摘要:

&NA;Because of the problem of pneumococcal resistance to &bgr;‐lactam and macrolide antibiotics, much more frequent in Spain than in other parts of the world, during the last decade, there has been a need to develop specific guidelines for the management of community‐acquired pneumonia (CAP). Owing to the characteristics of high‐level macrolide resistance, these antibiotics are not a valid treatment for pneumococcal pneumonia in Spain, and, therefore, they cannot be recommended as a first‐line empiric treatment for all episodes of nonsevere CAP. In contrast, penicillin and aminopenicillins still appear to be useful alternatives in the treatment of pneumococcal pneumonia, provided that they are adequately dosed. In 1996, the Spanish Respiratory Society (SEPAR) developed a newGuidelines for the Diagnosis and Treatment of Community‐Acquired Pneumonia,including a specific diagnostic and therapeutic approach for five different categories of CAP on the basis of three main characteristics: the clinical presentation, the relative risk for presenting uncommon pathogens, and the severity of the episode. The basic recommendation for the empiric treatment of nonsevere CAP in Spain was the prescription of an aminopenicillin (amoxicillin) or a macrolide according to the clinical presentation. The prescribed antibiotic had to be replaced by the alternative option if there was no improvement after 48 hours. Since the introduction of the new quinolones, the empiric antibiotic prescription for CAP in Spain has become much simpler, according to the recent consensus guidelines on the management of CAP issued by the SEPAR and the Spanish Society of Chemotherapy (SEQ).Clin Pulm Med 2000;7(1):1‐8

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The use of corticosteroids for treatment of interstitial lung disease (ILD) is problematic because of significant side effects and limited efficacy in some ILDs, particularly idiopathic pulmonary fibrosis (IPF). This review summarizes recent data and controversies regarding corticosteroid therapy in IPF and sarcoidosis. A few trials, which have compared corticosteroids alone with corticosteroids in combination with immunosuppressives for patients with IPF, suggest that combination therapy is more effective and should be the first‐line empiric therapy. Other anti‐inflammatory agents such as colchicine do not appear to be more effective than corticosteroids but are better tolerated. Therapy with new antifibrotic agents such as pirfenidone and interferon appears promising; however, its efficacy needs to be established in well‐designed, long‐term studies with control populations. Although corticosteroids are highly effective in treating acute symptoms and functional deterioration in sarcoidosis, the long‐term benefit of chronic corticosteroid use for patients who fail to remit is probably small. Alternative therapies, particularly methotrexate, have been used to suppress clinical deterioration in sarcoidosis. Although results in some studies are encouraging, the efficacy of methotrexate and/or an alternative regimen in the treatment of sarcoidosis remains to be established.Clin Pulm Med 2000;7(1):9‐14

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The portable chest radiograph (pCXR) plays a key role in the evaluation of critically ill patients, frequently revealing abnormalities that cannot be detected clinically. Unfortunately, high‐quality pCXRs may be difficult to obtain in the intensive care unit, where poor patient cooperation, inconsistent technique, and other obstacles may lead to inadequate studies. The value of the pCXR is enhanced by proper technique and state‐of‐the‐art equipment. When interpreting the pCXR, a comprehensive, orderly approach is mandatory. Life‐threatening complications, such as malpositioning of the endotracheal tube and tension pneumothorax, must be ruled out immediately. Next, it is important to identify common processes, such as pneumonia, pulmonary edema, and atelectasis, recognizing that their appearance may be altered by preexisting disease. Because patients are often supine, it is critical to recognize the features of disorders such as pneumothorax and pleural effusion when viewed in this position. Finally, when uncertainty exists, other modalities such as CT and ultrasound may prove to be invaluable.Clin Pulm Med 2000;7(1):15‐23

