In severe congestive heart failure, lymphatic drainage can increase 10-fold. Pastis et al hypothesize this could result in enlarged mediastinal lymph nodes. They retrospectively examined chest CT scans for 118 patients undergoing heart transplantation. Fifty-three had mediastinal LNs > 1 cm. In the 9 who had post-transplant CT scans available, mediastinal lymph nodes shrank after [… read more]
Masclans et al followed 38 patients with ARDS in 3 ICUs for 6 months. Health-related quality of life (Nottingham Test Profile) was lower than expected at 6 months, with 40% reporting limitations in daily activities mainly due to low energy, mobility and social functioning. Mild radiographic abnormalities and restrictive physiology were usually present on HRCT [… read more]
van der Aalst et al report that in the Dutch lung cancer screening NELSON trial, smokers with 1 or more indeterminate CT scans continued to smoke at the same rate as those with normal CT scans (reported by questionnaire 2 years later). Those with the abnormal CTs did report more attempts at smoking cessation, though. [… read more]
Actuarial survival in PAH has been predicted mainly by functional class and echocardiographic evidence of right heart failure. Observing 484 patients with WHO group I PAH for 5 years after diagnosis, Kane et al showed that using their own multivariate model (incorporating clinical data including renal function, BNP, DLCO, BP & HR, etc.) generated better [… read more]
Follow-up and nonpharmacological management of the idiopathic pulmonary fibrosis patient. Egan JJ, Eur Resp Rev 2011;20:114-117.
After 25 years of declines in coal workers’ pneumoconiosis (thanks to federal regulation of tolerable concentrations of coal dust and radiographic surveillance of miners), CWP and progressive massive fibrosis have been on the upswing since 2001, killing or disabling dozens of relatively young miners. Wade et al describe the trend in a cohort of 138 [… read more]
Bacterial pneumonia; tuberculosis; critical illness; pulmonary hypertension; smoking, and COPD in HIV-positive patients are discussed in >100 pages. Proc Am Thorac Soc 2011;8:215-332. Review.
Pulmonary rehabilitation, realities in clinical practice. Birnbaum S, CHEST 2011;139:1498-1502. Having trouble finding a pulmonary rehab program to refer your COPD patient into? That may be because in 2011, according to Mr. Birnbaum, Medicare paid outpatient centers $28 per rehabilitation session, per patient.
Due to its characteristic brain tumors causing intellectual delay and seizures, TSC-LAM usually presents in childhood. Seibert et al report a series of 79 adult women with TSC-LAM, 45 of whom were diagnosed in adulthood. 15 did not meet diagnostic criteria until after age 18. Ann Intern Med 2011;154:806-813.
Boutitie et al analyzed pooled anticoagulation clinic data from 2,925 people with a first deep venous thrombosis or pulmonary embolism in the UK. They found that the recurrence risk after stopping anticoagulation at 3 months was equivalent to stopping at 6 months. Proximal DVTs were more likely to recur than distal DVTs. BMJ 2011;342:d3036. FREE [… read more]
In a 3-center observational study, Pareek et al report that 20% of new immigrants to the UK (224 of 1229) had latent tuberculosis infection as detected by interferon-gamma release assay. Standing screening policy may miss ~70% of these cases. Lancet Infect Dis 2011;11:435-444.
Douma et al compared the Wells score, Geneva score, and the simplified versions of each, combined with D-dimer, on a prospective cohort of 807 patients with suspected PE (~23% of whom were found to have PE). With a negative D-dimer and a low-probability score using any rule, risk of pulmonary embolism was ~0.5%. However, only [… read more]
Survival of trauma patients after massive red blood cell transfusion using a high or low red blood cell to plasma transfusion ratio. Rajasekhar et al. Crit Care Med 2011;39:1507-1513. Meta-analysis.
No one knows, say Lee et al. They report on 27 Korean soldiers who were exposed to 5 barracks-mates with active TB; 26 eventually “converted” by tuberculin skin test/PPD or by interferon-gamma release assay. One-time TST/PPD identified 21, or 78%. IGRA every two weeks eventually diagnosed 26 (96%), but it took 14 weeks for 3 [… read more]
Gershengorn et al retrospectively compared two MICUs at Beth Israel: one with “midlevels” (nurse practitioners and physician assistants during the day with attending coverage overnight) and one that was all house staff 24/7. There were no differences in important outcomes (mortality, MICU or hospital LOS), although the study was nonrandomized and subject to bias. CHEST [… read more]
Salaun et al publish their experience using a simple algorithm for management of 321 consecutive patients with suspected pulmonary embolism at one center in France. The tool sought to avoid CT-angiography (and associated radiation) wherever possible, instead favoring leg ultrasounds and ventilation-perfusion scans. Only the indeterminate cases (a mere 35, or 11%) underwent CT-A. In [… read more]
In association with United Biosource Corp., Jones et al are championing a patient questionnaire called EXACT-PRO that seeks to standardize the definition of a COPD exacerbation. Here, they report on the production of their proposed 14-item measure to diagnose and grade the severity of COPD exacerbations. Breathlessness, cough-and-sputum, and chest symptoms form the core of [… read more]
Lung vasculitis and alveolar hemorrhage. Ten articles in 103 pages. Semin Resp Crit Care Med 2011;32:243-346. Review.
Taveira-DaSilva reports an observational series of 19 women treated with sirolimus for lymphangioleiomyomatosis. Of 12 women with chylous pleural effusions, most had a large improvement or resolution in their effusions. Ann Intern Med 2011;154:797-805. In a randomized trial of 89 LAM patients published in NEJM March 2011, sirolimus reduced decline of lung function.
The New York Times reported that hundreds of community hospitals frequently perform two chest CT scans back-to-back (one with, one without IV contrast), while academic centers almost never do. More than 70,000 patients were double-scanned; some hospitals did it >80% of the time on their Medicare chest patients. Defenders say they don’t do it to [… read more]