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Ioannis Psallidas, Nikolaos I Kanellakis, Rahul Bhatnagar, Rahul Ravindran, Ahmed Yousuf, Anthony J Edey, Rachel M Mercer, John P Corcoran, Robert J Hallifax, Rachelle Asciak, Prashanth Shetty, Tao Dong, Hania E G Piotrowska, Colin Clelland, Nick A Maskell, Najib M Rahman
BACKGROUND: Pleural infection is a common complication of pneumonia associated with high mortality and poor clinical outcome. Treatment of pleural infection relies on the use of broad-spectrum antibiotics, since reliable pathogen identification occurs infrequently. We performed a feasibility interventional clinical study assessing the safety and significance of ultrasound (US)-guided pleural biopsy culture to increase microbiological yield. In an exploratory investigation, the 16S rRNA technique was applied to assess its utility on increasing speed and accuracy versus standard microbiological diagnosis...
March 7, 2018: Chest
Antonio Anzueto, Marc Miravitlles
Chronic obstructive pulmonary disease (COPD) is often misdiagnosed and inappropriately treated in many patients. COPD is a distinct disease from adult-onset asthma; however, some patients with COPD may present with several forms of airway disease described as asthma-COPD overlap (ACO). Bronchodilators and inhaled corticosteroids (ICS) both have a place in standard maintenance treatment of COPD and asthma; however, recommendations for use differ widely. In patients with COPD, long-acting bronchodilators are effective initial monotherapy treatment, while ICS monotherapy is recommended as initial treatment in patients with asthma...
March 7, 2018: Chest
Harm-Jan de Grooth, Wai-Ping Manubulu-Choo, Anthe S Zandvliet, Angélique M E Spoelstra-de Man, Armand R Girbes, Eleonora L Swart, Heleen M Oudemans-van Straaten
BACKGROUND: Early high-dose intravenous vitamin-C is being investigated as adjuvant therapy in critically ill patients, but the optimal dose and infusion method are unclear. The primary aim of this study was to describe the dose-plasma concentration relationship and safety of four different dosing regimens. METHODS: Four-group randomized pharmacokinetic trial. Critically ill patients with multiple organ dysfunction were randomized to receive 2g/day or 10g/day vitamin-C as a twice daily bolus infusion or continuous infusion for 48 hours...
March 6, 2018: Chest
Khalid Gafoor, Shalin Patel, Francis Girvin, Nishant Gupta, David Naidich, Stephen Machnicki, Kevin K Brown, Atul Mehta, Bryan Husta, Jay Ryu, George Sarosi, Tomas Franquet, Johny Verschakelen, Takeshi Johkoh, William Travis, Suhail Raoof
Cavities are occasionally encountered on thoracic imaging. Their differential diagnosis is large and includes, among others, various infections, autoimmune conditions and primary and metastatic malignancies. We offer an algorithmic approach to their evaluation by initially excluding mimics of cavities then broadly classifying them according to the duration of clinical symptoms and radiological abnormalities.. An acute or subacute process (<12 weeks) suggests common bacterial and uncommon nocardial and fungal causes of pulmonary abscesses, necrotizing pneumonias, and septic emboli...
March 5, 2018: Chest
Lisa K Moores, Aaron B Holley, Jacob F Collen
No abstract text is available yet for this article.
March 2, 2018: Chest
Jason Chui, Rasha Saeed, Luke Jakobowski, Wanyu Wang, Basem Eldeyasty, Angel Zhu, LeeAnne Fochesato, Ronit Lavi, Daniel Bainbridge
BACKGROUND: A routine chest X-ray (CXR) is recommended as a screening test after central venous catheter (CVC) insertion. We sought to assess the value of a routine post-procedural CXR in the era of ultrasound-guided CVC insertion. METHODS: We performed a population-based retrospective cohort study to review the records of all adult patients who had a CVC inserted in the operating room in a tertiary institution between July 1, 2008 and December 31, 2015. We determined the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion...
February 28, 2018: Chest
Gerard A Silvestri, Nichole T Tanner, Paul Kearney, Anil Vachani, Pierre Massion, Alexander Porter, Steven C Springmeyer, Kenneth C Fang, David Midthun, Peter J Mazzone
BACKGROUND: Lung nodules are a diagnostic challenge with an estimated yearly incidence of 1.6 million in the United States. This study evaluated the accuracy of an integrated proteomic classifier in identifying benign nodules in patients with a pretest probability of malignancy (pCA) ≤50%. METHODS: A prospective multicenter observational trial of 685 patients with 8-30 mm lung nodules. Multiple reaction monitoring mass spectrometry measured the relative abundance of two plasma proteins, LG3BP and C163A...
February 26, 2018: Chest
Derick Asah, Shine Raju, Subha Ghosh, Sanjay Mukhopadhyay, Atul C Mehta
Non-thrombotic pulmonary embolism (NTPE) is a complete or partial occlusion of the pulmonary vasculature by various organic and inorganic materials. These include organic particulate matter (PM) such as adipocytes, tumor cells, bacteria, fungi, or gas and inorganic PM. While NTPE due to organic PM has been extensively reported in the medical literature, there are no comprehensive reviews of inorganic material embolizing to the lungs. The purpose of this article is to examine the current literature describing NTPE resulting from inorganic PM and foreign bodies (FB)...
February 23, 2018: Chest
Alessandra Marengoni, Davide L Vetrano, Ester Manes-Gravina, Roberto Bernabei, Graziano Onder, Katie Palmer
BACKGROUND: Frailty is common in seniors, and is characterized by diminished physiological reserves and increased vulnerability to stressors. Frailty can change the prognosis and treatment approach of several chronic diseases, including chronic obstructive pulmonary disease (COPD). The association between frailty and COPD has never been systematically reviewed. OBJECTIVES: To conduct a systematic review and meta-analysis assessing the association of COPD with frailty and pre-frailty...
February 22, 2018: Chest
Cristina Martínez, Ciro Casanova, Juan P de-Torres, José M Marín, Pilar de Lucas, Antonia Fuster, Borja G Cosío, Myriam Calle, Germán Peces-Barba, Ingrid Solanes, Ramón Agüero, Nuria Feu-Collado, Inmaculada Alfageme, Amparo Romero Plaza, Eva Balcells, Alfredo de Diego, Margarita Marín Royo, Amalia Moreno, Antonia Llunel Casanova, Juan B Galdiz, Rafael Golpe, Celia Lacárcel Bautista, Carlos Cabrera, Alicia Marin, Joan B Soriano, Jose Luis Lopez-Campos
BACKGROUND: Despite the existing evidence-based smoking cessation interventions, chances of achieving that goal in real-life are still low among COPD patients. We sought to evaluate the clinical consequences of changes in smoking habits in a large cohort of COPD patients. METHODS: CHAIN is a Spanish multicenter study carried out at pulmonary clinics including active and former smokers with COPD. Smoking status was certified by clinical history and co-oximetry. Clinical presentation and disease impact were recorded via validated questionnaires, including the London Chest Activity of Daily Living (LCADL) and the Hospital Anxiety and Depression Scale (HADS)...
February 21, 2018: Chest
Alessandro Zanforlin, Vanina Livi, Carlo Santoriello, Paolo Ceruti, Marco Trigiani, Manlio Valerio, Cristiano Perani, Paolo Carlucci, Antonio Palmiotti, Giampietro Marchetti
BACKGROUND: Lung ultrasound examination is becoming an even more important part of pulmonologists' clinical routine. As indicated in literature, the coordinates of any findings on lung parenchyma are based on surface landmarks or conventional quadrants. In our experience we noticed that lung fissures are clearly detectable as interruptions of the pleural line but this was never investigated before. The aim of the study is to evaluate if lung fissures are detectable in normal conditions in routine clinical practice...
February 21, 2018: Chest
David M Liebovitz, John Fahrenbach
No abstract text is available yet for this article.
February 21, 2018: Chest
Emanuel Citgez, Maaike Zuur-Telgen, Job van der Palen, Paul van der Valk, Daiana Stolz, Marjolein Brusse-Keizer
BACKGROUND: Elevated levels of Midrange-proadrenomedullin (MR-proADM) is associated with worse outcome in different diseases among which COPD. The association of stable state MR-proADM with severe exacerbations of COPD requiring hospitalisation (severe AECOPD), or with community acquired pneumonia (CAP) in COPD patients has not been studied yet. AIMS AND OBJECTIVES: The aim of this study was to evaluate the association of stable state MR-proADM with severe AECOPD and CAP in COPD patients...
February 20, 2018: Chest
James D Chalmers
No abstract text is available yet for this article.
February 20, 2018: Chest
W Ennis James, Efstratios Koutroumpakis, Biplab Saha, Alireza Nathani, Leahruth Saavedra, Recai M Yucel, Marc A Judson
BACKGROUND: Compared to pulmonary sarcoidosis, sarcoidosis without lung involvement may involve other immunopathologic mechanisms and be associated with other demographic and clinical features. METHODS: This was a retrospective analysis of clinical data collected in real time on 1,686 patients with biopsy-proven sarcoidosis from two large university sarcoidosis outpatient clinics in the United States. We compared differences in demographics characteristics and clinical presentation between pulmonary and non-pulmonary sarcoidosis (NPS)...
February 14, 2018: Chest
John B West, Daniel R Crouch, Janelle M Fine, Dipen Makadia, Daniel L Wang, G Kim Prisk
BACKGROUND: It would be valuable to have a noninvasive method of measuring impaired pulmonary gas exchange in patients with lung disease and so reduce the need for repeated arterial punctures. Here we report the results of using a new test in a group of outpatients attending a pulmonary clinic. METHODS: Inspired and expired P O2 and P CO2 are continually measured by small, rapidly responding analyzers. The arterial P O2 is calculated from the oximeter Sp O2 and the oxygen dissociation curve...
February 13, 2018: Chest
Su-Huan Chang, Yi-No Kang, Hsin-Yi Chiu, Yu-Han Chiu
BACKGROUND: The optimal initial treatment approach for pneumothorax remains controversial. This systemic review and meta-analysis investigated the effectiveness of small-bore pigtail catheter (PC) drainage in comparison with that of large-bore chest tube (LBCT) drainage as the initial treatment approach for all subtypes of pneumothorax. METHODS: We systematically searched PubMed and Embase for observational studies and randomized controlled trials published up to October 9, 2017, that compared PC and LBCT as the initial treatment for pneumothorax...
February 13, 2018: Chest
Laurie L Carr, Sean Jacobson, David A Lynch, Marilyn G Foreman, Eric L Flenaugh, Craig P Hersh, Frank C Sciurba, David O Wilson, Jessica C Sieren, Patrick Mulhall, Victor Kim, C Matthew Kinsey, Russell P Bowler
BACKGROUND: Lung cancer is a leading cause of death and hospitalization for patients with chronic obstructive lung disease, (COPD); a detailed understanding of which clinical features of COPD increase risk is needed. METHODS: To identify clinical and imaging features of smokers, with and without COPD, that are associated with an increased risk of lung cancer, we performed a nested case-control study of COPDGene subjects with and without lung cancer, age 45-80, who smoked at least 10-pack years...
February 13, 2018: Chest
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