Chest
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The treatment of small cell lung cancer (SCLC) has evolved significantly over the past 3 decades. Single-agent and combination chemotherapies given with radiotherapy have greatly improved response rates and median survival. Combination regimens such as cisplatin/etoposide, carboplatin/etoposide, ifosfamide/carboplatin/etoposide, cyclophosphamide/doxorubicin/vincristine, and etoposide/ifosfamide/cisplatin have all achieved good response rates. ⋯ New agents showing good preliminary single-agent activity in untreated SCLC include paclitaxel, vinorelbine, gemcitabine, topotecan, and teniposide. Results obtained with single-agent docetaxel and CPT-11 are thus far inconclusive. Studies evaluating response and survival rates of these new agents in combination with agents of known activity are underway.
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Comparative Study
Phrenic nerve dysfunction after cardiac operations: electrophysiologic evaluation of risk factors.
Phrenic nerve injury may occur after cardiac surgery; however, its cause has not been extensively investigated with electrophysiology. The purpose of this study was to determine by electrophysiologic means the importance of various possible risk factors in the development of phrenic nerve dysfunction after cardiac surgical operations. ⋯ Among the risk factors investigated, only the use of ice slush was significantly associated with postoperative phrenic nerve dysfunction. Therefore, ice should be avoided in cardiac surgery, since it does not seem to provide additional myocardial protection.
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Comparative Study
Evaluation of potential fat emboli during placement of intramedullary nails after orthopedic fractures.
To evaluate material with high echogenicity demonstrated by transesophageal echocardiography (TEE) during the reamed intramedullary nailing procedure in long-bone fracture patients, and to analyze BAL fluid (BALF) in these patients as well as in those with the fat embolism syndrome (FES). ⋯ The highly echogenic material seen in TEE during reamed intramedullary nailing could be fat globules on the basis of BALF analysis. However, all patients with large emboli by TEE do not develop FES. A factor other than mechanical obstruction by fat globules may be necessary for the development of FES.
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To critically appraise and summarize the studies examining the cost-effectiveness of noncardiac transitional care units (TCUs). ⋯ To date, the evidence in the literature is insufficient to determine under which circumstances, if any, TCUs are a cost-effective alternative technology to the traditional institution with only ICU and general ward beds.
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The aim of the present study was to evaluate the forced oscillation technique (FOT) in cystic fibrosis (CF) children and to participate in the discussion about the usefulness of beta2-antagonists in CF. ⋯ The results suggest that FOT measurements cannot replace baseline spirometric measurements in CF, but that the evaluation of the effect of beta2-agonists on the airway diameter in CF should include an FOT measurement.