Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study.

In patients treated with repository corticotrophin injection (RCI) for pulmonary sarcoidosis, effective management of adverse events may improve adherence. However, management of adverse events may be challenging due to limitations in real-world clinical experience with RCI and available published guidelines.We surveyed 12 physicians with a modified Delphi process using three questionnaires.

Argon plasma coagulation in the management of uncovered tracheal stent fracture.

Endotracheal and endobronchial stenting, particularly with uncovered stents, can be complicated by stent fracture, granulation tissue formation, direct airway injury, and airway obstruction. While stent removal is possible, it can result in significant complications and long-term benefit is not guaranteed. Argon plasma coagulation can be employed to trim fractured stent fragments and remove granulation tissue simultaneously.

The use of narrow band imaging in patients with benign disease: hereditary hemorrhagic telangiectasia.

: Narrow band imaging (NBI) is a new type of imaging technology that enhances the visibility of blood vessels used in the detection of abnormal angiogenesis in preneoplastic and neoplastic lesions. This technique is used in the diagnosis and management of dysplastic and malignant endobronchial lesions. To our knowledge, this is the first description of the use of NBI to diagnose and manage benign lesions, hereditary hemorrhagic telangiectasia (HHT).

Serosanguineous Pleural Effusions in a Patient With HIV and Kaposi Sarcoma: Pleuroscopic Findings.

A 22-year-old white homosexual male presented with severe shortness of breath. He was diagnosed as having human immunodeficiency virus/acquired immunodeficiency syndrome and skin manifestations of Kaposi sarcoma (KS). He had a significant pericardial effusion, which was drained.

Lymphangioleiomyomytosis: Are the Findings of Video-assisted Thoracoscopy Pathognomonic?

A 22-year-old African American female patient presented with a sudden onset of difficulty in breathing for approximately 2 days accompanied by bilateral pleuritic chest pain. Her past medical history was significant for tuberous sclerosis and mental retardation. Preliminary radiographic imaging showed bilateral pneumothoraces for which bilateral chest tubes were subsequently inserted.

Insertion of intracranial pressure monitors in fulminant hepatic failure patients: early experience using recombinant factor VII.

Background: Cerebral edema contributes to the high morbidity and mortality of fulminant hepatic failure (FHF).

Objective: We report the results of our early experience with insertion of intraparenchymal intracranial pressure (ICP) monitors in these highly coagulopathic patients.

Methods: Eleven consecutive patients with FHF met the criteria for invasive ICP monitoring.

Inhaled corticosteroids should be initiated before discharge from the emergency department in patients with persistent asthma.

National and International Guidelines concur that inhaled corticosteroids (ICS) are the preferred long-term maintenance drug therapy for mild persistent asthma for all ages. For moderate and severe persistent asthma, ICS are essential to optimal management, often concurrent with other key therapies. Despite strong evidence and consensus guidelines, ICS are still underused.

Mobilizing the patient in the intensive care unit: the role of early tracheotomy.

A large number of studies have evaluated the benefits of early tracheotomy. Heterogeneity in the various studies reviewed in this article is apparent, with early tracheotomy ranging from one to several days, and benefits regarding incidence of pneumonia and mortality are variable. An additional factor likely contributing to the differing results relates to the varied patient populations in the individual studies, which ranged from burn patients to medical ICU patients to trauma patients and head trauma patients.

Reducing emergency department visits and hospitalizations in African American and Hispanic patients with asthma: a 15-year review.

Minority populations in the United States continue to experience a disproportionate share of emergency department (ED) visits and hospitalizations due to asthma. This review examines programs that have attempted to reduce these acute care visits in African American and Hispanic patients. We performed a PubMed search of the English literature for studies published from March 1990 to March 2005, aimed at reducing ED visits and hospitalizations in patients with asthma.

The pathogenesis of ventilator-associated pneumonia.

Of the four routes of infection pathogenic bacteria can take, the inhalation and aspiration ones are the most important. Inhalation pneumonia is usually due to manipulation of the ventilator tubing and aspiration of the infected condensate. Aspiration of the colonized oropharyngeal contents through the open vocal cords and eventually around the blown up endotracheal cuff allows bacteria to invade the trachea and main bronchi.

Pneumonia in patients who require prolonged mechanical ventilation.

Nosocomial pneumonia is the most important infectious disease in patients who require prolonged mechanical ventilation. Understanding of the etiology helps to prevent ventilator-associated pneumonia (VAP). VAP can develop in four ways: by aspiration, inhalation, hematogenous spread and by contiguous spread.

A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients.

Objective: The timing of tracheotomy in patients requiring mechanical ventilation is unknown. The effects of early percutaneous dilational tracheotomy compared with delayed tracheotomy in critically ill medical patients needing prolonged mechanical ventilation were assessed.

Design: Prospective, randomized study.