Abstract:
:Many pathologists and pulmonologists have trained and practiced in an era during which therapeutic options for patients have increased manyfold with regard to pharmacologic agents. Toxicity to the lung may be recognized as data accumulate in the form of case reports and clinical reviews to document the clinical and pathologic manifestations. For the histopathologist, paradoxically the more we learn the more difficult problems of interpretation become. Drug reactions previously described extensively at the autopsy now can be relatively easily interpreted in living patients with tissue obtained by open lung biopsy. This latter procedure is becoming less common with diffuse infiltrative lung disease in favor of the transbronchial biopsy in which sampling error abounds. There may be no disease or minimal change. The pathologic lesions may be duly noted and described, but then defy interpretation. An accurate differential diagnosis following biopsy may not solve the clinical problems for which a tissue diagnosis was sought. A specific diagnosis may be made that does not fit the clinical picture, or the real "answer" may be revealed distressingly later in the clinical-course or, more distressingly, at autopsy. The prudent histopathologist deals with such limitation by objectively stating the observable facets of tissue injury and synthesizing an interpretation. Notwithstanding the burgeoning literature on mechanisms of injury of toxic substances, the "state of the art" in 1990 for interpretation of pulmonary drug reactions still lies with the exacting judgment of experienced clinical physicians. Proper evaluation can result in exclusion of important mimickers of interstitial lung disease, usually infection and neoplasia; accurate categorization of tissue injury and comparison with known injurious responses to the drug in question may lead to a relatively specific diagnosis of drug-induced injury. Most drug reactions in the lung are classified as an interstitial pneumonia. This article illustrates and describes several interstitial reactions to injury that have few histologic features in common. However, because the lung can only react to injury in a limited number of ways, lesions that were thought at one time to be a specific clinicopathologic entity, for example, DIP, now evoke an ever-expanding differential diagnosis. In applying diagnostic criteria emphasis must be placed on the areas of overlap among tissue reactions as well. Specific agents may cause changes that are described as common for that agent, but a given patient may react with a variation or in a distinctly uncommon manner. There is enormous potential in this field for the laboratory investigation of drug injury.(ABSTRACT TRUNCATED AT 400 WORDS)
journal_name
Clin Chest Medjournal_title
Clinics in chest medicineauthors
Smith GJsubject
Has Abstractpub_date
1990-03-01 00:00:00pages
95-117issue
1eissn
0272-5231issn
1557-8216journal_volume
11pub_type
杂志文章,评审abstract::Pulmonary embolism remains a leading cause of morbidity and mortality in the United States. However, with improved recognition and diagnosis, the risk of death diminishes. The diagnosis depends on the clinician's suspicion. Pulmonary emboli are categorized into low, intermediate, or high risk based on the scoring scal...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2018.04.013
更新日期:2018-09-01 00:00:00
abstract::Pseudomonas aeruginosa remains an important cause of pulmonary disease in patients who have cystic fibrosis. The development of antimicrobial therapy directed against this organism has resulted in the preservation of lung function and improved longevity. Efficacy has been demonstrated with agents administered via pare...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2007.02.003
更新日期:2007-06-01 00:00:00
abstract::Clinically apparent involvement of the heart and nervous system occurs in a relatively small number of patients with sarcoidosis. The diagnosis of myocardial and neurological sarcoidosis is difficult because anatomic presence of granulomas without clinical dysfunction is an important feature of sarcoidosis. The chest ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70420-2
更新日期:1997-12-01 00:00:00
abstract::As parenchymal lung disease in chronic obstructive pulmonary disease becomes increasingly severe there is a diminishing prospect of drug therapies conferring clinically useful benefit. Lung volume reduction surgery is effective in patients with heterogenous upper zone emphysema and reduced exercise tolerance, and is p...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2013.10.011
更新日期:2014-03-01 00:00:00
abstract::Pulmonary rehabilitation is an art of medical practice incorporating many therapeutic modalities with the goal of improving the patient's functional ability. The gains to be realized and the basis for improvement following pulmonary rehabilitation are detailed in this article. ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1986-12-01 00:00:00
abstract::Recognition and management of agitation, delirium, and pain are key areas. Reduced use of sedatives is an important measure that must be coupled with increased patient engagement, mobilization, and exercise. Use of low tidal volumes and low mean airway pressures during mechanical ventilation is helpful. A key hemodyna...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2016.01.006
更新日期:2016-06-01 00:00:00
abstract::Non-small cell lung cancer with very limited extent of metastatic spread commonly is termed, oligometastatic disease (OMD), and typically described as no more than 3 to 5 lesions. Definitive local therapy potentially leads to significant improvement in progression-free survival and overall survival. OMD may occur de n...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2020.02.004
更新日期:2020-06-01 00:00:00
abstract::The psychosocial assessment of applicants to the Toronto Lung Transplant Program provides the team with a variety of information including coping style; adjustment to illness; presence and management of psychiatric disorders; ability to adhere to medical recommendations; and available social support. This information ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1990-06-01 00:00:00
abstract::Lung cancer is a leading cause of cancer-related death in the world, and it accounts for more deaths than breast, colon, and prostate cancer combined in the United States. From a historical perspective, the premise behind early lung cancer detection strategy is that early detection of lung cancer is justified if early...
