摘要:

Asthma is a disease of airway hyperreactivity and chronic inflammation. Although corticosteroids are crucial to asthma antiinflammatory therapy, a small subset of asthmatic patients are corticosteroid dependent or resistant and particularly difficult to manage. High-dose corticosteroid treatment in these patients is accompanied with significant complications. Alternative anti-inflammatory agents have been used in difficult-to-control asthma in an attempt to spare corticosteroid use. Immunologic therapies investigated include cyclo-sporine, methotrexate, gold, and intravenous immunoglobulin. Non-immunologic treatments include troleandomycin, dapsone, and hydroxychloroquine. Recently, gene therapy has also been proposed. However, the most important factors in the management of severe persistent asthma remain close and careful monitoring by a respiratory specialist treatment of exacerbating conditions, education of patients regarding asthma care, and strict compliance with traditional therapies.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Pseudomonas aeruginosais an aerobic Gram-negative rod; it is an opportunistic pathogen that causes disease in patients with impaired host defenses. The defenses may be generally weakened by debility or cancer, or there may be an artificial breach in the defenses, such as an endotracheal tube, or specific humoral or cellular defects, such as seen in cystic fibrosis (CF).P aeruginosais particularly associated with progressive and ultimately fatal chronic respiratory infection in CF; patients with other forms of bronchiectasis may contract chronic infection that may be impossible to eradicate despite vigorous treatment.P aeruginosais a significant cause of nosocomial pneumonia, and several risk factors have been identified. Various bacterial products contribute to the pathogenicity of the bacterium. An exuberant chronic inflammatory response causes lung damage in bronchiectasis, whereas the acute inflammatory response may be inadequate in pneumonia, which is associated with bacteremia and high mortality.P aeruginosais inherently resistant to many antibiotics at concentrations that can be achieved in vivo, and with the exception of some quinolones, the antibiotics to which it is sensitive need to be given intravenously. A semisynthetic penicillin or third-generation cephalosporin is commonly used together with an aminoglycoside. In bronchiectasis, barriers to antibiotic penetration to the site of infection may reduce efficacy, and the use of nebulized antibiotics is an approach that attempts to overcome this. Future research will concentrate on preventative strategies and adjunct therapies to improve outcome.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Radiation is an effective therapeutic option for malignant disease. Dosing techniques have been refined to the point that radiation therapy is usually safe and well tolerated. Unfortunately, damaging effects to normal lung inside the radiation field are unavoidable, leading to the clinical syndromes “radiation pneumonitis” and “radiation fibrosis.” Onset of disease occurs 6 weeks to 6 months after radiation and includes symptoms of dyspnea, cough, chest pain, and fever. Treatment of severe cases may require corticosteroids. A chest radiograph initially shows an alveolar infiltrate inside the radiation field that later develops the typical appearance of fibrotic changes that can mimic tumor or infection. The pathogenesis involves free radical formation that directly damages cells and DNA. In addition, a diffuse inflammatory response characterized by increased lymphocytes followed by a cascade of cytokines and growth factors directs the fibrotic process. This is also seen in the contralateral untreated lung. Increased understanding of these mechanisms will suggest new strategies for improving the efficacy of radiation therapy while limiting toxic side effects.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Sinusitis is a very common disease frequently diagnosed and treated by both primary care physicians and specialists. Several problems, however, exist for the diagnosis and treatment of sinusitis. First, is the identification of patients solely on the basis of symptoms, because headache, rhinorrhea, and nasal congestion are extremely common in patients without sinusitis. The clinical dilemma is proper selection of patients for confirmation of the diagnosis. Another aspect is the quality of life of patients suffering from sinus disease, as sinusitis is clearly associated with considerable discomfort for the patient. Third, sinusitis can be underdiagnosed and can be the cause of other respiratory tract symptoms, for example, chronic cough, increased signs and symptoms of asthma, chronic bronchitis, chronic obstructive pulmonary disease, and cystic fibrosis. In addition, patients with decreased immunity, for example, cancer and patients with HIV have a higher incidence of sinusitis. This article reviews the latest knowledge in the pathophysiology of sinusitis and its treatment.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The benefits of specialist versus generalist care are a current debate in health care. This debate is particularly contentious in critical care because critical illness remains poorly defined: critical care is a relatively young specialty, there is a wide variation regarding who provides critical care, and there is doubt about the value of critical care. To help clarify these issues, in this article, we (1) define critical care; (2) define a critical care physician; (3) explore the value of critical care; (4) explore the value of a critical care physician; and (5) discuss future directions in critical care. The involvement of critical care physicians in the care of patients in the intensive care unit (ICU) appears to be associated with improved short-term outcomes, such as in-hospital mortality and ICU and hospital length of stay. The involvement of critical care physicians in the care of ICU patients appears to be associated with improved short-term outcomes. However, additional studies are needed to evaluate the population need for critical care and the effect of critical care on long-term outcomes, such as 5-year survival, functional status, and health-related quality of life.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The decision whether to wean is a challenge to physicians, because in as many as 10|X% to 20|X% of cases, weaning fails to avoid reintubation or unnecessarily prolongs ventilation. Noninvasive mechanical ventilation (NIMV) is a readily available method for supplying ventilatory support. Although the advantages for NIMV are substantial in some scenarios (long-term home mechanical ventilation, sleep apnea syndromes, acute respiratory failure in patients with chronic obstructive pulmonary disease), the evidence for its use during weaning is lacking. NIMV can be used in weaning in two different ways: first, as a supportive ventilatory method, which allows for early withdrawal of the endotracheal tube, and, second, as a ventilatory aid in patients in whom extubation fails. Whether the different ways of providing NIMV account for clinical differences in outcome remains uncertain.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The follow-up and management of lung transplant recipients can be challenging. Early perioperative complications are generally related to technical aspects of the surgery. Later postoperative complications may involve one or more organ systems and include the management of graft dysfunction. Infections are a major cause of morbidity and mortality after lung transplantation. The predominant pathogens include bacteria, fungi, and viruses, of which cytomegalovirus plays a major role. Rejection of the allograft remains the major limitation to long-term survival of patients and may be divided into 3 categories: hyperacute, acute, and chronic rejection. Adequate management of the immunosuppressive regimen is essential, with appropriate attention to drug interactions and individual toxicities.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Abstracts from Literature Synopsis:Measurements of D-dimers in patients evaluated angiographically for pulmonary embolism were obtained using 5 different commercially available latex agglutination assays to determine whether this method is reliable in excluding the diagnosis of pulmonary embolism.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Abstracts from Literature Synopsis:A multicenter international study was conducted to define the clinical risk factors and natural history of pulmonary embolism.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Abstracts from Literature Synopsis:This pilot study was performed to evaluate the effectiveness of bronchial artery infusion (BAI) of chemotherapeutic agents as a treatment for centrally located early-stage lung cancer. Seven patients with centrally located early-stage squamous cell lung carcinoma diagnosed bronchoscopically were offered BAI with cis-diamminedichloroplatinum (CDDP: dosage 50 to 150 mg/body, 35 to 100 mg/m2) as a curative attempt. All patients showed complete remission within 1 to 6 weeks after BAI. Three patients developed severe bronchial ulcers as a complication of BAI.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID