Acute respiratory distress syndrome (ARDS), the most severe form of acute lung injury (ALI), remains a devastating condition with a high mortality. It is characterised by alveolar injury and increased pulmonary vascular permeability. Vascular endothelial cell growth factor (VEGF) was identified by its properties to increase permeability and act as a cellular growth factor, hence its potential for a key role in the pathogenesis of ALI/ARDS. This review describes the basic biology of VEGF and its receptors as an essential prerequisite to discussing the available and sometimes paradoxical published data, before considering a paradigm for the role of VEGF in the human lung.

Ro 21-7634 was examined for oral antiallergic activity in two in vivo models commonly used to evaluate antiallergics. In the rat PCA test, this drug had an oral ID50 of 1.14 mg/kg and was found to be more potent than several other antiallergics including Disodium Cromoglycate (cromoglycate), Oxatomide, Doxanthrazole, Xanoxate, 2,6-bis (ethyoxyoxalylamino) pyridine, PRD-92-EA and M + B 22,948. In contrast to cromoglycate, Ro 21-7634 was found to be an orally active inhibitor of antigen-induced broncho-constriction in passively sensitized rats (ID50 = 0.2 mg/kg). In addition, Ro 21-7634 inhibited antigen-induced histamine release in an in vivo passive peritoneal anaphylaxis test system, following intraperitoneal administration. Ro 21-7634 demonstrated no end organ antagonism toward histamine, metacholine or serotonin in the guinea pig.

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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an advance in bronchoscopy. It is a staging tool for nonsmall cell lung cancer (NSCLC) but also allows diagnosis of unexplained mediastinal lymphadenopathy due to malignant and benign disease. It is a minimally invasive procedure that is used to stage suspected NSCLC with hilar nodes, discrete N2 or N3 disease, or bulky mediastinal disease. After a negative EBUS-TBNA result, if the pretest probability of lung cancer is high, a mediastinoscopy is still recommended, although in the light of recent trial data this is likely to change. EBUS-TBNA is expensive, which may limit its development in resource-rationed health care systems. Conventional (without ultrasound) transbronchial needle aspiration (TBNA) still has a useful role in lung cancer staging, especially where EBUS-TBNA is not available; it can help avoid unnecessary mediastinoscopies.