Canadian respiratory journal : journal of the Canadian Thoracic Society
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Obstructive sleep apnea (OSA) is a common diagnosis in clinical practice. Excessive daytime sleepiness may be a warning for possible OSA. ⋯ High levels of excessive daytime sleepiness in this particular rural population are common and men >55 years of age are at highest risk. Examination of reasons for residual sleepiness and snoring in persons with and without sleep apnea is warranted.
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Review Case Reports
Management of necrotizing pneumonia and pulmonary gangrene: a case series and review of the literature.
Necrotizing pneumonia is an uncommon but severe complication of bacterial pneumonia, associated with high morbidity and mortality. The availability of current data regarding the management of necrotizing pneumonia is limited to case reports and small retrospective observational cohort studies. Consequently, appropriate management for these patients remains unclear. ⋯ Necrotizing pneumonia often leads to pulmonary gangrene. Computed tomography of the thorax with contrast is recommended to evaluate the pulmonary vascular supply. Further study is necessary to determine whether surgical intervention, in the absence of pulmonary gangrene, results in better outcomes.
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Staging of the mediastinal and hilar lymph nodes plays a crucial role in identifying the best treatment option for patients with confirmed or suspected lung cancer and, in many cases, can simultaneously confirm a diagnosis of cancer. Noninvasive modalities, such as computed tomography (CT), positron emission tomography (PET) and PET-CT, are an important first step in this assessment. Ultimately, invasive staging is frequently required to confirm or rule out the presence of metastatic disease within the lymph nodes. The present focused review describes and compares noninvasive and invasive modalities for mediastinal staging in lung cancer.
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Studies comparing continuous renal replacement therapy modalities are lacking. Theoretically, continuous venovenous hemofiltration (CVVH) could be more effective than continuous venovenous hemodiafiltration (CVVHDF), and may be associated with fewer complications; however, there are no published data to support this hypothesis. ⋯ The present retrospective review suggests that the use of CVVH does not reduce mortality or hospital length of stay when compared with CVVHDF. Future randomized trials should control for different patient populations and continue to evaluate the removal of small molecules such as hormones.