摘要:

Although asthma remains a common malady, inflicting suffering, expensive therapy, and sometimes even death on its victims, recent advances in our understanding of its pathology have provided a number of potential new treatment modalities. The essential insight has been the identification of asthma as an inflammation-related condition. The great complexity of the inflammatory response, although somewhat bewildering, provides numerous avenues that can be followed by researchers in an effort to halt inflammatory processes. In addition, it has been realized that asthma is a multifactorial disease in which some patients may manifest certain characteristics, whereas others may not. This serves to further complicate an understanding of the disease, and it seems likely that several forms of treatment will be required to effectively treat the population affected with asthma. Bronchodilator treatments have been supplemented with anti-inflammatory–inhaled corticosteroid treatments that are very effective in most, but not all, asthmatic patients. There are possible side effects with these powerful drugs, however, and patient compliance is a recognized problem. Thus, a variety of new anti-inflammatory drugs have been developed, and some will undergo clinical testing. In particular, these include drugs that modulate the activity of leukotrienes, a group of endogenous mediators that have important anti-inflammatory and broncho-constricting properties.

ISSN:1068-0640    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Rapidly growing mycobacteria have only recently been recognized as pulmonary pathogens. When such organisms are recovered from respiratory secretions, well-defined diagnostic criteria suggested by the American Thoracic Society can be followed to determine the significance of a rapidly growing mycobacteria isolate.Mycobacterium abscessusis the rapidly growing mycobacteria species most frequently (82%) responsible for lung disease, followed byMycobacterium fortuitum(13%). The typical patient is an elderly, nonsmoking woman with no known underlying lung disease. Some underlying conditions that are associated with rapidly growing mycobacterial lung disease include previous mycobacterial disease, gastroesophageal disorders with chronic vomiting, cystic fibrosis, and lipoid pneumonia. Human immunodeficiency virus infection is not an apparent risk, and the single largest group of patients are those with no underlying disorder. The chest radiograph typically shows bilateral noncavitary upper lung field infiltrates and may not be typical for pulmonary tuberculosis. With repeated isolation from the sputum of a rapidly growing mycobacteria species (especiallyMycobacterium abscessus),more invasive diagnostic procedures, such as bronchoscopy, almost invariably confirm the diagnosis. Treatment is guided by in vitro susceptibilities.Mycobacterium fortuitumisolates are usually susceptible to oral antibiotic agents, whereasMycobacterium abscessusisolates are susceptible only to parenteral agents and the newer macrolides (clarithromycin and azithromycin). Long-term cure is generally possible only withMycobacterium fortuitumor localized disease due toMycobacterium abscessus.Surgical resection is important for patients with lung disease caused byMycobacterium abscessus.

ISSN:1068-0640    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The most frequent types of systemic vasculitis to affect the lung are Wegener's granulomatosis, microscopic polyangiitis, and the Churg-Strauss syndrome. Although all three typically affect the small vessels, Wegener's granulomatosis and, frequently, Churg-Strauss syndrome have characteristic necrotizing granulomatous features. All three syndromes lack immune complex deposits but are associated with anti-neutrophil cytoplasmic antibodies, which have been implicated in their pathogenesis. The initial disease phase of Wegener's granulomatosis is usually dominated by symptoms resulting from the necrotizing granulomatous inflammation affecting the respiratory tract. This initial phase frequently responds to trimethoprim-sulfamethoxazole. During the generalized vasculitic phase of Wegener's granulomatosis, immunosuppression with the standard regimen consisting of oral prednisone and cyclophosphamide is required. Alternative immunosuppressive regimens have been tried because of the high toxicity rate of the standard regimen. Plasma exchange and, most recently, intravenous immunoglobulin have been used in patients not responding to standard immunosuppression with mixed results. Most cases of Churg-Strauss syndrome respond promptly to oral glucocorticoids alone.

ISSN:1068-0640    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Environmental lung disease is any respiratory ailment that results from inhalation of airborne substances, either particulate or gaseous. Some forms of environmental lung disease such as reactive airways dysfunction syndrome are not immunologically mediated, and no immunologic workup is indicated. However, if a patient has a history compatible with an immunologically mediated disease such as asthma or hypersensitivity pneumonitis, appropriate immunologic evaluation should be performed. With the identification, preparation, and characterization of the putative antigen(s), a variety of tests can be used to evaluate the immune mechanism. However, these tests are corroborative only and are to be used in conjunction with a compatible clinical history and other appropriate clinical evaluations such as pulmonary function tests and chest films. Once a diagnosis is established, corticosteroids or other medications may be useful in the management of the acute disease, but the definitive treatment is avoidance of the antigen.

