Clinics in chest medicine
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Clinics in chest medicine · Sep 1995
ReviewThoracoscopic management of malignant pleural effusions.
Thoracoscopy has been around for decades, advocated by some, but until recently, ignored by many. Not surprisingly, its diagnostic and therapeutic efficacy in patients with suspected or proven malignant pleural effusions has withstood the test of time. Today, the potential benefits of thoracoscopy must be weighed against its cost in patients with limited life expectancy. ⋯ Several studies demonstrate that thoracoscopic talc pleurodesis is more frequently successful than other methods of pleurodesis. As a staging procedure, thoracoscopy helps determine extent of disease, and possibly, prognosis in patients with metastatic pleural carcinomatosis, lung cancer, and malignant mesothelioma. As this procedure is increasingly rediscovered by our medical and surgical communities, greater clinical and experimental investigation aimed at establishing successful management strategies in patients with malignant pleural effusions will hopefully occur.
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Chronic, major-vessel thromboembolic disease represents a potentially correctable form of pulmonary hypertension. A thorough understanding of the unique problems associated with each aspect of care in these patients is essential to ensure a minimal perioperative mortality and satisfactory long-term outcome. This article reviews the cause, natural history, evaluation, surgical management, and postoperative course of patients with chronic thromboembolic pulmonary hypertension undergoing thromboendarterectomy.
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Clinics in chest medicine · Mar 1995
ReviewEpidemic nosocomial pneumonia in the intensive care unit.
The changing and expanding spectrum of pathogens associated with nosocomial pneumonia (NP) will require modification in our approach to both endemic and epidemic NP in the ICU. Knowledge of specific pathogens, modes of transmission, and sources or reservoirs of epidemic NP is crucial to the recognition, control, and prevention of these infections in ICU patients. This article reviews the epidemiology of nosocomial NP outbreaks and outlines guidelines for investigating suspected epidemics of NP within the ICU. Preventive strategies including appropriate surveillance for recognizing epidemic clusters, adherence to barrier isolation precautions, proper disinfection and sterilization of respiratory care equipment, and judicious use of antimicrobial agents are also discussed.
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Clinics in chest medicine · Mar 1995
ReviewPrevention of ventilator-associated pneumonia. An attainable goal?
Nosocomial pneumonia is a common and serious problem among hospitalized patients, particularly those treated with mechanical ventilation. This article discusses infection control, the role of respiratory therapy equipment and endotracheal tubes, mobilization of tracheobronchial secretions, the role of the gastrointestinal tract, nutritional support and the role of the stomach, prophylactic antibiotics, and immunomodulation. Although there are no proven modalities for immunoprophylaxis of nosocomial pneumonia, it is possible that early administration of a single agent or combination of immune modulators may prove effective in reducing the mortality associated with nosocomial pneumonia.
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Clinics in chest medicine · Mar 1995
ReviewPneumonia complicating adult respiratory distress syndrome.
Aspiration bronchopneumonia occurs in most patients undergoing prolonged mechanical ventilation. These pneumonias adversely affect lung function and release bacteria into the systemic circulation via the lungs' lymphatics. Through this mechanism, clinically occult pneumonias may initiate activation of systemic inflammation, leading to the syndrome of multiple organ failure.