2008 November 22

Percutaneous lung biopsy: an ordering clinician’s guide to current practice.

Semin Respir Crit Care Med Start a Discussion »

Nov 222008

Percutaneous lung biopsy: an ordering clinician's guide to current practice.

Semin Respir Crit Care Med. 2008 Aug;29(4):323-34

Authors: Moore EH

The discovery of a pulmonary nodule or mass usually leads to a clinical assessment of patient risk factors for malignancy and an imaging workup. The latter may include appropriately timed follow-up, computed tomography with the possible addition of a computed tomographic nodule enhancement study, positron emission tomography, and/or percutaneous biopsy of the lung lesion or associated lymph nodes or metastatic lesions. This article reviews the rationale for the imaging workup of lung lesions and the details of percutaneous needle biopsy, including risks, technical feasibility, techniques, needle systems, cytological/pathological evaluation, accuracy, complications, and complication management.

PMID: 18651352 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Rational investigation of upper abdominal pain.

Aust Fam Physician Start a Discussion »

Nov 222008

Rational investigation of upper abdominal pain.

Aust Fam Physician. 2008 Aug;37(8):602-7

Authors: Grimpen F, Pavli P

BACKGROUND: Upper abdominal pain is a common problem with an extraordinary diversity of possible causes. Many patients have no structural disease, and making the correct diagnosis can be a challenge. The roles of endoscopy, testing for Helicobacter pylori, and imaging techniques have been debated widely and continue to be a matter for discussion. OBJECTIVE: This article details the value of various investigations in the setting of specific presentations of upper abdominal pain. DISCUSSION: Functional dyspepsia is a common cause of upper abdominal pain but the diagnosis should only be made after consideration of more serious pathology. The various organic causes of upper abdominal pain and the appropriate investigations are discussed. Early endoscopy is advisable in the presence of alarm symptoms and in patients over 55 years of age.

PMID: 18704205 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Adverse renal and metabolic effects associated with oral sodium phosphate bowel preparation.

Clin J Am Soc Nephrol Start a Discussion »

Nov 222008

Adverse renal and metabolic effects associated with oral sodium phosphate bowel preparation.

Clin J Am Soc Nephrol. 2008 Sep;3(5):1494-503

Authors: Heher EC, Thier SO, Rennke H, Humphreys BD

Colorectal cancer can be prevented by the removal of adenomatous polyps during screening colonoscopy, but adequate bowel preparation is required. Oral sodium phosphate (OSP), an effective bowel purgative, is available over the counter and requires a substantially lower volume than polyethylene glycol-based preparative agents. Accumulating reports implicate OSP in electrolyte disturbances as well as acute kidney injury (AKI) in a syndrome termed phosphate nephropathy (a form of nephrocalcinosis). Despite published case reports and case series, the actual incidence, risk factors, and natural history of phosphate nephropathy remain largely undefined. Several recent observational studies have provided new information on these important issues while supporting a link between OSP and acute phosphate nephropathy as well as the development of chronic kidney disease in elderly patients, many of whom had a normal serum creatinine at the time of OSP ingestion. This review summarizes current knowledge about the renal complications of OSP, risk factors for its development, and the pathophysiology of acute and chronic kidney damage in nephrocalcinosis.

PMID: 18596115 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Primary central nervous system lymphoma.

Arch Pathol Lab Med Start a Discussion »

Nov 222008

Primary central nervous system lymphoma.

