Official American Thoracic Society/Japanese Respiratory Society Clinical Practice Guidelines: Lymphangioleiomyomatosis Diagnosis and Management

"BACKGROUND: Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease that primarily affects women. The purpose of these guidelines is to provide recommendations for the diagnosis and treatment of LAM. METHODS: Systematic reviews were performed to summarize evidence pertinent to our questions. The evidence was summarized and discussed by a multidisciplinary panel. Evidence-based recommendations were then formulated, written, and graded using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: After considering the panel's confidence in the estimated effects, the balance of desirable (i.e., benefits) and undesirable (i.e., harms and burdens) consequences of treatment, patient values and preferences, cost, and feasibility, recommendations were formulated for or against specific interventions. These included recommendations for sirolimus treatment and vascular endothelial growth factor D testing and recommendations against doxycycline and hormonal therapy. CONCLUSIONS: Evidence-based recommendations for the diagnosis and treatment of patients with LAM are provided. Frequent reassessment and updating will be needed."

The Role of Laparoscopy in the Acute Abdomen and Trauma.

The use of laparoscopy for the treatment of various surgical diseases has been well described, and its use is widely accepted. Diagnostic laparoscopy (DL) has been used by gynecologists for many years, and only recently has its use by the general surgeon gained interest. The ease of use and its ability to directly visualize the abdominal viscera have lead many surgeons to suggest the use of laparoscopy in the evaluation of the acute and traumatized abdomen, The proposed benefits include reduced incidence of nontherapeutic laparotomies and shortened hospital stay as compared with current diagnostic regimens. Despite these proposed benefits, the use of DL in the management of the trauma patients is restricted to the hemodynamically stable patient. In the setting of blunt trauma, DL has been demonstrated to accurately diagnose solid organ injuries and is capable of predicting individuals requiring celiotomy. The role of DL in this setting has been shown to accurately determine the absence of peritoneal violation and has resulted in shortened hospital stay and reduced hospital costs. In summary, the role of DL in the injured patient is evolving. In the setting of blunt trauma, further research is required to accurately identify a subset of patients that will benefit from the use of DL over current methods. Hemodynamically stable victims of penetrating trauma clearly benefit most from DL's ability to determine the presence of peritoneal violation and avoid a formal laparotomy with its increased morbidity.