The Clinical Respiratory Journal

Our medical research library holds 24 studies published in The Clinical Respiratory Journal (2012–2025). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 23 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Blackwell Publishing
• Published: 2007 to the present, England
• Language: English
• ISSN: 1752-6981 (print), 1752-699X (electronic)
• Its record in the NLM Catalog

2020s

• Distant Metastatic Pattern and Its Prognostic Significance in Malignant Pleural Mesothelioma: A Population-Based Study Based on a Machine Learning Model. J. Yu, C. Peng, Q. Ye, et al. 2025;19(11):e70133. PubMed · Publisher · Free full text

  Abstract

  Background: Malignant pleural mesothelioma (MPM) is an insidious and aggressive tumor, often hindering timely clinical interventions. Despite its clinical relevance, epidemiological research focusing on MPM metastases remains limited.

  Methods: We conducted a retrospective review of MPM cases with site-specific metastasis records from the Surveillance, Epidemiology, and End Results (SEER) between 2010 and 2019. Propensity Score Matching was employed to minimize bias between distant metastasis and non-distant metastasis groups. A prognostic model for predicting overall survival was established using clinical variables derived from Lasso regression. Variable importance for survival outcomes was estimated using the Random Survival Forests algorithm. The performance of the nomogram was evaluated using the receiver operating characteristic (ROC) curves and calibration plots.

  Results: The presence of distant metastasis significantly reduced median overall survival from 10.5 to 7 months, with further detriment observed in cases with sarcomatoid histology and without chemotherapy intervention. Multivariable analysis identified sarcomatoid subtype, T4 stage, N1+ nodal involvement, and bilateral disease as significant predictors of increased metastatic potential. Histology, surgery, and metastasis status emerged as the top three clinical variables influencing survival. The nomogram demonstrated strong discrimination and calibration for predicting the 1-year and 3-year overall survival in both training and validation cohorts. The contralateral lung was the most frequent site of distant metastasis, with lymph node metastasis presenting a significantly better prognosis than that observed in patients with metastases to other organs.

  Conclusions: The large population-based analysis provides a comprehensive characterization of site-specific metastases in MPM. The identified risk factors can help stratify patients at higher risk for metastatic progression and support early, targeted clinical decision-making.

  © 2025 The Author(s). The Clinical Respiratory Journal published by John Wiley & Sons Ltd.

• Evaluation of the efficacy and safety of a new flex-rigid pleuroscope. S. Ishii, H. Watanabe, M. Suzuki, et al. 2021;15(1):91-96. PubMed · Publisher · Free full text

  Abstract

  Objective: New flex-rigid pleuroscope enables observations with a maximum angle of curvature of 180° , allowing visualization of the area near the insertion site of the pleuroscope. And, it improved the image quality and channel inner diameter. The aim of this study was to evaluate the clinical effectiveness and safety of a new flex-rigid pleuroscope.

  Methods: A retrospective analysis of patients who were examined with a new flex-rigid pleuroscope under local anesthesia at our institution was conducted. Pleuroscopy was performed in 33 patients with undiagnosed exudative pleural effusions from December 2016 to March 2019.

  Results: A total of 33 patients (10 women, 23 men); their median age 74 years (range 24-90) were investigated. Pleuroscopy showed that 18 had malignant pleural disease (54%), and 15 had benign pleural diseases (46%). The top three most frequent causes of pleural disease were pleural metastases of lung carcinoma (30.3%), pyothorax (15.1%), and malignant pleural mesothelioma (12.1%). In 32 cases (97%), observation at the introducer insertion site was possible. It was not possible in one case due to hard adhesions. The diagnostic rate was 100%, and the complication rate was 6.1%. There were no major complications, and minor complications included mild pain (one case) and minor bleeding (one case) that was stanched spontaneously.

  Conclusions: The new flex-rigid pleuroscope is effective and safe for diagnosing pleural effusions. The improved bending angle is likely to minimize the blind area. The new pleuroscopy fiberscope may improve the diagnostic rate.

  © 2020 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.

• The role of endothelial nitric oxide synthase gene polymorphisms in patients with lung cancer. C. Koçer, N. Benlier, S.O. Balci, et al. 2020;14(10):948-955. PubMed · Publisher

  Abstract

  Objectives: Lung cancer is a disease characterized by uncontrolled cell growth in the lung tissues. The most common causes of lung cancer include smoking, exposure to radon gas, asbestos, environmental pollutants as well as genetic factors. Nitric oxide (NO) has potential mutagenic and carcinogenic activity and may play an important role in lung cancer. Endothelial NO, synthesized from L-arginine by endothelial NO synthase (eNOS), inhibits apoptosis and promotes angiogenesis and tumor cell proliferation. The aim of the present study was to examine the possible relationship between eNOS gene intron 4 variable number of tandem repeat (VNTR) and exon 7-G894T (Glu298Asp) polymorphisms and lung cancer risk.

