Abstract：
:Patients with diagnosed or suspected lung cancer first require appropriate staging and proven anatomic resectability. Excellent pre-operative spirometric data (FEV1 > 2.0 L, > 60% predicted) should recommend the patient for surgery immediately without further testing. Those whose preoperative FEV1 is less than 60% predicted or whose DLCO is less than 60% predicted should be sent for quantitative lung scanning to estimate postoperative spirometry and diffusing capacity. Results showing FEV1-PPO and DLCO-PPO greater than 40% of normal suggest an acceptable surgical risk, and the patient should be referred accordingly. Those whose results are less than 40% of predicted should be exercised in some capacity to assess oxygen transport. We believe that cycle ergometry with incremental workloads and the standard monitoring is the best technique available for this (Table 1). Patients with a predicted postoperative FEV1 (or DLCO) greater than 35% of normal values and whose peak exercise VO2 is greater than 15 mL/kg/min should be offered surgery with the goal of removing the smallest volume of tissue that would be compatible with a cure. Those who do not meet these criteria, however, should not be summarily refused surgery if they are willing to accept the possibility of an earlier death or prolonged disability over the certainty of a cancer-related death in the foreseeable months ahead. Because the lung scan prediction of postoperative regional physiology and the exercise test of global oxygen transport examine different aspects of physiologic operability, we would not disagree with anyone who would advocate doing both tests in those at high risk by virtue of spirometric criteria. The logic of this combined approach is illustrated by Figure 1.
journal_name
Clin Chest Medjournal_title
Clinics in chest medicineauthors
Gilbreth EM,Weisman IMsubject
Has Abstractpub_date
1994-06-01 00:00:00pages
389-403issue
2eissn
0272-5231issn
1557-8216journal_volume
15pub_type
杂志文章,评审abstract：:Respiratory viruses are common in solid organ and hematopoietic stem cell transplant recipients and a recognized cause of significant morbidity and mortality. Epidemiology, risk factors, and attributable mortality in both populations are reviewed. In addition, virus-specific prevention and treatment options, including...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2017.07.012
更新日期：2017-12-01 00:00:00
abstract：:Because of physiologic changes associated with aging and the development of chronic illness, the elderly will continue to be at risk for catastrophic illnesses including adult respiratory distress syndrome (ARDS). Current management of elderly patients with ARDS is only supportive and focused on avoiding complications...
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：:In the United States, trauma is the leading cause of death in people under 40 years of age. Chest trauma is a relatively common but potentially lethal injury and requires a high level of suspicion, rapid diagnosis, and appropriate therapy. Methods for the assessment, diagnosis, and treatment of chest trauma are discus...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1994-03-01 00:00:00
abstract：:Lung cancer remains the most common fatal malignancy, so even modest therapeutic advances are potentially beneficial to large numbers of patients. For patients with regional nodal metastases identified at thoracotomy, adjuvant chemotherapy may be of benefit and additional clinical trials are in progress. Locally advan...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1993-03-01 00:00:00
abstract：:The last decade has heralded a paradigm shift in the evaluation and treatment of advanced non-small cell lung cancer (NSCLC). No longer are patients with NSCLC considered a homogeneous population treated in the same way; rather, clinical characteristics, histology, and an expanding array of molecular markers are incre...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2011.08.017
更新日期：2011-12-01 00:00:00
abstract：:Patient adherence to prescribed tuberculosis regimens must be assured to prevent relapse, acquired resistance, and transmission. Directly observed therapy (DOT), an outpatient management strategy designed to ensure adherence, is not widely used because it is perceived to be inordinately expensive. The primary focus of...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70365-8
更新日期：1997-03-01 00:00:00
abstract：:Available targeted therapies for pulmonary arterial hypertension are capable only of slowing progression of the disease and a cure remains elusive. However with the improved understanding of the pulmonary vascular remodeling that characterizes the disease, there is optimism that the disconnect between preclinical and ...
