#pleural disease symptoms

[mesolawcenter]

Why Is Mesothelioma Incurable in 2024? | Behind the Reason

Introduction Mesothelioma, a rare and aggressive form of cancer, remains challenging to cure despite advances in medical research. Its unique characteristics and the way it develops make it difficult to treat effectively. This article explores why mesothelioma is incurable and what options are available for patients.

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1. What Makes Mesothelioma Different from Other Cancers? Mesothelioma originates in the mesothelial cells that line organs like the lungs and abdomen.

Aggressive nature: It spreads quickly to nearby tissues.

Late diagnosis: Symptoms often appear decades after asbestos exposure.

2. Why Is Mesothelioma Difficult to Diagnose Early? The latency period of mesothelioma, combined with non-specific symptoms, leads to delayed detection.

Latency period: Can be 20-50 years from asbestos exposure to symptom onset.

Similar symptoms: Mimics conditions like pneumonia or bronchitis.

3. How Does Mesothelioma Spread in the Body? Mesothelioma tends to spread to nearby organs and tissues, complicating treatment.

Localized spread: Often extends to the lungs, diaphragm, or heart.

Metastasis: Advanced stages may spread to distant parts of the body.

4. What Treatment Options Are Available for Mesothelioma? While there is no cure, treatments can help manage symptoms and prolong life.

Surgery: Removes tumors but is not always possible due to spread.

Chemotherapy: Helps to shrink tumors and manage growth.

Radiation therapy: Used to target cancer cells and reduce pain.

5. Are There Any Emerging Treatments for Mesothelioma? New therapies aim to improve patient outcomes and quality of life.

Immunotherapy: Boosts the body's immune response to target cancer cells.

Gene therapy: Investigates altering cell behavior to combat the disease.

Clinical trials: Offer access to cutting-edge treatments.

6. What Is the Focus of Current Mesothelioma Research? Research continues to explore better detection methods and new treatments.

Early detection: Developing blood tests and biomarkers for earlier diagnosis.

Targeted therapy: Aims to attack specific cancer cells without harming healthy cells.

Conclusion The incurability of mesothelioma is largely due to its aggressive nature, late diagnosis, and the complexity of its spread. Despite these challenges, advancements in research provide hope for better management and improved quality of life for those affected.

FAQs

Why does mesothelioma take so long to develop? The asbestos fibers cause chronic irritation that eventually leads to cancer after many years.

Can mesothelioma be detected before symptoms appear? Currently, it is difficult, but researchers are working on early detection methods.

Is palliative care common for mesothelioma patients? Yes, palliative care is often used to manage pain and improve comfort.

Why can't surgery cure mesothelioma? Surgery cannot always remove all cancer cells due to their spread to surrounding tissues.

Are mesothelioma survival rates improving? New treatments have improved some outcomes, but survival rates remain low.

What is the most promising new treatment for mesothelioma? Immunotherapy has shown promise in extending survival in some patients.

[transgenderteensurvivalguide]

Can binding cause pleural effusion?

I've been feeling pressure in my rib and chest area for a while and recently it's gotten worse as well as my ability to breath, could it be from binding? I don't have any bruised or broken ribs

I do have an inflammatory disease but I don't think it's that

Lee says:

We are not medical professionals, which is why I would recommend that you speak to someone who is!

I can't tell you whether the symptoms that you are experiencing are caused by binding or worsened by binding because I'm not a medical professional who has taken your medical history and examined you, but I can tell you that it's important to get it checked out by someone who can diagnose the issue and recommend a plan to address it.

You should call your primary care provider/general practitioner/family doctor, and/or send a message to them through the patient portal if there is one.

If you don't have a doctor or other provider who you usually see for an annual check-up or sick visit, you could look to see if there are any urgent care clinics near you who accept your insurance.

And don't bind until you've been cleared to do so by a medical professional-- it sucks, but it's time to take a break from binding, just in case it could exacerbate the issue.

If you've been having unexplained issues breathing for a while, you should see a medical professional. That's always true. If you're worried about telling your parents about your concerns about binding because you're closeted or they don't approve of you binding, don't mention binding when you explain why you'd like to go to the doctor, just tell your parents about your symptoms.

