摘要:

Patients with chronic obstructive pulmonary disease (COPD) are especially prone to bronchial colonization and acute infection, including acute infectious exacerbations and community-acquired as well as nosocomial pneumonia. Bacterial colonization may promote bronchial inflammation, predispose to acute exacerbations, and thereby contribute to respiratory decline.Haemophilus influenzaeandStreptococcus pneumoniaeare the most frequently encountered pathogens in both stable disease as well as acute exacerbations. The role of bacterial infection in acute exacerbations remains subject to controversy; however, evidence is in favor of regular antimicrobial treatment in patients with severe exacerbations. COPD represents an important risk factor for community-acquired pneumonia (CAP). Microbial patterns for CAP differ from exacerbations in that S.pneumoniaeand “atypical” bacterial pathogens predominate. Similarly, COPD has been recognized as an important risk factor for nosocomial pneumonia. Initial empiric antimicrobial treatment of both severe acute exacerbations and pneumonia should take into account regional drug resistance rates to penicillin ofS. pneumoniaeand should cover Gram-negative enteric bacilli. The additional treatment of atypical bacterial pathogens andPseudomonas aeruginosashould be considered individually.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Acute respiratory infection is one of the main causes of human disease worldwide. In the developing countries, acute respiratory infections are the main cause of death in children <5 years old. When lower tract manifestations are predominant in children, viruses are the most common agents, whereas in adults, bacteria are the leading causes of this syndrome. Upper respiratory tract infections are mainly viral in origin in the general population. Respiratory tract infections and reinfections occur throughout life but are more frequent in childhood. Several viruses belonging to different families and genera can cause infections, and it is impossible to recognize the etiologic agent on clinical grounds alone. Virologic diagnosis is easy to perform and permits specific antiviral treatment, potential withdrawal of antibiotics, and recognition of an epidemic situation with institution of preventive measures when indicated.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Inhalation of irritant gases, vapors, fumes, and particulates occurs in industry, agriculture, homes, and in structural fires. Acute responses to irritants can include rhinoconjunctivitis, pharyngitis, laryngospasm, bronchospasm, chemical bronchitis, and chemical pneumonitis. Subacute/chronic sequelae may include irritant rhinitis/sinusitis, irritant-induced asthma, irritant-associated vocal cord dysfunction, odor-triggered panic attacks, and bronchiolitis obliterans. Overlapping presentations, particularly for disorders producing episodic dyspnea in the workplace, can pose difficulties in the differential diagnosis. Similarities and differences in clinical presentation are reviewed in this article, as well as the importance of integrating psychosocial dynamics into the medical workup.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

As respiratory system diseases in childhood are very common, lung function tests are in demand. The least complicated measurement of lung function is the recording of flow and volume plotted as a loop during tidal breathing. Recently, tidal flow-volume loop (TFVL) analysis has been extensively used as a valuable, simple, and relatively noninvasive lung function technique in infants and children. Lung function measurement by tidal breathing is a method that can be performed at any age, with minimal patient cooperation, or even when the patient is sedated. TFVL analysis has not been found to negatively alter respiration even in acutely ill patients. This article reviews technical and practical issues related to TFVL analysis. Influence of measurement conditions, as well as comparison with other commonly used lung function tests are also discussed. The different areas of TFVL applicability in diagnosis, disease management, and research are shown.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

