Journal Watch 05-09-09

Thorax has plopped through my letter box, leaving a host of interesting new Chest research on my mat.

Of interest this month:

A very interesting meta-analysis of studies looking at timeliness in lung cancer treatment.  Does quicker therapy make any difference to outcome? There’s no evidence to say that it does,  but if it is important, here are the factors that delay therapy:  age under 70; being investigated in a teaching hospital; needing radical rather than palliative radiotherapy; being initially referred to a non-respiratory consultant; having co-morbidities; having non-respiratory symptoms at presentation.

The department of public health in Fukuoka, Japan, has shown that maternal intake of linolenic acid increases risk of childhood eczema, but maternal intake of alpha-linolenic acid protects agains infantile wheeze.  So, rapeseed oil good, walnut oil bad.  If you’re Japanese.

A little less controversial is the Queensland based study showing that maternal smoking reduces FEV1 in childhood, and this reduction persists into early adulthood.  Some of the reduction is due to low birth weight, and also increased rates of childhood asthma for children of maternal smokers.  Interestingly the reduction in FEV1 was more marked in boys.  This anomaly is not explained in the study.

A group from Taiwan have shown that ultrasound of TB associated pleural effusions is useful in predicting the long term sequelae of TB – septated effusions at presentation predicts residual plural thickening of > 10mm at 1 year (Odds Ratio 145). Ultrasound of pleural effusions is rapidly becoming the standard of care for all effusions, and certainly DundeeChest aims to do USS of every effusion we see.

Those clever doctors in Harvard show that a high serum bilirubin in patients admitted to the ICU with sepsis is predictive of ARDS.  They postulate that high levels of bilirubin in blood promote erythrocyte cells lysis, and stimulate oxidative stress.  My spider sense is tingling…

Finally, if you need any more persuasion that EBUS TBNA is the future of lung cancer diagnosis and staging, Pulav Shah and the Brompton group have a meta-analysis of 10 EBUS TBNA studies.  The AUC for the ROC curve is 99%, specificity is 100%, sensitivity 88%.  So.  Not too bad a test then?  Our local experience is also excellent – first EBUS was non diagnostic, every subsequent EBUS has been diagnostic of malignancy.  Technology of the future, today.

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