If you think that your parents might not allow you to go to the doctor, start by going to the school nurse, explaining your symptoms, and see if they'd call your parents or write a note for your parents recommending that they take you to the doctor. That might make them more likely to take you if they tend to otherwise disregard your concerns.

But when you do go to the doctor, do mention your binding, as well as what symptoms you're experiencing and how long you've been experiencing them.

I've had two family members get pneumonia in the last year, and one had to be hospitalized and the other needed a CT scan to diagnose lung issues, and both needed antibiotics. There are a lot of illnesses and injuries that can cause issues with breathing (example one: COVID!) but some things don't always improve without treatment.

It seems like you've been having these issues for a while, so I'd encourage you to do whatever you have to be sure you get the care that you need instead of waiting it out and seeing if you get better.

I hope you feel better soon anon! And again, please do seek out medical attention IRL!

[lastlycoris]

Liver transplantation.

The one time you might actually want cancer.

Why? Because having a primary liver cancer bumps you up on the liver transplant list. But it can't just be any cancer - there's a criteria for acceptable cancer burden for adult liver transplant, which is known as Milan Criteria. Essentially one big tumor smaller than 5 cm or 3 small tumors less than 3 cm each. The tumor can't have left the liver either aka metastasis. However if it's too small (<2 cm ), you don't get priority listing for having that cancer. Kind of like Goldilocks - the tumor has to be just right.

Now first off, you almost never get a primary liver tumor aka hepatocellular carcinoma (HCC) without something wrong in the liver in the first place.

This is usually Cirrhosis aka fibrosis of the liver, which can be caused by Hepatitis C or more commonly drinking too much alcohol too often. The liver fails cause its cells are dead or dying, and the resulting scarring prevents blood from your GI tract from returning properly to your systemic blood. This pseudo-blockage results in fluid backing up in your body, resulting in ascites (fluid in the belly) and pleural effusion (fluid in the lung space) and generalized soft tissue swelling.

The body tries to compensate for this by making alternate paths. Problem is the liver is also a filter, and bypassing the filter through an alternate path affects the brain - a common symptom is confusion and sometimes coma in these patients. Official term is hepatic encephalopathy.

Cirrhosis patients can also literally turn yellow because bilirubin, which occurs from the normal breakdown of red blood cells, can't be processed well by a dysfunctional liver. Liver does a lot of other important stuff too, but I'd go on forever with that - so I'll end that here.

In any case, the only treatment for cirrhosis is getting a new liver - once cirrhosis occurs, it cannot reverse, only worsen. The liver transplant list uses its own criteria known as MELD which I also won't get into here, but generally the sicker you are, the higher you are on the transplant list.

Cirrhosis is essentially a breeding ground for primary liver cancer because cirrhosis is essentially repeated constant inflammation - and all it takes is one cell to heal in the absolutely worst way - and then you have a cancer. This is why cirrhosis patients get yearly liver imaging screening to detect that.

Milan Criteria was created because a good number of liver transplants in cancer patients turned out to have recurrent liver cancer in the new liver. After Milan was implemented, long-term recurrence-free survival improved from 30% to 75%. I believe the sizes used in Milan acts as a surrogate for the likelihood of microscopic metastasis, cancer that's left the liver but too small to be seen in imaging, but don't quote me on that.

Now why did I bring this up? One of the residents asked out loud about why we don't just cut out the cancer.

For one, cirrhosis ensures another one will pop up eventually, and for two, cutting a cancer out also means cutting out good tissue (or semi-okay in a cirrhotic's case) to create the disease-free margin. You don't have much good tissue left in a cirrhosis liver.

You could ablate the cancer by frying it with heat or freezing it, but you again have the issues of damaging normal tissue. Typically excision or ablation is done when there's no chance patient will get a donor liver.

There's also TACE (transarterial chemoembolization) which can be used to shrink tumors, usually back into the limits imposed by Milan criteria. Because if your cancer is too big for Milan, you don't get a liver. There are strict rules for that, and if you break them, your liver transplant service is not getting donor livers.

[mcatmemoranda]

Reviewing questions:

Blindness is a potentially devastating complication of sarcoidosis. Ocular sarcoid can develop in up to half of all cases and most commonly presents as anterior uveitis or keratoconjunctivitis. The most serious complication is optic neuritis.

