News - Part 8

She has coauthored two books about academic writing and is on the editorial board of the journal English for Specific Purposes. She has worked as an EIL teacher for 22 years and has served as consultant for the US Department of State. Both authors brought different strengths to the audience during the interactive sessions of instruction, as indicated by the written evaluations provided by the audience.
During preparation of learning exercises, the language professional and the peer regularly worked independently to revise problematic sections of EIL manuscripts or publications, thereby creating the opportunity to compare the editing by the language professional with that of the peer. This process confirmed the contention of Parkhurst that “feedback given by… writing teachers… addresses… problems of form and/or presentation, whereas… the feedback of (subject) experts… focuses on ideas and content….” We further explore this difference through the example below. website

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How Authors Can Cope With the Burden of English as an International LanguageEnglish is the language of the most widely read and quoted medical journals. This poses a challenge for many authors whose native language is not English. Such authors struggle with the English language burden just as native English-speaking professionals are challenged by language barriers in countries where another language is spoken. Given these linguistic challenges, English as an international language (EIL) authors tend to believe that their manuscripts are significantly less likely to be accepted than manuscripts from native speakers. In reality, at least 50% of the publications in many of the best peer-reviewed journals are contributed by EIL authors. For example, from 2003 to 2005, the Journal of Thoracic and Cardiovascular Surgery received 59 to 63% of its manuscript submissions from EIL authors (P. Fried, MBA; personal communication; January 2006) and the experience of the Annals of Thoracic Surgery was essentially the same (H. Pusztay, BA; personal communication; January 2006). For both journals, the acceptance rates of EIL-authored manuscripts is essentially the same as that for native speakers.

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Paraneoplastic Polymyositis Associated With Squamous Cell Carcinoma of the Lung: DiscussionThere have been various reports in the medical literature describing the association between lung cancer and polymyositis. Some authors consider this a tenuous relationship at best. Others point to an increased risks of malignancy overall in those with polymyositis, but the risk is far less common than with dermatomyositis. Lymphomas, bladder, colorectal, and pancreatic cancers are the most common malignancies occurring in patients with polymyositis.>> Corticosteroids remain the standard treatment of polymyositis despite a lack of randomized studies. Other treatment modalities include cytotoxic agents and IV IG.
A MEDLINE search between 1966 and 2003 revealed only two cases of polymyositis associated with histologically proven bronchogenic SQCCA. In one case, polymyositis occurred in a 72-year-old, male nonsmoker 4 years before stage IV non-small cell lung cancer was diagnosed. The second case occurred in 73-year-old, male smoker, but few clinical data were provided. Source

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Transbronchial biopsies and right hilar transbronchial needle aspirate were nondiagnostic. Cytologic findings of BAL of the right upper lobe were positive for squamous cell carcinoma (SQCCA). Mediastinoscopy and metastatic workup including bone scan and head CT were negative. Anti-Smith, anti-ribonucleoprotein, anti-neutrophil cytoplasmic antibody, anti-HU serology findings were also negative.
A trial of corticosteroids was initiated without significant clinical improvement. The patient continued to have severe proximal muscle weakness, and his CK remained elevated with values between 6,000 U/L and 9,000 U/L. After an acceptable cardiac and pulmonary preoperative risk assessment, a right upper lobe resection and lymph node (LN) dissection were performed via a standard right thoracotomy. The pathology revealed a large (4 X 3 X 2 cm) right hilar LN nearly completely replaced by the metastatic SQCCA.

Interestingly, there was no lung parenchymal involvement, no capsular penetration, and all other LN stations were without disease. No obvious communication between the bronchial lumen and the right hilar LN was demonstrated. The postoperative course was complicated by Pseudomonas and methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia. Steroids were continued, however, and the CK level slowly decreased. Despite this, the weakness failed to resolve, nosocomial pneumonia developed, and patient eventually died of progressive respiratory failure on postoperative day 26.
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Paraneoplastic Polymyositis Associated With Squamous Cell Carcinoma of the Lung: Case ReportParaneoplastic syndrome (PNS) is a constellation of signs and symptoms that are unrelated to the local effects of the primary tumor or its metastases and can present as the first sign of malignancy. PNS occurs in 7 to 10% of all patients with cancer. The association between various cancers and polymyositis has been reported.2 Lung cancer-associated dermatomyositis has been described in multiple publications; however, an association between polymyositis and lung cancer has been debated.
A 56-year-old, previously healthy man with a 65-pack-year history of cigarette smoking and a family history of lung cancer was admitted on January 8, 2003, with a 3-month history of progressive proximal muscle weakness. This weakness initially was confined to the lower extremities but progressed to involve the upper extremities over a 2-week period.

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In view of the potentially catastrophic effects of infections in the immunocompromised host and the broad differential diagnosis, the appearance of pulmonary infiltrates in individuals after solid-organ transplantation merits an aggressive diagnostic approach. Our patient’s illness was unresponsive to standard broad-spectrum antibacterial treatment, which prompted further investigation. The diagnosis of SRL-IPH in this case is based on exposure to the drug preceding the onset of pulmonary symptoms; the development of new infiltrates on chest radiograph; exclusion of infection or alternative pulmonary disease; CT and lung pathology consistent with drug-induced pathology; and clinical and radiologic improvement after withdrawal of the drug. These features fulfill strict criteria advocated for the diagnosis of drug-induced pulmonary hypersensi-tivity. cfm-online-shop.com

There is a paucity of cases reported in the literature that satisfy these criteria (Table 1). Our case supports this association, and its clinical, radiologic, and histologic characteristics provide additional information for clinicians. Our patient acquired symptoms only 2 weeks after the initiation of sirolimus (previous reports describe a minimum of 6 weeks), and the presence of fine end-inspiratory crepitations has not previously been described.
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The development of breathlessness and pulmonary infiltrates after solid-organ transplantation presents a significant management problem. The differential diagnosis includes opportunistic infections secondary to drug-induced immunosuppression, posttransplant lymphopro-liferative disease, recurrence of the underlying disease, and drug toxicity. Since its introduction in 1999, sirolimus has been increasingly used as a potent immunosuppressant in solid-organ transplantation principally to avoid the nephrotoxic side effects of the calcineurin inhibitors (CNIs). We present a case of sirolimus-induced pulmonary hypersensitivity (SRL-IPH). A 73-year-old woman received an orthotopic liver transplant for hepatitis C virus (HCV) cirrhosis. Initial immunosuppression was tacrolimus, azathioprine, and prednisolone. A liver biopsy 18 months later showed mild-grade, moderate-stage recurrent HCV-related liver disease prompting replacement of tacrolimus with sirolimus, which is antifibrotic. Over the next 2 months, the serum sirolimus concentration was 6.1 to 13.1 ng/mL (normal range, 5 to 15 ng/mL). Two weeks after starting sirolimus, a nonproductive cough, dyspnea, and malaise developed. ventolin inhalers

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