java barcode generate code C Surgery for COPD in Objective-C

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C Surgery for COPD
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1 Lung transplantation Experience with both single and bilateral sequential lung transplantation for severe COPD is extensive Requirements for lung transplantation are severe lung disease, limited activities of daily living, exhaustion of medical therapy, ambulatory status, potential for pulmonary rehabilitation, limited life expectancy without transplanta-
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tion, adequate function of other organ systems, and a good social support system Average total charges for lung transplantation through the end of the first postoperative year exceed $250,000 The two-year survival rate after lung transplantation for COPD is 75% Complications include acute rejection, opportunistic infection, and obliterative bronchiolitis Substantial improvements in pulmonary function and exercise performance have been noted after transplantation 2 Lung volume reduction surgery Lung volume reduction surgery (LVRS), or reduction pneumoplasty, is a surgical approach to relieve dyspnea and improve exercise tolerance in patients with advanced diffuse emphysema and lung hyperinflation Bilateral resection of 20 30% of lung volume in selected patients results in modest improvements in pulmonary function, exercise performance, and dyspnea The duration of any improvement as well as any mortality benefit remains uncertain Prolonged air leaks occur in up to 50% of patients postoperatively Mortality rates in centers with the largest experience with LVRS range from 4% to 10% The National Emphysema Treatment Trial compared LVRS with medical treatment in a randomized, multicenter clinical trial of 1218 patients with severe emphysema Overall, surgery improved exercise capacity but not mortality when compared with medical therapy The persistence of this benefit remains to be defined Subgroup analysis suggested that patients with upper lobe predominant emphysema and low exercise capacity might have improved survival, while other groups suffered excess mortality when randomized to surgery 3 Bullectomy Bullectomy is an older surgical procedure for palliation of dyspnea in patients with severe bullous emphysema Bullectomy is most commonly pursued when a single bulla occupies at least 30 50% of the hemithorax In this procedure, the surgeon removes a large emphysematous bulla that demonstrates no ventilation or perfusion on lung scanning and compresses adjacent lung with preserved function Bullectomy can now be performed with a CO2 laser via thoracoscopy
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and mechanical interventions (see Dyspnea, Treatment, above) As patients near the end of life, meticulous attention to palliative care is essential (see 5)
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Cote CG et al New treatment strategies for COPD Pairing the new with the tried and true Postgrad Med 2005 Mar;117(3): 27 34 [PMID: 15782671] Gluck O et al Recognizing and treating glucocorticoid-induced osteoporosis in patients with pulmonary diseases Chest 2004; 125:1859 [PMID: 15136401] Hersh CP et al: Predictors of survival in severe, early onset COPD Chest 2004 May;126(5):1443 76 [PMID: 15539711] Hogg JC et al The nature of small-airway obstruction in chronic obstructive pulmonary disease N Engl J Med 2004 Jun 24;350(26):2645 53 [PMID: 15215480] Pauwels RA et al Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary Am J Respir Crit Care Med 2001 Apr;163(5):1256 76 [PMID: 11316667] Shapiro SD COPD unwound N Engl J Med 2005 May 12;352 (19):2016 9 [PMID: 15888704]
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BRONCHIECTASIS
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Chronic productive cough with dyspnea and wheezing Recurrent pulmonary infections requiring antibiotics A preceding history of recurrent pulmonary infections or inflammation, or a predisposing condition Radiographic findings of dilated, thickened airways and scattered, irregular opacities
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General Considerations
Bronchiectasis is a congenital or acquired disorder of the large bronchi characterized by permanent, abnormal dilation and destruction of bronchial walls It may be caused by recurrent inflammation or infection of the airways and may be localized or diffuse Cystic fibrosis causes about half of all cases of bronchiectasis Other causes include lung infection (tuberculosis, fungal infections, lung abscess, pneumonia), abnormal lung defense mechanisms (humoral immunodeficiency, 1antiprotease deficiency with cigarette smoking, mucociliary clearance disorders, rheumatic diseases), and localized airway obstruction (foreign body, tumor, mucoid impaction) Immunodeficiency states that may lead to bronchiectasis include congenital or acquired panhypogammaglobulinemia; common variable immunodeficiency; selective IgA, IgM, and IgG subclass deficiencies; and acquired immunodeficiency from cytotoxic therapy, AIDS, lymphoma, multiple myeloma, leukemia, and chronic renal and hepatic diseases However, most patients with bronchiectasis have panhypogammaglobulinemia, presumably reflecting an immune system response to chronic airway infection Acquired primary bronchiectasis is now uncommon in the United States because of improved control of bronchopulmonary infections
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