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Pulmonary consequences of chronic liver diseases can be classified in terms of their effects on the pleural space, lung parenchyma (airways and interstitium), and pulmonary circulation. Clinically, such liver‐lung problems can result in varying degrees of hypoxemia, restrictive or obstructive lung physiology, and pulmonary hemodynamic abnormalities. This review addresses some of the recent clinical literature and emphasizes liver‐lung problems from the pulmonary perspective, including concerns that arise in liver transplant candidates.Clin Pulm Med 2000;7(1):24‐29

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Respiratory monitoring provides a better physiologic understanding of the critically ill patient. Arterial blood gas analysis is a commonly used invasive technique to assess gas exchange and acid base status. However, with the development of noninvasive methods to assess gas exchange, pulse oximetry and capnography have become more popular. Research has also focused on other invasive techniques that assess the degree of tissue hypoxia. Monitoring respiratory neuromuscular function is rarely done at the bedside, but advances in technology enable the measurement of respiratory drive by analyzing breathing patterns. Assessing respiratory muscle function at the bedside is accomplished by measuring respiratory pressures with voluntary maneuvers or stimulation of the phrenic nerve. These measurements provide information on respiratory muscle performance and may predict success or failure after discontinuation of mechanical ventilation. Other tests of pulmonary function in the critically ill patient include compliance and vital capacity measurements and the generation of flow‐volume and pressure profile curves. In addition, the ability to measure autopositive end‐expiratory pressure provides valuable information on respiratory system mechanics. Most importantly, a complete physical examination coupled with the use of respiratory monitoring equipment greatly enhances the predictive power of all monitoring systems. In this way, a better understanding of the pathophysiology of a patient's disease will be gained.Clin Pulm Med 2000;7(1):30‐40

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The first implantable endovascular devices for the treatment of venous thromboembolism (VTE) were the Mobin‐Uddin Umbrella (1969) and the Kimray‐Greenfield filter (1973). Current vena cava filters (VCFs), like the initial devices, filter and trap emboli from distal venous beds that may embolize to the lungs. Their design promotes caval interruption without occluding venous flow. Percutaneous catheter deployment of devices usually within the inferior vena cava has facilitated their placement of VCFs. Increased experience with this adjunct to the management of VTE has shown favorable safety and efficacy profiles. Ease of placement, familiarity with these devices, and favorable efficacy profiles have all been implicated for the current increase in VCF placement. Many authors have advocated their use in a number of clinical settings that would not be considered typical indications, and many of these indications remain controversial. Standard indications for VCF insertion in patients with VTE include (1) contraindications to anticoagulant therapy; (2) failure of anticoagulant therapy; (3) free‐floating proximal thrombi; (4) surgical embolectomy or endarterectomy; (5) chronic recurrent pulmonary embolism with pulmonary hypertension. Current “evolving” indications and practices include (1) alternative locations, including both the suprarenal inferior vena cava and superior vena cava; (2) primary treatment of VTE in patients without contraindications to anticoagulation; (3) primary prophylaxis in patients historically at high risk for VTE; and (4) the use of temporary VCFs. Significant questions regarding improvement in survival, cost‐effectiveness, and long‐term safety and efficacy compared with anticoagulation remain unanswered.Clin Pulm Med 2000;7(1):41‐47

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Pulmonary lymphoproliferative disorders encompass a spectrum of diseases that range from low‐grade lymphomas of the bronchus‐associated lymphoid tissue to the newly described pleural effusion lymphoma (AIDS‐related body cavity‐based lymphoma). The development of new immunohistochemical and molecular biologic markers of these disorders has provided new insights into pathogenesis, diagnosis, and classification of these lesions. This article will review the major important clinical and pathologic features of each disease and highlight new observations and theories regarding their pathogenesis and treatment.Clin Pulm Med 2000;7(1):48‐60

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Synopsis:Patients with a first episode of idipathic venous thromboembolism may benefit from treatment with anticoagulant agents for longer than 3 months.Source:Kearon C et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med 1999;340:901‐7.

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1068-0640    

出版商:OVID    

年代:2000

数据来源: OVID