisplatin, mitomycin C and recombinant interferon alpha 2a (CM-In), or cisplatin, mitomycin C and ifosfamide (CMI), or cisplatin and gemcitabine (CG). We found a significant difference in the median survivals of the patients with CT compared to BSC, 11.3 months versus 8.0. Objective response rate was 28/109 (25.7%) with 3.7% of complete response rate. Stable disease rate was 39/109 (35.8%). There was a significant difference between median survivals of patients with objective response (17 months) and median survivals of patients with progressive diseases (6 months) and also with stable diseases (16 months). There was a significant difference between the stable disease and the progressive disease. Stages 3 and 4 patients of epithelial cell type having received chemotherapy live longer than those not having received chemotherapy (12 months versus 4). There was no significant difference between the survivals of the different chemotherapy regimens. The toxicity with CT regimens were mild and well-tolerated. We conclude that CT prolongs survival compared to BSC in patients with DMPM. Survivals of patients with objective response prolong considerably with CT compared BSC. We observed that stages 3 and 4 patients with epithelial cell type got benefit from CT. Especially, of epithelial cell type stages 1 and 2 should receive multimodal treatment.

Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure.

BACKGROUND: Mortality rate, the possible factors affecting mortality and intubation in patients with acute exacerbation of chronic obstructive pulmonary diseases (COPD) and hypercapnic respiratory failure (RF) are yet unclear. OBJECTIVE: To identify the possible factors affecting mortality and intubation in COPD patients. DESIGN: A prospective study using data obtained over the first 24h of respiratory intensive care unit (RICU) admission. Consecutive admissions of 656 patients were monitored and 151 of them who had acute exacerbation of COPD and hypercapnic RF were enrolled. SETTING: University hospital, Department of Chest Diseases, RICU. RESULTS: Mean age was 65.1 years. The mean APACHE II score was 23.7. Eighty-seven patients (57.6%) received mechanical ventilation (MV) via an endotracheal tube for more than 24 h. Twenty-two patients received non-invasive ventilation (NIV). Fifty patients died (33.1%) in hospital during the study period. The mortality rate was 52.9% in patients in need of MV. In the multivariate analysis, the need for intubation, inadequate metabolic compensation for respiratory acidosis, and low (=bad) Glasgow Coma Score (GCS) were determined as independent factors associated with mortality. The low GCS (OR: 0.61; CI: 0.48-0.78) and high APACHE II score (OR: 1.24; CI: 1.11-1.38) were determined as factors associated with intubation. CONCLUSION: The most important predictors related to hospital mortality were the need for invasive ventilation and complications to MV. Adequate metabolic compensation for respiratory acidosis at admittance is associated with better survival. A high APACHE II score and loss of consciousness (low GCS) were independent predictors of a need to intubate patients.

Peripheral intrapulmonary lipoma: a case report and review of the literature.

Lipomas are common benign tumours, but intrathoracic lipomas are rare and peripheral lung lipomas are exceptionally rare. Eight cases have been described in the world literature. We report a case of lipoma arising in the periphery of the left lower lung in a 54-year old woman. Grossly, it was presented as a well- circumscribed, thinly encapsulated, rounded, pale yellow mass. A wedge resection was done of the left lung and the microscopic findings revealed lipoma of the lung. The present paper recapitulates the macroscopic and microscopic features, the treatment and the differential diagnosis of this rare neoplasm.

High body mass index and long duration of intubation increase post-extubation stridor in patients with mechanical ventilation.

Approximately 20% of mechanically ventilated patients experience post-extubation stridor (PES) and reintubation, which subsequently may lead to an increased risk of morbidity and mortality. The risk of PES development is significantly higher in obese patients. Low air leakage between the endotracheal tube and the trachea, following cuff deflation, may indicate a higher risk for the development of PES. The aim of this study is to identify the relationship between body mass index (BMI) and PES using the cuff-leak test in patients intubated in the respiratory intensive care unit. A total of 67 consecutive intubations on 56 different ventilated patients were included in this study. The mean age was 63.6 +/- 12.1 years and 84% of the patients were male. PES developed in seven patients (10.4%). The mean cuff-leak volume was 395 +/- 187 ml in non-PES patients and 240 +/- 93 ml in PES patients (p = 0.023). The mean BMI was 36 +/- 13 kg/m2 in PES patients and 24 +/- 7 kg/m2 in non-PES patients (p = 0.046). BMI > 26.5 kg/m2 (OR: 1.2), low cuff-leak volume (< 283 ml) and mechanical ventilation required for more than 5 days (OR: 0.9) were independent variables for PES occurrence. We therefore suggest that non-obese patients, short-term intubated patients and those having a high air leakage around the endotracheal tube could be extubated without much difficulty.

Primary lymphoepithelioma-like carcinoma of the lung.

Lymphoepithelioma-like carcinoma (LELC), best known to occur in the nasopharynx, can arise in a variety of sites, such as the salivary gland, thymus, lung, stomach, and skin. Primary LELC of the lung is very rare, with only limited information in the literature. We presented a case of a 66-year-old white man with a T2N0M0 lymphoepithelioma-like carcinoma of the lung. Immunohistochemical analysis was negative for Epstein-Barr virus. Observation of the nasopharynx and a computerized tomography of the cavum were normal.