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Feb 192012
 

Traditional bronchoscopy with transbronchial biopsy (TBBx) has only a 34% sensitivity at diagnosing peripheral pulmonary nodules < 2 cm in size. Transthoracic needle aspiration (TTNA)’s superior sensitivity of 90% for diagnosing peripheral lesions makes it the standard of care for peripheral lesions, but TTNA carries a considerable risk for pneumothorax. A huge proportion of patients experience [… read more]

Feb 182012
 

Please also see the newer post describing the final results of PANTHER-IPF, published in NEJM 2012. PANTHER-IPF, a landmark clinical trial testing commonly used therapies for idiopathic pulmonary fibrosis, was stopped in October 2011 for apparent harm caused to patients by prednisone and azathioprine. This news was released back then, but maybe you missed it, as [… read more]

Feb 172012
 
Tobacco warnings, free speech, and "in-activist" judges (NEJM)

Legal eagle Kevin Outterson explains the latest twists in the saga of the FDA’s quest to get large, scary pictures on every cigarette package under its new regulatory muscle of the 2009 Obama-authorized Tobacco Control Act. R.J. Reynolds sued, and federal judge Richard Leon took their side in November 2011, deciding to apply the more [… read more]

Feb 162012
 

Do you conduct original investigations in respiratory medicine? Are you tired of publishing your work in The New England Journal of Medicine, Science and Nature? Well, Lancet has been feeling left out. They’d like to publish your manuscript(s) in a September 2012 issue to coincide with the European Respiratory Society meeting. They’ve issued a call for [… read more]

Feb 142012
 

Chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are common and together contribute enormously to the global burden of chronic disease. Although surely these conditions overlap and interact, surprisingly little study has been given to their interrelationship. Macchia et al prospectively evaluated and followed two cohorts of patients aged > 59, recruited from [… read more]

Feb 112012
 

My post featured on KevinMD: Obama health reform adviser Ezekiel Emanuel has been writing regularly in the lay and medical press to soften up physicians and the public for the coming of the mysterious accountable care organizations. But are rank-and-file docs buying the party line? Will physicians buy into ACOs? (KevinMD) http://www.kevinmd.com/blog/2012/02/physicians-buy-acos.html

Feb 102012
 

The Cochrane Collaboration smells a rat around Pharma’s handling of its data on oseltamivir (Tamiflu) and zanamivir (Relenza). They’re taking the unusual step of publicly calling for Roche (Tamiflu) and GlaxoSmithKline (Relenza) to make available their data from the original clinical studies that led to approval of the two blockbuster drugs. They point out that [… read more]

Feb 092012
 

Allergic rhinitis is mostly just an annoyance for 400 million people worldwide, but the condition can predispose to frequent upper respiratory infections, and worsen asthma; Alexander Greiner et al tell you what you need to know in this review in Lancet. Incidence peaks in the teenage years. The nasal inflammation of allergic rhinitis synergizes with [… read more]

Feb 082012
 

One-third of smokers try to quit each year, but few stay quit. Even with varenicline (Chantix), the most effective smoking cessation aid to date, only 10% are abstinent at one year. Anne Joseph, Steven Fu, Dorothy Hatsukami et al wonder if that’s partly because our (fee-for-service-driven) intermittent-visit model of patient care and counseling leaves craving [… read more]

Feb 062012
 

Januel et al report findings of a systematic review and meta-analysis to estimate the total incidence of acute symptomatic venous thromboembolism (symptomatic DVT or pulmonary embolism) among patients receiving proper thromboprophylaxis after hip or knee replacements. They came up with rates of 1.1% after knee replacements, and 0.5% after hip replacements. The rate of pulmonary [… read more]

Feb 052012
 
Systemic steroids for severe sepsis and septic shock (Review)

The benefits of corticosteroids as a treatment for severe sepsis and septic shock (if any) are unknown: Although adrenal suppression is common in sepsis, it is still unclear how to assess adrenal function, or whether it should be done at all. The sensitivity and specificity of the cosyntropin (ACTH) stimulation test are unknown, and its [… read more]

Feb 032012
 

Jean-Pierre Tourtier and Sophie Cottez of the Military Hospital Val-de-Grâce, Paris share the case of a 61-year-old man who underwent vertebroplasty after a therapeutic laminectomy for resection of a vertebral hemangioma. Cement made it into his paravertebral vascular system, and thence to his systemic circulation and pulmonary arteries, where it made for some interesting radiographic pictures. [… read more]

Feb 022012
 

Here’s a great example of how weak findings in small, underpowered studies — findings which should be at most viewed as hypothesis-generating — become transmuted into Serious Studies With Important Implications when the lay press give them too much credit. In this case, the Los Angeles Times, Huffington Post, and CNN took the bait after [… read more]

Jan 292012
 

The Obama administration is about to mandate strict new reporting requirements that will, in effect, require that every gift to a doctor from a pharma or device company be recorded on a publicly accessible government website. This initiative was authorized in the federal health care law, but the details were unspecified and implementation delayed.  Senators Charles Grassley [… read more]

Jan 282012
 

Hayder Saeed and Suleiman Massarweh of the University of Kentucky share with us the story and images of a woman presenting with weight loss and cough, and discovered to have hypertrophic pulmonary osteoarthropathy, velvety palmar skin, clubbing … and an 11 cm adenocarcinoma in the right lung. Saeed H, Massarweh S. Hypertrophic Pulmonary Osteoarthropathy and [… read more]

Jan 282012
 
Apixaban for thromboprophylaxis post-discharge causes bleeding (ADOPT Trial, NEJM)

For years, Pharma have been itching to prove a benefit of extended chemoprophylaxis against DVT / PE in medically ill patients after hospital discharge. Three weeks or more of enoxaparin after surgical knee or hip replacement is standard care, since it reduces the high risk of serious venous thromboembolism with a relatively low risk of [… read more]

Jan 272012
 

C. difficile has always been a foul and disgusting adversary, but lately it’s becoming more formidable and deadly, according to Linda Bobo, Erik Dubberke and Marin Kollef. A few highlights of this excellent review: C.diff infections (CDI) have more than doubled since 2001, to > 340,000 discharges in 2008. Attributable mortality is 6-7%, but may [… read more]

Jan 212012
 

People who survive the initial hyperinflammatory “cytokine storm” of severe sepsis regain their blood pressure, but are at high risk for secondary infection and viral reactivation. Animal models strongly suggest sepsis-induced immune suppression occurring later in the course of sepsis is to blame, but that’s never been proven in humans. Jonathan Boomer, Kathleen To, Richard [… read more]

Jan 212012
 
Omitting heparin prophylaxis in first 24 ICU hours associated with higher mortality (CHEST)

As you know, the risk for DVT and PE in the ICU are high. How high? Depends on how you count them. Asymptomatic, ultrasound-surveillance-detected DVTs have an incidence of 5-10% during the ICU stay (from the PROTECT trial and a 2005 series), even when patients receive proper thromboprophylaxis. The incidence is even higher (up to 80%) in trauma [… read more]