Search

Pulmonary embolism is a frequent disease with well known acquired or hereditary risk factors. The first diagnostic step is to determine a pre-test probability of the disease based on the revised Geneva score. Further work up with D-Dimers, blood gases and ECG, will ascertain the diagnostic of the condition. The prognosis will be better evaluated with BNP and troponine. Negative D-Dimers can rule out pulmonary embolism when pre test probability of the disease is low or intermediate. Radiological work-up includes computed tomographic pulmonary angiography when D-Dimers are positive and when the pre test probability is high, or ventilation/perfusion scan in case of iodine allergy or renal failure. Finally, guidelines will help choosing which patients suffering of pulmonary embolism have to undergo a hematological assessment or oncologic screening.

Emphysema is one of the components of chronic obstructive pulmonary disease beside the bronchial, vascular and systemic parts. The pathogenesis involves an inflammatory process (macrophages, neutrophiles and lymphocytes), but also an imbalance between proteases-anti-proteases and the oxidative stress by the formation of oxygen radicals. On the therapeutic level, these physiopathological pathways are the rational basis to the progressive use of antioxidants (mainly N-acetylcysteine) or, for the moment at an experimental level, of anti-proteases (inhibitors of serine proteases, cysteine proteases and the matrix metalloproteases). To reach the secondary lobule, site of the emphysema, the inhaled future treatments will have to be constituted of small particles, as in cigarette smoke, in order to distribute into the most homogeneous way the affected lung.