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：:Massive hemoptysis accounts for a minority of all patients with hemoptysis but poses a major challenge for the acute and long-term treatment. Massive hemoptysis can lead to asphyxiation and airway obstruction, shock, and exsanguination. Bronchoscopy plays an integral part in managing massive hemoptysis in diagnosis an...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70129-5
更新日期：1999-03-01 00:00:00
abstract：:Smoking is overwhelmingly the major cause of chronic bronchitis and emphysema worldwide. Additional risk factors for developing COPD are presented, along with the variables that govern cigarette smoke deposition in the lung. Major paradigms for the pathogenesis of COPD, including the protease-antiprotease and oxidant-...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(05)70008-3
更新日期：2000-03-01 00:00:00
abstract：:The pathogenesis of O2 toxicity involves intracellular production of partially reduced O2 metabolites, which increases with O2 partial pressure. Cytotoxic O2 metabolites impair enzyme function and inhibit DNA, protein, and surfactant lipid biosynthesis. Compounds used clinically that increase O2 metabolism or that are...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1990-03-01 00:00:00
abstract：:This article reviews several important noninfectious pulmonary complications that threaten survival, pulmonary function, and quality of life after lung transplantation. Topics reviewed include primary graft dysfunction (PGD), native lung hyperinflation, anastomotic complications, phrenic nerve injury, pleural complica...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2005.06.006
更新日期：2005-12-01 00:00:00
abstract：:This article assesses the role of pharmacotherapy in the management of respiratory muscle dysfunction. It focuses on two classes of drugs, the methylxanthines and the sympathomimetic agents. A prospective section focuses also on the particularities of the diaphragm among the skeletal striated muscles. In addition, a n...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1988-06-01 00:00:00
abstract：:The modern history of cystic fibrosis (CF) is one of continuous improvement. Guidelines and evidence-based medicine provide a general roadmap for directing improvement efforts. Data and measurement are central to quality improvement (QI), a way of keeping score and staying on track. This article describes the history ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2007.02.013
更新日期：2007-06-01 00:00:00
abstract：:The heart and lungs are intimately linked. Hence, impaired function of one organ may lead to changes in the other. Accordingly, heart failure is associated with airway obstruction, loss of lung volume, impaired gas exchange, and abnormal ventilatory control. Cardiopulmonary exercise testing is an excellent tool for ev...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2019.02.010
更新日期：2019-06-01 00:00:00
abstract：:The host response to microbial invasion in the lung must be sufficiently vigorous to allow for microbial eradication but appropriately controlled to prevent spillover of the response into the systemic circulation. Although inflammatory responses in pneumonia are generally compartmentalized, microbial and host factors ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2004.10.009
更新日期：2005-03-01 00:00:00
abstract：:The types of pulmonary arterial hypertension described here all focus attention on the changes produced in the lung's microcirculation, particularly the precapillary unit. Although one senses intuitively that obliteration of resistance arteries is an effective cause of hypertension, we emphasize that cell metaplasia a...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：
更新日期：1983-05-01 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：:ICU-acquired weakness is a common problem and carries significant morbidity. Despite evidence that early mobility can mitigate this, implementation outside of the research setting is lagging. Understanding barriers at the systems as well as individual level is a crucial step in successful implementation of an ICU mobi...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2015.05.006
更新日期：2015-09-01 00:00:00
abstract：:Endobronchial ablative therapies, such as mechanical debulking, laser therapy, electrocautery, argon plasma coagulation, cryotherapy, brachytherapy, photodynamic therapy, microdebrider bronchoscopy, resector balloon deobstruction, and intratumoral chemotherapy, are performed through a rigid or flexible bronchoscope in...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2017.11.008
更新日期：2018-03-01 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：:This article focuses primarily on the recent literature on abdominal compartment syndrome (ACS) and the definitions and recommendations published by the World Society for the Abdominal Compartment Syndrome. The definitions regarding increased intra-abdominal pressure (IAP) are listed and are followed by an overview of...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2008.09.003
更新日期：2009-03-01 00:00:00
abstract：:Thoracic imaging is widely used to detect lower respiratory tract infections, identify their complications, and aid in differentiating infectious from noninfectious thoracic disease. Less commonly, the combination of imaging findings and a clinical setting can favor infection with a specific organism. This confluence ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2015.02.005
更新日期：2015-06-01 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：:It has been proposed that invasive carcinoma of the bronchus develops through a transition from preinvasive lesions to overt malignancy. Newer diagnostic technologies have provided a more sensitive way to diagnose preinvasive lesions and a better understanding of the prevalence of such lesions. The natural history of ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2011.08.008
更新日期：2011-12-01 00:00:00
abstract：:Early detection and surgical resection are essential for the treatment of lung cancer. It would be ideal to be able to detect and treat preinvasive bronchial lesions, defined as dysplasia and carcinoma in situ before progressing to invasive cancer. Advanced airway-assessment techniques have opened an avenue for early ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2013.04.005
更新日期：2013-09-01 00:00:00
abstract：:Sleep-related breathing disorders are strongly associated with increased risk of stroke independent of known risk factors. The direction of causation favors sleep-disordered breathing leading to stroke rather than the other way around, although definitive proof of this awaits the results of prospective cohort studies....
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/s0272-5231(03)00027-3
更新日期：2003-06-01 00:00:00
abstract：:Two recent major guidelines on diagnosis and treatment of ventilator-associated pneumonia (VAP) recommend consideration of local antibiotic resistance patterns and individual patient risks for resistant pathogens when formulating an initial empiric antibiotic regimen. One recommends against invasive diagnostic techniq...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2018.08.002
更新日期：2018-12-01 00:00:00
abstract：:Pulmonary complications occur in 40% to 60% of recipients of bone marrow trans-plants, account for more than 90% of mortality, and develop during identifiable phases. Phase 1 (Days 1-30) includes pulmonary edema; diffuse alveolar hemorrhage; and various bacterial, fungal, and viral infections; Phase 2 (Days 31-100) us...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/S0272-5231(03)00121-7
更新日期：2004-03-01 00:00:00
abstract：:Inhaled corticosteroids (ICS) have led to improved asthma control and reduced asthma mortality in the Western world. ICS are effective in combating T-helper type 2-driven inflammation featuring mast cell and eosinophilic airway infiltration. Their effect on innate immunity-driven neutrophilic inflammation is poor and ...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2012.05.004
更新日期：2012-09-01 00:00:00
abstract：:Bullectomy for giant bullae, lung volume reduction surgery, and lung transplantation are three surgical therapies that may benefit highly selected patients with advanced chronic obstructive pulmonary disease. In this article, each procedure is reviewed, with an emphasis on guidelines for patient selection and clinical...
journal_title：Clinics in chest medicine
pub_type： 杂志文章,评审
doi：10.1016/j.ccm.2007.05.004
更新日期：2007-09-01 00:00:00