  Methods: DNA was extracted from peripheral blood leukocytes of 107 lung cancer patients and 100 control subjects. Designated polymorphisms were identified by polymerase chain reaction (PCR) and/or restriction fragment length polymorphism (RFLP).

  Results: Our study showed that the frequencies of the b/b genotype and b allele of eNOS gene intron 4 VNTR polymorphism were significantly higher in lung cancer patients than in controls (P < 0.05). However, there was no significant association between eNOS gene G894T polymorphism and lung cancer risk (P > 0.05).

  Conclusion: These results suggest that the presence of the intron 4 VNTR* b allele and b/b genotype may be a genetic risk factor for development of lung cancer. Further larger-scale studies are needed to confirm these findings.

  © 2020 John Wiley & Sons Ltd.

2010s

• Intrapleural immunotherapy: An update on emerging treatment strategies for pleural malignancy. V. Murthy, D. Katzman, D.H. Sterman. 2019;13(5):272-279. Review PubMed · Publisher

  Abstract

  Objectives: Malignant pleural mesothelioma and malignant pleural effusions are a major therapeutic challenge, and are associated with impairment in quality of life and increased mortality. Advances in systemic therapies of malignant pleural mesothelioma have demonstrated limited clinical benefit and there is ongoing interest in intrapleural immunotherapies which have been demonstrated to be well tolerated overall with variable clinical responses. We have reviewed the literature to provide a comprehensive summary of novel intrapleural immunotherapeutic paradigms, including oncolytic virus therapy, gene-mediated cytotoxic immunotherapy, direct cytokine-mediated immunotherapies, innate immunomodulators and adoptive transfer of intrapleural chimeric antigen receptor T-cell therapy.

  Data Sources: A review of PubMed for original manuscripts and conference reports published between 1998 and 2018 pertaining to intrapleural immunotherapy, as well as examination of reference lists from reviewed manuscripts.

  Study Selection: Human clinical trials on intrapleural immunotherapies in subjects with malignant pleural mesothelioma or malignant pleural effusion were included in this review, including some relevant preclinical studies and anticipated ongoing trials reported on Clinicaltrials.gov.

  Results: Twenty-six clinical trials were identified, in addition to three trials currently in progress.

  Conclusion: Intrapleural immunotherapies for pleural malignancy have demonstrated promise with regard to generating durable tumor-specific immune responses with possible clinical benefits which merit further investigation as part of multimodal chemotherapeutic and immunotherapeutic regimens.

  © 2019 John Wiley & Sons Ltd.

• Pleura revisited: From histology and pathophysiology to pathology and molecular biology. G. Karpathiou, M. Peoc'h. 2019;13(1):3-13. Review PubMed · Publisher

  Abstract

  Pleural cavity has an interesting physiology that when impaired gives rise to pleural effusions a rather frequent problem in respiratory medicine practice. Their aetiology varies widely producing distinct pathological lesions with different prognosis and treatment. The basic morphological features of pleural diseases, neoplastic and non-neoplastic, will be analysed in this review with an emphasis to their pathophysiology, differential diagnosis and clinicopathological correlations.

  © 2018 John Wiley & Sons Ltd.

• Advances in pleuroscopy. S. Anevlavis, M.E. Froudarakis. 2018;12(3):839-847. Review PubMed · Publisher

  Abstract

  Objectives: To describe the technique of pleuroscopy, its clinical uses such as diagnosis of exudative pleural effusion, treatment of pleural infection, treatment of pneumothorax, and diagnosis and pleurodesis of malignant pleural mesothelioma. Also to describe the newer techniques developed such as minothoracoscopy, semirigid thoracoscopy, narrow band imaging pleuroscopy, infrared pleuroscopy, autofluorescence pleuroscopy.

  Data Source: We searched the pubmed the last decade for publications with the key words pleuroscopy, medical thoracoscopy, pneumothorax and pleuroscopy, malignant pleural mesothelioma, minothoracoscopy, semirigid thoracoscopy, autofluorescence pleuroscopy.

