Respiration; international review of thoracic diseases
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Comparative Study
The value of small-bore catheter thoracostomy in the treatment of malignant pleural effusions.
Malignant pleural effusions can cause severe debilitating symptoms and impair the quality of life. Treatment is often palliative, usually consisting of sequential thoracenteses or tube thoracostomy with or without sclerotherapy. Large-bore thoracostomy tubes have traditionally been used for drainage and sclerotherapy. More recently, the use of small-bore catheters has been studied. ⋯ Pleurodesis can successfully be performed via a small-bore catheter in patients with recurrent malignant pleural effusion. To validate the results of the study, a prospective randomized study, comparing this device (Pleuracan) and a 'standard' 16- to 24-french chest drain, should be performed.
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There is a pressing need for more effective drug treatments for COPD. New bronchodilators include a long-acting anticholinergic tiotropium bromide and a dual beta2-dopamine2-receptor agonist. But no treatments prevent the progression of COPD. ⋯ These include phosphodiesterase-4 inhibitors, nuclear factor-kappaB inhibitors and p38 MAP kinase inhibitors. Small molecule protease inhibitors, including neutrophil elastase inhibitors and selective matrix metalloproteinase inhibitors are also in development. Future drug targets may be identified by gene array and proteomics.
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Although mixed venous O2 saturation (SvO2) accurately indicates the balance of O2 supply/demand and provides an index of tissue oxygenation, the use of a pulmonary artery (PA) catheter is associated with significant costs, risks and complications. Central venous O2 saturation (ScvO2), obtained in a less risky and costly manner, can be an attractive alternative to SvO2. ⋯ ScvO2 and SvO2 are closely related and are interchangeable for the initial evaluation of critically ill patients even if cardiac indices are different. SvO2 can be estimated with great accuracy by ScvO2 in 92% of the patients using a power model.
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Comparative Study
Effect of continuous positive airway pressure therapy on infectious complications in patients with obstructive sleep apnea syndrome.
Nasal continuous positive airway pressure (CPAP) is a well-established, widely used and effective treatment of obstructive sleep apnea syndrome (OSAS). Unfortunately, side effects are frequent during CPAP treatment. ⋯ Our results suggest that patients using CPAP therapy either with or without heated humidity seem to be at an increased risk of upper airway infections compared to conservatively treated patients.
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Increased interleukin-5 (IL-5) levels have been reported in bronchoalveolar lavage fluid (BALF) from patients with acute eosinophilic pneumonia (AEP); however, it still remains to be determined whether IL-5 is responsible for the eosinophil accumulation in the lung. ⋯ These findings suggest that locally produced IL-5 plays an important role in eosinophil accumulation of AEP.