2012 July 17

Ancillary findings on CT pulmonary angiograms and abnormalities on chest radiographs in patients in whom pulmonary embolism was excluded.

Clin Appl Thromb Hemost Start a Discussion »

Jul 172012

Ancillary findings on CT pulmonary angiograms and abnormalities on chest radiographs in patients in whom pulmonary embolism was excluded.

Clin Appl Thromb Hemost. 2012 Mar-Apr;18(2):201-5

Authors: Stein PD, Matta F, Sedrick JA, Saleh T, Badshah A, Denier JE

Abstract

To determine whether chest radiographs identify some abnormalities not shown as ancillary findings on computed tomography(CT) pulmonary angiograms of patients in whom pulmonary embolism (PE) was excluded. This was a retrospective study of reports of negative 64-detector CT pulmonary angiograms and chest radiographs. Among 332 patients with no PE, pulmonary parenchymal disease was shown in 60 (18%) only on standard chest radiographs, and pleural or pericardial disease was shown in 17 (5%) only on chest radiographs. Skeletal abnormalities were reported more frequently on standard chest radiographs, lymph nodes more frequently on CT angiograms. Some abnormalities on chest radiographs of patients in whom PE is excluded may not be described as ancillary findings on CT pulmonary angiograms. This suggests a need for ancillary findings on CT pulmonary angiograms to be described systematically. At present, however, plain chest radiographs in some patients show ancillary findings not reported on CT angiograms. [corrected].

PMID: 21873359 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

New noninvasive ultrasound techniques: can they predict liver cirrhosis?

ultrasound q Start a Discussion »

Jul 172012

New noninvasive ultrasound techniques: can they predict liver cirrhosis?

Ultrasound Q. 2012 Mar;28(1):5-11

Authors: Yu H, Wilson SR

Abstract

OBJECTIVE: This study aimed to determine the threshold values and accuracy of 2 noninvasive techniques, contrast-enhanced ultrasound with maximum-intensity projection (MIP) imaging and ultrasound elastography, acoustic radiation force impulse (ARFI), to differentiate a normal from a cirrhotic liver.

MATERIALS AND METHODS: One hundred thirty-two patients were predicted clinically as having a normal liver (n = 60) or cirrhosis (n = 72). All had MIP liver vessel evaluation on an Acuson Sequoia and 90 of them had ARFI on an S2000 (Siemens, Mountain View, Calif). Two readers reviewed 4 parameters on MIP data and predicted cirrhosis (n = 65) or normal (n = 67) outcome. They were considered as having cirrhosis when more than 1 MIP parameter was positive. Acoustic radiation force impulse values above 1.36 m/s suggested cirrhosis. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic accuracy of the ARFI measurement and to extract the optimal cutoff value in the differentiation of a cirrhotic liver from a noncirrhotic liver.

RESULTS: Sixty-four patients (64/65, 98.5%) with abnormal and 8 (8/59, 13.6%) with normal vessels on MIP imaging were clinically cirrhosis (P < 0.001). Forty-five patients (45/49, 91.8%) with abnormal ARFI (? 1.36 m/s) and 6 (6/41, 14.6%) with normal ARFI (<1.36 m/s) had a clinical cirrhotic liver (P < 0.001). Sensitivity and specificity of MIP of vessel morphology to predict cirrhosis were 89% (64/72) and 98% (59/60), respectively. Acoustic radiation force impulse showed a sensitivity of 88% (45/51) and a specificity of 90% (35/39), and the area under the receiver operating characteristic curve was 0.932, suggesting very good accuracy. The combination of ARFI and MIP showed increased sensitivity and specificity to 95.8% and 100%.

CONCLUSIONS: Liver evaluation with MIP and ARFI contributes to a noninvasive prediction of cirrhosis.

PMID: 22357223 [PubMed - indexed for MEDLINE]

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Evaluation and differential diagnosis of marked, persistent eosinophilia.

Semin Hematol Start a Discussion »

Jul 172012

Evaluation and differential diagnosis of marked, persistent eosinophilia.

Semin Hematol. 2012 Apr;49(2):149-59

Authors: Mejia R, Nutman TB

Abstract

High-grade eosinophilia can be a diagnostic dilemma, as the etiologies are extensive and varied. Hypereosinophilic syndromes (HES) are a group of heterogeneous disorders, many of which remain poorly defined. By definition, HES must be distinguished from other disorders with persistently elevated eosinophilia with a defined cause. Although marked eosinophilia worldwide is most commonly caused by helminth (worm) infections, non-infectious causes must be considered, and include drug reactions, malignancies, and immunologic, inflammatory and allergic diseases.

PMID: 22449625 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events.

Am J Cardiol Start a Discussion »

Jul 172012

Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events.