journal_title:Clinics in chest medicine
pub_type: 杂志文章
doi:10.1016/j.ccm.2009.09.001
更新日期:2010-03-01 00:00:00
abstract::This review focuses on the top ten causes of ventilator-associated pneumonia (VAP), updating an earlier study. These pathogens have specific risk factors, different patterns of clinical resolution, and a wide range of attributable mortality. The discussion herein analyzes these aspects, placing particular emphasis on ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2004.10.017
更新日期:2005-03-01 00:00:00
abstract::Severe asthma remains poorly understood and frustrating to treat, partly because it is a heterogeneous disease. Recent improvements in the definition of severe asthma have allowed better characterization of the phenotypes of severe asthma and the related physiologic and pathologic abnormalities. Early-onset severe ast...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2005.10.002
更新日期:2006-03-01 00:00:00
abstract::The specialty has the knowledge and technology to change the outcome of lung cancer. Lung cancer, diagnosed in early stages, is as curable as all other cancers. Sputum cytology is the initial step in diagnosing roentgenographically occult lung cancer. Sputum cytology is complementary to CT scanning. Sputum cytology id...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(03)00060-1
更新日期:2002-03-01 00:00:00
abstract::In the past it was believed that respiratory disability could be objectively assessed by comparing the measured O2 consumption requirement of the job with the subjects' measured or estimated maximal oxygen consumption. More recently, it has become clear that this "classic" paradigm does not completely apply to all sit...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1992-06-01 00:00:00
abstract::Because the AIDS epidemic continues to grow, there is a sense of urgency to develop new treatment strategies, both for HIV infection and for AIDS-related illnesses. The rapid gathering of basic information related to HIV type 1 biology and opportunistic infections has led to an explosion in physicians' ability to diag...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70338-5
更新日期:1996-12-01 00:00:00
abstract::Tobacco dependency syndrome is an organic disease caused by chronic use of inhaled tobacco smoke. It is occasionally controlled by willpower alone, but often requires pharmacotherapy in conjunction with various techniques to manage the psychological manifestations. The two effective drugs are bupropion, which is an or...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70018-6
更新日期:2000-03-01 00:00:00
abstract::This article gives a broad overview of the increasingly important applications of bronchoscopy, flexible (FOB) and rigid (RB), in a modern medical intensive care unit. Special emphasis is made to bronchoscopy use in mechanically ventilated patients. Therapies such as endobronchial stenting and Nd:YAG laser are being u...
