Abstract:
:Prophylaxis for DVT unequivocally is beneficial in patients identified to be at high risk. Heparin prophylaxis with subcutaneous low-dose UFH is adequate in some clinical settings but less effective in others. LMWH preparations are effective and safe as prophylaxis in certain medical patients as well as in general surgery and elective hip replacement. Efficacy and safety are demonstrated in the therapy of established venous thromboembolism. Subcutaneous administration of LMWH once or twice daily may prove more convenient from both the patient and nursing viewpoint, particularly in the treatment of established DVT. Monitoring is not necessary when using LMWH preparations as prophylaxis, and a fixed-dose without weight adjustment has been used in most prophylaxis trials. When treating established DVT, less monitoring is likely to be required than currently is the case with UFH. Although the cost of LMWH preparations is greater than that of UFH, the decrease in the occurrence or recurrence of thromboses that has been demonstrated in some trials might prove an effective balance. Future avenues to explore include discovery of better means to standardize the LMWH preparations and determination of the efficacy and safety of LMWH in specific populations, such as those in intensive care units, cancer patients, nursing home patients, and outpatients in general. Although cost-benefit is favorable thus far, meticulous assessment in other settings may enhance the acceptance of these agents. Long-term follow-up could be helpful in determining the relative effect of different heparin preparations on the frequency of postphlebitic syndrome. Comparison of different LMWH fractions may follow, as well as further investigations of newer ultra-low-molecular-weight agents. One LMWH preparation (enoxaparin) already has been approved in the United States for prophylaxis in the setting of elective hip replacement; and dalteparin has been approved here for use as DVT prophylaxis in patients undergoing abdominal surgery when there appears to be a significant risk of thromboembolism. It is likely that LMWH preparations will become even more widely used in North America and that the approved indications will expand to include prophylaxis in numerous settings and the treatment of established venous thromboembolism.
journal_name
Clin Chest Medjournal_title
Clinics in chest medicineauthors
Tapson VF,Hull RDsubject
Has Abstractpub_date
1995-06-01 00:00:00pages
281-94issue
2eissn
0272-5231issn
1557-8216journal_volume
16pub_type
杂志文章,评审abstract::Sjögren's syndrome is one of the most common systemic rheumatic diseases. Pulmonary disease is prevalent in Sjögren's syndrome; respiratory manifestations include chronic cough, obstructive airways disease, pulmonary lymphoma, and interstitial lung disease that may progress to severe pulmonary fibrosis. ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70110-6
更新日期:1998-12-01 00:00:00
abstract::Massive hemoptysis is a rare, but life-threatening event. Death from massive hemoptysis is usually due to aspiration of blood. Thus, the initial evaluation should occur simultaneously with efforts to control the patient's airway and respiratory status. Therapeutic interventions can be directed with an understanding of...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1992-03-01 00:00:00
abstract::From our studies, it is clear that diaphragm muscle neuromotor control is responsive to alterations in innervation and activation. These adaptations to altered use appear to be most pronounced among fast-twitch motor units composed of type II muscle fibers. Because the plasticity involves diminished contractile streng...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-12-01 00:00:00
abstract::Pathologic conditions affecting the abdomen are a significant cause of morbidity and mortality in the intensive care unit, but their importance is not widely recognized. This article presents several aspects of abdominal pathology that can occur in intensive care unit patients. This pathology may have a considerable i...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70145-3
更新日期:1999-06-01 00:00:00
abstract::Traditionally, a subset of patients diagnosed as having idiopathic pulmonary fibrosis had positive results on cellular biopsies (prominent lymphoplasmacytic inflammation), bronchoalveolar lavage lymphocytosis, a clinical response to steroids, and a better long-term prognosis. On review of the lung histopathology, the ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2011.11.003
更新日期:2012-03-01 00:00:00
abstract::Although they are complex, the pulmonary-renal syndromes can be readily understood and managed using a clinical approach firmly grounded in the fundamental pathophysiology of these disorders. Several important principles must be borne in mind. First, therapeutic intervention must be preceded by making as firm a diagno...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1989-12-01 00:00:00
abstract::Lung diffusing capacity for carbon monoxide (Dlco) remains the only noninvasive pulmonary function test to provide an integrated picture of gas exchange efficiency in human lungs. Due to its critical dependence on the accessible "alveolar" volume (Va), there remains substantial misunderstanding on the interpretation o...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2019.02.005
更新日期:2019-06-01 00:00:00
abstract::Rapidly growing mycobacteria (RGM) include a diverse group of species. We address the treatment of the most commonly isolated RGM-M abscessus complex, M fortuitum, and M chelonae. The M abscessus complex is composed of 3 closely related species: M abscessus senso stricto (hereafter M abscessus), M massiliense, and M b...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2014.10.004
更新日期:2015-03-01 00:00:00
abstract::Viral pneumonia is a common complication for patients with hematologic malignancies and after hematopoietic cell transplantation causing significant morbidity, and often mortality. Infections are predominantly caused by herpes viruses, either by reactivation of latent infection, or less commonly primary infection, or ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2016.12.009
更新日期:2017-06-01 00:00:00
abstract::An older smoker tends to be asked less often to quit although he or she has much to gain from achieving a nonsmoking status. Multiple barriers may interfere with attempting to quit including nicotine withdrawal, doubted self-efficacy, other smokers in one's environment, or misperceptions of little gain from quitting. ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-09-01 00:00:00
abstract::With the performance of more endoscopic procedures and newly developed diagnostic and therapeutic modalities, a wealth of information around the actual procedure is created. To date, accepted guidelines for standardized documentation are lacking. The authors present recommendations for minimal guidelines that may help...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70051-4