Am J Cardiol. 2012 May 15;109(10):1449-53

Authors: Rana JS, Gransar H, Wong ND, Shaw L, Pencina M, Nasir K, Rozanski A, Hayes SW, Thomson LE, Friedman JD, Min JK, Berman DS

Abstract

The value of coronary artery calcium (CAC) scoring versus multiple biomarkers in increasing risk prediction for cardiovascular disease (CVD) remains unknown. The study group consisted of 1,286 asymptomatic participants (mean ± SD 59 ± 8 years old) with no known coronary heart disease. Mean follow-up time was 4.1 ± 0.4 years with the primary outcome of combined CVD (cardiac death, myocardial infarction, stroke, and late target vessel revascularization). CAC was calculated by the method of Agatston. Biomarkers measured were C-reactive protein, interleukin-6, myeloperoxidase, B-type natriuretic peptide, and plasminogen activator-1. During follow-up 35 participants developed CVD events including cardiac deaths (6%), myocardial infarction (23%), strokes (17%), and late revascularizations (54%). In Cox proportional-hazards models adjusted for Framingham Risk Score (FRS), presence of log CAC beyond FRS was associated with increased hazards for CVD events (hazard ratio 1.7, 95% confidence interval [CI] 1.4 to 2.0, p <0.001). Multiple biomarkers score was also associated with increased risk beyond FRS (hazard ratio 2.1, p = 0.02) per 1-U increase in score; however, the c-statistic did not increase significantly (0.75, 95% CI 0.68 to 0.84, p = 0.32). The c-statistic increased when log CAC was incorporated into FRS without or with multiple biomarkers score (c-statistic 0.84, p = 0.003 and p = 0.008 respectively). Addition of CAC to risk factors showed significant reclassification (net reclassification improvement 0.35 (95% CI 0.11 to 0.58, p = 0.007; integrated discrimination index 0.076, p = 0.0001), whereas addition of multiple biomarkers score did not show significant reclassification. In conclusion, in this study of asymptomatic subjects without known CVD, addition of CAC but not biomarkers substantially improved risk reclassification for future CVD events beyond traditional risk factors.

PMID: 22425333 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Inhibition of the renin-angiotensin-aldosterone system: is there room for dual blockade in the cardiorenal continuum?

J Hypertens Start a Discussion »

Jul 172012

Inhibition of the renin-angiotensin-aldosterone system: is there room for dual blockade in the cardiorenal continuum?

J Hypertens. 2012 Apr;30(4):647-54

Authors: Volpe M, Danser AH, Menard J, Waeber B, Mueller DN, Maggioni AP, Ruilope LM

Abstract

Antagonism of renin-angiotensin-aldosterone system is exerted through angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, renin inhibitors and mineralocorticoid receptor antagonists. These drugs have been successfully tested in numerous trials and in different clinical settings. The original indications of renin-angiotensin-aldosterone system blockers have progressively expanded from the advanced stages to the earlier stages of cardiorenal continuum. To optimize the degree of blockade of renin-angiotensin-aldosterone system, dose uptitrations of angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists or the use of a dual blockade, initially identified with the combination of angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists, have been proposed. The data from the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) study do not support this specific dual blockade approach. However, the dual blockade of angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists with direct renin inhibitors is currently under investigation while that based on an aldosterone blocker with any of the previous three drugs requires more evidence beyond heart failure. In this review, we revisited potential advantages of dual blockade of renin-angiotensin-aldosterone system in arterial hypertension and diabetes.

PMID: 22278139 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Eradicating central line-associated bloodstream infections statewide: the Hawaii experience.

Am J Med Qual Start a Discussion »

Jul 172012

Eradicating central line-associated bloodstream infections statewide: the Hawaii experience.

Am J Med Qual. 2012 Mar-Apr;27(2):124-9

Authors: Lin DM, Weeks K, Bauer L, Combes JR, George CT, Goeschel CA, Lubomski LH, Mathews SC, Sawyer MD, Thompson DA, Watson SR, Winters BD, Marsteller JA, Berenholtz SM, Pronovost PJ, Pham JC

Abstract

The authors' goal was to determine if a national intensive care unit (ICU) collaborative to reduce central line-associated bloodstream infections (CLABSIs) would succeed in Hawaii. The intervention period (July 2009 to December 2010) included a comprehensive unit-based safety program; a multifaceted approach to CLABSI prevention; and monitoring of infections. The primary outcome was CLABSI rate. A total of 20 ICUs, representing 16 hospitals and 61 665 catheter days, were analyzed. Median hospital bed size was 159 (interquartile range [IQR] = 71-212) and median ICU bed size was 10 (IQR = 8-12). Median unit catheter days per month were 112 (IQR = 52-197). The overall mean CLABSI rate decreased from 1.5 infections per 1000 catheter days at baseline (January to June 2009) to 0.6 at 16 to 18 months postintervention (October to December 2010). The median rate was zero CLABSIs per 1000 catheter days at baseline and remained zero throughout the study period. Hawaii demonstrated that the national program can be successfully spread, providing further evidence that most CLABSIs are preventable.

PMID: 21918016 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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