摘要:

Retention of mucus and dyspnea are very well-known symptoms in patients with obstructive lung disease. The potential causes and consequences of retention of mucus are discussed. In addition to medical treatment, physical therapeutic interventions may be indicated. In this article, the clinical and research assessment of mucus-mobilizing techniques is discussed. In the case of retention of mucus, the first choice of treatment is forced expirations or coughing. Additional techniques can be considered when forced expirations are not effective. Improvement in patient compliance with these measures is essential.Reducing dyspnea could be useful in the care of patients with chronic lung disease by improving the quality of life. The quantification of dyspnea is discussed, and an overview is given with regard to measurement instruments. Reducing dyspnea can be achieved by different physical therapeutic interventions that depend on the etiologic causes of symptoms.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This article reviews the possible mechanisms by which viral respiratory tract infections may be involved in the pathogenesis of asthma and chronic obstructive pulmonary disease. The discussion emphasizes the distinction between acute infections, latent infections, and persistent infections and describes pertinent issues that concern the use of laboratory techniques to document viral infections. Despite rapid advances in knowledge of the possible contribution of viral respiratory tract infections to obstructive pulmonary diseases, in large part made possible by the application of powerful immunologic and molecular biologic techniques, there remain important unanswered questions, and an improved understanding of the complex interplay between host, viral, and environmental factors may result in innovative strategies for treatment and prevention.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Pulmonary histiocytosis X (PHX) is a form of Langerhans' cell histiocytosis that affects the lungs as the sole or predominant manifestation. The disease is characterized by an abnormal proliferation of Langerhans' cells (LC), which seem to serve as accessory cells for a lung immuno-pathologic response. PHX can occur at any age, but is frequently observed in young adults and almost exclusively in smokers. Up to 35% of the patients are asymptomatic at the time of presentation, and an initial diagnosis of interstitial lung disease is usually made because of an abnormal chest radiograph. The most common symptoms are cough and dyspnea. Chest roentgenograms show diffuse reticulonodular infiltrates, usually more pronounced in the upper lobes, and often sparing the costophrenic angles. As the disease progresses, nodular opacities decrease and cystic changes become prominent. Computed tomography shows nodules and thin-walled cysts, a combination of images almost unique to this disease, and which strongly supports the diagnosis of PHX. Lung function tests are variable; they can be normal or exhibit obstructive, restrictive, or mixed dysfunction. Decreased diffusing capacity is found in up to 80% of patients. Histopathologic confirmation remains the most definitive way to establish the precise diagnosis. This usually shows multiple micronodular lesions, initially composed of LC, eosinophils, and other inflammatory cells, and later by fibroblasts and connective tissue. Nodules display a typical starfish configuration. LC can be distinguished ultrastructurally by the presence of Birbeck granules or by positive immunostaining with OKT6 marker. The clinical course of the disease is uncertain and varies from complete or partial regression to progression until the end-stage lung. Treatment consists of corticosteroids, but cessation of smoking should be strongly encouraged.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The sinopulmonary syndromes result from diseases that affect both the paranasal sinuses and the lower respiratory tract. The association between sinusitis and asthma has been highlighted in the last decade. Although experimental studies in humans have failed to confirm the presence of a sinusitis-mediated broncho-constriction, numerous clinical studies have demonstrated an improvement in asthma severity after medical and surgical treatment of sinus disease. Recently, functional endoscopic sinus surgery has been introduced to treat recalcitrant sinusitis and focuses on restoring the patency of the ostiomeatal complex. In the difficult-to-treat asthmatic patient where sinus disease is of concern, CT scan of the paranasal sinuses is the diagnostic test of choice, especially when endoscopic sinus surgery is being considered. Frequent sinopulmonary infections that lead to bronchiectasis characterize the sinopulmonary syndromes associated with both ciliary dyskinesia and hypogammaglobulinemia. Ultrastructural ciliary defects can lead to a spectrum of functional disorders from immobility to