Arch Pathol Lab Med. 2008 Nov;132(11):1830-4

Authors: Bhagavathi S, Wilson JD

Primary central nervous system lymphoma (PCNSL) is an uncommon extranodal non-Hodgkin lymphoma. Its incidence has increased during the last 3 decades and has been reported in both immunocompromised and immunocompetent patients. Immunocompromised patients are affected at a younger age compared with immunocompetent patients. It presents with raised intracranial pressure and focal neurologic and neuropsychiatric symptoms. The lesions are typically solitary. The majority of the lesions are located in the periventricular area, whereas in a few cases they are located in the supratentorial area. Diffuse large B-cell lymphomas constitute most PCNSLs, whereas T-cell, low-grade, anaplastic, and Hodgkin lymphomas are rarely encountered. The morphology of PCNSL shows a characteristic angiocentric pattern and is positive for B-cell markers by immunohistochemistry. The differential diagnosis of PCNSL includes central nervous system gliomas, metastatic tumors, demyelinating disorders, subacute infarcts, and space-occupying lesions due to an infectious etiology. The understanding of the molecular mechanisms involved in the pathogenesis of PCNSL and the identification of molecular biomarkers have lagged behind that of systemic nodal lymphomas. Primary central nervous system lymphomas are treated with combined radiotherapies and chemotherapies. The prognosis for PCNSL is worse than for other extranodal lymphomas.

PMID: 18976024 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Vertebroplasty and kyphoplasty for spinal metastases.

Curr Opin Support Palliat Care 2 Responses »

Nov 222008

Vertebroplasty and kyphoplasty for spinal metastases.

Curr Opin Support Palliat Care. 2008 Mar;2(1):9-13

Authors: Chi JH, Gokaslan ZL

PURPOSE OF REVIEW: Pathologic fractures of the spine are extremely painful and cause significant disability and morbidity in patients suffering from metastatic cancer. Often, these patients are not candidates for open surgical procedures and cannot address mechanical instability and radiation therapy can take weeks to become effective. Minimally invasive surgical techniques have been developed over the past several years, offering a simple and effective way of managing painful pathologic fractures. RECENT FINDINGS: Vertebroplasty and kyphoplasty offer patients a minimally invasive, percutaneous procedure that dramatically reduces pain related to pathologic spinal fractures almost immediately with very low complication rates. Visual analog scale pain scores, narcotic usage and quality of life scales (SF-36) have all been shown to improve in a durable fashion for over 1 year. Also, these procedures can be performed before, after or concurrently with most radiation and chemotherapy protocols. SUMMARY: We recommend vertebroplasty or kyphoplasty in properly selected patients with painful pathologic fractures as early as possible. Newer biomaterials, which are softer than currently used cement, may offer better protection from adjacent level fracturing and lower complication rates.

PMID: 18685387 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Hospital resource utilization with doripenem versus imipenem in the treatment of ventilator-associated pneumonia.

Clin Ther Start a Discussion »

Nov 222008

Hospital resource utilization with doripenem versus imipenem in the treatment of ventilator-associated pneumonia.

Clin Ther. 2008 Apr;30(4):717-33

Authors: Merchant S, Gast C, Nathwani D, Lee M, Quintana A, Ketter N, Friedland I, Ingham M

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common nosocomial infection that is associated with prolonged length of stay (LOS) and significant mortality. OBJECTIVE: The aim of this study was to compare resource utilization with doripenem, an investigational carbapenem, versus imipenem from a hospital perspective among patients with VAP. METHODS: This analysis was based on data from a Phase III, randomized, open-label, noninferiority study that compared clinical cure of VAP with doripenem 500 mg q8h i.v. (4-hour infusion) with imipenem 500 mg q6h (30-minute infusion) or 1000 mg q8h i.v. (1-hour infusion). Total hospital LOS, intensive care unit (ICU) LOS, and time on mechanical ventilation for doripenem and imipenem were compared in a clinical modified intent-to-treat population. P values were determined using the generalized Wilcoxon test, which compared treatments in a time-to-event analysis, censoring patients at the late follow-up visit (28-35 days after the end of i.v. therapy). RESULTS: Patients in the doripenem and imipenem groups had similar baseline clinical characteristics. Median hospital LOS was significantly shorter with doripenem versus imipenem (22 vs 27 days; P=0.010); median time on mechanical ventilation was significantly shorter for doripenem (7 vs 10 days; P=0.034); median ICU LOSs were similar between the 2 groups (12 vs 13 days). Clinical cure and mortality rates were similar. CONCLUSIONS: Of the 3 primary end points in this analysis, hospital LOS and time on mechanical ventilation were significantly shorter with doripenem compared with imipenem; no statistical significance was observed in ICU LOS. These findings suggest that doripenem use may be associated with an economic and clinical benefit to patients and hospitals.

PMID: 18498921 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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