  Conclusion: Medical thoracoscopy is the method of choice for investigation of the undiagnosed exudative pleural effusions. Newer techniques, such as narrow band imaging thoracoscopy, infrared thoracoscopy, autofluorescence thoracoscopy are offering a promising future for medical thoracoscopy.

  © 2017 John Wiley & Sons Ltd.

• Association between increased small airway obstruction and asbestos exposure in patients with asbestosis. X. Yang, Y. Yan, C. Xue, et al. 2018;12(4):1676-1684. PubMed · Publisher

  Abstract

  Background: Asbestos exposure may cause asbestos-related lung diseases including asbestosis, pleural abnormalities and malignancies. The role of asbestos exposure in the development of small airway obstruction remains controversial. Anatomic and physiologic small airway abnormalities may develop as part of the pathophysiologic process of asbestosis. We hypothesized that inhalation of asbestos may induce small airway defects in addition to asbestosis and pleural abnormalities.

  Methods: In total, 281 patients with newly diagnosed asbestosis were evaluated. Clinical data were collected from the patients' medical charts. The patients were classified into various stages according to their chest X-ray findings using the International Labour Organization classification. Pulmonary function was evaluated by plethysmography and the forced oscillation technique.

  Results: Expiratory flow, including the predicted values of the maximum expiratory flow between 25% and 50% of the forced vital capacity (MEF25-50 ), was significantly lower in the different stages of asbestosis. Accordingly, the predicted percentage of R5 -R20 was significantly higher with increasing stages of asbestosis. Furthermore, the duration of exposure to asbestos was significantly associated with the forced expiratory volume in the first second (FEV1 )/forced vital capacity (FVC) ratio and the predicted percentage of MEF25 or MEF50 according to the regression analysis in non-smoking patients with asbestosis. The predicted percentage of FEV1 or the FEV1 /FVC ratio was significantly lower and the predicted percentage of R5 -R20 was significantly higher in smokers than non-smokers.

  Conclusions: The patients with asbestosis have small airway obstructive defects that are significantly associated with asbestos exposure.

  © 2017 The Authors. The Clinical Respiratory Journal Published by John Wiley & Sons Ltd.

• Current treatments and trials in malignant pleural mesothelioma. A.C. Bibby, N.A. Maskell. 2018;12(7):2161-2169. Review PubMed · Publisher

  Abstract

  Objectives: This article aims to review the evidence from recent clinical trials in mesothelioma, and to provide an overview of relevant clinical trials that are currently in progress.

  Data Source: Ovid MEDLINE, 1946 to present.

  Study Selection: Clinical trials of therapeutic interventions were considered for inclusion, regardless of phase. Of 258 papers identified in the literature search, 88 were potentially eligible based on abstract screening. Following evaluation of full-text articles, 35 were selected for inclusion in the review.

  Results: Since the original trial that demonstrated the efficacy of pemetrexed and cisplatin in mesothelioma, multiple trials have been conducted that have further informed management options. Anti-angiogenesis agents such as bevacizumab and nintedanib appear promising as adjuncts to first-line chemotherapy. Meanwhile, immunotherapy, anti-mesothelin agents and molecular targeted therapies are potential areas for development, with ongoing trials promising to deliver interesting results over the next few years. Current evidence does not support surgical intervention; however, investigations are ongoing as to the role of extended pleurectomy/decortication, and surgery in the context of trapped lung. Finally radiotherapy is effective as a palliative measure for pain control, but is not indicated prophylactically to prevent the development of procedure tract metastases.

  Conclusion: A large amount of high-quality mesothelioma research has been conducted in the past decade. As a result, several new therapies are likely to become available in clinical practice in the near future. With multiple trials ongoing, the horizon for patients with mesothelioma looks brighter than ever before.

  © 2018 John Wiley & Sons Ltd.

• Deciduoid mesothelioma of the thorax: A comprehensive review of the scientific literature. P. Paliogiannis, C. Putzu, G.C. Ginesu, et al. 2018;12(3):848-856. Review PubMed · Publisher

  Abstract

  Objective: Deciduoid mesothelioma is a rare variant of malignant epithelioid mesothelioma. It often involves the peritoneum, but also thoracic cases have been reported. The aim of the present review is to describe the demographic, clinical, radiological, and pathological features of such a rare variant of thoracic mesothelioma, and the state of the art regarding the therapeutic approaches currently available.

  Data Source: English-language articles published from 1985 to June 2016, and related to thoracic deciduoid mesothelioma cases were retrieved using the Pubmed database.

  Study Selection: The search terms were "mesothelioma," "thoracic mesothelioma," "epithelial mesothelioma," "pleural mesothelioma," and "deciduoid mesothelioma."