ISSN:1068-0640    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The respiratory muscles are the only skeletal muscles whose continuous function is necessary to maintain life. Hypercarbic respiratory failure due to dysfunctional respiratory muscles is a common finding in patients in the intensive care unit. A thorough understanding of the action of the respiratory muscles and the methods by which their function can be assessed is essential to health care professionals working in the intensive care unit. The respiratory muscles are one component of the “respiratory pump/” which includes the respiratory control centers in the central nervous system, the nerve pathways along which impulses to initiate muscle contraction are transmitted, the breathing muscles themselves, as well as peripheral mechano- and chemoreceptors that contribute to the regulation of breathing. The assessment of the respiratory muscle function in the intensive care unit includes: 1) a thorough evaluation of the medical history including a review of medications; 2) a careful physical examination; 3) radiologic evaluation; and 4) more complex tests that measure pressures generated by contraction of the respiratory muscles, the electromyographic signal they produce, or the movements of the thorax and abdomen caused by their contraction.

ISSN:1068-0640    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Radiation therapy injures lungs and limits the effectiveness of cancer treatment. The lung injury becomes clinically significant depending on beam arrangement, fractionation schedule, volume of irradiated lung, coexisting disease, and unknown factors. Although the pathogenesis of radiation-induced lung toxicity is well understood, predicting the onset of clinically significant pneumonitis, fibrosis, and loss of pulmonary function is difficult. Pulmonary function can improve if a tumor that obstructs ventilation and perfusion responds to radiation exposure. The treatment of acute lung injury within 2 to 3 months of exposure is usually successful with anti-inflammatory drugs and supportive care. However, there are no well-accepted predictors of late lung injury, and acute toxicity does not necessarily predict the later dysfunction because of fibrosis and atelectasis. Studies of pulmonary function and of blood levels of transforming growth factor-β as predictors of fibrosis are current protocols of the Radiation Therapy Oncology Group. In addition, sulfhydryl-containing inhibitors of angiotensin converting enzyme, such as captopril, attenuate lung injury in rats and are beginning to be assessed for this benefit in patients receiving thoracic irradiation.

ISSN:1068-0640    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Hemothorax is defined as a bloody pleural effusion in which the pleural fluid hematocrit is 50% or more of the peripheral blood hematocrit. Most hemothoraces occur because of blunt or penetrating trauma. Hemothorax is defined as spontaneous when it occurs in the absence of trauma. Spontaneous hemothorax has been seen in association with many disease states, but it is not a common finding in any of them. The most common causes of spontaneous hemothorax include pneumothorax, coagulopathy, aortic dissection, and pulmonary vascular malformation. Although sanguineous pleural effusions are commonly associated with malignant carcinomas of the chest, true hemothorax is distinctly unusual. The initial diagnostic evaluation should focus on the potentially fatal causes, including aortic aneurysm, pulmonary arteriovenous malformation, and coagulopathy. Once the cause of spontaneous hemothorax has been identified, specific therapy should be directed toward the underlying disorder. Large hemothoraces should be drained with a thoracostomy tube to monitor blood loss and to decrease the risk of fibrothorax. In the setting of hemothorax refractory to chest tube drainage, hemodynamic instability, or massive bleeding, thoracoscopy or thoracotomy should be considered. We describe a case of spontaneous hemothorax secondary to angiosarcoma of the lung and discuss the major diagnoses to consider when evaluating a spontaneous hemothorax.

ISSN:1068-0640    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SYNOPSISDespite decreasing levels of bacteremia, interleukin-1 and tumor necrosis factor release was demonstrated after antibiotic treatment of experimental Gram-negative sepsis. Antibiotic-induced filamentation of bacteria appears to foster local release of endotoxin.SOURCEDofferhoff ASM, Potthoff H, Bom VJJ, et al. The release of endotoxin, TNF and IL-6 during the antibiotic treatment of experimental Gram-negative sepsis. J Endotoxin Res 1995;2:37–44.

ISSN:1068-0640    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SYNOPSISTwo recent clinical investigations in ventilator-associated pneumonia provide clinically useful information. Kollef and colleagues, in a series of 72 patients suspected of ventilator-associated pneumonia, demonstrated that the use of a catheter to obtain mini bronchoalveolar lavage for quantitative culture use provided similar microbial information to that obtained by bronchoscopic protect-ed-specimen brush. Valles and colleagues used continuous glottic aspiration in critically ill patients expected to require long-term mechanical ventilation. They reported a reduced incidence of early onset of nosocomial pneumonia due to Gram-positive organisms and Haemophilus influenzae.SOURCEKollef MH, Bock KR, Richards RD, et al. The safety and diagnostic accuracy of minibronchoalveolar lavage in patients with suspected ventilator-associated pneumonia. Ann Intern Med 1995;122:743–8. Valles f, Artigas A, Rello J, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995;122:179–86.

ISSN:1068-0640    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SYNOPSISObstructive sleep should be considered in women, even in premenopausal women, if certain craniofacial abnormalities are present.SOURCEGuilleminault C, Stoohs R, Young-do K, et al. Upper airway sleep-disordered breathing in women. Ann Intern Med 1995;122:493–501.

ISSN:1068-0640    

出版商:OVID    

年代:1995

数据来源: OVID