Clinics in chest medicine
-
Clinics in chest medicine · Jun 1993
ReviewPerioperative respiratory care of the patient undergoing upper abdominal surgery.
The respiratory system is invariably affected during and after abdominal surgery. In high-risk patients, this may result in the development of postoperative pulmonary complications (PPC). Several pulmonary and nonpulmonary risk factors have been identified as good predictors for PPC. This article summarizes the treatments that may help prevent the development of PPC in patients undergoing upper abdominal surgery.
-
Clinics in chest medicine · Jun 1993
ReviewCardiac risk evaluation and management in noncardiac surgery.
A careful history, physical examination, resting electrocardiogram, and chest radiograph are essential for preoperative cardiac assessment of adult patients. The nine individual Goldman indicators of increased perioperative cardiac risk and evidence of an unstable coronary ischemic syndrome should be specifically sought in each patient and treated when possible. After initial assessment, patients who still have a medium level of perioperative risk can usually be accurately assigned to a high- or low-risk category through the use of exercise testing and the selective use of dipyridamole thallium imaging.
-
Clinics in chest medicine · Mar 1993
ReviewEvaluation and management of solitary and multiple pulmonary nodules.
Solitary pulmonary nodules are malignant in 50% of cases. The 5-year cure rate after resection of a malignant nodule averages 50% and is even higher if the nodule is small. Stability for 2 years suggests benignity, and the presence of calcification in certain patterns indicates that the nodule is probably benign. ⋯ The "wait and watch" strategy may be advisable under certain circumstances. Multiple pulmonary nodules are usually due to metastatic spread from an extrapulmonary primary tumor. Biopsy is usually advisable because the nodules may be due to a curable benign process.
-
Pleural effusions are common in the setting of lung cancer. A pleural effusion associated with lung cancer is an ominous finding, but a small percentage of patients are candidates for curative surgery. ⋯ When a malignant pleural effusion is diagnosed, the clinician must decide on the most appropriate form of palliation for the symptomatic patient. In the symptomatic patient with a reasonable life expectancy and pleural fluid pH of more than 7.3, chemical pleurodesis appears to be the most effective and least morbid therapy.
-
Sepsis remains an uncommon, but potentially devastating problem in the previously healthy pregnant patient. Although septic sequelae, including organ failure and shock, are unusual, they are likely to lead to morbidity and mortality as high, or higher, than in the general population. At the present time, hemodynamic support, surgery, and antimicrobial therapy aimed at reducing polymicrobial aerobic and anaerobic infection remain the gold standard of therapy. New antimediator and anti-inflammatory therapies offer promise of improved survival in the general and obstetric population with severe sepsis.