ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Recently, considerable enthusiasm has been generated by early reports that show significant subjective and objective functional improvement among patients with end-stage emphysema in whom lung volume reduction surgery is performed. Surgical reduction of the lungs can be achieved via sternotomy or by video-assisted thoracoscopic surgery, used to either resect a diseased lung with stapling devices or to shrink the bullous areas with laser therapy. Most investigators who use these techniques report an early increase in airflows, reduced residual volumes, and improved oxygenation, which in some patients will permit independence from oxygen therapy. These encouraging reports have to be cautiously weighed against the fact that there is important morbidity (prolonged air leak, secondary pneumonia, bleeding, respiratory failure) in a small percentage of patients. Mortality has been reported between 3% and 18%. Further clinical research is of critical importance to best define the profile of patients most likely to benefit from this surgery with the least possible risk. Similarly, further data must be available to define the long-term effects of volume reduction surgery.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We report a singular case of pulmonary botryomycosis resulting from chronic aspiration pneumonia. Botryomycosis is not caused by any one particular microorganism but is defined by its unique morphology of granules in a suppurative focus of infection. To our knowledge, this is the first case of pulmonary botryomycosis reported diagnosed by sputum examination rather than by lung tissue examination. We hypothesize that pulmonary botryomycosis and actinomycosis are likely to be different etiologic manifestations of the same disease process, resulting from a chronic suppurative aspiration pneumonia. The exact pathogenesis of this unique host-pathogen relationship that results in granule formation is unknown, but factors that cause a persistence of an infection are likely to play a major role.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Because of the large spectrum of clinical presentations, similarities with other diseases, and difficulties in identifying the responsible agent, the diagnosis of hypersensitivity pneumonitis (HP) is sometimes difficult to make. Serum precipitin analysis and lung histology are commonly used as aids to confirm the diagnosis of HP; however, their routine uses and usefulness remain questionable. Because specific precipitating antibodies are seen in exposed subjects who do not have HP and the number of antigens commercially available for testing is limited, there are large numbers of false-positive and false-negative serologic analyses. This test is, therefore, of limited clinical usefulness. The recent advent of high-resolution computed tomography has greatly added to the parameters needed to confirm the diagnosis. When this technology is used, combined with other diagnostic procedures such as bronchoalveolar lavage, histologic confirmation of HP by a lung biopsy may no longer be required in most cases

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Nonsurgical treatments for obstructive sleep apnea (OSA), although forming the mainstay of therapy, have limitations in effectiveness and/or patient compliance. These limitations have generated interest in developing surgical treatment for this disorder. Although tracheostomy bypasses the collapsing segments of the upper airway and eliminates the OSA, the negative psychosocial implications of undergoing a tracheostomy limit its applicability as a treatment for OSA. Other forms of upper airway surgery for OSA have as their goal reconstruction of the upper airway to increase its dimensions or alter the spatial interrelationships of its components. Surgical approaches include modification of the soft tissue components and the skeletal components. Various surgical procedures may be applied individually or in a multistep protocol, depending on the needs of the patient. Determining the specific location(s) and mechanism of upper airway collapse is an important step in surgical planning. Postoperative success at each stage must be documented by objective polysom-nographic evaluation. Indications for surgery include objectively documented OSA severe enough to be the cause of significant symptoms, medical complications, or excessive risk for future morbidity or mortality.There should be no specific pathologic lesion that when corrected would eliminate the OSA. Nonsurgical approaches should have been rejected or tried unsuccessfully. The risk/benefit ratio of proceeding with upper airway surgery should be favorable.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The principle of double effect (PDE) is an important principle of medical ethics. Yet it is often poorly understood, abused, and criticized. In this article, the author explains the purpose of the PDE. It is further explained that the PDE requires (1) that there be two effects that follow from the doctor's actions; (2) that one effect be intended and the other unintended; (3) that the unintended bad effect cannot be the cause of the intended good effect; and (4) that the good effect must outweigh the bad effect. The differences between intentions, beliefs, desires, and motives are explained. Screening questions about clinical intentions are proposed, and guidelines for morphine dosing that would be consistent with an intention to relieve pain and not to cause death are offered. The PDE does not relieve physicians of responsibility for their actions, but only sets conditions under which they may not be held morally culpable for the unintended side effects of actions they undertake responsibly. As an example, the use of morphine is distinguished from the use of pancuronium to treat the gasping of a patient for whom ventilator treatment is being discontinued. The PDE would permit the use of morphine, but the PDE would not permit the use of pancuronium in such a case

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

As many as 20% of ventilated patients need a gradual transition between mechanical ventilation and spontaneous breathing, that is, a weaning process. The decision to undertake this weaninig process is generally supported by various clinical criteria that evaluate oxygenation and ventilation capacity. Conventional weaning criteria remain the most useful in everyday practice at the patient's bedside, but the reliability of some of them has been questioned by recent studies. In contrast, the new predictive criteria certainly allow a better pathophysiologic approach to weaning, but they are frequently complex and require specific equipment and are difficult to apply in daily clinical practice.A weaning attempt consists of a brief test to evaluate the ability to breathe spontaneously. At this time, no data exist to indicate the optimal duration of such a spontaneous breathing trial nor to determine the best method for performing it. Intolerance to the spontaneous breathing trial means that the patient needs a weaning process, which usually is performed with intermittent mandatory ventilation, pressure support ventilation, or progressive T-piece trials. Recent data demonstrate that weaning outcome may be influenced by the technique employed. Patients are more quickly weaned with pressure support ventilation or trials o spontaneous breathing with a T-tube than with intermittent mandatory ventilation. The best way to perform weaning for each technique and the specific populations that may benefit from each technique still remain to be elucidated.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Patients with connective tissue diseases commonly have involvement of the respiratory system. In this review, we discuss the respiratory complications of the following connective tissue diseases: systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, polymyositis/dermatomyositis, Sjogren's syndrome, ankylosing spondylitis, relapsing polychondritis, and mixed connective tissue disease. Particular attention is given to the clinical manifestations of pulmonary involvement with these disorders, including involvement of the pleura, upper and lower airway, lung interstitium, and the pulmonary vasculature. In appropriate instances, diagnostic and therapeutic considerations are also reviewed.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SYNOPSISAirflow resistance of the various materials of the ventilatory circuit is clinically significant and should be taken into account when deciding which component to choose.SOURCELucangelo U et al. Valoracion comparativa de los niveles de humidifica-cion en intercambiadores de calor-humedad en la ventilacion mecdnica. Med Intensiva 1995;19:125–9

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SYNOPSISThe first step normally carried out in clinical practice, the manual cleaning of the bronchoscopes, is the most critical point leading to adequate disinfection of these devices. Without this step, both the fenolate glutaraldehyde and the povidone-iodine may fail.>SOURCE: Rodríguez-Froján G et al. Estudio experimental de la desinfección del broncofibroscopio. Enferm Infecc Microbiol Clin 1994;12:433–8.

ISSN:1068-0640    

出版商:OVID    

年代:1996

数据来源: OVID