Aortic Mycetoma From Disseminated Cunninghamella Species Infection.

Cunninghamella species are aggressive, opportunistic fungi that are becoming more commonly reported in immunocompromised patients. We present a case of disseminated Cunninghamella sp. infection after stem cell transplant for refractory multiple myeloma with formation of bilateral pleural effusions and an aortic mycetoma.

Comparison of Forced and Slow Vital Capacity Maneuvers in Defining Airway Obstruction.

Background: Obstructive lung disease is diagnosed by a decreased ratio of FEV to the vital capacity (VC). Although the most commonly used VC is FVC, American Thoracic Society guidelines suggest alternative VCs, for example, slow VC (SVC), may offer a more-accurate evaluation of breathing capacity. There is recent evidence that using only FEV/FVC underrecognizes obstruction in subjects at high risk and who are symptomatic.

Study of Active Duty Military Personnel for Environmental Deployment Exposures: Pre- and Post-Deployment Spirometry (STAMPEDE II).

Background: There is significant concern about the respiratory health of deployed military service members given the reported airborne hazards in southwest Asia, which range from geologic dusts, burn pit emissions, chemical exposures, and increased rates of smoking. There has been no previous comparison of pre- and post-deployment lung function in these individuals.

Methods: Military personnel who deployed to southwest Asia in support of ongoing military operations were recruited from the Soldier Readiness Processing Center at Fort Hood, Texas, from 2011 to 2014.

A Comparison of Global Lung Initiative 2012 with Third National Health and Nutrition Examination Survey Spirometry Reference Values. Implications in Defining Obstruction.

Rationale: Obstructive lung disease is diagnosed by a decreased ratio of forced expiratory volume in 1 second (FEV) to forced vital capacity (FVC); however, there is no universally accepted lower limit of normal for the FEV/FVC ratio. Current established reference values use the Third National Health and Nutrition Examination Survey (NHANES III) database. In 2012, the Global Lung Initiative (GLI) introduced GLI12, which is a compilation reference set that uses standard deviation values to define normal spirometry.

Effect of a pulmonary nodule fact sheet on patient anxiety and knowledge: a quality improvement initiative.

Introduction: The utilisation of chest CT for the evaluation of pulmonary disorders, including low-dose CT for lung cancer screening, is increasing in the USA. As a result, the discovery of both screening-detected and incidental pulmonary nodules has become more frequent. Despite an overall low risk of malignancy, pulmonary nodules are a common cause of emotional distress among adult patients.

The Safety and Utility of Fiberoptic Bronchoscopy in the Very Elderly.

Background: Flexible bronchoscopy (FB) is a common modality for diagnostic sampling within the thorax. It is utilized often in the elderly population, but there is limited data on the safety and utility of the procedure in the very elderly.

Methods: FBs performed outside the intensive care unit in the San Antonio Military Health System on patients 85 years and older were reviewed.

Pulmonary Function and Respiratory Health of Military Personnel Before Southwest Asia Deployment.

Background: Significant concern exists regarding the respiratory health of military personnel deployed to Southwest Asia, given their exposures to numerous environmental hazards. Although the deployed military force is generally assumed to be fit, the pre-deployment respiratory health of these individuals is largely unknown.

Methods: Soldiers deploying to Southwest Asia were recruited from the pre-deployment processing center at Fort Hood, Texas.

Non-traumatic Pulmonary Emergencies in the Deployed Setting.

Purpose Of Review: Pulmonary disorders accounted for up to 8% of the over 70,000 medical evacuations conducted from Iraq and Afghanistan in the past 15 years. This review of non-traumatic pulmonary emergencies provides an overview of deployed military medical treatment capabilities and highlights pulmonary emergencies requiring aeromedical evacuation from theater.

Recent Findings: Recent studies have improved the epidemiologic evaluation of non-traumatic pulmonary disease, highlighted specific parenchymal diseases, and revealed infection pathologies unique to the deployed setting.

Chronic Left Lower Lobe Pulmonary Infiltrates During Military Deployment.

Deployment to Southwest Asia is associated with increased airborne hazards such as geologic dusts, burn pit smoke, vehicle exhaust, or air pollution. There are numerous ongoing studies to evaluate the potential effects of inhaled particulate matter on reported increases in acute and chronic respiratory symptoms. Providers need to be aware of potential causes of pulmonary disease such as acute eosinophilic pneumonia, asthma, and vocal cord dysfunction that have been associated with deployment.

Deployment-related Respiratory Issues.

Military deployment to Southwest Asia since 2003 in support of Operations Enduring Freedom/Iraqi Freedom/New Dawn has presented unique challenges from a pulmonary perspective. Various airborne hazards in the deployed environment include suspended geologic dusts, burn pit smoke, vehicle exhaust emissions, industrial air pollution, and isolated exposure incidents. These exposures may give rise to both acute respiratory symptoms and in some instances development of chronic lung disease.

Transudative chylothorax from cirrhosis complicated by lung entrapment.

A patient with long-standing cirrhosis due to hepatitis C and hepatic hydrothorax was evaluated for increasing symptoms and presence of a large right pleural effusion. Thoracentesis revealed evidence of a chylothorax with rapid reaccumulation of pleural fluid. Repeat thoracentesis with manometry identified presence of entrapped lung which complicated treatment options.

Protein and microRNA biomarkers from lavage, urine, and serum in military personnel evaluated for dyspnea.

Background: We have identified candidate protein and microRNA (miRNA) biomarkers for dyspnea by studying serum, lavage fluid, and urine from military personnel who reported serious respiratory symptoms after they were deployed to Iraq or Afghanistan.

Methods: Forty-seven soldiers with the complaint of dyspnea who enrolled in the STudy of Active Duty Military Personnel for Environmental Dust Exposure (STAMPEDE) underwent comprehensive pulmonary evaluations at the San Antonio Military Medical Center. The evaluation included fiber-optic bronchoscopy with bronchoalveolar lavage.

Pure red cell aplasia caused by ribavirin and interferon treatment.

Anemia is a common complication of hepatitis C (HCV), and antiviral treatment can further increase this risk. We present the case of a 59-year-old man with HCV treated with ribavirin and pegylated interferon alpha (INF-α) who presented with severe anemia. Two months after initiating treatment his hemoglobin dropped from 14.