Respiratory medicine
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Respiratory medicine · Aug 2008
Review Case ReportsPost-intubation pulmonary embolism and tracheal stenosis: a case report and review of the literature.
Tracheal stenosis may be attributed to several conditions including trauma, infection, tumour or congenital and collagen vascular diseases. Despite improvement in the design of tracheal tubes, however, tracheal stenosis following intubation still remains an important cause for tracheal obstruction, which may be life threatening and often misdiagnosed. ⋯ Here, we describe for the first time, an otherwise healthy patient who was mechanically ventilated due to a labor accident and developed acute pulmonary embolism that was further complicated with post-intubation tracheal stenosis. The patient was treated with anticoagulant therapy and oral corticosteroids and was further referred to a specialist centre for consideration for non-surgical endoscopic treatment.
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Respiratory medicine · Jul 2008
ReviewEmerging paradigms in the management of malignant pleural effusions.
Malignant pleural effusions (MPE) are a common clinical problem in patients with neoplastic disease. The development of MPEs in advanced malignancies can cause significant morbidity and mortality. ⋯ Despite multiple new therapies placement of chest tube with sclerotherapy remains the standard of care. The purpose of this article is to review the emerging therapeutic options for MPE management.
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Respiratory medicine · Jun 2008
ReviewIt's about time--directing our attention toward modifying the course of COPD.
The course of COPD has traditionally been equated with an accelerated decline in the forced expiratory volume in one second (FEVi) over time in patients with COPD, compared to healthy individuals. However, other important clinical outcomes associated with COPD also worsen over time and should also be considered in conceptualizing the course of COPD. These include health status, breathlessness related to activities of daily living, exercise capacity, the frequency of exacerbations, and peripheral muscle weakness. ⋯ As novel therapeutic agents become available that may alter the underlying pathology of COPD, additional markers and outcomes of disease progression will be needed to provide a more comprehensive assessment. There has been increasing interest in predicting and assessing mortality as it is the final outcome of disease progression. In this review we have considered three approaches toward modifying the course of COPD: smoking cessation, reduction in lung hyperinflation through medical and surgical approaches, and long-term pharmacotherapy.
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Respiratory medicine · Jun 2008
ReviewInhaled corticosteroids during pregnancy: a review of methodologic issues.
There is evidence in the literature that inhaled corticosteroids (ICSs) are safe for pregnant women with asthma and their infants. Although this is useful information about ICS use during pregnancy, some articles must be viewed cautiously because of lack of power and adjustment for potentially important confounding variables. ⋯ While there currently is some degree of evidence to support the safety of ICS use during pregnancy, this review highlights the limited statistical power of several studies published in this area.
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Respiratory medicine · May 2008
ReviewMonitoring of patients with COPD: a review of current guidelines' recommendations.
The goals for the management of COPD are to delay the process of disease progression and alleviate its manifestations. The follow-up of the patients' physical and mental condition is part of best practice management when monitoring routines results in information that contributes to the achievement of management goals. However, the recommendations on monitoring procedures may differ between guidelines and may not be based on scientific evidence. The aim of this article is to review the current guideline recommendations on monitoring routines for COPD. ⋯ Some monitoring routines were recommended frequently, especially follow-up of lung function indices. However, evidence to support the guideline recommendations for the monitoring of patients with COPD is missing. The effect of monitoring on care process and outcomes should be assessed.