Chest
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Currently, only a few chemotherapeutic agents (ifosfamide, mitomycin, vinblastine, and vindesine) have consistently produced single-agent response rates greater than 15% in patients with non-small-cell lung cancer (NSCLC). While combination chemotherapy with these and other agents may prolong survival in some patients with advanced disease, complete responses and long-term disease control are achieved only infrequently. ⋯ These results have brightened the prospects for chemotherapy against NSCLC. This article reviews available data for several of these agents: navelbine, which is an analogue of vinblastine, the camptothecins CTP-11 and topotecan, and taxol, the first of a novel class of antimicrotubule drugs.
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A study of 51 patients undergoing elective major abdominal surgery was carried out to determine the incidence of postoperative respiratory failure requiring mechanical ventilation for more than 24 h and which preoperative and intraoperative factors are associated with this respiratory complication. Mechanical ventilation for more than 24 h was required in 12 of the 51 patients. ⋯ Preoperative abnormalities in FEV1 did not identify which patients were destined to require postoperative ventilation. Significant differences for the ventilated versus the nonventilated patients included a longer history of cigarette smoking, a lower preoperative PaO2, and a large intraoperative blood loss.
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A patient with bilateral vocal cord paralysis developed chronic respiratory failure. Treatment with nocturnal inspiratory positive airway pressure via nasal mask improved symptoms and reduced hypercapnia.
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Case Reports
Diagnosis of unilateral mainstem bronchial obstruction following single-lung transplantation with routine spirometry.
Single-lung transplantation has become a treatment option for many patients with advanced pulmonary disease. Recent advances in surgical technique and refined immunosuppressive regimens have led to improvement in long-term outcomes, but postoperative complications, including airway disorders, remain problematic. ⋯ Surveillance spirometry performed 6 weeks after transplantation demonstrated a new initial plateau in the maximal expiratory flow-volume curve suggestive of a variable intrathoracic airway obstruction. This unique aberration in the flow-volume curve sheds new insight into the physiologic abnormalities of spirometry in patients receiving lung transplants.
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We compared the diagnostic value of quantitative cultures of bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) samples in 40 patients with moderately severe community-acquired pneumonia (CAP). None had received antibiotics previously. BAL quantitative cultures were performed in 13 control patients without pneumonia. ⋯ Quantitative cultures from both techniques correlated very well (r = 0.71, p < 0.0001). We conclude that both TPC and BAL have similar accuracy to determine etiologic diagnosis of CAP. There was good qualitative and quantitative agreement between both techniques.