Treatment options in stage III non-small cell lung cancer.

Lung cancer is responsible for over 1 million deaths annually, worldwide. The disease becomes symptomatic in advanced stages, so the diagnosis is delayed and 90% of cases cannot benefit from a curative treatment. In NSCLC surgical resection represents the best option for long term survival in resectable stage III and in clinical stage I/II. Patients with stage IIIB or IV usually receive chemotherapy or palliative treatment. For patients with no driver mutation detected platinum based combination chemotherapy is the first choice. Definitive radiotherapy is considered an lternative for patients who are not candidates for combined modality treatment. When a stage IV cancer is diagnosed based on an isolated metastasis, the patient's benefit from the removal of the etastasis and of the primary tumor if it is resectable. The prognosis in NSLC is mainly influenced by the TNM stage at diagnosis. The rate of survival decreases in opposing correlation with the stage of the cancer. Poor performance status, reduced lung capacity, weight loss, vascular invasion are indicators for a poor prognosis

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.

Sarcoidosis and Aspergillosis: case presentation.

Sarcoidosis is a multisystemic inflammatory disease of unknown etiology, characterized by noncaseous epithelioid cell granulomas. The evolution of the disease may be complicated by opportunistic infections such as aspergillosis, that usually appears in type IV sarcoidosis. We present the case of a 74 year-old women with a history of sarcoidosis for over 7 years, who presented for hemoptysis. She was diagnosed with pulmonary cavitary aspergillosis and treatment with ltraconazole was initiated. The patient was monitored every two months. At the one year follow up, the patient was asymptomatic, with a good treatment tolerance and no decline in lung function, despite the pulmonary fibrosis. The sputum exams continued to be positive for Aspergillus, the HRCT-scan described a chronic pulmonary aspergillosis. The antifungical treatment was continued, under careful monitoring. The patient remained asymptomatic with no further decline in lung volumes. The particularity of the case consists in the lack of symptoms, despite pulmonary fibrosis, and the therapeutic challenges of chronic pulmonary aspergillosis.

Clinical characteristics of obese patients with hypertension and chronic ischemic heart disease.

UNLABELLED: Obesity is a risk factor for arterial hypertension, type 2 diabetes and cardiovascular diseases. Some studies reported an obesity paradox: obese patients with cardiovascular diseases have better prognosis than patients with body mass index BMI <25 kg/m2. The objective of the study was to identify the differences between the clinical characteristics of obese hypertensive patients with chronic ischemic heart disease in comparison with lean hypertensive patients with chronic ischemic heart disease. MATERIALS AND METHOD: The study included 219 patients with hypertension and chronic ischemic heart disease, consecutively hospitalized in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest, Romania. We analyzed data from the hospital record database. RESULTS: 73 from the 219 patients were obese (33.33%). Of the 219 patients, 15.98% had a BMI 20-24.9 kg/m2, 50.68% BMI 25-29.9 kg/m2, 22.37% BMI 30-34.9 kg/m2, 6.84% BMI 35-39.9 kg/m2, 4.10% BMI > 40 kg/m2. The majority of obese patients were women: 67.12% women and 32.87% men. Obese patients (BMI > 30 kg/m2) had a higher prevalence of diabetes, dyslipidemia, left ventricle hypertrophy and heart failure than those with normal weight (BMI 20-24.9 kg/m2). Blood pressure control was achieved in 51.52% of normally weight patients, as compared to 34.69% of obese patients (BMI > 30 kg/m2). Diabetes was controlled in 42.85% of normally weight patients, as compared to 18.36% of obese patients. CONCLUSIONS: In conclusion, in patients with hypertension and chronic ischemic heart disease, the clinical profile worsens as BMI increases. Also, there is an inverse relationship between control rates of arterial hypertension and diabetes and BMI. Blood pressure was uncontrolled in a high percentage of obese hypertensive patients with ischemic heart disease.

Unilateral pulmonary hilar tumor mass: is it always lung cancer?

Sarcoidosis is a multisystem inflammatory disease of unknown etiology, characterized by noncaseating epithelioid cell granulomas. In sarcoidosis, the most common radiological findings are mediastinal and bilateral hilar lymph node enlargement. We present a case of sarcoidosis with a rare radiological aspect of pulmonary hilar tumor mass.A 54-year-old female patient, active smoker (40 packs/year), with a history of cutaneous lupus, was admitted in our institute for progressive dyspnea and dry cough. At admission physical examination and laboratory tests were normal. Pulmonary function tests diagnosed an obstructive syndrome. Chest X-ray showed a tumor mass of the right pulmonary hilum. Transbronchial biopsy was nondiagnostic. HRCT-scan showed a tumor mass in the right hilum, which raised the suspicion of a lung cancer. PET-CT scan revealed a high metabolic activity of the tumor mass and of a paratracheal right lymphadenopathy. Lymph node biopsy by mediastinoscopy showed noncaseating epithelioid-cell granulomas, sustaining the diagnosis of sarcoidosis. The outcome was favorable, with spontaneous remission without treatment, but with a relapse that responded after systemic corticotherapy.In conclusion, even if a tumor mass in the pulmonary hilum is highly suggestive of lung cancer, a positive diagnosis should be made only after histological examination, because other benign conditions, like sarcoidosis, could have such an aspect.

The contribution of exercise testing in the prescription and outcome evaluation of exercise training in pulmonary rehabilitation.

Pulmonary rehabilitation is a comprehensive therapeutic intervention with proven efficacy in relieving symptoms and increasing exercise tolerance in patients with chronic respiratory diseases.One of the main components of a pulmonary rehabilitation program is lower limbs exercise training. There are several ways of establishing the optimal intensity of the exercise training, using the target heart rate, symptom scores, walking tests and laboratory exercise tests with or without ventilation or gas exchange measurements. Each of these methods has advantages and disadvantages.The gold standard in exercise capacity evaluation is cardiopulmonary exercise testing (CPET) which brings a high level of objectivity in exercise tolerance evaluation and provides information on mechanisms responsible for its decline; this allows a better training prescription and a correct evaluation of rehabilitation outcomes.