  Results: Forty-four cases included in 16 articles, published in the period under investigation, were analyzed in detail.

  Conclusions: The mean age of the patients was 63 years, and the male to female ratio 1.7:1. Approximately 58% had exposure to asbestos, and 73% had a smoking history; familiarity was rarely reported. The most common anatomical site of origin was the right pleura, and the most frequent clinical manifestations were chest pain, dyspnea, cough, and weight loss. Thoracic X-ray and computed tomography were the imaging techniques most employed for diagnosis and surgical planning. The pathological diagnosis was obtained by examination of surgical or biopsy specimens in most cases. The best treatment strategy of deciduoid mesothelioma is a matter of debate; nevertheless a multidisciplinary approach is currently the best option for the choice of the adequate therapeutic scheme.

  © 2017 John Wiley & Sons Ltd.

• Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle. R. Trisolini, F. Natali, M. Ferrari, et al. 2018;12(4):1725-1731. PubMed · Publisher

  Abstract

  Introduction And Objectives: Endosonography has become standard of care in the diagnostic work-up of mediastinal lymphadenopathy and peribronchial lung lesions, but its success rate in some specific settings/conditions may be hampered by limited needle flexibility and size. We report on our initial experience with the 19G Flex needle, characterized by larger size and greater flexibility as compared with the currently available cytology needles.

  Methods: Retrospective review of prospectively collected data on the first 13 consecutive patients submitted to endosonography with the 19G Flex needle. Patients were included if they had: (a) suspicion of a histologically complex disease (ie, lymphoma); (b) suspicion of an advanced lung cancer possibly requiring extensive genotyping; (c) a lesion whose sampling with a 22G needle had failed because of lack of visibility when the needle was loaded into the scope.

  Results: The 13 patients enrolled had a mean age of 58.15 ± 17 years and a male to female ratio of 8:5. Target lesions (mean size 18.6 ± 6.4 mm) were lymphadenopathies (9 patients), lung lesions (3 patients) and a pleural nodule (1 patient). Histology core/s and a definite diagnosis (adenocarcinoma, 4 cases; lymphoma, 2; mesothelioma, 2, metastases from extrathoracic tumors, 2; non-small-cell lung cancer not otherwise specifiable, 1; small cell carcinoma, 1; sarcoidosis, 1) were obtained in 100% of patients. A single case of self-resolving bleeding was the only complication we observed.

  Conclusions: Preliminary results obtained with the dedicated Flex 19G needle are promising, as sample size/quality is satisfactory and the needle influence on scope flexibility is minimal.

  © 2017 John Wiley & Sons Ltd.

• Global trends in mortality from malignant mesothelioma: Analysis of WHO mortality database (1994-2013). O. Abdel-Rahman. 2018;12(6):2090-2100. PubMed · Publisher

  Abstract

  Background And Objective: Little is known about the extent to which asbestos use ban has affected global trends in malignant mesothelioma. This study investigated recent global mortality trends of malignant mesothelioma.

  Methods: Data were collected from International Agency for Research on Cancer/World Health Organization mortality database to examine age-standardized, gender-specific mortality rates for malignant mesothelioma (ICD10-C45). Cross-sectional mortality rates (2009-2013) as well as trends over time (1994-2013) were also reported. Gender-specific annual percent change (APC) was calculated to examine trends over time for each country.

  Results: Among the 30 countries with highest mesothelioma mortality in men, there is almost 10-fold variation in mortality rates during 2009-2013 ranging from 6.25 per 100 000 for United Kingdom to 0.64 per 100 000 in Portugal; whereas, among the 30 countries with highest mesothelioma mortality in women, there is a 4-fold variation in mortality rates during 2009-2013 ranging from 1.08 per 100 000 for United Kingdom to 0.26 per 100 000 in Ireland. Mortality rates were higher in men compared to women in 32 out of 35 evaluable countries. Among males and over the last 10 years of covered years, mesothelioma mortality was significantly declining in 9 countries (United Kingdom, Sweden, France, Germany, Netherlands, Canada, United States, Australia, and New Zealand); whereas, it was significantly rising in 5 countries (Poland, Spain, China-Hong Kong, Japan, and Republic of Korea). In the remaining countries, APC was stable. Among females and over the last 10 years of covered years, mesothelioma mortality was significantly declining in 1 country only (Italy); whereas, it was significantly rising in 3 countries (Poland, Argentina, and Republic of Korea). In the remaining countries, APC was stable.