A complete ophthalmologic examination at the time of diagnosis is recommended, as asymptomatic disease can result in permanent visual impairment. All patients with sarcoidosis should have a careful history and physical examination to identify other organ involvement before having further testing, including ECG, pulmonary-function testing, and baseline laboratory studies (calcium level, alkaline-phosphatase level, renal-function, and hepatic-function tests) to evaluate the extent of disease.

McConnell's sign is defined as right ventricular free wall akinesis with sparing of the apex. Typically this looks as if the apex of the RV is a trampoline. Echocardiogram shows right ventricular strain and a positive McConnell sign, which is indicative of pulmonary embolism (PE).

All patients who have known or suspected bronchiectasis and who are acutely ill with suspected lower respiratory tract infection should be empirically treated with an antipseudomonal antibiotic, such as cefepime until culture results are available to guide treatment decisions.

Heerfordt’s syndrome (uveoparotid fever) is another collection of clinical findings specific enough to diagnose sarcoidosis without a biopsy. These signs and symptoms include uveitis, parotid gland enlargement, and facial nerve palsy.

Lofgren’s syndrome is a form of acute sarcoidosis. Sarcoidosis is a multisystem disease characterized by the presence of noncaseating granulomas and although classically described in African Americans, it has one of its highest prevalences in the northern European population. Clinical variants exist with certain forms having diagnostic and prognostic value. Lofgren’s syndrome is the combination of erythema nodosum, bilateral hilar adenopathy, migratory polyarthralgias, and fever. This pattern is so consistent that it has 95% diagnostic specificity and allows diagnosis of sarcoidosis without a biopsy. Among European patients, the presence of Lofgren’s syndrome portends to a good prognosis. For mild disease symptomatic treatment with non-steroidal anti-inflammatory agents is reasonable or low dose prednisone may be added.

The optimal management of laryngotracheitis (croup) is determined by the severity of disease. There are numerous scoring systems for croup severity, with the Westley croup score being the most validated and most often used. The Westley croup severity scale includes evaluation for the presence of stridor at rest, retractions, and cyanosis as well as assessment of mental status and air entrance. Regardless of any official scoring system, most physicians would consider the presence of retractions and stridor at rest to be indications of moderate to severe disease that requires evaluation in the emergency department. The presence of cyanosis, confusion, depressed mentation, agitation, severe retractions, or absent breath sounds would indicate severe disease and/or the possibility of impending respiratory failure.

Mild cases of croup are treated on an outpatient basis with cool mist therapy and fluid replacement. Moderate cases may require supplemental oxygen, oral or intramuscular corticosteroids, or racemic epinephrine. Severe cases are best treated with hospitalization and racemic epinephrine.

Bottom Line: The most important step in initial management of laryngotracheitis includes nebulized epinephrine (racemic or L-epinephrine) and dexamethasone along with humidified oxygen, fever reduction, and hydration. Epinephrine acts almost immediately, while steroids have a delayed onset of action.

Pneumothorax is defined as a collection of air in the pleural space. The result is pleural separation of the visceral and parietal pleura. Spontaneous pneumothorax lacks an antecedent event (e.g. trauma). There are two types: primary and secondary. Primary spontaneous pneumothorax (PSP) occurs in patients without recognizable underlying lung disease. Secondary spontaneous pneumothorax (SSP) occurs in patients with visible underlying lung disease (e.g. COPD). The most common etiology of PSP is rupture of a subpleural bleb (which are usually not seen on imaging and are undiagnosed). Many cases initially diagnosed as PSP may eventually be diagnosed as SSP after further workup.

Management depends on the size of the pneumothorax. The spectrum of management includes watchful waiting, aspiration, chest tube insertion, and thoracoscopy with pleurodesis or lung resection.

Rhinosinusitis can be defined as either viral/bacterial and if bacterial, as complicated/uncomplicated. Complicated rhinosinusitis implies the extension of disease outside the nasal cavity/sinuses into adjacent structures, such as soft tissues, ophthalmologic tissues, and nervous system.

