No abstract

Chemotherapy is the cornerstone of treatment in many stages of cancer. Because there are many diagnostic options when a patient with cancer presents with nonspecific, respiratory, clinical manifestations, a multidisciplinary diagnostic approach is warranted. The top priority is to rule out life-threatening causes such as lung infection, which could be properly treated if a prompt, accurate diagnosis is given. Reaching a definitive diagnosis may require the use of one or more invasive techniques. This review highlights the risks and characteristics of chemotherapy-induced pulmonary toxicity caused by those agents that have been commonly used to treat cancer in the last decade. Clinicians should keep a high index of suspicion when a possible diagnosis of chemotherapy-induced lung toxicity is concerned, because early withdrawal of the offending drug is the most efficacious therapy.

The classic concept of massive hemoptysis has been replaced by the newer one of life-threatening hemoptysis (LTH), which means any bleeding from the lower respiratory tract that may cause the death of the patient. Although asphyxia is the usual mechanism of death, hypovolemic shock also plays a role in certain cases. The amount of expectorated blood does not always correlate with the actual volume of bleeding. The underlying state of health, especially basal respiratory function, plays a crucial role when the real consequences of bleeding are considered. The following factors have to be evaluated when a temporary or definitive treatment is chosen: setting of the hemoptysis, presumptive etiology, degree of clinical instability, equipment resources, and personal expertise in different techniques. The most important role of bronchoscopy is its rapid availability when hemoptysis is severe and the patient is not sufficiently stable to be immediately taken to the angiography department. In that situation, orotracheal intubation and bronchoscopy may be lifesaving. Rigid bronchoscopy, in skilled hands, has proven to be superior to flexible bronchoscopy in massive hemoptysis. Fiberoptic bronchoscopy (FOB) is also helpful as an extreme emergency measure to properly place an orotracheal tube contralateral to the bleeding side. Endoscopic local measures may sometimes help to transitorily stop bleeding. If the cause of hemoptysis is itself susceptible to primary surgical treatment and the condition of the patient is sufficiently good in terms of pulmonary reserve, life expectancy, and hemodynamic stability, then surgery is indicated. If the condition of the patient is not good enough, a temporary method to stop hemorrhage and stabilize the patient is then warranted. Although bronchoscopy and bronchial artery embolization (BAE) should be ideally complementary, recent data suggest that BAE may be a more effective temporary measure to stop bleeding.

No abstract

Though bodily self-disturbances are well documented in schizophrenia, interoceptive functioning (i.e., the perception of the internal state of the body) remains poorly understood in this population. In fact, only two studies to date have empirically measured interoceptive ability in schizophrenia. Both studies documented a deficit in interoceptive accuracy (i.e., objective performance on a heartbeat detection task), and one noted differences in interoceptive sensibility (i.e., subjective experience of interoception) in this population. To our knowledge, interoceptive awareness (i.e., metacognitive awareness of one’s interoceptive ability) has never been measured in schizophrenia and the link between interoceptive functioning and schizotypy remains unexplored. The present study addresses this gap by investigating the three dimensions of interoception in individuals with schizophrenia and matched controls (Experiment 1, N=58) and across the schizotypy spectrum (Experiment 2, N=109). Consistent with the literature, Experiment 1 documented a deficit in interoceptive accuracy and differences in interoceptive sensibility in individuals with schizophrenia. For the first time, our study revealed intact interoceptive awareness in individuals with schizophrenia. Against our expectations, we found no link between schizotypy and interoceptive functioning in Experiment 2. Our novel findings bear important clinical implications as insight into one’s interoceptive limitations (i.e., intact interoceptive awareness) might promote treatment seeking behavior in schizophrenia. The lack of association between interoceptive ability and schizotypy in non-help-seeking youths suggests that changes in interoception may only arise with the onset of psychosis.