Surgery for other pulmonary fungal infections, Actinomyces, and Nocardia.

Surgical participation in the management of fungal infections has changed since the advent of effective antimicrobials. Even so, a surgeon may be called on for a variety of reasons, depending on the specific fungal infection and the evolution of thoracic disease. Specific fungal infections are enumerated. Each organism, its clinical picture, and method of diagnosis are briefly described and the medical and surgical management of thoracic disease are discussed.

Thoracic surgery in the elderly: areas of future research and studies.

Elderly patients (defined as those aged more than 75 years) require specialized care due to the problems associated with deteriorating organ function, minimal organ reserve, blunted responses to stress, and general overall frailty; however, careful, well-planned trials for elderly patients undergoing thoracic surgical procedures have been few, sporadic, and nebulous to date. With the help of the Council on Surgical and Related Medical Specialties of the American Geriatrics Society, a thorough review of the body of literature has been conducted and a research agenda has been defined. Important surgical issues remain to be defined and investigated.

Acute postoperative compromise in cardiovascular function after chest surgery.

Attention to preoperative cardiovascular risk factors, appropriate preparation, early recognition, and treatment are essential to prevent potential catastrophic cardiac events from leading to life-threatening situations in the postoperative period.

Overexpressed nuclear factor kappaB correlates with enhanced expression of interleukin-1beta and inducible nitric oxide synthase in aged murine lungs to endotoxic stress.

BACKGROUND: Transcriptional regulation is a major determinant of interleukin-1beta (IL-1beta) protein synthesis. Nuclear factor kappaB (NF-kappaB) plays a central role in the regulation of IL-1beta and subsequent IL-1beta-dependent inflammatory processes. Previously, we observed in a murine endotoxic stress model a progressive increase with age in the amount of IL-1beta mRNA. We test the aging pulmonary response of NF-kappaB and NF-kappaB-dependent genes, IL-1beta, and inducible nitric oxide synthase (iNOS) in the same model. METHODS: Young (2-month-old) and senescent (25-month-old) mice were given 0.5 mg/kg lipopolysaccharide (LPS) intraperitoneally. Lung and blood samples were harvested after 4 hours. IL-1beta production in blood samples and the expression levels of protein and mRNA of IL-1beta and iNOS in lung tissues were measured. NF-kappaB binding activity in lung tissues was also determined. RESULTS: LPS induced higher levels of IL-1beta in the sera and lungs of senescent mice over young mice. Northern and Western blot analyses showed that mRNA and protein signals of IL-1beta and iNOS were significantly higher in old lungs than in young lungs. Electrophoretic mobility shift assay also showed that NF-kappaB activation was significantly higher in the older animals. CONCLUSIONS: Our results suggest that elevated activation of NF-kappaB, at least in part, contributes to the dysregulated expression of IL-1beta and iNOS in the lungs of senescent animals. Thus increased expression of proinflammatory cytokines and inflammatory responsive genes in the lung may play a role in the increased susceptibility in aging animals to endotoxic stress.

A novel instrument for the evaluation of the pleural space: an experience in 34 patients.

STUDY OBJECTIVES: To test a novel semirigid pleuroscope to be used by pulmonologists for the diagnosis and treatment of pleural diseases. DESIGN: Prospective study. SETTING: Three tertiary referral centers for pulmonary diseases. PATIENTS: Thirty-four patients who were referred for medical thoracoscopy between September 2000 and April 2001. MEASUREMENTS AND RESULTS: Thirty-six procedures were performed. The most common indications were for pleurodesis of a malignant pleural effusion (53%) or for evaluation of an exudative effusion of unknown etiology (44%). All operators found the instrument easy to use. In all but one case, the images were thought to be adequate, despite the presence of adhesions in 12 patients and loculations in 8 patients. Pleural biopsies were performed in 13 patients, and talc pleurodesis procedures were performed in 25 patients. Mean (+/- SD) duration of chest tube drainage was 2.9 +/- 1.8 days postprocedure. There were no complications. CONCLUSIONS: The prototype semirigid pleuroscope is a useful instrument in the diagnosis and management of pleural diseases. It is similar in design to a standard flexible bronchoscope, so the skills involved in operating the instrument should already be familiar to the practicing pulmonologist. It is compatible with existing video processors and light sources, so little additional equipment must be added to the endoscopy suite. The semirigid pleuroscope may allow for an increase in the performance of medical thoracoscopy by pulmonologists.