Articles: injury.
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Despite recent advances in technology, the mortality rate for patients suffering from adult respiratory distress syndrome remains in the range of 40-50%. This high mortality rate may be in part related to complications from ventilator management, such as ventilator-induced lung injury. In these patients, adjunct therapies aiming at ameliorating ventilator-induced lung injury are being developed. This article discusses the rationale for use of pharmacologic adjunct therapies, including inhaled nitric oxide, surfactant replacement therapy, antioxidants, prostaglandins, and corticosteroids, in patients with acute lung injury, and reviews the effectiveness of these agents in human clinical trials to date.
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Bronchiolitis obliterans with organizing pneumonia (BOOP) is a pathological syndrome common to a variety of pulmonary inflammatory disorders. It is defined by the presence of buds of granulation tissue consisting of fibroblasts and collagen within the lumen of the distal airspaces. ⋯ Other imaging presentations consist of diffuse infiltrative opacities or focal pneumonia. Improvement with corticosteroids is usually spectacular, but relapses are common after stopping or while reducing treatment.
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Carboplatin, a second-generation antineoplastic drug, is much less ototoxic than cisplatin in humans and many laboratory animals. However, when a moderate dose of carboplatin is administered to chinchillas, it can selectively destroy inner hair cells (IHCs) and type-I ganglion neurons without damaging the outer hair cells (OHCs). One of the earliest signs of injury from carboplatin is damage to type I, spiral ganglion neurons. ⋯ IHC loss leads to a reduction in neural input (i.e., sensory deprivation) to the central auditory system. Surprisingly, although the neural input to the central auditory system is reduced, evoked response amplitudes recorded from the auditory cortex are often enhanced. These results indicate that when the neural input to the central auditory brain is reduced, the central auditory system compensates for the reduced input by increasing its gain.
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The authors report their experience with 42 patients in whom anterior lumbar fusion was performed using titanium cages as a versatile adjunct to treat a wide variety of spinal deformity and pathological conditions. These conditions included congenital, degenerative, iatrogenic, infectious, traumatic, and malignant disorders of the thoracolumbar spine. Fusion rates and complications are compared with data previously reported in the literature. ⋯ The complication rate mirrors the low morbidity rate associated with the anterior approach. A detailed study of clinical outcomes is in progress. Patient selection and strategies for avoiding complication are discussed.