Current opinion in pulmonary medicine
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Culture and molecular approaches have established that lower airway infections are polymicrobial. We consider how this new perspective in cystic fibrosis (CF) may affect treatment choices. ⋯ A comprehensive understanding of airway infections offers the potential for improved disease management in CF patients. Accurate quantitative microbiology will be a prerequisite for routine intervention based on the polymicrobial perspective of CF infection exacerbations.
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Review
Preoperative screening and perioperative care of the patient with sleep-disordered breathing.
Emerging data are raising concerns that patients with known or suspected obstructive sleep apnea (OSA) are at increased risk for a myriad of perioperative complications. Strategies to identify patients preoperatively with OSA, or at risk for OSA, are being advocated. In addition, approaches to identify patients most at risk for OSA-related postoperative complications have been described. While lacking solid evidence, a number of perioperative management strategies have been proposed for the care of these patients. ⋯ OSA is quite common in patients presenting for elective surgery and has been linked to increased perioperative complications. Attempts to identify these patients preoperatively appear prudent. Protocols on how best to manage these patients are available, although validation of their effectiveness is needed.
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Review Comparative Study
Comparative manifestations and diagnostic accuracy of high-resolution computed tomography in usual interstitial pneumonia and nonspecific interstitial pneumonia.
Of the idiopathic interstitial pneumonias, the differentiation between idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonitis (NSIP) raises considerable diagnostic challenges, as their clinical presentations share many overlapping features. IPF is a fibrosing pneumonia of unknown cause, showing a histologic pattern of usual interstitial pneumonia (UIP), and has a poorer prognosis than does NSIP. This review examines whether the radiographic features of IFP and NSIP as assessed by high-resolution computed tomography (HRCT) can be used to distinguish between these two entities. ⋯ The finding of honeycombing as the predominant HRCT feature suggests the diagnosis of UIP and may exclude the need for biopsy. Predominant features of GGOs are not specific enough to distinguish between NSIP and UIP.
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Familial pulmonary fibrosis has long been recognized and suggests that pulmonary fibrosis may have a genetic origin in some cases with an autosomal dominant transmission. ⋯ These genes point to alveolar epithelium injury and repair as a major component of the fibrotic process.