Chest
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To evaluate the indications, safety, therapeutic impact, and outcome of fiberoptic bronchoscopy (FOB) in coronary care unit (CCU) patients. ⋯ FOB may be diagnostically useful in the evaluation of pulmonary abnormalities in selected patients with acute cardiac disease, can be performed safely, and may influence management decisions. Positive bronchoscopy cultures often influence therapy but are associated with higher mortality, suggesting a lethal effect of nosocomial pneumonia in this subset of CCU patients. The risks of FOB must be weighed with the impact of FOB results on patient outcome, and its role requires further investigation.
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A case of acute intoxication presented as toxic pneumonitis after exposure to Roundup (glyphosate) (Solaris Group, Monsanto; San Ramon, CA) herbicide in an agriculture worker. The correct etiologic factor causing this specific clinical picture was identified only 2 weeks later, after a thorough occupational history was taken and meticulous delineation of the working conditions and exposures of the involved worker were made. ⋯ In these situations, rapid and comprehensive evaluation is necessary in order to clearly identify the causative agent(s) and to initiate the appropriate treatment. Consulting occupational physicians at this early stage may facilitate early and accurate diagnosis.
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Case Reports
Successful treatment of gemcitabine toxicity with a brief course of oral corticosteroid therapy.
Gemcitabine is a nucleoside analog that is useful in the treatment of solid tumors. Its use has been postulated to produce lung injury by causing a capillary leak syndrome. ⋯ Following the administration of oral corticosteroids, she had complete resolution of all signs and symptoms of gemcitabine toxicity. Physicians should be aware of this treatable complication of gemcitabine therapy.