journal_title:Clinics in chest medicine
pub_type: 杂志文章
doi:10.1016/s0272-5231(05)70041-1
更新日期:2001-06-01 00:00:00
abstract::Delirium is a frequent complication in older patients in the ICU and often persists beyond their ICU stay. Delirium in older persons in the ICU is a dynamic and complex process. There is a high prevalence of pre-existing cognitive impairment in patients who are admitted to the medical ICU. This pre-existing cognitive ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(03)00092-3
更新日期:2003-12-01 00:00:00
abstract::Leptospirosis is a worldwide disease. In this time of globalization knowledge about leptospirosis is important. Although pulmonary involvement has an incidence varying from 20% to 70% and its exteriorization may vary from mild to severe, The severe form appears to be becoming more prevalent (at least in Brazil) and ma...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(01)00010-7
更新日期:2002-06-01 00:00:00
abstract::With the increasing threat of pandemic influenza and catastrophic bioterrorism, it is important for intensive care providers to be prepared to meet the challenge of large-scale airborne epidemics causing mass casualty respiratory failure. The severe acute respiratory syndrome outbreak exposed the vulnerability of heal...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2008.01.001
更新日期:2008-06-01 00:00:00
abstract::This article review available strategies for mechanically ventilating patients with the adult respiratory distress syndrome. The authors first present the conventional strategies of mechanical ventilation: volume-limited mechanical ventilation with positive end-expiratory pressure (PEEP) at normal inspiratory-expirato...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1990-12-01 00:00:00
abstract::Blood gas analyses are an essential part of modern patient care. Although all blood gas instruments have pH, PCO2, and PO2 electrodes based on the same principles, instruments in current use vary greatly in design, operator dependence, and accuracy. For the clinician to obtain accurate and timely results there must be...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1989-06-01 00:00:00
abstract::Cough is a complex physiologic event that protects the lungs from mechanical, chemical, and thermal injury. It is a normal reflex and therefore helps humans to adapt to an ever-changing environment. Cough can also be a pathologic reflex in that it may be an important and often the only sign of serious disease, may sig...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1987-06-01 00:00:00
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journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2013.08.002
更新日期:2013-12-01 00:00:00
abstract::The long-term ventilated patient is at high risk for developing nosocomial pneumonia or tracheobronchitis. In general, the frequency of infection increases with the duration of mechanical ventilation, but the risk appears to be greatest in the first week of intubation. Although these types of infection are common and ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70026-5
更新日期:2001-03-01 00:00:00
abstract::Inhaled corticosteroids (ICSs), when used in combination with long-acting bronchodilators, reduce the risk of exacerbations and improve health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with bronchodilator or ICS therapy alone. Potential side effects of ICSs include ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2020.05.006
更新日期:2020-09-01 00:00:00
abstract::In therapy for ventilator-associated pneumonia, it is essential to get initial empiric therapy correct; this is challenging because many patients are infected with multidrug-resistant pathogens. The need for achieving appropriate therapy can lead to broad-spectrum empiric therapy, which can represent antibiotic overus...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2011.05.009
更新日期:2011-09-01 00:00:00
abstract::The term "steroid-resistant (SR) asthma" has been used to describe a group of asthmatics who demonstrate persistent airway obstruction and inflammation despite treatment with high doses of systemic glucocorticoids. There are at least two forms of SR asthma, that is, primary and acquired types. Type I SR asthma is acqu...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70405-6
更新日期:1997-09-01 00:00:00
abstract::The objectives of this article are to (1) understand how respiratory event definitions and syndrome threshold values affect prevalence estimates of obstructive sleep apnea in adults, (2) recognize important risk factors for obstructive sleep apnea in adults, and (3) understand current theories of the underlying mechan...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2010.02.011
更新日期:2010-06-01 00:00:00
abstract::The adult respiratory distress syndrome is a reaction of the lung to a variety of severe direct or indirect pulmonary insults. It is characterized by acute respiratory distress, severe hypoxemia requiring high oxygen fractions, and "stiff lungs" requiring approaches to ventilatory management cited elsewhere in this is...
journal_title:Clinics in chest medicine
pub_type: 杂志文章
doi:
更新日期:1982-01-01 00:00:00
abstract::Pneumonia, acute bronchitis, and sinusitis are common infections encountered by the pulmonary specialist. Such conditions are usually treated with antibiotics, and their use requires an understanding of their pharmacokinetic properties as well as their antimicrobial spectrum and adverse side effects. ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1986-09-01 00:00:00