Chest
-
Pulmonary venous hypertension (PVH) is a well-described cause of pulmonary hypertension (PH) in patients with left heart disease associated with elevated left heart filling pressure. PVH results from a number of processes, including left-sided valvular disease, constrictive pericardial disease, restrictive cardiomyopathies, and left ventricular (LV) systolic dysfunction. PVH in patients with normal LV systolic function, commonly referred to as diastolic dysfunction, is not well characterized. We observed that many patients with PH due to PVH have obesity, hypertension, diabetes mellitus, and hypercholesterolemia, which are clinical features of the metabolic syndrome (MS), a previously identified cause for systemic vascular disease. ⋯ PVH is highly associated with the MS. Our results suggest that the MS may predispose patients to develop pulmonary vascular disease.
-
Patients with usual interstitial pneumonia (UIP) associated with collagen vascular disease (CVD) have been reported to have a better prognosis than those with idiopathic pulmonary fibrosis with a UIP pattern (IPF/UIP) seen on histology. The aim of this study was to evaluate the pathologic and radiologic differences between the two conditions and their relationship with clinical outcome. ⋯ The germinal centers score was the best discriminative between CVD-UIP and IPF/UIP patients; it was of marginal prognostic significance. Age, TLC, and HC score were independent prognostic factors in all patients with UIP histology.
-
Multicenter Study
Surrogate decision makers' responses to physicians' predictions of medical futility.
Although physicians sometimes use the futility rationale to limit the use of life-sustaining treatments, little is known about how surrogate decision makers view this rationale. We sought to determine the attitudes of surrogates of patients who are critically ill toward whether physicians can predict futility and whether these attitudes predict surrogates' willingness to discontinue life support when faced with predictions of futility. ⋯ Doubt about physicians' ability to predict medical futility is common among surrogate decision makers. The nature of the doubt may have implications for responding to conflicts about futility in clinical practice.
-
Controlled Clinical Trial
Diagnostic and prognostic values of pleural fluid procalcitonin in parapneumonic pleural effusions.
The role of procalcitonin (PCT) in parapneumonic pleural effusion (PPPE) as a diagnostic and prognostic biomarker of the outcome has not been examined before. ⋯ S-PCT has higher diagnostic accuracy than PF-PCT in differentiating PPPEs from non-PPPEs. However, both PF-PCT and S-PCT are useful in the severity assessment of patients with PPPEs. The PF-PCT/S-PCT ratio may help to predict prolonged chest tube drainage.
-
In the general population, rates of certain respiratory infections (and mortality from these infections) are higher in winter. We hypothesized that in patients with idiopathic pulmonary fibrosis (IPF) and/or pulmonary fibrosis (PF) from any cause, death rates would be increased during the winter season, independent of recognized infection. Our objective was to determine if mortality rates from IPF and/or PF of any cause exhibit seasonal variation. ⋯ Mortality rates from PF exhibit significant seasonal variation, with the highest rates occurring in the winter, even when recognized infection is excluded. Further studies are necessary to determine if this seasonal variation exists in a prospective cohort and, if so, to uncover its etiology.