  Conclusions: There is a worldwide variability in the burden and trends of mesothelioma mortality; and despite the ban on asbestos in many countries, mesothelioma still represents an important cause of mortality.

  © 2018 John Wiley & Sons Ltd.

• Positive pleural cytology is an indicator for visceral pleural invasion in metastatic pleural effusions. M.E. Froudarakis, J. Plojoux, E. Kaspi, et al. 2018;12(3):1011-1016. PubMed · Publisher

  Abstract

  Introduction: In case of undiagnosed pleural effusions, it is necessary to conduct thoracentesis with pleural fluid (PF) cytology. Yet, sensitivity of PF cytology is widely variable as a result of sample size, experience, and preparation method.

  Objectives: The aim of this study was to assess whether pleural fluid (PF) cytology is correlated to visceral or parietal pleural invasion as assessed by thoracoscopy in metastatic pleural effusions.

  Methods: All records of patients with pleural effusion were reviewed. The inclusion criteria were as follows: PF cytology, reported appearance of macroscopic pleural invasion during thoracoscopy and malignant diagnosis. Patients with mesothelioma were excluded. Finally, 287 patients who met all criteria were selected. According to the thoracoscopy findings, the extent of the disease on the pleura was analyzed in relation to the PF cytology.

  Results: In this study, 160 patients (55.7%) had a positive PF cytology (Group A) while 127 (44.3%) recorded negative PF cytology (Group B). From Group A, patients with visceral pleural invasion were 120 (75%) while only 49 patients (38.5%) were found from Group B and the difference was statistically significant (P < .00001). In univariate analysis, visceral pleural invasion was strongly associated with positive PF cytology (P < .001). Other significant associations with positive PF cytology included PF bloody aspect (P = .012), and endoscopic mixed pattern of pleural invasion (P = .0039). Only visceral pleural invasion was statistically significant in multivariate analysis (P < .001).

  Conclusions: In patients with pleural metastatic disease, visceral pleural invasion is the only significant factor associated with positive pleural fluid cytology.

  © 2017 John Wiley & Sons Ltd.

• Relation between neutrophil/lymphocyte ratio and primary tumor metabolic activity in patients with malign pleural mesothelioma. B.A. Özyürek, Ö. Özmen, T.Ş. Özdemirel, et al. 2018;12(2):646-651. PubMed · Publisher

  Abstract

  The aim of this study was to evaluate the relationship of the pre-treatment blood neutrophil/lymphocyte count ratio (NLR) with the maximum standard uptake value (SUVmax) of primary masses on positron emission tomography/computed tomography (PET/CT) taken before treatment in patients diagnosed with malignant pleural mesothelioma (MPM) and to evaluate the contribution to prognosis. A retrospective evaluation was made of 73 patients diagnosed with MPM in our hospital between January 2006 and January 2014. The SUVmax value of the primary mass on pre-treatment PET/CT, the haemogram parameters (Hb, Hct, NLR, MPV, PLT) at the time of diagnosis, the progression history, the date of the final visit, and the date of death of exitus patients was recorded from patient files PET/CT. The study group comprised 37 males (50.7%) with a mean age of 56.1 ± 11.4 years. The median survival time of these patients was 13 months. The survival time of the patient group aged <55 years was significantly longer (P = .006). Although the survival time of patients with NLR < 3 and SUVmax < 5 was longer, the difference was not statistically significant (P = .63, P = 0.08). A statistically significant difference was determined between the mean (or median) SUVmax values of the patient groups with NLR < 3 and NLR ≥3 (P = .019) with the SUVmax value of the NLR < 3 group found to be low. In conclusion, in patients with MPM, NLR ≥3 and high SUVmax values at the time of diagnosis can be considered an indicator of poor prognosis but are not a guide in the prediction of progression.

  © 2016 John Wiley & Sons Ltd.

• What is the significance of non-specific pleuritis? A trick question. J. Janssen, F. Maldonado, M. Metintas. 2018;12(9):2407-2410. PubMed · Publisher

  Abstract

  Non-specific pleuritis (NSP) is defined as fibrinous or inflammatory pleuritis which cannot be attributed to a specific benign or malignant etiology. It can be diagnosed in biopsies in up to 30% of cases of exudative pleuritis after thoracoscopy, with a mean of 19.2%. In 66 out of 469 (14.2%) patients in combined series, a malignant pleural disease (mostly mesothelioma) was found during a follow-up of at least 21 months. Most likely, a follow-up time of 12 months is sufficient, although the current routine is a follow-up of 2 years. Because of a benign course in 85% of patients with NSP, a repeated invasive procedure after thoracoscopy is only indicated in a limited group of patients. The most important indications for a repeated pleural biopsy are persistent chest pain, recurrent pleural effusion, radiologic findings suggestive for malignant pleural disease.

