Current opinion in pulmonary medicine
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Review
Interventional pulmonology techniques for treating malignant large airway obstruction: an update.
This paper reviews the recent literature on the management of malignant large airway obstruction using interventional pulmonology techniques. ⋯ A number of interventional pulmonology techniques are available to treat large airway obstruction from malignant tumor. Clinical studies and personal experience attest to their utility. More evidenced-based studies are needed to help determine the best technique for a particular type of obstruction.
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Transthoracic ultrasound has received increased interest from chest physicians in recent years. Modern ultrasound devices are user friendly, inexpensive, lightweight, and portable, which makes them suited for outpatient settings as well as for bedside investigation of the severely ill. Ultrasound is set to become a practical and essential tool for the pulmonologist in the near future. ⋯ The current literature documents the progress in the application of ultrasound for the practicing chest physician. In this article the authors describe the most recent developments and follow up with some simple but essential advice for the novice venturing into chest ultrasound.
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Although malignant pleural effusions are a common medical problem, research into their optimal management remains sparse. The aim of this review is to summarise recent developments in this area. ⋯ In the authors' opinion, the major developments in the management of malignant effusions during the past year are the development of safer pleurodesis agents and the promise of better combination chemotherapy agents for the treatment of mesothelioma.
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Review Comparative Study
Nosocomial pulmonary infections in HIV-positive patients.
Nosocomial infections (NI) constitute a significant public health problem and contribute to prolonged hospitalization, additional healthcare costs, and excess morbidity and mortality. Immunocompromised patients, including HIV-infected individuals, are at increased risk for NI, and 15-18.3% of them are represented by lower respiratory tract infections. Nosocomial pulmonary infections (NPI) appear to be more common in patients with acquired immunodeficiency syndrome (AIDS), as a result of the degree of immunosuppression, prior use of antibiotics, and exposure to invasive procedures. ⋯ Although underestimated, NI occur commonly in HIV-infected patients, and among them nosocomial pneumonia, including tuberculosis and bacterial pneumonia, are associated with significant morbidity and mortality. The improvement of antiretroviral therapeutic options in developed countries has resulted in a decreased hospitalization rate of HIV-infected individuals. Healthcare delivery in the in- and outpatient setting represents a potential for infections, including lower respiratory tract ones, according to the degree of immunosuppression and the intensity of invasive procedures. To minimize the risk of acquisition of healthcare associated low respiratory tract infections, adherence of healthcare workers to common infection practices, specific respiratory precautions, and early identification of persons who have tuberculosis or are at high risk for active tuberculosis, should be strengthened.
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This review summarises some of the notable papers on ventilator-associated pneumonia (VAP) from January 2003 to October 2004. ⋯ Prevention remains the key to reducing VAP prevalence.