Pediatric pulmonology
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Pediatric pulmonology · Feb 1998
Randomized Controlled Trial Multicenter Study Clinical TrialPlacebo-controlled, double-blind, randomized study of aerosolized tobramycin for early treatment of Pseudomonas aeruginosa colonization in cystic fibrosis.
In chronic Pseudomonas aeruginosa pulmonary infection of patients with cystic fibrosis (CF), antibiotic therapy generally fails to eradicate the bacterial pathogen. The mucoid bacterial phenotype, high sputum production by the host, and low airway levels of antibiotics seem to be responsible for the observed decrease in antibiotic efficacy. We hypothesized that early antibiotic treatment by inhalation in CF patients may be able to prevent or at least delay airway infection. ⋯ Using life table analysis, the time to conversion from a P. aeruginosa-positive to a P. aeruginosa-negative respiratory culture was significantly shorter in the tobramycin-treated group than in the placebo group (P < 0.05, log rank test). Lung function parameters and markers of inflammation did not change in either group during treatment. The results of this study suggest that early tobramycin inhalation may prevent and/or delay P. aeruginosa pulmonary infection in CF patients.
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Pediatric pulmonology · Feb 1998
ReviewEvidence-based pediatric pulmonary medicine: how can it help?
Evidence-based medicine aims to identify, critically appraise, and apply the best available evidence in making decisions about the care of patients. These aims are similar to those conscientious clinicians have always sought to achieve, but an evidence-based approach applies a systematic and rigorous methodology to this process to ensure that the evidence applied is relevant and of high quality. Because of the volume of potentially relevant information that needs to be accessed from the medical literature, many clinicians rely on reviews of the evidence. ⋯ These challenges include diagnostic uncertainty, lack of objective endpoints, and aspects of generalizability of randomized controlled trials. Despite these difficulties, there are now many examples of systematic reviews and evidence-based approaches in pediatric pulmonology. If applied appropriately, they can ensure that management of patients is based on clinically useful diagnostic tests and treatments that have been shown to be effective and not harmful.
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Pediatric pulmonology · Feb 1998
Case ReportsDemonstration of tracheal bronchus associated with tracheal stenosis using direct coronal computed tomography.
A 2-year-old boy presented with chronic wheezes and was refractory to medical treatment. A high carina with bilateral bronchial stenosis was erroneously diagnosed by bronchoscopic examination. ⋯ A direct coronal computed tomographic scan of the tracheobronchial tree is a useful imaging technique for the delineation of airway configuration when the bronchoscope fails to pass beyond a stenotic region. A coronal computed tomographic scan may make invasive tracheobronchography unnecessary.