Remember when you were a third year medical student? Me neither. But that’s when you first started to build that tough & isolating carapace to protect you from all the overwhelming emotions flying through the hospital, & you, this essay suggests. A seasoned clinical educator and a third-year med student have a conversation about our [… read more]
Patel et al ran 9,999 computer simulations using various vancomycin doses and MICs. When the MIC was 2.0 or greater, 2 g IV q12 hours failed to achieve target drug levels 57% of the time, with 35% predicted nephrotoxicity. But…it’s also true that multiple vancomycin models have been published, which are each internally valid using their own [… read more]
Mucormycosis: clinical presentations and management: Sun H, Lancet Infect Dis 2011;11:301-311.
In a retrospective review of 418 tunneled pleural catheters placed over 2 years, 91% of patients did not require any other drainage procedure. Spontaneous pleurodesis occurred in one-quarter, in whom the catheter was taken out at a median 44 days. More patients with catheters placed in the operating room achieved pleurodesis (36%). Complication rate overall [… read more]
Post cardiac arrest syndrome: Review of therapies: Stub D, Circulation 2011;123:1428-1435.
Pressors and inotropes in circulatory shock: Hollenberg SM, AJRCCM 2011;183:847-855. Vasopressors review.
Survival varies widely among people with N1 non-small cell lung cancer. Examining SEER data on 1,682 patients age > 65, who had a median 8 lymph nodes resected between 1992 and 2005, Wisnivesky et al observe that the ratio of positive-to-negative sampled lymph nodes independently predicted survival. Having more than 50% positive LNs foretold a median survival [… read more]
Probiotics and lung diseases: Forsythe P, CHEST 2011;139:901-908.
Establishing mediastinal spread of non-small cell lung cancer (N2-3 disease) precludes surgery and worsens prognosis; whether PET-CT imaging can improve overall accuracy or safely prevent mediastinoscopies is still unknown. Fischer et al re-heat the data from their 2009 NEJM randomized trial in Denmark, with EUS-FNA and mediastinoscopy on 189 NSCLC patients, in which they concluded that the [… read more]
Pseudomonas pneumonia: Epidemiology, clinical diagnosis, source (Part 1) Fujitani S et al, CHEST 2011;139:909-919.
Ashraf et al selected people with lung nodules from the Danish Lung Cancer Screening Trial, referring them for PET. Having a suspicious PET scan, or a volume-doubling time (VDT) of < 1 year, each separately had a sensitivity of 71% and a specificity of 91% for lung cancer. Combining PET data with VDT improved sensitivity [… read more]
Sleep medicine, a 3,000-year history: Kirsch DB, CHEST 2011;139:939-946.
A retrospective look at 447 patients with stage I non-small cell lung cancer by Inoue et al suggests yes, but without affecting survival. When cancer recurred in those initially diagnosed by CT-guided needle biopsy, pleural dissemination was more likely (8 of 13 recurrences). However, 5-year disease free survival was 89% in the CT-biopsy group and [… read more]
Status epilepticus, refractory, treatment of: Holtkamp M, Curr Opin Crit Care 2011;17:94-100.
Subarachnoid hemorrhage, critical care of: Wartenburg KE, Curr Opin Crit Care 2011;17:85-93.
In 173 patients free of bronchiolitis obliterans syndrome at least 6 months post-transplant, having 10 or more colony-forming units of mesenchymal cells in bronchoalveolar lavage fluid carried a >5.0 hazard ratio for subsequently developing BOS. The relation persisted after multivariate analysis, report Badri et al. AJRCCM 2011;183:1062-1070.
Tako-tsubo cardiomyopathy, natural history of: Parodi G et al, CHEST 2011;139:887-892.
Fang et al prospectively observed 126 patients undergoing lung transplant at 9 U.S. centers. PA pressure was obtained invasively in the OR just after transplant. Those who developed grade 3 primary graft dysfunction at 72 hours (1′ endpoint) had mPAP of 38.5 mm Hg, compared to 29.6 for those who did not; the relationship persisted [… read more]
Venous thromboembolism, long term management of: Bauer K, JAMA 2011;305:1336-1345.
Analyzing 50,481 victims of prolonged mechanical ventilation in Taiwan 1997-2007, Hung et al report outcomes were frankly terrible, with median survival of about 4 months. Those with a primary indication of neurologic damage fared significantly better. Those with a PMV indication of COPD, younger than 85, had 6-18 months median survival. Authors take the additional [… read more]