  © 2018 John Wiley & Sons Ltd.

• Clinically occult primary fallopian tube carcinoma presenting as a malignant pleural effusion. R. Hiensch, K. Meinhof, A. Leytin, et al. 2017;11(6):1086-1090. Case report PubMed · Publisher

  Abstract

  We report the first known case of malignant pleural effusion (MPE) as the sole presenting feature of clinically occult primary fallopian tube carcinoma (PFTC). A 57-year-old healthy woman was admitted with dyspnea. Evaluation demonstrated a right pleural effusion, fluid of which was malignant. The immunohistochemical profile, including negative calretinin, favored metastatic adenocarcinoma over mesothelioma but could not identify the primary tumour site. Pleural biopsy was not pursued as it would not have helped localize the primary. Chest, abdomen and pelvic computed tomography (CT) demonstrated only borderline lymphadenopathy in the left para-aortic lymph node chain that was hypermetabolic on positron emission tomography. Ultrasound and CT showed normal adnexal anatomy. These findings, coupled with an elevated serum CA-125, prompted empiric neoadjuvant chemotherapy targeting epithelial ovarian carcinoma (EOC) followed by surgery, which revealed a tiny left PFTC with negative peritoneal washings. Sampled left para-aortic lymph nodes were positive. The pleural effusion resolved after chemotherapy. Malignant pleural disease without peritoneal involvement is more characteristic of PFTC than of EOC, in which MPE is common but almost always accompanies peritoneal carcinomatosis. The extensive lymphatic supply of the fallopian tube promotes distant metastasis of small, seemingly localized tumours. This case is a reminder that the clinician should not be dissuaded from considering carcinoma of Müllerian origin, especially PFTC, as the cause of a MPE even in the face of normal gynecologic imaging. Appropriately broad immunohistochemical staining and careful attention to even minimal lymphadenopathy can be invaluable in pinpointing the primary tumour site in such patients.

  © 2015 John Wiley & Sons Ltd.

• Malignant mesothelioma with fungating masses and multiple sites involvement. J.K. Sim, J.Y. Oh, K.H. Min, et al. 2017;11(4):524-528. Case report PubMed · Publisher

  Abstract

  Malignant mesothelioma (MM) is a rare tumor associated with asbestos exposure. It typically presents as thickening or nodularity of the pleura, although it can also originate from other sites consisting of mesothelia and have manifestations other than thickening or nodularity. Several studies have implied that these different manifestations are associated with a different tumor biology. We report the case of a 54-year-old man with multiple fungating masses diagnosed as MM on histological examination.

  © 2015 John Wiley & Sons Ltd.

• Spontaneous bilateral haemothorax as presentation of primary pleural epithelioid haemangioendothelioma. L. Ferreiro, E. San-José, J. Suárez-Antelo, et al. 2017;11(6):1079-1085. Case report PubMed · Publisher

  Abstract

  Pleural epithelioid haemangioendothelioma (EHE) is a rare tumour that originates in the vascular endothelium with an intermediate degree of malignancy between haemangioma and angiosarcoma. Smoking and asbestos exposure are unproven risk factors and diagnosis is usually confirmed by thoracoscopy, since pleural fluid (PF) cytology is often not conclusive. Immunohistochemistry can also help to confirm the diagnosis. We report an 85-year-old patient with bilateral pleural EHE diagnosed by thoracoscopy, who debuted with a spontaneous bilateral haemothorax, the second described so far, and we conducted a thorough review of the literature to describe the clinical, radiological and prognostic features, as well as the PF, of this rare tumour.

  © 2016 John Wiley & Sons Ltd.

• Imaging findings from a case of pleural low-grade fibromyxoid sarcoma similar to mesothelioma with pleural effusion. W. Liang, S. Xu. 2016;10(1):120-4. Case report PubMed · Publisher

  Abstract

  Low-grade fibromyxoid sarcoma as a rare type of tumor shows no specific clinical symptoms and is mainly treated via total or partial surgical resection. We present a 40-year-old woman accompanied with respiratory symptoms. The chest contrast-enhanced computed tomography scan revealed pleural lesions mimicking pleural mesothelioma. Further chest contrast-enhanced magnetic resonance imaging (MRI) revealed a cystic solid mass in the right cavity. The mass was partially resected. Pathological examination revealed pleural low-grade fibromyxoid sarcoma. We report the imaging manifestations of this case. Contrast-enhanced MRI examination is a necessary step for those cystic solid masses that occur in the pleura.

