La Revue du praticien
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Idiopathic interstitial pneumonias represent approximately 30% of all interstitial lung diseases. The new classification of idiopathic interstitial pneumonias published in 2013 distinguishes 6 major entities, including chronic fibrosing forms (idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia), acute/subacute forms (cryptogenic organizing pneumonia and acute interstitial pneumonia) and smoking-related disorders (respiratory bronchiolitis interstitial lung disease and desquamative interstitial pneumonia). Pleuroparenchymal fibroelastosis is individualized as a new rare clinco-pathologic entity. For cases not fitting any specific clinic- pathological category, a pragmatic classification based on disease behavior is proposed.
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Idiopathic pulmonary fibrosis is a chronic disease, which affects more frequently subjects older than 60 years, males, and smokers or ex-smokers. The diagnosis is based on a pattern of usual interstitial pneumonia at high resolution computed tomography of the chest and/or at the video- assisted thoracic surgical lung biopsy, and by multidisciplinary discussion in a specialized center, after ruling out possible causes and specific contexts (as connective tissue disease). ⋯ Drug therapy should be part of a global care management. Several approaches are considered for an earlier diagnosis and treatment.
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Long-term intravenous catheters (LTIVC) are standard practice for patients with chronic diseases such as cancer, digestive disease requiring total parenteral nutrition or end-stage renal disease. Even if they greatly improved patients' care, the use of LTIVC is also associated with microbial contamination and subsequent infection. These catheter-related infections are associated with morbidity, mortality and increased health-care costs. As patients carrying these LTIVC stay at home for their treatment (home parenteral nutrition for instance) or between cycles of treatment (antineoplastic chemotherapy or dialysis), it is mandatory that general practitioner and nurses are aware of recent data on the epidemiology, diagnosis and treatment of LTIVC-related infections.