American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Dec 2012
Biliary Sarcoidosis: Early Diagnosis Minimizes the Need for Surgery.
Biliary sarcoidosis is an unusual clinical entity which mimics autoimmune biliary disease and malignant distal obstruction. Three cases were managed in this series. ⋯ The third diagnosis was made using a Whipple resection specimen. Biliary sarcoidosis is an important consideration in those with an enigmatic presentation of jaundice as they may be managed non- operatively if expeditiously diagnosed.
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Am. J. Respir. Crit. Care Med. · Dec 2012
High levels of virus-specific CD4+ T cells predict severe pandemic influenza A virus infection.
T-cell responses have been implicated in control and exacerbation of lung injury during influenza A virus (IAV) infection. ⋯ High levels of circulating virus-specific CD4(+) T cells to two viral internal proteins (nucleoprotein and matrix) in the first phase of infection are associated with subsequent development of severe IAV infection. This finding could be an early and specific marker for ensuing clinical deterioration. Contrasting levels of antigen-specific CD8(+) T cells in lungs and blood have implications on design and analysis of clinical trials for T-cell vaccines because measurements of T cells in the periphery may not reflect events in the lungs.
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Am. J. Respir. Crit. Care Med. · Dec 2012
Randomized Controlled Trial Multicenter StudyNatriuretic peptide-driven fluid management during ventilator weaning: a randomized controlled trial.
Difficult weaning from mechanical ventilation is often associated with fluid overload. B-type natriuretic peptide (BNP) has been proposed as a tool for predicting and detecting weaning failure of cardiovascular origin. ⋯ Our results suggest that a BNP-driven fluid management strategy decreases the duration of weaning without increasing adverse events, especially in patients with left ventricular systolic dysfunction. Clinical trial registered with www.clinicaltrials.gov (NCT00473148).
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Am. J. Respir. Crit. Care Med. · Dec 2012
Randomized Controlled Trial Multicenter StudyRandomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults.
Most vascular catheter-related infections (CRIs) occur extraluminally in patients in the intensive care unit (ICU). Chlorhexidine-impregnated and strongly adherent dressings may decrease catheter colonization and CRI rates. ⋯ A large randomized trial demonstrated that chlorhexidine-gel-impregnated dressings decreased the CRI rate in patients in the ICU with intravascular catheters. Highly adhesive dressings decreased dressing detachment but increased skin and catheter colonization. Clinical trial registered with www.clinicaltrials.gov (NCT 01189682).
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Medical problems occur at high altitude because of the low inspired Po(2), which is caused by the reduced barometric pressure. The classical physiological responses to high altitude include hyperventilation, polycythemia, hypoxic pulmonary vasoconstriction-increased intracellular oxidative enzymes, and increased capillary density in muscle. However, with the discovery of hypoxia-inducible factors (HIFs), it is apparent that there is a multitude of responses to cellular hypoxia. ⋯ An alternative strategy is to increase the barometric pressure as in aircraft cabins. A hybrid approach combining both strategies shows promise but has never been used. Mines that are being developed at increasingly high altitudes pose great medical problems.