  © 2014 John Wiley & Sons Ltd.

• Asbestos and the lung in the 21st century: an update. S. Prazakova, P.S. Thomas, A. Sandrini, et al. 2014;8(1):1-10. Review PubMed · Publisher

  Abstract

  The asbestos-related disorders (ARDs) are currently of significant occupational and public health concern. Asbestos usage has been banned in most developed countries, but asbestos is still used in many developing countries and the number of cases of ARDs worldwide is rising. Many countries are now experiencing an epidemic of ARDs that is the legacy of occupational exposure in the 1960s-1980s because of the long latency period between asbestos exposure and manifestation of disease. It is likely that asbestos-related mortality and morbidity will continue to increase. Although the most feared complications of asbestos inhalation are the malignant conditions such as mesothelioma and lung cancer, asbestos inhalation more frequently results in benign conditions such as pleural plaques, diffuse pleural thickening, and asbestosis (pulmonary fibrosis due to asbestos exposure). Over recent years, there have been changes in the epidemiology of mesothelioma, in clinical management of ARDs and developments in new techniques for early detection of malignancy. This review provides an update on the respiratory manifestations of asbestos exposure and also considers advances in screening methods that may affect future management in the workplace.

  © 2013 John Wiley & Sons Ltd.

• Malignant transformation of well-differentiated papillary mesothelioma 13 years after the diagnosis: a case report. L. Costanzo, S. Scarlata, G. Perrone, et al. 2014;8(1):124-9. Case report PubMed · Publisher

  Abstract

  Well-differentiated papillary mesothelioma (WDPM) is a rare mesothelial tumour affecting mostly the peritoneum of women in their reproductive age, but it may occur also at other sites, including the pleura. It is considered a specific pathological entity different from diffuse malignant mesothelioma as it displays a characteristic histological pattern and is associated with a slowly progressive clinical course. We report the case of a 79-year-old man with a history of right pleural WDPM at age 64, which was successfully treated with chemotherapy, radiotherapy and talc pleurodesis. Thirteen years after the first diagnosis, he presented with mediastinal lymph nodes metastasis and with an extremely rare pattern of tracheal and bronchial infiltration that was detected at bronchoscopy. Biopsy samples revealed loss of histological differentiation of the neoplastic cells. This case report highlights that WDPM is a tumour of uncertain malignant potential that may undergo transformation over many years. Finally, the role of immunohistochemistry in the diagnosis of WDPM and the possible mechanisms leading to this unique way of metastatisation are discussed.

  © 2013 John Wiley & Sons Ltd.

• Other causative factors for lung diseases in populations exposed to asbestos. J.H. Lange, W.C. Heymann, L. Cegolon. 2014;8(2):253-4. Letter · Comment PubMed · Publisher

• Spiroergometric parameters at maximal exercise testing assessed functional respiratory impairment in asbestos-induced fibrosis. J. Schneider, R. Arhelger, M. Funk. 2014;8(2):175-84. PubMed · Publisher

  Abstract

  Introduction: Exercise intolerance is typical for asbestosis. We examined the correlation of spiroergometric parameters with severity of asbestosis according to the International Labour Office (ILO) classification. Patients were compared to a healthy control group.

  Objectives: Nineteen consecutive male patients with compensated asbestosis and 24 healthy subjects were examined.

  Methods: All participants underwent pulmonary functional testing including maximal cardiopulmonary exercise testing (CPET). Results were compared to those of healthy subjects; the correlation to disease status was investigated.

  Results: Significantly lower VCin , FVC, FEV1 , MEF50 , TLC and PaO2 at rest (P<0.001) were observed in asbestosis patients. Lower peak (weight-related) work rate (WR, WR/kg), (weight-related) oxygen uptake (V'O2 , V'O2 /kg), oxygen pulse (V'O2 /hr), ventilation volume (V'E ), carbon dioxide output (V'CO2 ) and blood lactate was associated (P<0.001) with more severe asbestosis according to the ILO-classification. Significant positive correlations (P<0.001) were seen for alveolar-arterial oxygen difference [P(A-a)O2 ] and PaCO2 . Multiple regression analysis revealed that asbestosis was the only significant factor associated with the spiroergometric parameters (P<0.001). A reduction of V'O2 , V'O2 /kg, V'O2 /hr, V'E , or V'CO2 at identical submaximal workload could neither be detected among the asbestosis severity nor in comparison to healthy subjects. Only the respiratory frequency was depending on severity of asbestosis.

