Chest
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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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Marijuana and alkaloidal cocaine ("crack") are the two most commonly smoked substances in the United States after tobacco. While regular tobacco smoking has been found to be associated with extensive microscopic alterations in bronchial mucosa, little information is available concerning the effect of crack cocaine and marijuana on tracheobronchial histopathology. ⋯ Marijuana and tobacco smoking each produces significant bronchial mucosal histopathology and the effects of marijuana and tobacco appear additive. Cocaine appears to lead to fewer significant bronchial mucosal alterations than marijuana or tobacco when smoked alone and does not add to the changes associated with marijuana. When smoked together with tobacco, however, cocaine appears to augment the bronchial injury caused by tobacco smoking.
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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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Lung clearance of 99mTc-labeled diethylenetriamine pentaacetate (DTPA) is a sensitive test of altered alveolar epithelial permeability that has been found to be increased in smokers of tobacco, as well as a small number of healthy smokers of crack cocaine, suggesting the possibility of subclinical crack-related lung injury. ⋯ Whereas regular smoking of tobacco alone or with other substances increases alveolar epithelial permeability, habitual smoking of cocaine and/or marijuana has no measurable effect on alveolar permeability in the absence of tobacco nor any additive effect to that of tobacco alone.