Clinics in chest medicine
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Clinics in chest medicine · Dec 2005
ReviewHepatopulmonary syndrome and portopulmonary hypertension: implications for liver transplantation.
Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH) are uncommon pulmonary vascular consequences of advanced liver disease. HPS, characterized by arterial hypoxemia caused by pulmonary vascular dilatation, may resolve completely after liver transplantation. POPH, caused by vasoproliferation/constriction and obstruction of pulmonary arterial blood flow, is associated with higher risk for liver transplantation and increased post-transplantation mortality. With or without transplantation, survival in patients who have these syndromes is associated with specific oxygenation and hemodynamic variables.
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Under most conditions, the lungs compensate for the stresses of illness to ensure adequate acquisition of oxygen. Even with exposure to high altitude, the lungs' adaptations ensure that this process takes place. This process is challenged by global hypoxia, especially if there is impairment in the three processes needed for adequate tissue oxygenation: (1) intact ventilatory drive to breathe; (2) sufficient increase in alveolar ventilation, which is stimulated by that drive; and (3) intact gas exchange at the alveolar-capillary interface. This article reviews the mechanisms that make the study of high altitude relevant to patients who have heart or lung disease at low altitude.
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Clinics in chest medicine · Jun 2005
ReviewThe DOTS strategy for controlling the global tuberculosis epidemic.
This article reviews the principles, scientific basis, and experience with implementation of the directly observed treatment strategy, short course (DOTS) for tuberculosis. The relevance of DOTS in the context of multidrug-resistant tuberculosis and the HIV epidemic also is discussed.
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Sepsis is a frequent and often fatal complication of pneumonia. This article discusses the epidemiology, pathophysiology, and treatment of sepsis in the setting of pneumonia. Particular consideration is given to the role of mechanical ventilation in amplifying organ dysfunction in sepsis and to treatments that have positive effects on sepsis mortality and respiratory dysfunction.
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Clinics in chest medicine · Mar 2005
ReviewPreventing pneumonia: the role for pneumococcal and influenza vaccines.
Streptococcus pneumoniae and influenza cause a wide spectrum of illness and result in substantial morbidity and mortality. They are significant public health concerns, and vaccines against both organisms exist. The pneumococcal polysaccharide vaccine has been available in its current form for over 20 years. ⋯ The role for revaccination remains controversial. Traditional influenza vaccine is composed of three virus types and decreases rates of serologically confirmed cases of influenza, hospital admissions for respiratory infection, and mortality. The pneumococcal and influenza vaccines are considered cost-effective options for pneumonia prevention.