Seminar in Respiratory Medicine最新文献

{"title":"Therapy of Pulmonary Edema","authors":"K. Brigham","doi":"10.1055/s-2008-1070986","DOIUrl":"https://doi.org/10.1055/s-2008-1070986","url":null,"abstract":"Any rationale for therapy in patients with pulmonary edema depends on the therapeutic endpoint. As discussed earlier in this volume, there are several abnormalities of lung function, in addition to edema (that is, excess fluid in the lungs), that may be major contributors to the hypoxemia, so that if oxygenation is the variable used to assess the effectiveness of therapy, manipulations which reduce the amount of edema may not appear efficacious. It may well be that drugs that may improve airway function or alter functions of the pulmonary vasculature are therapeutic in some conditions even though they do not improve oxygenation or reduce the amount of edema. This article will deal only with therapies aimed at reducing the amount of edema in the lungs or preventing further accumulation of edema fluid. The discussion will present rationales based on what is known about the pathogenesis of pulmonary edema, discussed in the previous articles.","PeriodicalId":311434,"journal":{"name":"Seminar in Respiratory Medicine","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1983-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125731626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Pulmonary Edema on Airway Reactivity","authors":"J. Sheller, J. Snapper","doi":"10.1055/s-2008-1070982","DOIUrl":"https://doi.org/10.1055/s-2008-1070982","url":null,"abstract":"Airway hyperreactivity can be defined as an extreme sensitivity of the airways to a wide variety of pharmacologic, chemical, or physical stimuli. It is a characteristic and consistent feature of patients with asthma and is present in some patients with chronic bronchitis. Airway hyperreactivity can be manifested clinically as cough, wheezing, and tachypnea. Airway reactivity to a stimulus is assessed objectively by measurements of pulmonary function that reflect airway constriction, such as the forced expiratory volume in one second (FEV1) or airway resistance (Raw)One method of measuring the degree of airway reactivity present in a patient or experimental animal is to administer increasing doses of a bronchoconstrictor material such as methacholine or histamine by inhalation and to make sequential measurements of pulmonary function. The results of such a study in a patient with hyperreactive airways (solid symbols) and in a patient with normal airways (open symbols) are depicted in Figure 1. The patient with airway hyperreactivity developed a significant degree of bronchoconstriction after inhaling relatively small amounts of histamine; the patient with normal airways reacted only slightly to large doses of histamine. Because airway hyperreactivity can be present in patients with normal spirometry, assessment of airway reactivity has been proposed as a diagnostic test of otherwise inapparent asthma. Despite the term \"cardiac asthma,\" airway hyperreactivity has not been reported to accompany episodes of left ventricular failure, or to follow bouts of cardiogenic pulmonary edema. As discussed earlier in this issue, the wheezing present during cardiogenic pulmonary edema probably results from passive narrowing of the airways, and does not indicate the presence of airway hyperreactivity. However, there is suggestive evidence that noncardiogenic pulmonary edema, the adult 100","PeriodicalId":311434,"journal":{"name":"Seminar in Respiratory Medicine","volume":"237 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1983-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132031594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Treatment of Mycobacterium Avium-Intracellulare Complex Disease","authors":"P. Davidson","doi":"10.1055/s-2007-1012161","DOIUrl":"https://doi.org/10.1055/s-2007-1012161","url":null,"abstract":"Unlike the isolation of Mycobacterium tuberculosis from sputum in man, the finding of M. avium-intracellulare from the same source creates a clinical dilemma. This organism (actually a complex of organisms that are closely related morphologically, serologically, and biochemically) is found commonly in man's environment but seldom as a cause of disease. Infection without disease must be frequent, since delayed hypersensitivity reactions to purified protein derivatives of this complex occur with a high incidence in areas in which the organisms predominate. Colonization of the respiratory tract undoubtedly occurs. Factors such as rate of infection or colonization and incidence of disease remain speculative. It is certain, however, that disease does occur. It presents with a wide spectrum of clinical characteristics from the nonprogressive, asymptomatic to the acute, disseminated, often fatal form. In general, the organism is considered less virulent and the disease more likely asymptomatic and more slowly progressive than that of tuberculosis. It should be remembered, however, that tuberculosis also has a broad clinical spectrum, and our knowledge of the complex inter-relationships of organism and host is limited, particularly for M. avium-intracellulare. It is easier to be complacent about this disease, since the ogre of contagiousness does not compel our attention as it does with tuberculosis. Unfortunately, this attitude is further enhanced by uncertain expectations of treatment. However, the majority of patients with disease are responsive to currently available therapy. DIAGNOSTIC CONSIDERATIONS","PeriodicalId":311434,"journal":{"name":"Seminar in Respiratory Medicine","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1981-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125305151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Presentation and Diagnosis of Tuberculosis","authors":"E. Fernandez","doi":"10.1055/s-2007-1012158","DOIUrl":"https://doi.org/10.1055/s-2007-1012158","url":null,"abstract":"A definitive diagnosis of tuberculosis requires the demonstration on culture of Mycobacterium tuberculosis from secretions or tissues of the infected host. Despite its great variability, the clinical pattern of the disease may be helpful. Classically, tuberculosis is considered