Interstitial lung disease (ILD) is a broad category of lung diseases that includes more than 150 disorders characterized by scarring or fibrosis of the lungs. In Pulmonary Arterial Hypertension and Interstitial Lung Disease: A Clinical Guide, renowned experts provide a state-of-the-art overview of the problems seen by physicians in the clinical management of ILDs. Divided into two sections, the first part provides and update on general issues and introduces both interstitial lung disease and associated pulmonary hypertension. A detailed analysis of the pathology of the various interstitial lung diseases is also provided. The second part addresses specific categories of disease. Bronchiolitis, hypersensitivity pneumonitis, and other conditions are covered, and the use of inspiratory and expiratory high resolution CT scan is discussed as well. This important new text is an invaluable resource for the practicing physician who must be aware of the broad and troubling manifestations of interstitial lung disease.

Airway sensory nerve terminals are tailored to detect changes in the physical and chemical environment, thereby supplying local pulmonary information to the central nervous system. Since most intrapulmonary nerve terminals arise from fibres travelling in the vagal nerve, the classification of sensory airway receptors' is largely based on their action potential characteristics, electrophysiologically registered from the vagal nerve. However, the architecture of airways and lungs makes it nearly impossible to functionally locate the exact nerve terminals that are responsible for the transduction of a particular intrapulmonary stimulus. In this monograph we focus on three sensory receptor end organs in lungs that are currently morphologically well-characterised: smooth muscle-associated airway receptors (SMARs), neuroepithelial bodies (NEBs) and visceral pleura receptors (VPRs). Unravelling the main functional morphological and neurochemical characteristics of these sensory receptors using advanced immunohistochemistry and confocal microscopy has already allowed us to draw important conclusions about their potential function(s). The current development of ex vivo lung models for the selective identification of SMARs, NEBs and VPRs using vital staining will certainly facilitate direct physiological studies of these morphologically well-characterised airway receptors, since these models allow direct live studies of their functional properties.

Leading investigators review the highlights of current fibrosis research and the experimental methodologies used uncover the mechanisms that drive it. In their discussion of research methodologies utilizing cultured cells to model various aspects of the fibrotic response in vitro, the authors describe the isolation, characterization, and propagation of mesenchymal cells, and highlight the similarities and differences between methods that are appropriate for different types of fibroblasts. Approaches for studying collagen gene regulation and TGF-b production are also discussed, along with experimental methodologies utilizing animal models to study the pathogenesis of fibrosis. The protocols follow the successful Methods in Molecular Medicine (TM) series format, each offering step-by-step laboratory instructions, an introduction outlining the principles behind the technique, lists of the necessary equipment and reagents, and tips on troubleshooting and avoiding known pitfalls.

This practical volume highlights traditional, novel, and evolving aspects of the diagnosis and treatment of pulmonary embolism (PE). The contributors comprise an international team of experts. Important aspects of diagnosis, risk stratification, and differential treatment of patients with PE are presented in a concise, yet comprehensive manner. Emphasis is placed on specific issues related to PE, including pregnancy, cancer, thrombophilia, and air travel.

La crescita esponenziale dell'interesse per la ventilazione non invasiva (NIV) verificatasi negli ultimi 10-15 anni, non solo dal punto di vista clinico e applicativo, ma anche speculativo, ha pochi eguali nella recente storia della medicina.
In Italia e in Europa in generale tale metodica e applicata su larga scala, prevalentemente nei reparti di Pneumologia e nelle Unita di Cure Intermedie Respiratorie, mentre per quanto riguarda la sua applicazione nei reparti di Terapia Intensiva Generale (UTI) i dati emersi da uno studio multicentrico condotto nei paesi francofoni vedono la NIV impiegata in una quantita di casi che rappresenta fino al 50% dei pazienti che richiedono assistenza ventilatoria.
Il recente studio EUROVENT ha inoltre dimostrato come la NIV non si limiti alla sua applicazione "acuta," dal momento che circa 25.000 pazienti sono attualmente ventilati "in cronico" a domicilio. Inoltre, si calcola che milioni di cittadini europei soffrano attualmente di disturbi respiratori durante il sonno, e per molti di essi il trattamento medico di prima scelta e rappresentato dalla NIV. Questo libro si propone lo scopo di richiamare l'attenzione sulle piu recenti acquisizioni in questo campo, con la speranza di fornire uno strumento valido e maneggevole per la scelta e l'impostazione della migliore modalita di ventilazione.

