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May not be necessary if patient has obvious M1 disease on chest x-ray or physical examination 2 Intravenous iodine contrast enhancement is not essential but is recommended in probable mediastinal invasion 3 While optimal in most cases, tissue diagnosis may not be necessary prior to surgery in some cases where the lesion is enlarging or the patient will undergo surgical resection regardless of the outcome of a biopsy Modified and reproduced, with permission, from Pretreatment evaluation of non-small cell lung cancer Consensus Statement of the American Thoracic Society and the European Respiratory Society Am J Respir Crit Care Med 1997;156:320

NSCLC Disadvantages of PET imaging include limited resolution below 1 cm; the expense of FDG; limited availability; and false-positive scans due to sarcoidosis, tuberculosis, or fungal infections 2 Preoperative assessment See 3 3 Pulmonary function testing Many patients with NSCLC have moderate to severe chronic lung disease that increases the risk of perioperative complications as well as long-term pulmonary insufficiency following lung resection All patients considered for surgery require spirometry In the absence of other comorbidities, patients with good lung function (preoperative FEV1 > 2 L) are at low risk for complications from lobectomy or pneumonectomy If the FEV1 is less than 2 L, then an estimated postoperative FEV1 should be

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calculated The postresection FEV1 may be estimated from considering preoperative spirometry and the amount of lung to be resected; in severe obstructive disease, a quantitative lung perfusion scan may improve the estimate A predicted post-lung resection FEV1 > 800 mL (or > 40% of predicted FEV1) is associated with a low incidence of perioperative complications High-risk patients include those with a predicted postoperative FEV1 < 700 mL (or < 40% of predicted FEV1) In these patients and in those with borderline spirometry cardiopulmonary exercise testing may be help ful A maximal oxygen uptake (V O2) of > 15 mL/kg/min identifies patients with an acceptable incidence of complica tions and mortality Patients with an V O 2 of < 10 mL/kg/min have a very high mortality rate at thoracotomy Hypoxemia and hypercapnia are not independent predictors of outcome 4 Screening The optimal screening of smokers for lung cancer is unclear Both chest radiographs and analysis of expectorated sputum is ineffective Recent studies have tried to assess the role of chest CT scans A study by Bach et al showed that CT screening of populations increases the diagnosis of lung cancer but does not reduce the risk of advanced lung cancer or reduce mortality The investigators of the International Early Lung Cancer Action Program, however, suggested that there is a role for screening with chest CT These studies highlight how complex and confusing the analysis of screening for lung cancer can be At the present time, there are inadequate data to recommend the use of chest CT to screen smokers for lung cancer The National Lung Screening Trial is an ongoing large, multicenter study that should answer the question definitively

Untreated acute angle-closure glaucoma results in severe and permanent visual loss within 2 5 days after onset of symptoms Affected patients need to be observed for development of chronic glaucoma

Gandhewar RR et al Acute glaucoma presentations in the elderly Emerg Med J 2005 Apr;22(4):306 7 [PMID: 15788849]

No symptoms in early stages Insidious progressive bilateral loss of peripheral vision, resulting in tunnel vision but preserved visual acuities Pathologic cupping of the optic disks Usually associated with persistent elevation of intraocular pressure

Chronic glaucoma is characterized by gradually progressive excavation ( cupping ) and pallor of the optic disk with loss of vision progressing from slight constriction of the peripheral fields to complete blindness In chronic open-angle glaucoma, primary or secondary, the intraocular pressure is elevated due to reduced drainage of aqueous through the trabecular meshwork In chronic angle-closure glaucoma, flow of aqueous into the anterior chamber angle is obstructed In normaltension glaucoma, intraocular pressure is not elevated but the same pattern of optic nerve damage occurs, probably due to vascular insufficiency Primary open-angle glaucoma is bilateral There is an increased prevalence in first-degree relatives of affected individuals and in diabetics In blacks, it is more frequent, occurs at an earlier age, and results in more severe optic nerve damage Secondary open-angle glaucoma may result from uveitis, ocular trauma, or corticosteroid therapy, whether it be topical, systemic, inhaled, or administered by nasal spray In the United States, it is estimated that 2% of people over 40 years of age have glaucoma, affecting more than 2

Function Module V45W0001 Contains: EXIT_SAPLV45W_001

All persons over age 40 years should have intraocular pressure measurement and optic disk examination every 2 5 years In persons with diabetes and in individuals with a family history of glaucoma, annual examination is indicated

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