更新日期:2001-06-01 00:00:00
abstract::Lung transplantation is an accepted treatment for a large number of end-stage pulmonary diseases. There are several complications that pertain specifically to lung transplant recipients, including airway ischemia, reperfusion edema, infections, acute rejection, obliterative bronchiolitis, and other postoperative probl...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70257-4
更新日期:1999-12-01 00:00:00
abstract::Quantitative assessment of pulmonary metabolic function has been shown to be a novel and important approach to obtaining specific and subtle biochemical information regarding endothelial cell function in the normal and diseased lung. A primary consideration in this measurement of whole organ metabolism, whether it be ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1989-03-01 00:00:00
abstract::Chronic thromboembolic pulmonary hypertension is one of the few forms of pulmonary hypertension that is surgically curable. It is likely underdiagnosed and must be considered in every patient presenting with pulmonary hypertension to avoid missing the opportunity to cure these patients. This article discusses the epid...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2010.07.006
更新日期:2010-12-01 00:00:00
abstract::Polymerase chain reaction-based diagnosis has become the standard for viral pneumonia and other respiratory tract infections. Expansion of respiratory viral panels (RVPs) outside of influenza and, possibly, respiratory syncytial virus has led to the ability to diagnose viral infections for which no approved specific a...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2016.11.003
更新日期:2017-03-01 00:00:00
abstract::Nonresolving pneumonia is a common and frequently misunderstood problem faced by the practicing pulmonologist. While radiographic resolution of most infections is relatively long and lags behind clinical signs of recovery, data suggest that a variety of host defense problems are a consequence of systemic illness and a...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1987-09-01 00:00:00
abstract::Available data show that Africa, together with the Americas and western and central Europe, reported the lowest prevalence of multidrug-resistant tuberculosis (MDR-TB). However, sub-Saharan Africa has a high TB incidence and the highest human immunodeficiency virus (HIV) prevalence in the world, and because of the hig...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2009.08.019
更新日期:2009-12-01 00:00:00
abstract::Primary graft dysfunction (PGD) is the most important cause of early morbidity and mortality following lung transplantation. PGD affects up to 25% of all lung transplant procedures and currently has no proven preventive therapy. Lung transplant recipients who recover from PGD may have impaired long-term function and a...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2011.02.007
更新日期:2011-06-01 00:00:00
abstract::Nontuberculous mycobacteria (NTM) are important emerging cystic fibrosis (CF) pathogens, with estimates of prevalence ranging from 6% to 13%. Diagnosis of NTM disease in patients with CF is challenging, as the infection may remain indolent in some, without evidence of clinical consequence, whereas other patients suffe...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2015.11.001
更新日期:2016-03-01 00:00:00
abstract::Lung cancer can be diagnosed based on histologic biopsy or cytologic specimens. The 2015 World Health Organization Classification of Lung Tumors addressed the diagnosis of lung cancer in resection specimens and in small biopsies and cytology specimens. For these small specimens, diagnostic terms and criteria are recom...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2019.11.001
更新日期:2020-03-01 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::The features characterizing pneumonia due to Mycoplasma pneumoniae are described. Typical cases, along with chest radiographs of laboratory-documented cases, are presented. ...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1991-06-01 00:00:00
abstract::The mechanisms for exercise intolerance in chronic obstructive pulmonary disease are complex and multifaceted. Although ventilatory limitation caused by abnormal pulmonary function is a major contributor to this phenomenon, other factors may play an important role in limiting exercise. These other factors include depr...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70178-7
更新日期:2000-12-01 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::Complications of tracheotomy are largely preventable. Although some authors cite these complications as indications for prolonged endotracheal intubation to avoid tracheotomy, others believe that the laryngotracheal complications of prolonged endotracheal intubation warrant early tracheotomy. Obviously, unnecessary tr...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1991-09-01 00:00:00
abstract::VAP is clearly associated with an increased mortality, principally because of virulent pathogens such as P. aeruginosa. Part of the increased mortality may be due to inadequacies of antibiotic therapy. Apparent failure of antibiotic therapy has many causes; some are related to deficiencies of the antibiotic therapy, b...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-03-01 00:00:00
abstract::Illicit drug users comprise a substantial and growing proportion of the HIV-infected population. Although they develop pulmonary complications common to all HIV transmission groups, they also have unique respiratory illnesses due to the direct effect of the illicit drugs on the lung. Bacterial infections, tuberculosis...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/s0272-5231(05)70348-8
更新日期:1996-12-01 00:00:00
abstract::The Hispanic population in the United States is diverse in many respects. Although there is marked variation in the prevalence, morbidity, and mortality of asthma among Hispanic subgroups in the United States, these differences are poorly understood. Future stu-dies of asthma should include large samples of Hispanic s...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2006.04.004
更新日期:2006-09-01 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::Because there is insufficient cellular energy for organisms to perform their functions at the same constant rate and at the same time, all biologic processes show rhythmicity, each with its own unique frequency, amplitude, and phase. Optimal sleep and wakefulness requires proper timing and alignment of desired sleep-w...
journal_title:Clinics in chest medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ccm.2010.02.009
更新日期:2010-06-01 00:00:00