Simplify, simplify! Henry David Thoreau For writers of technical books, there can be no better piece of advice. Around the time of writing the first edition - about a decade ago - there were very few monographs on this s- ject: today, there are possibly no less than 20. Based on critical inputs, this edition stands thoroughly revamped. New chapters on ventilator waveforms, airway humidification, and aerosol therapy in the ICU now find a place. Novel software-based modes of ventilation have been included. Ventilator-associated pneumonia has been se- rated into a new chapter. Many new diagrams and algorithms have been added. As in the previous edition, considerable energy has been spent in presenting the material in a reader-friendly, conv- sational style. And as before, the book remains firmly rooted in physiology. My thanks are due to Madhu Reddy, Director of Universities Press - formerly a professional associate and now a friend, P. Sudhir, my tireless Pulmonary Function Lab technician who found the time to type the bits and pieces of this manuscript in between patients, A. Sobha for superbly organizing my time, Grant Weston and Cate Rogers at Springer, London, Balasaraswathi Jayakumar at Spi, India for her tremendous support, and to Dr. C. Eshwar Prasad, who, for his words of advice, I should have thanked years ago. vii viii Preface to the Second Edition Above all, I thank my wife and daughters, for understanding.

Respiratory diseases affect a large proportion of the population and can cause complications when associated with pregnancy. Pregnancy induces profound anatomical and functional physiological changes in the mother, and subjects the mother to pregnancy-specific respiratory conditions. Reviewing respiratory conditions both specific and non-specific to pregnancy, the book also addresses related issues such as smoking and mechanical ventilation. Basic concepts for the obstetrician are covered, including patient history, physiology and initial examinations. Topics such as physiological changes during pregnancy and placental gas exchange are discussed for the non-obstetrician. Guidance is practical, covering antenatal and post-partum care, as well as management in the delivery suite. An essential guide to respiratory diseases in pregnancy, this book is indispensable to both obstetricians and non-obstetric physicians managing pregnant patients.

Ultrasound scanners are available in an increasing number of clinical areas. They are excellent for identifying the presence of a pleural effusion and the optimal site for aspration. The National Patient Safety Agency recommends their use prior to insertion of chest drains for pleural effusions. This book is for clinicians who want to start using portable ultrasound scanners to look at the chest. It will teach you some basic physics and how to adjust the controls on the scanner. Then you will learn how to recognise a pleural effusion. When you are proficient at identifying pleural effusions, you can start to look for some of the other clinical conditions which are shown in the many illustrations in this book. There are examples of the artefacts which may catch you out, with diagrams to explain how they are caused. Once you have started to use ultrasound at the bedside, you will not want to undertake "blind" pleural aspirations ever again. Competency in this technique is becoming the norm for those involved in managing patients with disease of the chest; this book will help you along that road

Respiratory system and artificial ventilation are key topics when considering the main aspects of Anaesthesiology and Critical Care Medicine: assisted ventilation techniques are essential to preserve the patient s life, but just as any other treatments they can be also extremely pernicious.

Scientific research and clinical evidences are equally fundamental in investigating the best methods to provide effective support and increase positive outcomes. It is obviously desirable that this knowledge and know-how are widely shared among scientists and practitioners.

With this purpose, the book includes contributions by an international panel of authors and gathers their varied and valuable expertise up to illustrate principles, study results and case experiences on respiratory physiopathology, respiratory mechanics, respiratory functions monitoring, artificial ventilation and diagnostic radiology in respiratory dysfunction failure.

