Clinics in chest medicine
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Pregnancy may affect the diagnosis, management, and outcome of infiltrative lung disease (ILD). Conversely, ILD may affect pregnancy. ILD may occur as a result of drugs administered commonly or specifically during pregnancy. ⋯ During pregnancy ILD may arise de novo and preexisting ILD may be exacerbated or significantly worsened. Some ILDs generally do not alter the management of pregnancy, labor, or delivery. Preexisting ILD no longer contraindicates pregnancy systematically, but thorough evaluation of ILD before pregnancy is required to identify potential contraindications and adapt monitoring.
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Clinics in chest medicine · Dec 2010
ReviewDeep vein thrombosis prophylaxis in hospitalized medical patients: current recommendations, general rates of implementation, and initiatives for improvement.
Venous thromboembolism (VTE), which encompasses deep vein thrombosis and pulmonary embolism, is a leading cause of preventable morbidity and mortality following hospitalization. In the last decade, investigators have used randomized controlled trials to assess the efficacy and safety of various methods of VTE prevention for more than 20,000 medical patients. Identifying medical patients at risk for VTE and providing effective prophylaxis is now an important health care priority to reduce the burden of this morbid and sometimes fatal disease. ⋯ It is effective, safe, and cost effective. Multiple scientific guidelines support VTE prophylaxis in medical patients. Regulatory and accreditation agencies have mandated that hospitals use formalized systems to assess VTE risk and provide clinically appropriate prophylaxis measures to patients at risk.
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Hypercoagulable states can be inherited or acquired. Inherited hypercoagulable states can be caused by a loss of function of natural anticoagulant pathways or a gain of function in procoagulant pathways. ⋯ Venous thromboembolism occurs when the risk exceeds a critical threshold. Often a triggering factor, such as surgery, pregnancy, or estrogen therapy, is required to increase the risk above this critical threshold.
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Clinics in chest medicine · Sep 2010
ReviewUtility of bronchoalveolar lavage in evaluation of patients with connective tissue diseases.
Pulmonary involvement is common in patients with connective tissue diseases (CTDs), and significantly contributes to morbidity and mortality in this patient population. There are different forms of lung pathology in CTDs, which include primary involvement such as interstitial lung disease or pulmonary hemorrhage, and pulmonary complications resulting from other CTD-related organ involvement including aspiration pneumonia due to muscle weakness or esophageal fibrosis. Moreover, iatrogenic lung disease, such as medication-induced hypersensitivity pneumonitis or opportunistic infections due to immunosuppression, may develop. ⋯ Moreover, in view of the broad variability of clinical course of CTD-related interstitial lung disease, identification of biomarkers helpful in predicting prognosis becomes of key importance. In addition to radiological assessment and functional testing that provide information regarding localization and severity of lung disease, bronchoalveolar lavage (BAL) appears helpful in revealing the nature of lung pathology and intensity of lung inflammation through sampling of cells and fluid from the lower respiratory tract. The aim of this article is to critically review available data concerning the evaluation of BAL cytology in different forms of lung disease associated with CTDs.
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Sjögren syndrome is a slowly progressing autoimmune disease. Pulmonary manifestations are frequent in primary Sjögren syndrome but often not clinically significant; the most common are xerotrachea, interstitial lung diseases, and small airway obstruction. Pulmonary manifestations in Sjögren syndrome have a slow progression and favorable prognosis, with the exception of primary pulmonary lymphoma and pulmonary hypertension.