摘要:

There are two classes of leukotriene-modifying agents: the 5-lipoxygenase inhibitors and the cys-LT1receptor antagonists. Both of these classes were initially studied in instances of provoked asthma, such as exercise-and aspirin-induced asthma, and have been effective in these cases. With such positive results, there has been great interest in their effectiveness in chronic asthma. Studies using these agents as first-line therapy in chronic asthma have been promising, and work is ongoing to determine how these agents compare with existing therapy and how they can be combined with concomitant medications for asthma.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Candidaspp account for the large majority of fungal infections. The incidence of nosocomial fungal infections has been steadily increasing over the last several years because of the increasing number of patients treated in intensive care units, the common administration of antimicrobial agents, and the use of invasive measures in these patients. The route of infection inCandidapneumonia is endobronchial in cases of aspiration or hematogenous in patients with candidemia. Because colonization of the lower respiratory tract withCandidais common, especially in the intubated and mechanically ventilated patient, the diagnosis cannot be established microbiologically. Even quantitative cultures of respiratory secretions cannot distinguish colonization from infection. Although serologic markers ofCandidainfection or candidemia are commercially available, the diagnosis ofCandidapneumonia is best made by histologic examination of lung tissue. According to the route of infection, characteristic histologic signs (e.g., budding yeast, pseudohyphae) can be documented. However, because of the uncharacteristic clinical presentation ofCandidapneumonia, early presumptive therapy may be initiated in some cases. Amphotericin B remains the drug of choice in patients without bacteriologic identification of the fungus, because of resistance of some non-albicans Candidaspecies against fluconazole. However, patients withCandida albicanspneumonia may profit from the lower toxicity of fluconazole therapy. Because mortality even of treatedCandidapneumonia remains high, preventive measures are of particular interest. Risk factors for candidemia have been identified (e.g., neutropenia, mechanical ventilation) and may serve to guide prevention ofCandidapneumonia.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by the presence of eosinophilic material in the alveoli. Recent data suggest that PAP is due to a deficiency of granulocyte-macrophage colony-stimulating factor (GM-CSF) or receptors for GM-CSF. Patients generally present with cough or dyspnea, but physical examination findings are nonspecific. The classic chest radiographic pattern is a bat wing appearance, although various radiographic patterns have been described. Either transbronchial or surgical biopsy can confirm the diagnosis. When indicated for dyspnea or hypoxemia, treatment consists of whole lung lavage. Ongoing studies are evaluating the efficacy of GM-CSF injection as an alternative therapy. Although the prognosis in PAP is generally good, relapse is common.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Lung transplantation (LTx) is a widely recognized therapeutic option for end-stage pulmonary diseases. It has improved not only survival but also quality of life of recipients. Osteoporosis constitutes a medical condition that could affect long-term outcome and eligibility for LTx. Despite this, there is a lack of attention given to this issue by the medical community. There is reported 30% to 50% incidence of osteoporosis among LTx candidates. Risk factors for bone loss in the pre-LTx period are multiple and mainly associated with long-term glucocorticoid therapy. The main cause of bone loss after LTx appears to be immunosuppressive therapy, mostly because of the action of cyclosporine. Similarly, with what has been described for other solid organ transplants, the first 6 to 12 months after surgery is the period with the highest skeletal damage. Prospective studies concerning prevention and treatment of bone loss in this population have yet to be published. On the basis of our observations, we emphasize the need for an early evaluation of bone mass status. Efficient pharmaceutical prevention and treatment of bone loss in all candidates for LTx is required to avoid posttransplant bone quality deterioration. Maintenance of adequate levels of vitamin D and calcium and hormonal replacement when needed are mandatory. Antiresorptive drugs, such as biphosphonates, appear to be the best treatment option. Similarly, in the posttransplant period, it is imperative to continue with the same strategy.