Lung
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Chronic cough is a common condition that causes considerable physical and psychological morbidity. The physical symptoms of cough are readily apparent; however, the psychosocial symptoms are often overlooked. ⋯ They should be used in conjunction with other cough severity measures such as cough frequency monitors to obtain a more complete assessment of cough severity. Recent cough guidelines endorse the measurement of cough-specific quality of life and these questionnaires are ideal tools to facilitate this.
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Gastroesophageal reflux disease (GERD) is a common cause of unexplained chronic cough. This article reviews important clinical considerations regarding association, diagnosis, and treatment of GERD in the setting of chronic unexplained cough.
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Comparative Study Clinical Trial
Increased pleural fluid adenosine deaminase levels in patients with malignant pleural effusions: a potential predictor of talc pleurodesis outcome.
Chemical pleurodesis using various sclerosing agents is accepted palliative therapy for patients with recurrent, symptomatic, malignant pleural effusions (MPE). However, the utility of various clinical and biochemical parameters in predicting pleurodesis outcome is still controversial. The objective of this study was to investigate the relationship between pleural fluid adenosine deaminase (Pf-ADA) levels and talc pleurodesis outcomes, and to compare Pf-ADA levels to various other biochemical variables with respect to predicting talc pleurodesis outcome in patients with MPE. ⋯ In analysis of the subgroup, Pf-ADA were found to be a good marker for discrimination between successful and unsuccessful pleurodesis in patients with MM (p < 0.001) but not in the MPC group (p = 0.068). These results indicate that Pf-ADA levels could be considered predictors of the outcome of pleurodesis, especially in patient with MM. Furthermore, the present study also demonstrated that Pf-ADA level is a superior test to predict the outcome of pleurodesis compared to pleural fluid pH and albumin level.
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Comparative Study
Pleural mesothelial cells mediate inflammatory and profibrotic responses in talc-induced pleurodesis.
Intrapleural talc is used to produce pleurodesis in malignant pleural effusions. Prior in vivo studies have documented an acute inflammatory response to talc in the pleural space but the cellular source of cytokines has not been identified. The aim of this study was to investigate the acute response of rabbit pleural mesothelial cells challenged with talc used for pleurodesis and compare it to prior studies of the response to talc in the rabbit pleural space. ⋯ At 6 h, the IL-8, VEGF, and TGF-beta(1) levels produced by talc-exposed PMC increased significantly and remained elevated for up to 48 h. These cytokine levels rose at similar times and at the same or higher levels than have been measured in the rabbit pleural space in prior studies. We report that viable, talc-exposed, pleural mesothelial cells may actively mediate the primary inflammatory pleural response in talc-induced pleurodesis.
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Randomized Controlled Trial
Efficacy of corticosteroids in the treatment of community-acquired pneumonia requiring hospitalization.
Recent studies suggested that administration of corticosteroids may improve clinical outcomes in patients with severe pneumonia. ⋯ In moderate-severe CAP, administration of corticosteroids promotes resolution of clinical symptoms and reduces the duration of intravenous antibiotic therapy.