5 NSCLC

5 NSCLC, , , , , 1FACT : 60 Problem : :

G.I. (ACEI) , , , . Airway irritants; Inhaled smokes, dusts, fumes, postnasal drip, Aspiration (gastric contents, oral secretion, foreign body)Airway diseases; URI, acute or chronic bronchitis, cancer, asthma, bronchiectasis, external compression of node or massParenchymal lung disease; pneumonia, lung abscess, interstitial lung diseasesCHFDrug-induced (ACE inhibitors) [stimuli, ligand] (receptor] (medulla) , , ,/, , , , Recurrent laryngeal nerve()Closure of glottisPhrenic, spinal, vagal , , Glottis open COPD(virus, fungus, bacteria)IPFAsthma ,GERD ( ) (ACEI)()

3- ;

73-82% Postnasal drip syndrome (PNDS) ACE

COPD

ACEI - ACE .

- .

- 10 20 , 0 44 .

- 1 .

- Class ACE Inhbitor .ACEI ?- 1 4 .ARB .22 2 , .15 ACEI 3 , , , 40 (ROS ) Fever/chill 39.6? 35/Inspiratory crackle, wheezing on right lower anterior lung fields COPD(virus, fungus, bacteria)IPFAsthma GERD ( ) (ACEI)() ?

(CAP), antihistamine, decongestantDry cough : , ACE

Pnuemothorax, , ILD, ( )Crackle and wheezing , .

.

conditionpercussionfremitusbreath soundvoice transmissionadventitious soundnormalresonantnormalvesicularnormalabsentconsolidation or atelectasiswith patent airwaydullbronchialbronchophony,whisperedpectoliloquy,egoghonycracklesconsolidation or atelectasiswith blocked airwaydullabsentAsthmaresonantnormalvesicularnormalwheezingILDresonantnormalvesicularnormalcracklesemphysemahyper-resonantabsent or wheezingpneumothoraxhyper-resonantabsentpleural effusiondullabsent or pleural friction rub

COPDCOPD 40 11.8% , . 60 1 40 (40) COPD . COPD . COPD . localized .

CXR -( spirometer)FEV1.0%(FEV1.0/FVCx100%) 83%FEV1 -> 69%FEF25-75% -> 27%DLCO 79%

Chest x-ray

CT GGA3cm bronchus . Right hilum subcarnial area LN

bronchus necrosis mass 5 squamous cell carcinoma

. (cancer pearls) .

squamous cell carcinoma Cancer Staging staging

Metastasis , , , . Bone scan case stage IIIb .

stage IIIb carina involve pneumonectomy + tracheal sleeve resection + bronchus reanastomosis( FEV1 1L )

5Stage 3b

Chemotherapy with Dosetaxel and cis-platinum neoadjuvant tx stage .