Current criteria for the presumptive (many of these cases may still be viral) diagnosis of acute bacterial rhinosinusitis (ABRS) include persistent symptoms lasting more than 10 days without any evidence of clinical improvement or a biphasic illness pattern which is also called double worsening, meaning the patient was sick, improved, and then became sicker a second time within a short time frame, usually within a 10 day period. The IDSA guidelines from 2012 also recommend the use of a high fever greater than 39C associated with severe symptoms for 3-4 days as being more consistent with bacterial rhinosinusitis. According to the guidelines by the American Academy of Otolaryngology-Head and Neck Surgery published in 2015, fever itself early in the course of illness is not sensitive or specific enough to warrant treatment based on this vital sign alone, and they do not recommend using this as criteria for the diagnosis of ABRS. They agree with the other criteria used by the IDSA and acknowledge that a "severe" presentation may warrant the use of antibiotics as recommended by the IDSA and the American Academy of Pediatrics which considers more than 3 days of high fever and purulent nasal discharge as a severe presentation of ABRS in children.

Summary Criteria for the Diagnosis of ABRS

Signs or symptoms of acute rhinosinusitis present for 10 days or more after symptom onset with no improvement

Acute worsening of improving rhinosinusitis within 4-6 days of symptom onset or "double-sickening."

Severe rhinosinusitis: onset of high fever greater than 39C and severe symptoms within 3-4 days of onset

Tx of ABRS: amoxicillin, amoxicillin-clavulanate, doxycycline if PCN allergic, or respiratory fluoroquinolone in kids who can't take doxycycline. I just had a pt in clinic who had bacterial rhinosinusitis and I gave him amoxicillin-clavulanate.

Bottom Line: In patients with ABRS who require antibiotic therapy, the initial therapy of choice is with amoxicillin with or without clavulanate.

One of the feared complications of acute bacterial rhinosinusitis (ABRS) is orbital cellulitis. This infection commonly develops in the setting of ABRS due to the direct extension of bacteria from the sinus cavity into the orbit. Commonly it can project through the roof of the maxillary sinus. Additionally, there can be extension through the adjacent soft tissues. The diagnosis of this condition is clinical and is confirmed with radiographic imaging (CT scan of the sinuses). The presence of pain/difficulty with eye movement, double vision, eye swelling, and erythema should be concerning for orbital infection. The initial imaging test of choice would be with a contrasted CT study of the face and orbits. An MRI could also be performed and has similar accuracy, but is generally slower and more expensive to obtain. Additionally, patients with suspected orbital cellulitis should be evaluated by ophthalmology in the emergency department and started on IV antibiotics with coverage for MRSA (vancomycin generally).

If the sinuses are the suspected source, ampicillin-sulbactam or piperacillin-tazobactam can be added to vancomycin as long as there is no concern for CNS involvement. If the CNS is involved, it should be noted that both ampicillin-sulbactam and piperacillin-tazobactam have relatively poor CNS penetration, and a 3rd generation cephalosporin (ceftriaxone) should be used with the addition of metronidazole for coverage of anaerobic organisms. General guidelines for sepsis and infection should be followed with the physician obtaining the regular laboratories including a complete blood count, metabolic profile, blood cultures, and lactate.

Symptoms of Complicated ABRS:

Proptosis or impaired extraocular movements Painful eye movements Diplopia or impaired vision Periorbital edema or erythema Cranial nerve palsies Altered mental status Neck stiffness/meningeal signs Papilledema

Complications of ABRS:

Meningitis Orbital cellulitis Cavernous sinus thrombosis/thrombophlebitis Preseptal cellulitis

Ruptured eardrum:

Tympanic membrane perforations are commonly caused by trauma or acute otitis media and are usually noted on otoscopic examination. Perforations with marked hearing loss or other concerning neurologic signs such as nystagmus, ataxia, or vomiting should receive a prompt evaluation by an otolaryngologist. Supportive care only is a perfectly reasonable treatment plan for patients with simple perforations with minimal hearing loss and no neurologic signs. Many perforations will heal spontaneously within 4 weeks and require no intervention.

[allenchris365]

What is Pneumothorax?

Pneumothorax is a medical condition where air accumulates in the pleural space, the area between the lung and the chest wall. This can cause the lung to collapse, leading to difficulty breathing and chest pain. Pneumothorax can occur spontaneously, often in tall, thin individuals or as a result of injury, lung disease, or medical procedures. Symptoms may include sudden sharp chest pain and shortness of breath. Treatment options vary depending on the severity and cause, ranging from observation to procedures that remove the air from the pleural space.