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Assessment of inspiratory and expiratory pressure development is a standard test used to evaluate patients with breathing disorders. The purpose of the present article is to examine the utility and limitations of these measurements. Measurement of maximum inspiratory pressure (Pimax) and maximum expiratory pressure (PEmax) generation requires, first and foremost, a cooperative patient and adequate instruction in performance of the required maneuvers (i.e., a maximal inspiratory effort performed against an occluded airway for determination of Pimax and a maximal expiratory effort against an occluded airway for measurement of PEmax). To adequately interpret Pimax and PEmax measurements, one must be aware of the physiologic variables that influence these pressure measurements, including lung volume and the static recoil pressure of the respiratory system. In addition, because these parameters are effort dependent, reproducibility is a potential problem. It is also important to realize that Pimax and PEmax measure only maximal respiratory force generation and are not indicators of “low frequency” muscle force-generating capacity or muscle endurance. Nevertheless, assessment of Pimax and PEmax is important in several clinical conditions including (1) defining the differential diagnosis in patients manifesting a restrictive ventilatory defect during routine pulmonary function testing, (2) determining the severity of respiratory muscle involvement in patients with a known myopathy, (3) assessing the need for ventilatory support in myopathic disorders, (4) evaluating patients with acute respiratory failure of unknown origin, (5) providing information about respiratory muscle dysfunction in patients with systemic disturbances (e.g., sepsis) that affect muscle performance, (6) providing prognostic information in patients with known disorders that affect muscle function, and (7) evaluating patients to be weaned from mechanical ventilation.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Lymphangioleiomyomatosis (LAM) is a rare disease of unknown origin that affects women of reproductive age. The presence of spontaneous pneumothorax, hemoptysis, and chylous effusion or ascites in a young woman prompts the diagnosis. Most patients present with progressive dyspnea and cough. High-resolution CT usually shows bilateral diffuse cystic airspace disease with cysts of variable sizes. Pulmonary function tests show predominantly an obstructive pattern. The treatments available for LAM at this point are not clearly effective. Since its description more than 50 years ago, various treatment modalities including corticosteroids and cytotoxic agents have been tried without any significant benefit. Because the disease predominantly affects women of childbearing age, hormonal manipulation has been attempted with questionable success. Recent advances in molecular biology have thrown some light on the pathophysiology of this disease and may pave the way for future therapies. Most patients who have LAM die within 10 to 15 years of diagnosis because of progressive respiratory failure. More than 40 patients with LAM have had lung transplantation. LAM-specific posttransplant complications occur, and there are rare reports of recurrence of the disease in the transplanted lung. In this review, we describe the clinical, physiologic, radiologic, and pathologic characteristics of this disease and discuss the various currently available treatment options as well as future possibilities in the treatment of this rare and progressive disease.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Significant improvements in operative technique, immunosuppression, and treatment of infections have led to higher 1-year lung transplant recipient survival than in the past. Favorable outcome is dependent on the early functional recovery of the transplanted lung. Routine perioperative management includes respiratory support, preemptive antimicrobial therapy, chest tube management, and hemodynamic and cardiovascular monitoring. When functional recovery of the transplanted lung is delayed, recipient survival is dependent on aggressive supportive respiratory management. A thorough understanding of the tempo and presentation of perioperative respiratory complications that are unique to this population is important in their early diagnosis and management Pulmonary venous obstruction, rejection, and infection must be excluded. In the presence of graft failure, supportive measures such as independent lung ventilation, extracorporeal membrane oxygenation, and retransplantation should be considered.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Chemical pleurodesis provides successful palliation for properly selected patients with both malignant and nonmalignant recurrent symptomatic pleural effusions. Talc, administered either by poudrage through a thoracoscope or slurry via a chest tube, has the highest success rates. Pleurodesis is less likely to be successful when pleural fluid pH and glucose are low (<7.20 and <60 mg/dL, respectively) and pleural space elastance is high (≥19 cm H2O). Small-bore catheters appear to be as effective for drainage as standard-sized chest tubes. Talc, when delivered as a slurry, appears to be the most cost-effective agent However, there have been reports of acute respiratory failure associated with talc pleurodesis, although talc may not have been causative in many of these cases. Unresolved issues relating to pleurodesis include the ideal agent, optimum dose and dwell time, necessity for rotating the patient, and daily drainage before chest tube removal.

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

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID