RESUMO
A systemic infection due to community-acquired methicillin-resistant Staphylococcus aureus occurred in a hospital-naive 17-year-old girl with no history of soft-tissue infection. Although the initial signs and symptoms were indolent, systemic manifestations occurred, including extensive lung parenchymal damage and acute respiratory distress syndrome. The patient required long-term mechanical ventilation and was given linezolid for 8 weeks. Blood cultures eventually became negative for the staphylococci, and the patient was discharged to a rehabilitation facility. A probable source of the infection was the patient's self-cutting and self-piercing.
Assuntos
Bacteriemia/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Abscesso Epidural/microbiologia , Abscesso Pulmonar/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Adolescente , Bacteriemia/tratamento farmacológico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Abscesso Epidural/tratamento farmacológico , Feminino , Humanos , Abscesso Pulmonar/tratamento farmacológico , Resistência a Meticilina , Infecções Estafilocócicas/tratamento farmacológicoRESUMO
The differential diagnosis of pleural masses is limited. Asbestos-related disease and invasive bronchogenic carcinoma make up the majority of cases. The diagnostic yield of biopsies is low, and invasive procedures are often required to achieve diagnosis. A variety of imaging techniques are available to help differentiate between benign and malignant disease to help discern which patients to biopsy. While computed tomography has a relatively good sensitivity and specificity, magnetic resonance imaging (MRI) and positron emission tomography (PET) both appear to have higher accuracy. MRI has the added benefit of being an excellent aid in determining surgical resectability of tumors. MRI and PET are limited, however, by their cost and availability in certain regions.
Assuntos
Diagnóstico por Imagem/métodos , Neoplasias Pleurais/diagnóstico , Idoso , Diagnóstico Diferencial , Diagnóstico por Imagem/economia , Feminino , Humanos , Sensibilidade e EspecificidadeRESUMO
The treatment objectives for chronic obstructive pulmonary disease (COPD) include relieving symptoms such as dyspnea and cough, slowing the accelerated decline in lung function, decreasing exacerbations, and improving quality of life. All major guidelines for COPD management recommend beginning treatment with bronchodilators. There are several classes of bronchodilators, including beta-agonists, anticholinergics, and phosphodiesterase inhibitors, each with a specific mechanism of action. The overall approach to managing stable COPD involves a stepwise increase in treatment. Because of the progressive nature of emphysema, such an approach often involves combining bronchodilators from different pharmacologic classes. This review focuses on the pharmacologic properties of various bronchodilators and on recent studies that have examined combination therapy as a means to optimize treatment.