to be associated with constitutional symptoms: weakness, malaise, easy fatigability, weight loss, fever, sweating (characteristically occurring at night), myalgia, indigestion, and amenorrhea. Fever may be excessive and septic in type, particularly in young black women. Tuberculosis may also present with nonspecific findings such as anemia, joint pains, or erythema nodosum.","PeriodicalId":311434,"journal":{"name":"Seminar in Respiratory Medicine","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1981-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133065332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Antimycobacterial Drugs","authors":"M. Lefkowitz","doi":"10.1055/s-2007-1012157","DOIUrl":"https://doi.org/10.1055/s-2007-1012157","url":null,"abstract":"Of the ten available antituberculosis drugs, none can stand alone as the treatment of choice. All proven regimens for treatment of active disease are combinations of two or more agents. None of the ten agents are free from dose-dependent side effects, idiosyncratic reactions, being a participant in a drug-drug interaction, or having their predicted action influenced by another pathologic or unusual physiologic condition in the patient. In this article, we will endeavor to identify certain pharmacologic, physiologic, pathologic, and pharmacokinetic factors that may help to maximize the effectiveness of the drugs, while minimizing the risks involved in their use. The antituberculosis drugs, their usual dosage, and their route of administration are shown in Table 1. In the past, these drugs were often considered to be first-line or second-line drugs. First-line drugs are those with greater efficacy and lesser toxicity than those considered to be second line. The second-line drugs are indicated in Table 1 by an asterisk. Today the most effective drugs in the treatment of tuberculosis are isoniazid (INH), rifampin (RM), pyrazinamide (PZA), and streptomycin (SM). Here-","PeriodicalId":311434,"journal":{"name":"Seminar in Respiratory Medicine","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1981-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115958153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Public Health Aspects of Tuberculosis","authors":"L. Farer","doi":"10.1055/s-2007-1012155","DOIUrl":"https://doi.org/10.1055/s-2007-1012155","url":null,"abstract":"Most patients with tuberculosis are found because they present themselves for medical care. A high level of suspicion toward patients who are coughing and producing sputum and prompt examination of these patients are essential steps for the prevention of tuberculosis transmission. In addition to cough and expectoration, reasons for suspecting tuberculosis include symptoms and signs such as hemoptysis, weight loss, fatigue, night sweats, fever, pain, and adenopathy; radiographic findings compatible with pulmonary tuberculosis; a significant reaction to the tuberculin skin test; and a history of exposure to another person with infectious tuberculosis. Suspicion should be heightened when these findings are associated with certain clinical situations that may increase the risk of developing tuberculosis. Examples of these special circumstances include prolonged treatment with corticosteroids or immunosuppressive drugs or both, chronic renal failure and dialysis, ileal bypass surgery or gastrectomy, diabetes mellitus, silicosis, and hematologic and reticuloendothelial disorders such as leukemias and lymphomas. Since symptoms are not specific for tuberculosis, it also helps to have demographic and epidemiologic knowledge of which persons in general are most apt to have tuberculosis, and specific knowledge of the tuberculosis situation in the local community. Although tuberculosis occurs in all segments of the population, case rates are higher in older persons than in younger persons, in males than in females, in foreign-born than native-born persons, and in races other than white. The vast majority of tuberculosis cases in the United States arises from a pool of 10 to 15 million persons with dormant tuberculous infection. The only detectable sign of infection in most of these persons is the ability to react significantly to a tuberculin skin test. Unless treated, these persons carry a lifelong risk of potentially developing disease and transmitting it to others.","PeriodicalId":311434,"journal":{"name":"Seminar in Respiratory Medicine","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1981-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125984376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Disease Caused by Organisms of the Mycobacterium Fortuitum Complex","authors":"J. Dalovisio","doi":"10.1055/s-2007-1012162","DOIUrl":"https://doi.org/10.1055/s-2007-1012162","url":null,"abstract":"The rapidly growing mycobacteria include the potentially pathogenic species Mycobacterium fortuitum and M. chelonei, the two species most commonly associated with human infection. Although most mycobacteria cause disease of the lung, M. fortuitum complex organisms do not typically infect the lung. The prototype of disease with these organisms is soft tissue infection after penetrating trauma. They may produce more serious problems, including endocarditis, sternal osteomyelitis following thoracotomy procedures, corneal infections, silicone breast prosthesis infections, peritonitis in peritoneal dialysis patients, and occasionally mycobacterial infections of the lung. 9 At the present time, treatment for M. fortuitum complex disease involves exposure of the patient to potentially toxic drugs and/or some type of surgical procedure. Because of this, it is very important that true infection be differentiated from colonization with these organisms. When these mycobacteria are isolated from body fluids that are ordinarily sterile, or from chronically draining sinuses, the diagnosis of infection may not be difficult. By contrast, M. fortuitum complex organisms are isolated from sputum of healthy individuals, making diagnosis of pulmonary infection extremely difficult. Since M. fortuitum complex lung infections are so unusual and treatment may involve exposure of the patient to significant morbidity, diagnosis should usually be established by the demonstration of parenchymal invasion by the organism. This ordinarily requires the demonstration of acid-fast organisms in lung tissue by special stains and the cultural confirmation of the mycobacterial species as M. fortuitum complex. The resistance of M. fortuitum complex organisms to conventional antimycobacterial drugs has been recognized repeatedly and consistently. This lack of effective chemotherapy has prompted a search for other antimicrobial agents that may be effective against these organisms. Most investigators have found amikacin to have fairly consistent in vitro activity against many strains of these organisms at safely obtainable serum levels. Other drugs that have shown less consistent in vitro activity include doxycycline, erythromycin, sulfonamides, and ethionamide. 