Current opinion in pulmonary medicine
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A variety of diseases either directly or indirectly affect the pleura, resulting in the accumulation of pleural fluid. A pleural effusion develops whenever the influx of fluid into the pleural space is greater than the efflux. It is now clear that the parietal pleura has the primary role in the reabsorption of pleural fluid normally and during pathologic conditions. Recently, models of experimental pleuritis have demonstrated the importance of inflammatory cytokines in the pathogenesis of both asbestos- and endotoxin-induced pleural effusions.
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Despite being a treatable and preventable disease, tuberculosis will kill an estimated 30 million people during the current decade. Tuberculosis is a global problem, and increases in case rates are occurring not only in the developing countries of the world but also in several industrialized nations, such as the United States. Coincident with the resurgence of tuberculosis in the United States, there has also been an alarming increase in the number and proportion of cases caused by strains of Mycobacterium tuberculosis that are resistant to multiple first-line drugs. ⋯ The HIV epidemic is playing a pivotal and permissive role in the resurgence of tuberculosis morbidity and mortality in those populations where tuberculosis and HIV are prevalent and overlap. Co-infection with HIV distorts the natural history and clinical expression of tuberculosis. Molecular biology has yielded important insights into the mechanisms of drug resistance and provided powerful tools for the rapid diagnosis and epidemiologic study of this disease.
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Infection with HIV was first recognized through a clustering of unusual respiratory infections. The lung has been a major target manifesting many of the infectious complications of the immunodeficiency. Noninfectious pulmonary complications in HIV-infected individuals are also common and have been recognized since the advent of the AIDS epidemic. ⋯ Bronchoscopists have accumulated a collection of endobronchial lesions uncommonly seen in non-HIV-related pulmonary consultation. In the following review, we discuss the epidemiology, pathology, pathogenesis, clinical features, diagnostic findings, prognosis, and therapeutic options available for each noninfectious pulmonary complication. As the life expectancy for HIV-infected patients increases, the incidence of noninfectious pulmonary complications will rise.
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Smoke inhalation injury affects nearly one third of all major burn victims. Significant inhalation exposures must be suspected in persons who were entrapped in a closed space or who became unconscious during a fire. ⋯ In addition to variable amounts of thermal loads, firesmoke may contain mixtures of carbon monoxide, hydrogen cyanide, nitrogen oxides, and other highly irritating gases. Each constituent of firesmoke may potentially create pulmonary and systemic toxicities and must be considered in every victim of smoke inhalation.
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This gathering of new observations about chronic obstructive pulmonary disease, collected under the loosely defined heading of "pathology," creates a certain air of excitement. Vascular engorgement in concert with muscle contraction produces small airways narrowing in asthma, but not in chronic obstructive pulmonary disease. Stenotic small airways can be visualized in three dimensions. ⋯ Microvascular injury seems to produce emphysema. The protease-antiprotease theory of emphysema has competition from the inflammation-repair-fibrosis sequence seen in other organs. The mystery of why some smoker's lungs remain unaffected by tobacco smoke is further documented but unsolved; neuroendocrine cells and their neuropeptides may be important.