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3181. Community-acquired pneumonia: a North American perspective.
The North American guidelines for pneumonia generally show agreement in both the Canadian and American approaches. However, much new data have appeared since the original recommendations, and revisions are needed. The general approach to empiric therapy that has been proposed in both the Canadian and American Thoracic Society documents does appear to be valid, and future recommendations will probably use the original approach as a framework for a more refined approach.
3183. Pseudomesotheliomatous adenocarcinoma of the lung in a patient with HIV infection.
Clinical and pathologic findings are presented of the first reported case in the English-language medical literature of pseudomesotheliomatous adenocarcinoma (PMA) occurring in an HIV-infected patient. PMA is an uncommon variant of peripheral lung cancer which typically occurs in elderly male patients. It mimics a malignant mesothelioma in terms of its clinical presentation and gross and microscopic appearance. The occurrence of this rare tumor in a young HIV-infected patient suggests some association between HIV infection and the development of PMA.
3184. Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy.
作者: S Lam.;T Kennedy.;M Unger.;Y E Miller.;D Gelmont.;V Rusch.;B Gipe.;D Howard.;J C LeRiche.;A Coldman.;A F Gazdar.
来源: Chest. 1998年113卷3期696-702页
In the treatment of lung cancer, the best outcome is achieved when the lesion is discovered in the intraepithelial (preinvasive) stage. However, intraepithelial neoplastic lesions are difficult to localize by conventional white-light bronchoscopy (WLB).
3185. Association between right ventricular function and perfusion abnormalities in hemodynamically stable patients with acute pulmonary embolism.
作者: R L Miller.;S Das.;T Anandarangam.;D W Leibowitz.;P O Alderson.;B Thomashow.;S Homma.
来源: Chest. 1998年113卷3期665-70页
Patients presenting with acute pulmonary embolism associated with hemodynamic compromise exhibit right ventricular enlargement and dysfunction on transthoracic echocardiogram. However, the degree of echocardiographic abnormalities among hemodynamically stable patients without preexisting cardiopulmonary disease during the acute stage of pulmonary embolism, and following treatment, is unknown. Therefore, this study was designed to assess the extent of right ventricular abnormalities detected on transthoracic echocardiogram in patients following acute pulmonary embolism and during treatment with anticoagulation or vena caval interruption. The extent of pulmonary vascular obstruction and complication rate on follow-up were also assessed.
3186. Rate of FEV1 change following lung volume reduction surgery.
Lung volume reduction surgery (LVRS) improves pulmonary function and dyspnea symptoms acutely in selected patients with heterogeneous emphysema. Limited data are available regarding long-term function following LVRS. We analyzed short-term (<6 months) and long-term rate of change of pulmonary function in 376 patients who underwent unilateral or bilateral LVRS using thoracoscopic or median sternotomy, staple, laser, or combined techniques. We hypothesized that the long-term rate of deterioration in lung function would be dependent on the surgical procedure used and would be greatest in those with the largest short-term postoperative improvement.
3188. CD4 lymphocyte counts and mortality in AIDS patients requiring mechanical ventilator support due to Pneumocystis carinii pneumonia.
To evaluate CD4 counts as a predictor of mortality in AIDS patients with respiratory failure due to Pneumocystis carinii pneumonia (PCP).
3189. Time to detection of Mycobacterium tuberculosis in sputum culture correlates with outcome in patients receiving treatment for pulmonary tuberculosis.
The purpose of this study was to determine whether the time to detection (TTD) of Mycobacterium tuberculosis in sputum culture correlates with the response to antituberculous treatment in patients with pulmonary tuberculosis.
3190. Bronchiolitis obliterans after lung transplantation: detection using expiratory HRCT.
作者: A N Leung.;K Fisher.;V Valentine.;R E Girgis.;G J Berry.;R C Robbins.;J Theodore.
来源: Chest. 1998年113卷2期365-70页
The objective of this study was to determine if air trapping, as detected on expiratory high-resolution CT (HRCT), is useful as an indicator of bronchiolitis obliterans (BO) in lung transplant recipients.