We trust it can represent a precious reference for professionals in their ongoing self-improvement process to increase skilfulness. Furthermore, we hope that this book can serve as a useful learning tool for medical students and can contribute to the education of future anaesthesiologists and intensivists."

This book covers the complete field of pleura and mediastinum pathology - from acquired multilocular thymic cyst to well-differentiated papillary mesothelioma. The alphabetically arranged entries, each of which provides a detailed description of a specific pathological disease pattern, allow readers to quickly and easily find the information they need.

This book provides an unbiased and evidence-based guide to the potential role of interventional pulmonology as an alternative to thoracic surgery. Interventional pulmonology is a new and quickly growing sub-specialty in pulmonary medicine and increasingly more pulmonologists are turning to interventional therapies over the more costly and invasive surgical options. The text thoroughly presents detailed coverage of and diagnostic methods for many diseases and conditions that pulmonologists encounter daily, including: diffuse lung infiltrates, solitary lung nodule, undiagnosed exudative pleural effusion, pneumothorax, hemoptysis, and airway foreign body. Experts then detail treatment options, from both a surgical and interventional perspective, with guidance on: when each procedure is most appropriate, what can be performed by a pulmonologist (with guidelines on how those procedures are done) versus what needs to be referred to a thoracic surgeon or an intervention pulmonologist, and the benefits and disadvantages involved with each option. This is an ideal guide for pulmonologists, trainees, and students to better understand the full scope of possible treatment options for their patients and to make the best informed decision about patient care.

This book provides a detailed account of the principles and practice of contemporary lung transplantation. An accomplished, international team of contributing authors have combined their expertise to provide scientific developments and clinical knowledge based on their extensive experience. The book covers pulmonary vascular and parenchymal lung disease, which necessitate transplantation, together with all aspects of the multidisciplinary management of lung transplant patients. It concludes by looking at future developments in the treatment of advanced respiratory failure. This multidisciplinary approach makes the publication suitable for several subspecialities in addition to pulmonary medicine and lung transplantation, including haematology, radiology and clinical psychology. It will serve as a valuable source of reference and practical information for medical specialists in transplantation and all those working in thoracic organ transplant units.

The goal of the first edition of Interventional Critical Care: A Manual for Advanced Care Practitioners was to fill a knowledge gap of the advanced practice provider (APP) specifically regarding the skills and understanding of critical care procedures in response to the rapidly expanding participation of APPs in critical care. Written by experts in the field, this successor edition adds to the content of the first by expanding upon ultrasonography areas to include more direct hemodynamic evaluations as well as the newer "e"FAST. It also explores the specialty of Urology to include more complex interventions. As billing and coding are necessary, the authors added appropriate CPT codes for each of the appropriate chapters. Most chapters have been completely re-written and updated from the first edition and have different authors - thereby a different perspective and experience level. Interventional Critical Care 2nd Edition serves as a valuable reference for physicians and advanced practice providers in daily practice in the ICU, OR and/or ED setting.

The development of new therapeutic strategies and the minimization of both direct and indirect costs represent crucial goals in the management of chronic diseases, particularly when these are characterized by a high degree of disability.

Chronic respiratory insufficiency (CRI) represents an example of a persistent disease worldwide, for which home management (i.e., daily nursing and treatment) was introduced more than two decades ago according to traditional operating protocols. "Home long-term oxygen treatment" (H-LTOT) was expected to produce significant clinical improvements, together with a substantial drop in CRI social costs (e.g., hospital admissions, number of exacerbations, pharmaceutical costs, and patienta (TM)s reduced productivity).

