Chest
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Randomized Controlled Trial Multicenter Study Clinical Trial
Emergency treatment of acute asthma with albuterol metered-dose inhaler plus holding chamber: how often should treatments be administered?
To determine the optimal treatment interval for administering albuterol metered-dose inhaler (MDI) with a holding chamber to patients presenting to the emergency department (ED) with acute asthma. ⋯ For acute asthma, albuterol MDI with a holding chamber can be given optimally at 60-min intervals with minimal adverse effects for the majority of patients. However, patients who initially demonstrate a low or poor bronchodilator response to albuterol should be given subsequent treatments at 30-min intervals. This will optimize care and conserve resources for patients who will benefit the most.
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Randomized Controlled Trial Clinical Trial
Prospective randomized trial of talc slurry vs bleomycin in pleurodesis for symptomatic malignant pleural effusions.
Symptomatic malignant pleural effusions are common sequelae in patients with certain malignancies. Pleurodesis via bedside thoracostomy is the current treatment option most commonly used. To our knowledge, this is the first prospective randomized trial to examine which agent, bleomycin or talc slurry, is superior in terms of effectiveness, safety, and cost. ⋯ Given the similar efficacy and significant cost advantage, we conclude that talc is the agent of choice when utilizing pleurodesis for control of symptomatic malignant pleural effusions.
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Randomized Controlled Trial Clinical Trial
Efficacy of metered-dose inhaler administration of albuterol in intubated infants.
To compare the safety and efficacy of metered-dose inhaler (MDI) albuterol to nebulized (NEB) albuterol administration. ⋯ MDI-administered albuterol is as safe and efficacious as nebulized-administered albuterol in intubated infants with bronchiolitis. Generalizability of these results is limited by differences in drug delivery with different brands of nebulizers and spacers and sites of attachment.
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In recent years, the emerging concept of bronchial inflammation as a prominent histopathologic characteristic of asthma has profoundly modified the view of the role of the mast cell, which was traditionally thought to be linked to the release of soluble chemical mediators substantially involved in the genesis of acute, immediate bronchospasm. The finding that the production of proinflammatory cytokines by mast cells in asthmatic airways is comparable, in some circumstances, to that of T-cell origin, has led to the hypothesis that mast cells, along with T lymphocytes and eosinophils, may also contribute to the genesis of chronic, persistent asthma. ⋯ Future studies will better explain the role of mast cells in asthma and, more specifically, the links with bone marrow-where mast cell progenitors originate-and the airways, where mast cells develop, differentiate, and assume the functions of mature cells. This article reviews recent data available on these topics.
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Multicenter Study Comparative Study
Likelihood of malignancy in a solitary pulmonary nodule: comparison of Bayesian analysis and results of FDG-PET scan.
To compare the probability of cancer in a solitary pulmonary nodule using standard criteria with Bayesian analysis and result of 2-[F-18] fluoro-2-deoxy-D-glucose-positron emission tomographic (FDG-PET) scan. ⋯ FDG-PET scan as a single test was a better predictor of malignancy in solitary pulmonary nodules than the standard criteria using Bayesian analysis. FDG-PET scan can be a useful adjunct test in the evaluation of solitary pulmonary nodules.