Review Articles

Oct 302011
 

Lucassen et al sharpened their pencils and tried to combine in a meta-analysis 52 studies (n=55,268) that examined the success of methods of using “gestalt” (subjective impression) or clinical decision rules (Wells, Geneva or revised Geneva scores) to diagnose acute pulmonary embolism. The punchline (and their unstated but implied conclusion) is, we just can’t safely [… read more]

Oct 272011
 

Resection of isolated pulmonary metastasis resulted in surprising longevity in this study by Hornbech et al. They report a series of 248 patients, 97% of whom had a complete resection of their pulmonary metastasis, following them for an average of 5 years. The five year survival rates after pulmonary metastasectomy were as follows: Colorectal cancer: [… read more]

Oct 232011
 

Talc pleurodesis is 90-95% effective at prevention of recurrent primary spontaneous pneumothorax. However, there have been reports of ARDS occurring after talc pleurodesis, mostly in patients with malignant pleural effusions, raising concerns over its use. Bridevaux et al report results of talc pleurodesis on 418 patients with primary spontaneous pneumothorax (PSP) at nine centers in Europe and [… read more]

Oct 222011
 

Is bronchoalveolar lavage useful in the diagnosis and management of interstitial lung disease? Meyer and Raghu believe so (although their manuscript title suggests they’re not 100% sure). They explain why in the October ERJ. They argue that if interpreted in the right clinical context, certain bronchoalveolar lavage findings can help cinch the diagnosis of ILD: Lymphocytes >= 25%: [… read more]

Oct 142011
 

Here’s a free “head-to-head” discussion with arguments for and against implementation of routine mild hypothermia for all patients with out-of-hospital cardiac arrest. The benefits of hypothermia after out-of-hospital ventricular fibrillation cardiac arrests are reasonably well-established, and multiple society guidelines (SCCM’s, AHA’s) advocate the practice. The question is whether to induce mild hypothermia / targeted temperature management in all [… read more]

Oct 122011
 

The elderly have been largely excluded from clinical trials on non-small cell lung cancer (NSCLC), as their surgical risks have been perceived as too high to benefit as a group from lung resection. Many people believe that in practice, elderly people with NSCLC have often been excluded from consideration for lung resection solely based on [… read more]

Oct 112011
 

In 2006, Medicare (we) spent 25% of our dollars on treatment for people in their last year of life. The debate rages, waged with euphemism in public and painful, conflicting emotions in private: how can we let Grandma go peacefully and with dignity, without feeling too guilty or ending up in front of a Senate subcommittee? [… read more]

Oct 092011
 

Smoking cessation counseling may feel like a waste of the time and effort required, since most smokers don’t quit. But evidence shows that even the <10% success rate of smoking cessation counseling saves millions of lives, compared to doing nothing. According to a recent smoking cessation review in the NEJM: Even those not ready to quit do 8% of the time [… read more]

Oct 072011
 

Zhang et al pooled 20 studies that compared ultrasound, chest X-ray, or both against a reference standard (usually CT scan) for the diagnosis of pneumothorax. Chest X-ray had a pooled sensitivity of 52% and specificity 99% for diagnosis of pneumothorax. Ultrasound’s pooled sensitivity was 88% and specificity, 100%. Unsurprisingly, the accuracy of ultrasonography to diagnose [… read more]

Oct 062011
 

Goncalves-Pereira and Povoa meta-reviewed 57 reviews of pharmacokinetics of common beta-lactam antibiotics (piperacillin, meropenem, cefepime, ceftazidime, etc.) on patients in ICUs. The results were troubling or at least confusing: studies reported wide variability in pharmacokinetics of beta-lactam antibiotics in critically ill patients, with volume of distribution and drug clearance varying more than 2-fold for the [… read more]

Oct 052011
 

Confirming my suspicions that when it comes to severe asthma, we are all mostly just faking it, this consensus guideline from the European U-BIOPRED public/private consortium points out how little we really know about this complex and variable illness. There are a couple of helpful tables and algorithms here to help you make sure you’ve [… read more]

Sep 282011
 

37 Canadian oncologists got together in a consensus panel to talk about biomarkers and histologic subtypes of non-small cell lung cancer. The take-home: All NSCLC should be tested for the EGFR mutation, as tyrosine kinase inhibitors can prolong survival for eligible patients. There is insufficient evidence to recommend routine testing for other mutations (KRAS, p53, [… read more]

Sep 172011
 

Surprisingly little is really known about airway remodeling in asthma, including its clinical course, or how treatment may modify it. Two examples: rather than occurring as a late sequela of unchecked inflammation, numerous recent studies show remodeling can occur in tandem with inflammation starting in early childhood. A recent NEJM article generates the hypothesis that [… read more]

Sep 082011
 

Part 1 of Levine et al’s excellent review on toxicology in the ICU. Some of their helpful recommendations/reminders: False positive UDS are common for tricyclics (diphenhydramine/Benadryl, carbamazepine, quetiapine/Seroquel), as are false negatives for benzodiazepines (lorazepam/Ativan, alprazolam/Xanax). The osmolal gap is elevated in ethanol, methanol, ethylene glycol, isopropanol, propylene glycol toxicity, but also in shock and [… read more]

Sep 032011
 

Everything new in COPD from the 10th Lund COPD Symposium, including biomarkers, risk factors, research into systemic effects and exacerbation prevention, and the latest cutting edge treatment: “Activity Promotion” (the article declares this a “paradigm shift” …. but wasn’t trying to get people to move more also part of the old paradigm?) Proc Am Thorac [… read more]

Sep 022011
 

September’s Current Opinion in Pulmonary Medicine has 4-5 review articles each on sarcoidosis (how to handle calcium problems; cardiac sarcoid); interstitial lung disease (biologics for connective-tissue disease related ILD; LAM therapies; stem cell therapy for pulmonary fibrosis), and pulmonary vascular disease. Curr Opin Pulm Med 2011;17.