[Metastasising squamous-cell carcinoma of the skin in a ten-year-old girl]

Pulmonary lymphangitis carcinomatosis: systematic review and meta-analysis of case reports, 1970-2018

Pulmonary lymphangitis carcinomatosis (PLC) is a life-threating complication in patients suffering from malignancies. Misleading and nonspecific symptoms often result in a delayed diagnosis. This review was aimed at evaluating epidemiology, clinical manifestations, and survival of patients with PLC reported in the literature. According to our knowledge, this study is the first such extensive analysis of PLC. We searched for the literature in the PubMed database for articles published from 1970 to 2018 using keywords: lung, pulmonary, lymphangitic, carcinoma, carcinomatosis. Pulmonary lymphangitis carcinomatosis rarely occurs, thus all data were extracted from case reports and case series consisted of a method for identifying individual-level patient data. In the final analysis, 108 articles (139 individual patient cases) were included. The mean age of PLC occurrence is 49.21 years. There is no difference in the prevalence between men and women. The most common underlying primary tumors coexisting with PLC are breast (17.3%), lung (10.8%), and gastric cancers (10.8%). Dyspnea and dry cough were the most common symptoms occurring in 59.0% and 33.8% of patients, respectively. In half the patients, PLC developed in fewer than ten months after first diagnosis of cancer. Pulmonary lymphangitis carcinomatosis diagnosis is associated with a poor prognosis: approximately half of patients die within two months of their first respiratory symptoms and three weeks from admission to hospital. Regarding survival time, we observed better results achieved in patients described between 2000 and 2018 compared to 1970 through 1999. In the presence of progressive dyspnea, cough, and lesions comparable to interstitial lung disease, diagnosis of PLC should be considered. Pulmonary lymphangitis carcinomatosis can be the first manifestation of primary occult neoplasm and may occur at any age. Adenocarcinoma, especially primary lung, breast, and gastric cancers is the most common cancer coexisting with PLC.

Congenital syndromes involving the lungs: pathogenetic models based on chinese medicine theories

BACKGROUND

Striking similarity seems to exist between the Jing-Luo and Zang-Fu theories of Chinese Medicine (CM) and clinical features of many so-called multiple congenital anomaly/mental retardation syndromes (MCA/MRs), as both may involve multiple organs and/or body systems.

MATERIALS, METHODS, AND RESULTS

Comparison of MCA/MRs involving the lungs and paths of 5 Jing-Mai traversing the organ has suggested that development of lung and radial ray (embryonic structure that gives rise to radial-side structures of the upper limb, in particular thumb and radius) are closely connected. The Lung Jing-Mai and those traversing the Kidneys may well explain combined malformations involving the lungs, radial ray, and the body's developmental midline. Furthermore, Zang-Fu theories such as "The Lungs rule the skin and body hair," and "The Lungs as a Zang pair with the Large Intestine" also seem to be in keeping with syndromes simultaneously affecting the lungs, colon, and skin. It may be deducible that the Jing-Mai, as described by CM, probably exists, and that the Jing-Mai and Zang-Fu theories have correctly summarized the connections between particular parts of the human body during embryonic development.

CONCLUSIONS

The CM theories therefore may provide important insights into the pathogenesis of relevant diseases as well as clues for development of new treatment for lung-related diseases.

Diseases of the generative nail apparatus. Part II: nail bed

Nail bed insults may affect the resultant nail product in a number of ways. If focal in nature, the severity and duration of the insult will determine the appearance of the nail product. Widespread insults may alter the size, shape or colour of the nail plate. Nail bed insults tend to present with more immediacy than nail matrical insults, as there is no need to wait until the nail grows out until the sign is obvious. We are less interested in the history of the event, than we are with the clinical sign being presented to us. Should treatment be required for focal nail bed insults, treatment is likely to be local and curative. Widespread nail bed insults may be associated with systemic diseases and if a result of local problems these may be difficult to treat.