Current Issue : January - March Volume : 2013 Issue Number : 1 Articles : 6 Articles
There has been an increase in lung transplantation in the USA. Lung allocation is guided by the lung allocation score (LAS), which\r\ntakes into account one measure of exercise capacity, the 6-minute walk test (6MWT). There is a paucity of data regarding the role\r\nand value of cardiopulmonary stress test (CPET) in the evaluation of lung transplant recipients while on the transplant waiting list\r\nand after lung transplantation. While clearly there is a need for further prospective investigation, the available literature strongly\r\nsuggests a potential role for CPET in the setting of lung transplant....
Background. Interstitial lung disease (ILD) is the most common complication of systemic sclerosis (SSc) with treatment ineffective.\r\nObjective: The aim of this meta-analysis was to provide an estimate of the safety and efficacy profile of Mycophenolate Mofetil\r\n(MMF) or sodium (MMS) in SSc-ILD patients. Materials and Methods. All studies were reviewed systematically. The main\r\nend-points were safety and efficacy profile as estimated by forced vital capacity (FVC)% and diffusion capacity of the lung\r\nfor carbon monoxide (DLCO)% of the predicted normal value (%pred.) before and after treatment in patients with SSc-ILD.\r\nQuality assessment and data extraction were performed independently by two reviewers. Results. Seventeen studies were reviewed\r\nsystematically. Six studies, one prospective, were eligible for analysis encompassing 69 patients, including 10 subjects from our, yet\r\nunpublished, retrospective study. There was no statistically significant difference in both efficacy outcomes of interest, including\r\nFVC% pred. (weighted mean difference 1.48, 95% confidence interval (CI): -2.77 to 5.72, P = 0.49) and DLCO% pred. (weighted\r\nmean difference -0.83, 95% CI: -4.75 to 3.09, P = 0.93). No cases of clinically significant side effects were documented.\r\nConclusions.Meta-analysis data suggest that MMF is a safe therapeutic modality which was associated with functional stabilization\r\nin patients with SSc-ILD....
Given the potential morbidity of traditional chest tube insertion, use of pigtail is desirable. The purpose of this\r\ncase series is to determine the efficacy of bedside pigtail thoracostomy catheters in Adult population by using bedside\r\nultrasound by the primary internist....
data showing hemodynamic deterioration in patients with Atrial Septal Defect (ASD) than in Ventricular Septal Defect\r\n(VSD).\r\nMethod: A proof of concept study was designed to evaluate effect of bosentan treatment for 12 months using both\r\nclinical outcome and Cardiac Magnetic Resonance (CMR).\r\nResults: Ten patients were enrolled with average age of 39.7 �± 9.7 years. There were 5 ASD and 5 VSD in each\r\ngroup. There is no statistical significance in baseline data among both groups. During the follow up period there is an\r\nimprovement of 6 Minute Walk Distance (6 MWD) at 4 months, but the effect levels off at 12 months. Patients with VSD\r\ngroup showed better improvement of 6 MWD more than in ASD group (p=0.52 at 4 months and p=0.009 at 12 months).\r\nAll CMR findings were not statistically different at 12 months. However, patients who had VSD showed significant\r\nimprovement in RV EF from baseline of 54.6 �± 14.5% to 56.27 �± 13.79% and 57.53 �± 7.66% when compared to ASD\r\nof 38.3 �± 11.5% to 38.72 �± 10.55% and 39.24 �± 10.80% at 4 months and 12 months respectively (p=0.025).\r\nConclusion: We demonstrated improvement of 6 MWD in ES with bosentan treatment for 12 months. We were\r\nnot able to show improvement in CMR parameter at 12 months, however, when compared, VSD group had significant\r\nimprovement in RVEF to ASD group....
Biologic agents have revolutionized the management of some inflammatory diseases like rheumatoid arthritis,\r\nseronegative spondyloarthropathies and Crohn�s disease; the selective inhibition of mediators involved in systemic\r\nchronic processes have allowed to expand the knowledge among the complex pathogenic pathways that are involved\r\nin inflammation and damage.\r\nThe off-label use of biologic drugs is expanding. This review highlights the theoretical basis that may support\r\nthe use of biologic drugs in the treatment of Systemic Sclerosis (SSc), a disabling and sometimes devastating\r\ndisease whose treatment remains largely unsatisfactory. Some progresses have been made concerning the vascular\r\ncomplications of the disease, but the skin and visceral fibrosis, which is the hallmark of the disease, is still orphan of\r\neffective therapy. Moreover the results of the limited clinical experience about biologic agent administration in SSc and\r\nSSc-interstitial lung disease are presented....
Empyema remains a challenge for modern medicine. Cases not amenable to lung decortication are particularly difficult to\r\ntreat, requiring prolonged hospitalizations and mutilating procedures. This paper presents the current role of thoracomyoplasty\r\nprocedures, which allow complete and definitive obliteration of the infected pleural space by a combination of thoracoplasty and\r\nthe use of neighbourhood muscle flaps (latissimus dorsi, serratus anterior, pectoralis, rectus abdominis, omentum, etc). Recent\r\npublications show an overall rate of success of 90%, with a quick and definitive healing. Although rarely indicated in our days,\r\nthis kind of procedures remain in the armamentarium of modern thoracic surgery. The importance of thoracomyoplasty derives\r\nfrom the fact that it may be a simple and definitive solution for complicated cases of chronic empyema not amenable to standard\r\ndecortication....
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