The present volume describes the evolution in the home management of severe CRI over the last two decades in Italy. It reviews a range of topics including the epidemiological aspects, complicating events, current systems for oxygen delivery with the most convenient interfaces, changing approaches to the patient--caregiver relationship, and the economic burden. Particular attention is paid to the new trends in telemedicine, which is regarded as the future step in respiratory medicine for home-assisted and home-ventilated patients. Data concerning the new role of nursing, the patienta (TM)s expectation of life, and the patienta (TM)s, family's, and doctora (TM)s perspective are also reported, together with an update on the economic impact of telemedicine and the continuing improvements in the quality of telematic H-OTLT.

Lung cancer remains the leading cause of cancer-related death in men, and in women, it has surpassed even breast cancer. According to the American Cancer Society, in 2001, there will be about 169,500 new cases of lung cancer in the United States: 90,700 among men and 78,800 among women. LUNG CANCER is the second installment in the M. D. Anderson Cancer Care Series, featuring the current standard approach to lung cancer care from the experts at M. D. Anderson Cancer Center. Designed for the practicing oncologist, this clinical guidebook allows for quick, authoritative access to the latest and best multimodality therapies. Topics covered in this volume include the clinical examination of patients with suspected lung cancer, thoracic imaging techniques for non-small cell and small cell lung cancer, pathology of lung cancer, treatment and management of non-small and small-cell lung cancer, including the role of guidelines and clinical pathways, molecular events in lung cancer and implications for prevention and therapy, palliation, and much more. Each of the 15 chapters ends with an up-to-date list of suggested readings, as well as "key practice points" highlighting the most important principles and practices of each chapter for at-a-glance reference. Over 50 illustrations and 40 tables round out the text. This thorough, practical volume is the essential clinical guide for oncologists, surgeons, and all physicians involved in the care of patients with lung cancer.

Mechanical ventilation and weaning is one of the most common procedures carried out in critically ill patients. Appropriate management of these patients is of paramount importance to improve the outcome in terms of both morbidity and mortality. This book offers the physiological and clinical basis required to improve the care delivered to patients undergoing mechanical ventilation.

This book provides practising clinicians with the relevant information for the diagnosis and management of COPD patients. Chronic obstructive pulmonary disease (or chronic bronchitis and emphysema) is a common cause of lost work days and ranks high in the list of causes of death. This volume covers all aspects of the disease. After discussing basic science, the emphasis is on the clinical management of these patients. It discusses specific problems, such as sleep problems, and includes recent trends, future perspectives and new developments in therapeutics.

Now in its fourth edition, Physiotherapy in Respiratory and Cardiac Care is an essential resource on the rationale and practicalities of physiotherapy for people with respiratory and cardiac disorders. Providing a clear, problem-solving approach, the book relates the physiology of the cardiorespiratory system to practice. Cardiac and paediatric physiotherapy have been expanded for the new edition, which is research-based throughout. The pathophysiology of respiratory and cardiac disorders is first examined, then linked to accurate patient assessment. The main part of the book then applies a logical approach to physiotherapy management, with adaptations for different groups of people. The text has been thoroughly updated. The analytic approach encourages students and practitioners to critically appraise the research base, use logical reasoning, and then evaluate and reflect on their practice.

Chlamydia pneumoniae is now recognized as an important human pathogen. Chlamydia pneumoniae is involved in 5%-15% of community acquired pneumonias, and recent data indicate its relevance in severe pneumonia and as a respiratory pathogen in immunocompromised subjects. A causal role for Chlamydia pneumoniae in the initiation, exacerbations and promotion of asthma has been suggested. Approximately 5% of chronic bronchitis exacerbations have been attributed to Chlamydia pneumoniae infections, and chronic infection may facilitate access of other pathogens to the lower respiratory tract. Another field of potential great social impact is the possible involvement of Chlamydia pneumoniae in the pathogenesis of atherosclerosis and related cardiovascular diseases. This book presents the current state-of-the-art knowledge on Chlamydia pneumoniae infection and highlights future lines of research.

