Fabien Maldonado

Pulmonary Toxicities from Conventional Chemotherapy

Despite significant recent progress in precision medicine and immunotherapy, conventional chemotherapy remains the cornerstone of the treatment of most cancers. Chemotherapy-induced lung toxicity represents a serious diagnostic challenge for health care providers and requires careful consideration because it is a diagnosis of exclusion with significant impact on therapeutic decisions. This review aims to provide clinicians with a valuable guide in assessing their patients with possible chemotherapy-induced lung toxicity.

Computer-Aided Nodule Assessment and Risk Yield Risk Management of Adenocarcinoma: The Future of Imaging?

Increased clinical use of chest high-resolution computed tomography results in increased identification of lung adenocarcinomas and persistent subsolid opacities. However, these lesions range from very indolent to extremely aggressive tumors. Clinically relevant diagnostic tools to noninvasively risk stratify and guide individualized management of these lesions are lacking. Research efforts investigating semiquantitative measures to decrease interrater and intrarater variability are emerging, and in some cases steps have been taken to automate this process. However, many such methods currently are still suboptimal, require validation and are not yet clinically applicable. The computer-aided nodule assessment and risk yield software application represents a validated tool for the automated, quantitative, and noninvasive tool for risk stratification of adenocarcinoma lung nodules. Computer-aided nodule assessment and risk yield correlates well with consensus histology and postsurgical patient outcomes, and therefore may help to guide individualized patient management, for example, in identification of nodules amenable to radiological surveillance, or in need of adjunctive therapy.

Reconfigurable parallel continuum robots for incisionless surgery

We propose a new class of robotic device for minimally-invasive surgery that lies at the intersection of continuum, parallel, and reconfigurable robotics. This Continuum Reconfigurable Incisionless Surgical Parallel (CRISP) paradigm involves the use of multiple needle-diameter devices inserted through the skin and assembled into parallel structures inside the body. The parallel structure can be reconfigured inside the patients body to satisfy changing task requirements such as reaching initially inaccessible locations or modifying mechanical stiffness for manipulation or palpation. Another potential advantage of the CRISP concept is that many small (needle-sized) entry points into the patient may be preferable in terms of both patient healing and cosmesis to the single (or multiple) larger ports needed to admit current surgical robots. This paper presents a mechanics-based model for CRISP forward and inverse kinematics, along with experimental validation.

Unexpandable lung from pleural disease

Unexpandable lung is a common complication of malignant pleural effusions and inflammatory pleural diseases, such as pleural infection (e.g. empyema and complicated parapneumonic effusion) and noninfectious fibrinous pleuritis. Unexpandable lung due to pleural disease may be because of an active pleural process, and is referred to as malignant or inflammatory lung entrapment.

Motion planning for continuum reconfigurable incisionless surgical parallel robots

Continuum Reconfigurable Incisionless Surgical Parallel (CRISP) robots consist of multiple needle-diameter flexible instruments that are assembled into a parallel structure inside the human body. With a camera placed at the tip of one of the instruments, the CRISP robot can be used to inspect anatomical sites in constrained body cavities in a minimally invasive manner. We introduce a motion planner for CRISP robots that computes manipulations of the flexible instruments outside the body such that the camera can visually inspect a user-specified site of clinical interest inside the body. Our sampling-based motion planner ensures avoidance of collisions with anatomical obstacles inside the body, enforces remote-center-of-motion constraints on the instruments entry points into the body, and efficiently handles the expensive computation of CRISP robot kinematics. We also extend the motion planner to estimate the set of points inside a body cavity that can be visually inspected by the camera of a CRISP robot for a given setup. We demonstrate our method in a simulated endoscopic medical procedure in the pleural space around a lung.

71 – Drug-Induced Pulmonary Disease

Drug-induced disease of any system or organ can be associated with high morbidity and mortality, and it is tremendously costly to the health care of our country. More than 100 medications are known to affect the lungs adversely, including the airways in the form of cough and asthma, the interstitium with interstitial pneumonitis and noncardiac pulmonary edema, and the pleura with pleural effusions. Patients commonly do not even know what medications they are taking, do not bring them to the physicians office for identification, and usually do not relate over-the-counter medications with any problems they have. They assume that all nonprescription drugs are safe. Patients also believe that if they are taking prescription medications at their discretion, meaning on an as-needed basis, then these medications are also not important. This situation stresses just how imperative it is for the physician to take an accurate drug history in all patients seen with unexplained medical situations. Cardiovascular drugs that most commonly produce a pulmonary abnormality are amiodarone, the angiotensin-converting enzyme inhibitors, and beta-blockers. Pulmonary complications will develop in 6% of patients taking amiodarone and 15% taking angiotensin-converting enzyme inhibitors, with the former associated with interstitial pneumonitis that can be fatal and the latter associated with an irritating cough that is not associated with any pathologic or physiologic sequelae of consequence. The beta-blockers can aggravate obstructive lung disease in any patient taking them. Of the antiinflammatory agents, acetylsalicyclic acid can produce several different airway and parenchymal complications, including aggrevation of asthma in up to 5% of patients with asthma, a noncardiac pulmonary edema when levels exceed 40 mg/dl, and a pseudosepsis syndrome. More than 200 products contain aspirin. Low-dose methotrexate is proving to be a problem because granulomatous interstitial pneumonitis develops in 5% of those patients receiving it. This condition occurs most often in patients receiving the drug for rheumatoid arthritis, but it has been reported in a few patients receiving it for refractory asthma. Chemotherapeutic drug-induced lung disease is almost always associated with fever, thus mimicking opportunistic infection, which is the most common cause of pulmonary complications in the immunocompromised host. However, in 10% to 15% of patients, the pulmonary infiltrate is due to an adverse effect from a chemotherapeutic agent. This complication is frequently fatal even when recognized early.(ABSTRACT TRUNCATED AT 400 WORDS)