1 2 , 1 4 1 9 No standardized method of susceptibility testing with conventional antibacterial agents has been developed for the nontuberculous mycobacteria. When testing the susceptibility for conventional antimycobacterial drugs, methods similar to those used for testing M. tuberculosis may be used. The rapidly growing mycobacteria also grow on standard nutrient media used in the bacteriology laboratory, such as blood agar, MacConkey's agar, or Mueller-Hinton agar. Since the organism may show visible growth within 48 to 72 hours of incubation, other methods have been used to test for susceptibility, including agar dilution and disk diffusion techniques. It is important to recognize, however, that none of these techniques demonst","PeriodicalId":311434,"journal":{"name":"Seminar in Respiratory Medicine","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1981-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131258009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Treatment of Disease Due to Mycobacterium Kansasii","authors":"C. Ahn, G. Hurst","doi":"10.1055/s-2007-1012160","DOIUrl":"https://doi.org/10.1055/s-2007-1012160","url":null,"abstract":"Much has been learned during the past three decades about the chemotherapy of tuberculosis. As a result, that disease has declined as a major health problem in the United States. During the same period of time, it has been recognized that pulmonary infections due to other mycobacterial species are not medical rarities. Indeed, there is a distinct possibility that the decrease in infection due to Mycobacterium tuberculosis has resulted in a greater segment of the population with less immunity to other mycobacterial infections and ultimately an increased incidence of these other infections. In the earlier days of mycobacterial chemotherapy, the treatment of the nontuberculous species was considered to be far less effective than was the case with tuberculosis. This is still the situation with most nontuberculous mycobacterial diseases, with the noteworthy exception of pulmonary infection due to M. kansasii. In this article we will give opinions concerning suitable chemotherapy of pulmonary disease due to M. kansasii, based upon our own observations as well as those of others.","PeriodicalId":311434,"journal":{"name":"Seminar in Respiratory Medicine","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1981-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128036997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of the Laboratory in the Management of Tuberculosis Patients","authors":"P. Gangadharam","doi":"10.1055/s-2007-1012156","DOIUrl":"https://doi.org/10.1055/s-2007-1012156","url":null,"abstract":"Historically, the importance of the laboratory in the diagnosis and management of tuberculosis patients dates back to 1882 when Robert Koch discovered the tubercle bacillus and confirmed the bacteriologic etiology of this disease. Soon after, specific methods for the detection of the bacilli in the sputum and other biologic fluids, mainly by the carbolfuchsin technique, developed by Ziehl-Neelsen, and the methods of cultivating the bacilli in artificial media, gave a great boost to the importance of the laboratory in this disease. The landmarks in the development of the role and importance of the laboratory are listed in Table 1. Contributions from the laboratory paralleled very closely other developments in the management of this disease. Of particular importance is the role of the laboratory in assisting the clinician in the proper use of chemotherapy. Soon after specific drugs were available, the laboratory was very prompt in assisting clinicians by advising about the suitability of any drug or combination of drugs by carrying out drug susceptibility tests. The laboratory also assisted the clinicians in measuring","PeriodicalId":311434,"journal":{"name":"Seminar in Respiratory Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1981-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133127769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letters to the Editors","authors":"T. Petty, R. Cherniack","doi":"10.1055/s-2007-1012163","DOIUrl":"https://doi.org/10.1055/s-2007-1012163","url":null,"abstract":"To the Editors In reference to Dr. Gerald Bristow's article in the July, 1980 issue of Seminars in Respiratory Medicine, Volume 2, Number 1, entitled \"Oxygen Therapy.\" He stated that it is important to recognize that with the venturi mask system the concentration of oxygen inhaled by the patient will usually be lower than the set on the manifold of the venturi mask system because of entrainment of room air through the side holes in the mask or between the face and the mask. This information is incorrect. Venturi-style masks are designed to deliver precise oxygen concentration and as a result of their accuracy, are a valuable tool in treating patients with chronic lung disease. Their precision occurs due to the high total flow of gas into the mask thereby nullifying any inherent leaks which occur in all masks. Specifications vary from one manufacturer to another but this list indicates approximate total flows to the mask at various concentrations:","PeriodicalId":311434,"journal":{"name":"Seminar in Respiratory Medicine","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1981-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125654871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}