In the 15 years of the acquired immunodeficiency syndrome (AIDS) pandemic much has been learnt about its natural history and complications. It is clear that the lung is a major target organ both for the human immunodeficiency virus (HIV), and a wide array of infectious and non-infectious pulmonary complications. A great deal of information on the epidemiology, microbiology, immunology, clinical features, diagnosis and management of these pulmonary complications has accumulated during the past 15 years. Given the enormous explosion in information, it is now timely to bring together this knowledge in this 25-chapter volume on AIDS and respiratory medicine. The contributors to this volume are prominent epidemiologists, doctors, microbiologists and scientists from Europe, USA and Africa. Professors Chretien and Enarson give a masterful account of the epidemiology of lung complications of HIV. Drs Zumla, Rowland Jones and Professor McMichael give a detailed summary of the lung immune responses to HIV. They outline normal lung defenses and discuss the consequences of HIV infection on them. The pulmonary radiological features of HIV and its complications as seen in the USA and Europe are illustrated by Professors Armstrong and Dee and this is compared and contrasted by Professor Tshibwabwa-Tumba who brings together his vast experience of chest X-rays in AIDS patients from Central Africa. Drs O'Doherty and Miller deal with the uses, and potential applications, of nuclear medicine in imaging of the chest in AIDS patients."

This text provides a practical introduction to peak flow measurement, its indications, uses and benefits, and associated problems.;Asthma is a very common condition affecting at least 12 per cent of schoolchildren and 5 per cent of adults. Recent guidelines proposed by the British Thoracic Society for the management of chronic and acute asthma recommend the domiciliary use of the peak flow meter to assist doctors in the management of the condition, as well as helping the patient manage his or her own asthma flow. This illustrated guide gives the doctor instructions on the correct use of the meter as well as providing information on the benefits and limitations of the test. Worked case histories and "real" examples of classical peak flow histories can be found throughout the text. It should be of use to respiratory physicians, general practitioners, practice nurses, physiotherapists and other health professionals involved in the day-to-day care of asthma patients.

Cardiovascular and Respiratory Bioengineering focuses on computational tools and modeling techniques in cardiovascular and respiratory systems that help develop bioengineered solutions. The book demonstrates how these technologies can be utilized in order to tackle diseases and medical issues. It provides practical guidance on how a bioengineering or medical problem can be modeled, along with which computational models can be used. Topics include computer modeling of Purkinje fibers with different electrical potential applied, modeling of cardiomyopathies caused by sarcomeric gene mutations, altered sarcomere function, perturbations in intracellular ion homeostasis, impaired myocardial energetics at reduced costs, and more. The book also discusses blood flow through deformable blood vessels in human aorta, abdominal aortic aneurysm, carotid artery, coronary artery and plaque formation, along with content on stent deployment modeling and stent design and optimization techniques.

Great progress has been made since the first description of the acute respiratory distress syndrome by the Denver group in 1967 (Lancet). Although we introduced the term 'adult respiratory distress syndrome' in our second and more detailed description of the syndrome (ehest, 1971), this was probably amistake for the simple reason that children also suffer the same syndrome fo11owing acute lung insults. Today, the syndrome of acute respiratory distress in adults (ARDS) is recognized as a worldwide problem, but the prevalence of disease varies in different parts of the world. A huge amount of research has focused on the mechanisms of acute lung injury and yet the exact sequence of events and media tors in inflammatory cascade, which result in acute respiratory failure from ARDS, is not known but many possibilities exist. The definition of ARDS has been gradua11y modified in recent years and investigators around the world are now co11aborating in order to establish more uniform concepts in identification, risk factors and mechanisms of lung injury, which someday will result in improved approaches to management. Already, at least some centers are showing improved outcomes in ARDS, achieving an approximate 60% survival rate. In the past, most large series documented only about a 40% survivability taking a11 causes of ARDS. This apparent progress is likely attributable to more meticulous and disciplined care than any specific pharmacologic attack on the basic mechanism resulting in ARDS.

This book should be of interest to general physicians, respiratory physicians, infectious diseases specialists.