Thorax
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Randomized Controlled Trial Clinical Trial
Randomised controlled trial of intrapleural streptokinase in community acquired pleural infection.
Standard treatment for pleural infection includes catheter drainage and antibiotics. Tube drainage often fails if the fluid is loculated by fibrinous adhesions when surgical drainage is needed. Streptokinase may aid the process of pleural drainage, but there have been no controlled trials to assess its efficacy. ⋯ Intrapleural streptokinase probably aids the treatment of pleural infections by improving pleural drainage without causing systemic fibrinolysis or local haemorrhage.
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Comparative Study
Relative production of tumour necrosis factor alpha and interleukin 10 in adult respiratory distress syndrome.
The adult respiratory distress syndrome (ARDS) may be regarded as an example of an uncontrolled or excessive inflammatory response in which tumour necrosis factor alpha (TNF-alpha) has been proposed to play a central role. Interleukin 10 (IL-10) has been identified as an important regulator of this response. The potential role for IL-10 in this context was investigated by measuring the relative production of IL-10 and TNF-alpha protein in the plasma, bronchoalveolar lavage (BAL) fluid, and alveolar macrophage culture supernatants of patients with, or at risk of developing, ARDS. ⋯ This study highlights the potential importance of the pro-inflammatory versus the anti-inflammatory imbalance in ARDS which may be reflected by the ratio of IL-10 and TNF-alpha in the lung.
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Comparative Study
Lymph node staging in non-small cell lung cancer: evaluation by [18F]FDG positron emission tomography (PET).
A study was undertaken to investigate the accuracy of positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) in the thoracic lymph node staging of non-small cell lung cancer (NSCLC). ⋯ FDG-PET provides a new and effective method for staging thoracic lymph nodes in patients with lung cancer and is superior to CT scanning in the assessment of hilar and mediastinal nodal metastases. With regard to resectability, FDG-PET could differentiate reliably between patients with N1/N2 disease and those with unresectable N3 disease.
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Pneumonitis is a rare but potentially life threatening side effect of methotrexate treatment for rheumatoid arthritis which needs to be distinguished from interstitial lung disease due to rheumatoid arthritis. ⋯ Methotrexate pneumonitis was associated with lymphocytic alveolitis with a preferential increase in CD4+ cells. This pattern differs from that in interstitial lung disease due to rheumatoid arthritis and may therefore assist in making an early diagnosis of methotrexate pneumonitis.
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Patients with acute leukaemia may have spuriously low arterial oxygen tensions (PaO2). The markedly increased numbers of white blood cells in these patients rapidly consume dissolved plasma oxygen resulting in dramatically decreased PaO2 and calculated oxygen saturations. The case history is reported of a patient with a white blood count of 191 000/mm3 in whom multiple arterial blood gas measurements documented hypoxaemia out of proportion to the clinical picture. Pulse oximetry was used to confirm higher haemoglobin oxygen saturations and to establish the spuriously low plasma oxygen tensions in this patient.