3192. Usual interstitial pneumonitis responsive to corticosteroids following varicella pneumonia.
Varicella pneumonia usually resolves after treatment, and occasionally miliary calcification develops on the roentgenogram of the chest years afterward. A case of varicella pneumonia is presented that followed a previously unreported course. In this case, usual interstitial pneumonitis (UIP) developed. The pneumonitis responded well clinically and radiographically to corticosteroid treatment. The role of viral pneumonia in the cause of UIP is discussed.
3193. Bilateral partial bronchial obstruction due to broncholithiasis treated with laser therapy.
The previously recognized modes of therapy for symptomatic broncholithiasis are broncholithectomy via surgery or bronchoscopy. A 46-year-old woman with bilateral partial bronchial obstruction was treated with Nd-YAG laser with complete resolution of symptoms and of airway obstruction.
3194. Tuberculin and anergy skin testing of patients receiving long-term hemodialysis.
Immunocompromised patients with chronic renal failure requiring hemodialysis (HD) are at increased risk of developing tuberculosis (TB). Routine TB screening of this population is recommended. This study examined the frequency of TB reactions and anergy in HD patients in a community with a high prevalence of TB.
3196. Antiphospholipid antibody syndrome presenting as a refractory noninflammatory pulmonary vasculopathy.
The clinical manifestations of antiphospholipid antibody syndrome (APLAS) are protean. Pulmonary manifestations are often thromboembolic in origin; ARDS and pulmonary hypertension have been reported as features of a widespread vasculopathy associated with systemic lupus or Sjögren's syndrome. This is the report of a woman with primary APLAS who died of a noninflammatory pulmonary vasculopathy. The case is unusual in its pulmonary manifestations, its initial response to corticosteroids and antithrombotic medications, its failure to stabilize with high-intensity warfarin sodium and aspirin treatment, and finally its fulminant progression despite multiple interventions.
3197. What is 'minimally invasive' coronary bypass surgery? Experience with a variety of surgical revascularization procedures for single-vessel disease.
Although the use of small incisions is theoretically appealing, it has been argued that the true advantage of minimally invasive approaches to myocardial revascularization lies in the avoidance of cardiopulmonary bypass.
3198. Activation of eosinophils in the airways of lung transplantation patients.
Eosinophils are important inflammatory cells involved in liver and renal allograft rejection. The role of these cells is less well defined in lung allograft rejection. Eosinophils may be activated in lung rejection and release cytotoxic eosinophil cationic protein (ECP). Other states of disease in lung transplant recipients, such as cytomegalovirus (CMV) and bacterial infection, may also be associated with activated eosinophils. We postulated that ECP may be detectable and elevated in the airway lavage samples obtained from lung transplant patients and may contribute to disease pathogenesis.
3199. Dyspnea response following bilateral thoracoscopic staple lung volume reduction surgery.
作者: M Brenner.;R J McKenna.;A F Gelb.;R J Fischel.;B Yoong.;J Huh.;K Osann.;J C Chen.
来源: Chest. 1997年112卷4期916-23页
Lung volume reduction surgery (LVRS) has shown promise for treating patients with severe emphysema in recent clinical trials. However, response following surgery is difficult to assess due to frequent discrepancies between subjective and objective outcomes. We evaluated the relationship between improvement in dyspnea and pulmonary function response in 145 consecutive patients with inhomogeneous emphysema enrolled in a bilateral thoracoscopic lung volume reduction protocol in order to assess predictors of improved dyspnea outcome and correlation of subjective and objective improvement measures.
3200. Prognosis and quality of life after valve surgery in patients older than 75 years.
作者: O M Shapira.;R M Kelleher.;J Zelingher.;D Whalen.;C Fitzgerald.;G S Aldea.;R J Shemin.
来源: Chest. 1997年112卷4期885-94页
Assessment of quality of life has become an increasingly important aspect of the risk-benefit analysis of any therapeutic intervention, particularly in high-risk populations, such as the elderly.
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