While health care costs rise at nearly twice the rate of inflation, intensive care unit (ICU) costs are rising even faster. Hospital costs may range from 30% to 45% of hospital charges; however, this ratio varies greatly for individual services. Either fixed versus variable costs or direct versus indirect costs is the typical way that ICU costs are categorized. The term “cost analysis” refers to a variety of different economic analyses. The sum of all direct costs associated with providing a service is best termed a cost minimization analysis (CMA) not cost analysis. Preferable is a cost-effective analysis (CEA), which allows comparison between different therapies designed to affect the same outcome. Cost-effectiveness ratios (CERs) allow the determination of the relative advantage of one therapy over another. The most useful types of analysis are the cost benefit analysis (CBA) and cost utility analysis (CUA). Using a CBA, different therapies for different disease states can be directly compared provided a dollar value can be assigned to every outcome. A CUA is the cost of the service divided by the societal benefit usually using quality-adjusted life-years (QALYs). Strategies to reduce ICU costs are also reviewed in this article. These strategies include reducing labor costs, altering disease-specific therapies, and changing health care delivery. The advantages, disadvantages, return on investment, and feasibility of implementing these strategies are discussed.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Positive pressure ventilation (PPV) is often required in critically ill patients with unstable cardiovascular status. Mechanical ventilation can result in further alterations of cardiac output (CO) and arterial blood pressure. The evidence supporting a variety of potential pathophysiologic mechanisms for hemodynamic instability related to PPV is examined. The predominant determinant of hypotension during mechanical ventilation appears to be a reduction in preload. The impaired preload is due to the smaller gradient for venous return caused by the increased intrathoracic pressure. Additional potential pathophysiologic effects of PPV include increased pulmonary vascular resistance, ventricular interdependence, changes in contractility, and altered humoral and autonomic responses. A number of clinical scenarios such as acute respiratory distress syndrome, obstructive airway disease, and heart failure, which commonly require mechanical ventilation, are examined in further detail.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Approximately one in eight tobacco smokers develops bronchogenic carcinoma over a lifetime. The ability to identify a cancer-susceptible smoker would enable the physician and public health authorities to target intensive smoking-cessation efforts and chemoprevention interventions on the highly susceptible smoker. Additionally, early lung cancer screening techniques could be focused on those at highest risk for lung cancer. Recent developments in the understanding of the influence of genetics on the pathogenesis and susceptibility to lung cancer are outlined, and these developments, combined with demographic and clinical information, profile the high-risk individual. Reviewed in this article are currently available and clinically applicable lung cancer early-detection strategies, which include molecular, cyto-pathologic, and imaging techniques. In addition, the authors review other modalities likely to be instituted in the near future. Pending reevalution of these strategies, it is reasonable to use plain chest radiographs as an initial screening tool in high-risk smokers, such as those with preexisting lung disease, family history of lung cancer, and ongoing occupational and/or tobacco smoke exposure.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In this perspective article, the authors focus on gender as it relates to pulmonary disease. The very real threat of smoking and lung cancer has been recognized, but gender-related issues in other conditions have not been emphasized. There are minor differences in bronchial responsiveness and breathing mechanics between men and women. The subconscious conversion disorder of vocal cord dyskinesis occurs predominantly in young adult women. Sleep apnea and sleep-disordered breathing have a prevalence of 4% in men and 2% in women, aged 30 to 60 years. Many of these women may go unrecognized or be labeled with chronic fatigue syndrome if a good history for sleep disorders is not obtained. Primary pulmonary hypertension is more common in women than men but only by 1.7 to 1.0 for all ages. With further review of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) data, the correlation of pulmonary embolism to estrogen use, child-bearing, and an increased incidence of thrombophlebitis has not been as strong as previously reported. Diseases such as lymphangioleiomyomatosis and the catamenial syndromes of pneumothorax, pleural effusions, and/or hemoptysis are unique to women but often present as perplexing clinical problems. The premenstrual exacerbation of asthma has been reported with increasing frequency. As evidence-based medical literature accumulates, gender-related differences and similarities will be clarified by studies with both men and women as subjects.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SYNOPSISA randomized, double-blind trial evaluating the efficacy of montelukast, a leukotriene receptor antagonist, versus placebo in mild-to-moderate asthma, showed efficacy for this new therapy.SOURCEReiss TF et al. Montelukast, a once-daily leukotriene receptor antagonist, in the treatment of chronic asthma. Arch Intern Med 1998;158:1213–20.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SYNOPSISA meta-analysis of 30 randomized, controlled trials evaluating the use of human albumin in the critically ill concluded that albumin was not beneficial and that it possibly would increase mortality.SOURCECochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. BMJ 1998;317:235–40.

ISSN:1068-0640    

出版商:OVID    

年代:1999

数据来源: OVID