dysmotility. Patients who are suspected to have ciliary dyskinesia can present with isolated defects that involve the cilia of the respiratory tract. The first step in evaluating patients who are suspected to have ciliary dysfunction is a functional and structural analysis of the nasal epithelial cilia, and when nondiagnostic, bronchial biopsies are often required. Cystic fibrosis and Young's syndrome are other examples of sinopulmonary syndromes characterized by obstructive azoospermia in men. Various humoral immunodeficiencies have been associated with sinusitis and bronchiectasis. Whereas agammaglobulinemia presents during the first years of life, other forms such as immuno-globulin G subclass deficiencies can manifest themselves later in childhood and early adulthood.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Massive hemoptysis is a medical emergency that requires timely and complete evaluation of the cause. Causes generally include tracheobronchial, cardiovascular, traumatic, parenchymal (localized or diffuse), or iatrogenic sources. Initial evaluation should include a complete medical history and physical examination, a chest radiograph, and possibly a computed tomographic scan of the thorax. Management tools available to the intensivist consist of observation, diagnostic bronchoscopy, endobronchial tamponade, airway intervention, arterial embolization, and surgery.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Tracheobronchial prostheses, also referred to as stents, are playing an increasingly important role in the bronchoscopic management of patients with benign or malignant tracheobronchial obstruction. Stents can be used in addition to other bronchoscopic techniques and in patients with extrinsic compression of the airways without exophytic disease when laser resection is not possible. In experienced hands, stent insertion is safe and effective, providing excellent palliation of the symptoms and effects of central airways obstruction. Although migration, obstruction by secretions or granulation tissue, and recurrent stenosis occur, complications can usually be managed effectively and are very rarely life threatening. Many stents made of silicone, metal, or a combination of both are currently available, although the general bias of most specialists is still toward silicone stent insertion through the rigid bronchoscope.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Auscultation remains a routine part of the clinical chest examination although objective techniques for pulmonary assessment have become available since Laennec's invention of the stethoscope. Recent advances in computer technology have offered possibilities for the practical measurement and documentation of respiratory sounds. Computer analyses have provided new information about the origin of respiratory sounds and their relation to lung health and disease. Respiratory acoustical measurements are about to be entered into clinical practice, which will expand the information that is gathered with more traditional measurements of lung function. The stethoscope will not be replaced by the new acoustic techniques, but its design will likely change based on new knowledge, and computers will play an important role in the teaching of chest auscultation.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SYNOPSISOccupational exposure to wood or metal dust was significantly associated with a risk of developing cryptogenic fibrosing alveolitis (idiopathic pulmonary fibrosis). This risk was compounded by cigarette smoking.SOURCEHubbard R et al. Occupational exposure to metal or wood dust and aetiology of cryptogenic fibrosing alveolitis. Lancet 1996;347:284–9.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SYNOPSISLung volume reduction surgery (LVRS) improves pulmonary function and dyspnea over the short term, in part by improving lung compliance. Laser bullectomy seems to be less effective and is associated with greater morbidity than stapled lung reduction. Elevated Paco2or reduced diffusing capacity predicted a complicated course.SOURCESciurba FC et al. Improvement in pulmonary function and elastic recoil after lung-reduction surgery for diffuse emphysema. N Engl J Med 1996;334: 1095–9. McKenna RJ et al. A randomized, prospective trial of stapled lung reduction versus laser bullectomy for diffuse emphysema. J Thorac Cardiovasc Surg 1996;111:317–22. Keenan RJ et al. Unilateral thoracoscopic surgical approach for diffuse emphysema. J Thorac Cardiovasc Surg 1996;111:308–16.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SYNOPSISIn sarcoidosis, long-term corticosteroid treatment resulted in improved pulmonary function, symptoms, and chest radiography. Spontaneous remission was observed in more than one third of patients.SOURCEGibson GJ et al. British Thoracic Society sarcoidosis study: effects of long term corticosteroid treatment. Thorax 1996;51:238–47.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID