摘要:

Individuals affected by cystic fibrosis experience dysfunction of multiple organ systems. Most morbidity and mortality are associated with progressive obstructive lung disease that is accentuated by periodic pulmonary exacerbations—acute declines in pulmonary function. Treatment of a pulmonary exacerbation must address multiple factors that may contribute to the worsening lung function. Culture and sensitivity data from lower airway secretions should be used to guide antimicrobial therapy. An aggressive airway clearance regimen should be individualized to the needs of each patient Nutritional supplementation improves lung function by satisfying increased energy needs and enhancing immune function. Management of acute exacerbations can also be complicated by other medical conditions such as hypoxemia, right heart failure, pneumothorax, hemoptysis, allergic bronchopulmonary aspergillosis, and pregnancy. Therefore, treatment of infection alone may not be sufficient in this patient population. Unfortunately, even the multidisciplinary and multisystem approach to the treatment of pulmonary exacerbations may not restore lung function to a preexacerbation baseline or prevent the overall relentless loss of lung function seen in patients with cystic fibrosis.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Cytomegalovirus (CMV) continues to account for a substantial percentage of the morbidity and mortality that follows organ transplantation. The three major consequences of CMV infection of the lung are CMV pneumonitis, pulmonary superinfection with opportunistic pathogens, and indirect CMV-mediated injury to the lung. In the last decade, considerable progress has been made toward elucidating risk factors for CMV pneumonitis, with rapid detection of CMV in respiratory specimens and other clinical samples and with the use of antiviral chemotherapy and immunoglobulin to prevent and treat CMV pneumonitis after transplantation. With the introduction of preventive ganciclovir therapy and a better understanding of the immunology of CMV in transplant recipients, there has been a significant change in the management of CMV pneumonitis. This article discusses the effect of these advances on patient outcome after transplantation and the challenges for the next decade.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The term “infiltrative lung disease” is used to describe a large spectrum of disorders. They are characterized by a great similarity in their radiologic, physiologic, and clinical presentation. To achieve an accurate diagnosis, performance of histopathologic studies is needed in most of the cases. Lung specimens can be obtained through transbronchial biopsies, but in some instances, open lung biopsies are required. In selected cases, other diagnostic techniques (e.g., high-resolution CT) may help in defining the condition. Many peripheral blood abnormalities may be associated with interstitial lung diseases and may be helpful in screening high-risk individuals searching for disease, in diagnosing disease activity, in monitoring the effectiveness of therapy, or in disclosing the presence of recurrences and/or complications. These serum or blood cell abnormalities should be used together with clinical and imaging data, because their use separately from clinical observations may lead to confusion (e.g., serum angiotensin-converting enzyme in sarcoidosis, serum precipitating antibodies in hypersensitivity pneumonitis, or cytoplasmatic antineutrophil cytoplasmic antibodies (c-ANCA) in Wegener granulomatosis). The sensitivity and specificity may vary widely in accordance with the blood components and the disease under consideration.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Gastroesophageal reflux (GER) is commonly associated with several types of respiratory symptoms in adults and children, but it is not always clear whether respiratory disease associated with reflux (RDAR) is caused by GER or vice versa. There is strong clinical and experimental evidence that apnea and apparent life-threatening events can be caused by laryngospasm secondary to aspiration of refluxed gastric contents, and it is also likely that GER is a common cause of recurrent croup and stridor. Although GER is commonly associated with asthma and infantile wheezing, its role as a cause of lower respiratory tract disease is poorly defined, and the mechanism of pathogenesis is unclear. The pH probe is commonly considered the gold standard for diagnosing GER, but its validity lies in its correlation with esophagitis and its accuracy in the diagnosis of RDAR is unknown. Medical treatment of GER typically consists of a combination of acid-blocking and prokinetic agents, which is often but not uniformly successful in controlling GER and RDAR. This review discusses the clinical association of various respiratory conditions with GER, clinical and experimental data on pathogenesis, controversies in diagnosis and treatment, and the reasons for the current difficulties in clearly defining the spectrum of respiratory disease associated with reflux.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The use of nitric oxide gas by inhalation to treat hypoxemia and pulmonary hypertension in mechanically ventilated patients has increased in the last few years. Nitric oxide is a potent vasodilator gas that when given by the inhalation route is selective for the pulmonary vessels and for ventilated lung regions. This double selectivity makes nitric oxide inhalation an ideal approach to treat patients with acute respiratory failure, in which hypoxemia and pulmonary hypertension are the main features. In this clinical setting, inhaled nitric oxide reduces pulmonary artery pressure and improves pulmonary gas exchange by diverting pulmonary blood flow from nonventilated to well-ventilated lung areas. The effects of inhaled nitric oxide upon oxygenation in patients with acute respiratory failure depend on the distribution of ventilation-perfusion abnormalities. The different distributions of these abnormalities among patients and even in the same patient during the course of the disease could be the reason of the great variability of responses to inhaled nitric oxide in acute respiratory failure. Nitric oxide has other actions that may be beneficial in patients with acute respiratory failure: reducing pulmonary artery pressure may attenuate pulmonary edema and inhibiting lung neutrophil migration and platelet aggregation may reduce the inflammatory lung process. Inhalation of nitric oxide may also have some potentially harmful effects due to nitrogen dioxide and peroxynitrite formation. The use of inhaled nitric oxide to treat patients with acute respiratory failure must take into account the benefit-risk ratio. Knowing the underlying pathophysiology of the disease and the nature of nitric oxide, its use can be beneficial, even life-saving, for some patients with refractory hypoxemia.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Tracheomalacia is defined as increased dynamic collapse of the tracheal wall producing clinical symptoms. The clinical features of tracheomalacia depend on the location, length, and severity of the weakness of the tracheal wall. The diagnosis is made by fiberoptic bronchoscopy in a spontaneously breathing child, and severity is based on the degree of tracheal collapse with mild <70|X% collapse, moderate 70|X% to 90|X%, and severe >90|X% collapse with exhalation. Primary tracheomalacia is an uncommon congenital malformation of the tracheobronchial cartilage that is usually mild and self-limited. Primary tracheomalacia is often associated with other abnormalities of cartilage development. Acquired tracheomalacia has been more frequently recognized in recent years, in part because of the increased survival of the smallest prematurely born infants who require long-term endotracheal intubation. Although acquired tracheomalacia can result from long-standing extrinsic compression of the trachea, in infants with congenital heart disease or bronchopulmonary dysplasia, it is more commonly due to intrinsic weakening of the cartilaginous airway support. Most tracheomalacia resolves over time and without the need for intervention. Therapeutic intervention is indicated when there is recurrent hypoxemia with respiratory distress and growth failure. The therapy of tracheomalacia has included respiratory support with continuous positive airway pressure, surgical intervention such as aortopexy or vascular repositioning, and, in some cases, medications such as cholinergic agonists and avoidance of bronchodilator medications.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Lung cancer is the leading cause of death from cancer in both men and women. The presence of distant metastases or metastases to mediastinal lymph nodes has a significant effect on prognosis. Clinical examination and the use of noninvasive studies such as CT scan and bone scan are currently used for staging patients with non-small cell lung cancer. Positron emission tomography (PET) with [18F1 fluoro-deoxyglucose (FDG) can detect increased glucose metabolism characteristic of malignant tumors. PET has been shown to have an accuracy of >90|X% when it is used to determine whether a lung nodule is malignant or benign. Studies with whole-body PET imaging have detected clinically occult metastases, undetected by other noninvasive studies, in a significant percentage of patients. Because mediastinal lymph nodes are easy to access either at the time of thoracotomy or by cervical mediastinoscopy, significantly more data are available regarding the utility of PET for the detection of mediastinal lymph node metastases in patients with non-small cell lung cancer. A number of studies confirm that PET plus CT is more accurate than CT alone at predicting the presence or absence of mediastinal lymph node metastases. A decision analysis has recently been published describing the use of PET for mediastinal staging of the patient with non-small cell lung cancer. Clinical trials are under development to determine the exact role of PET for detecting both distant metastases and mediastinal lymph nodes.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SYNOPSIS: The use of arginine vasopressin in patients with vasodilatory shock after cardiac bypass surgery increased blood pressure and reduced catecholamine pressor requirements.SOURCE: Argenziano M. Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use of a novel pressor agent. J Thorac Cardiovasc Surg 1998;116:973–80.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID