Chest
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Randomized Controlled Trial Multicenter Study Comparative Study
Predictors of Response to Endobronchial Coil Therapy in Patients with Advanced Emphysema.
The Lung Volume Reduction Coil Treatment in Patients With Emphysema (RENEW) trial reported improvements in quality of life, pulmonary function, and exercise performance following endobronchial coil treatment. ⋯ This post hoc analysis found that both significant hyperinflation (residual volume ≥ 200% predicted) and CT analysis are critical for patient selection and treatment planning for endobronchial coil therapy. Quantitative CT analysis is important to identify optimal lobar treatment and to exclude patients with insufficient emphysema (< 20% low attenuation area), whereas visual assessment identifies patients with signs of airway disease associated with worse outcomes.
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The insertion of a subclavian central venous catheter is generally associated with a high rate of success and a favorable risk profile. The use of ultrasound for procedural guidance has been demonstrated to further increase the rate of success and reduce the risk of specific mechanical complications, especially in patients with difficult surface anatomy. Many individual ultrasound techniques have been described in the literature; this article presents a systematic approach for incorporating these tools into bedside practice and includes a series of illustrative figures and narrated video presentations to demonstrate the techniques described.
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Review Case Reports
A 76-Year-Old Woman With Incidental Right Middle Lobe Atelectasis.
A 76-year-old nonsmoking woman visiting from Honduras for the last 6 months with no known medical history originally presented to the ED complaining of abdominal pain. While in the ED, an incidental right middle lobe collapse was found on CT abdomen scan. Review of systems was positive for a chronic productive cough with white sputum for 3 years. She denied association with fevers, chills, night sweats, hemoptysis, appetite changes, or weight loss.
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This review of sleep-related violence reports the nature of the underlying sleep-suspected conditions enountered and helps establish the spectrum of sleep-related behaviors resulting in forensic consequences. This information may begin to bridge the gap between the differing medical and legal concepts of automatisms (complex motor behaviors occurring in the absence of conscious awareness and therefore without culpability). Sleep medicine professionals are increasingly asked by legal professionals whether a sleep-related condition could have played a role in a forensic-related event. ⋯ In general, cases not accepted were declined on the basis of little or no merit or contamination by alcohol intoxication. Of those cases accepted, the proposed initial claim that a sleep phenomenon was operant was supported in approximately 50%, which were mostly non-rapid eye movement disorders of arousal. No cases were felt to be due to rapid eye movement sleep behavior disorder.
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Multicenter Study Comparative Study
Accuracy of high-speed video analysis to diagnose primary ciliary dyskinesia.
Diagnosis of primary ciliary dyskinesia (PCD) relies on a combination of tests. High-speed video microscopy analysis (HSVA) is widely used to contribute to the diagnosis. It can be analyzed on the day of diagnostic consultation, but the qualitative analyses are subjective. Diagnostic accuracy and reliability of assessing ciliary function have not been robustly evaluated. We aimed to establish the accuracy of HSVA to diagnose PCD compared with a combination of tests, and to assess the interobserver reliability of HSVA analysis. ⋯ Specialist scientists accurately diagnosed PCD using HSVA, with high interobserver agreement. HSVA can be reliably used to counsel patients and commence treatment on the day of testing while awaiting confirmatory investigations.