  Conclusions: The severity of asbestosis correlates with maximal WR, V'O2 , V'O2 /hr, V'E and gas exchange. At identical workload the discrimination between patients and controls was only possible concerning the respiratory frequency. For detection of limitations in asbestosis patients, maximal CPET is recommended.

  © 2013 John Wiley & Sons Ltd.

• Outcomes and complications following medical thoracoscopy. F.J. Brims, M. Arif, A.J. Chauhan. 2012;6(3):144-9. PubMed · Publisher

  Abstract

  Introduction: Thoracoscopy is an invasive procedure that may be performed by physicians for the investigation of exudative pleural effusion using local anaesthesia, conscious sedation and a rigid thoracoscope.

  Objectives: We sought to evaluate the safety and outcome of thoracoscopy in Portsmouth Hospitals, UK, a dockyard city with high previous asbestos usage.

  Methods: Retrospective casenote, radiology and laboratory result analysis of patients undergoing thoracoscopy in our institution over a 12-month period.

  Results: Fifty-seven of 58 casenotes were available for analysis. Median (interquartile range) age was 73.0 (66.5-79.0) years and 44 (77.2%) were male. Median time with chest drain post-procedure was 3.0 (2.0-5.0) days, and length of stay (LOS) was 4.0 (2.0-8.0) days. Malignant histology was reported in 40 (70.2%), with 25 (62.5%) cases of mesothelioma. There were no deaths related to the procedure. Hospital-acquired infection (HAI) occurred in six (10.5%: pneumonia four, empyema two), all had malignancy. The presence of HAI significantly prolonged the LOS 9.0 (7.5-23.5) vs no HAI 4.0 (2.0-7.0) days; P = 0.006). Four patients died within 1 month of the procedure, three had a malignant diagnosis, all had suffered HAI. Trapped lung (persistent hydropneumothorax 5 days post-procedure) occurred in 11 (19.2%), six of whom had benign histology. Performance status (European Cooperative Oncology Group) prior did not differ with reported histological type: benign 2.0 (2.0-2.0), malignant 2.0 (2.0-3.0), P = 0.170.

  Conclusions: Serious complications following thoracoscopy are rare. HAI is associated with malignancy and prolonged hospital stay. Benign histology may still confer significant morbidity.

  © 2011 Blackwell Publishing Ltd.

• Pemetrexed in malignant pleural mesothelioma and the clinical outcome. A. Knuuttila, E.R. Salomaa, S. Saikkonen, et al. 2012;6(2):96-103. PubMed · Publisher

  Abstract

  Introduction: Pemetrexed has emerged as standard chemotherapy for malignant pleural mesothelioma (MPM).

  Objectives: MPMs at two Finnish University Hospitals during 7 years (2000-2006) were reviewed in order to evaluate the treatments, survival and prognostic factors. The results in two periods (before pemetrexed use in 2000-2002 and with pemetrexed in 2003-2006) were compared.

  Methods: Data were collected from the individual patient records retrospectively, and analysed.

  Results: Altogether 197 patients were diagnosed with following histologies: 136 (69%) epithelioid, 19 (10%) sarcomatoid, 17 (9%) mixed, 25 (13%) not specified; 141 (72%) patients received treatment (five extrapleural pneumonectomy, 36 pleurectomy/decortication, 126 chemotherapy). Median survival was 12.9 months and the 1-, 2- and 3-year survivals were 51.8%, 21.8% and 12.1%, respectively. Univariate analysis showed no significant difference in survival between the patients diagnosed before or during the pemetrexed era (P = 0.124). The patients receiving pemetrexed or other chemotherapy had median survivals of 16.7 and 15.3 months, respectively. The independent prognostic factors for survival were histology and asbestos exposure. Non-epithelioid histology yielded 17 times higher risk of dying than epithelioid. Asbestos exposure doubled the risk of dying, but only in patients diagnosed in 2003-2006.

  Conclusions: Pemetrexed is beneficial for selected patients, but it has not changed the outcome of the whole MPM population as much as perhaps anticipated. Patient groups with various treatments or symptomatic care only reached survival results comparable to those reported in chemotherapy trials, thus emphasising the need for better subtyping of mesothelioma and individualising the treatment.

  © 2011 Blackwell Publishing Ltd.

Browse every journal in the library or the library by type of article, or return to medical research.