Chest
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Randomized Controlled Trial Clinical Trial
Corticosteroids in the treatment of tuberculous pleurisy. A double-blind, placebo-controlled, randomized study.
Although several studies on tuberculous (TB) pleurisy suggest that the addition of corticosteroids to anti-TB therapy may have beneficial effects, these agents are not used routinely. To assess the effects of short-term oral prednisone therapy in TB pleurisy, 74 patients were randomly assigned in a double-blind fashion to treatment with either placebo or prednisone at a dose of 0.75 mg/kg/d for up to 4 weeks with gradual reduction over an additional 2 weeks. All subjects received a standard 3-drug anti-TB chemotherapy regimen for 6 months. ⋯ Initial complete drainage of the effusion was associated with greater symptomatic improvement than any subsequent therapy. We conclude that standard anti-TB therapy and early complete drainage is adequate for the treatment of TB pleurisy. The addition of short-term oral prednisone therapy neither results in clinically relevant earlier symptom relief nor confers a beneficial effect on residual pleural thickening.
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Multicenter Study
Interobserver reliability of the chest radiograph in community-acquired pneumonia. PORT Investigators.
To evaluate the interobserver reliability of pulmonary radiographic findings in patients with community-acquired pneumonia (CAP). ⋯ In patients with CAP, two university radiologists identified the presence of infiltrate, multilobar disease, and pleural effusion with fair to good interobserver reliability. However, interobserver reliability for the pattern of infiltrate and the presence of air bronchograms was poor.
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Comparative Study
Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. Assessment with serial CT.
To determine the outcome of areas of ground-glass attenuation and assess disease progression on serial high-resolution CT (HRCT) scans of patients with biopsy specimen-proved usual interstitial pneumonia (UIP) and desquamative interstitial pneumonia (DIP). ⋯ In patients with UIP, areas of ground-glass attenuation usually increase in extent or progress to fibrosis despite treatment. Areas of ground-glass attenuation in most patients with DIP remain stable or improve with treatment.
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To derive a method of taking into account the effects of obstruction on the FVC, allowing more accurate assessment of other negative ("restrictive") influences. ⋯ A simple equation can be used to discount the negative effects of obstruction on FVC. This allows more accurate clinical interpretation and can be useful in the analysis of epidemiologic data.
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To determine whether sectional development in pulmonary and critical care medicine influences medical house officers' (HO) interests and knowledge about respiratory medicine, we reviewed HO performance on the American Board of Internal Medicine (ABIM) certifying examination during 4 years before and 5 years after reorganization of our section. After major changes in the program and introduction of new educational opportunities, HOs more often selected pulmonary consultation electives (68.6% vs 47.8%; p = 0.009) and entered pulmonary fellowships after completion of residency training (12% vs 3%; p = 0.047). Total ABIM examination score did not change, but performance on its respiratory disease component improved from a median national percentile score of 48.5% (1986 to 1989) to 80.0% (1990 to 1994) (p = 0.0365). ⋯ Academic development in pulmonary/critical care faculty has an important influence on medical HO interests in and knowledge of that discipline. Plans for the future structure of academic pulmonary/critical care sections must take into account this impact on the training of generalists. Although institutional priorities, resources, and shifting external forces will define how, where, and by whom respiratory medicine will be taught, an appropriate number of faculty members and sufficient commitment of their time to HO education must be preserved.