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Pulmonary Journal Club

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May 2017 Phoenix Pulmonary/Critical Care Journal Club
October 2015 Phoenix Pulmonary Journal Club: Lung Volume Reduction
September 2015 Tucson Pulmonary Journal Club: Genomic Classifier
   for Lung Cancer
April 2015 Phoenix Pulmonary Journal Club: Endo-Bronchial Ultrasound in
   Diagnosing Tuberculosis
February 2015 Tucson Pulmonary Journal Club: Fibrinolysis for PE
January 2015 Tucson Pulmonary Journal Club: Withdrawal of Inhaled
    Glucocorticoids in COPD
January 2015 Phoenix Pulmonary Journal Club: Noninvasive Ventilation In 
   Acute Respiratory Failure
September 2014 Tucson Pulmonary Journal Club: PANTHEON Study
June 2014 Tucson Pulmonary Journal Club: Pirfenidone in Idiopathic
   Pulmonary Fibrosis
September 2014 Phoenix Pulmonary Journal Club: Inhaled Antibiotics
August 2014 Phoenix Pulmonary Journal Club: The Use of Macrolide
   Antibiotics in Chronic Respiratory Disease
June 2014 Phoenix Pulmonary Journal Club: New Therapies for IPF
   and EBUS in Sarcoidosis
March 2014 Phoenix Pulmonary Journal Club: Palliative Care
February 2014 Phoenix Pulmonary Journal Club: Smoking Cessation
January 2014 Pulmonary Journal Club: Interventional Guidelines
December 2013 Tucson Pulmonary Journal Club: Hypothermia
December 2013 Phoenix Pulmonary Journal Club: Lung Cancer
   Screening
November 2013 Tucson Pulmonary Journal Club: Macitentan
November 2013 Phoenix Pulmonary Journal Club: Pleural Catheter
   Infection
October 2013 Tucson Pulmonary Journal Club: Tiotropium Respimat 
October 2013 Pulmonary Journal Club: Pulmonary Artery
   Hypertension
September 2013 Pulmonary Journal Club: Riociguat; Pay the Doctor
August 2013 Pulmonary Journal Club: Pneumococcal Vaccine
   Déjà Vu
July 2013 Pulmonary Journal Club
June 2013 Pulmonary Journal Club
May 2013 Pulmonary Journal Club
March 2013 Pulmonary Journal Club
February 2013 Pulmonary Journal Club
January 2013 Pulmonary Journal Club
December 2012 Pulmonary Journal Club
November 2012 Pulmonary Journal Club
October 2012 Pulmonary Journal Club
September 2012 Pulmonary Journal Club
August 2012 Pulmonary Journal Club
June 2012 Pulmonary Journal Club
June 2012 Pulmonary Journal Club
May 2012 Pulmonary Journal Club
April 2012 Pulmonary Journal Club
March 2012 Pulmonary Journal Club
February 2012 Pulmonary Journal Club
January 2012 Pulmonary Journal Club
December 2011 Pulmonary/Sleep Journal Club
October, 2011 Pulmonary Journal Club
September, 2011 Pulmonary Journal Club
August, 2011 Pulmonary Journal Club
July 2011 Pulmonary Journal Club
May, 2011 Pulmonary Journal Club
April, 2011 Pulmonary Journal Club
February 2011 Pulmonary Journal Club 
January 2011 Pulmonary Journal Club 
December 2010 Pulmonary Journal Club

 

Both the Phoenix Good Samaritan/VA and the Tucson University of Arizona fellows previously had a periodic pulmonary journal club in which current or classic pulmonary articles were reviewed and discussed. A brief summary was written of each discussion describing thearticle and the strengths and weaknesses of each article.

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Entries in tuberculosis (2)

Wednesday
Apr222015

April 2015 Phoenix Pulmonary Journal Club: Endo-Bronchial Ultrasound in Diagnosing Tuberculosis

Lin SM, Chung FT, Huang CD, Liu WT, Kuo CH, Wang CH, Lee KY, Liu CY, Lin HC, Kuo HP. Diagnostic value of endobronchial ultrasonography for pulmonary tuberculosis. J Thorac Cardiovasc Surg. 2009;138(1):179-84. [CrossRef] [PubMed]

The diagnosis of tuberculosis in patients with inability to produce sputum or in patients that remain acid-fast bacilli (AFB) smear negative with high index of clinical suspicion remains a challenge and often results in treatment delay. This study examined the role in using endobronchial ultrasound (EBUS) to locate parenchymal infiltrates to allow for more accurate sampling of bronchial lavage fluid and transbronchial biopsies. The study examined 121 patients divided into 2 groups, 73 patients received EBUS guided bronchoscopy and 48 pts received conventional bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsies. It should be noted that patients undergoing transbronchial biopsies in the non-EBUS group appeared to have biopsies done without the use of fluoroscopy. The results showed that when EBUS was used to locate the parenchymal infiltrate the BAL smear was positive 31% vs 12% in non-EBUS patients and the transbronchial biopsies were positive in 24% vs 4.2% in non-EBUS. The study had several limitations as it did not utilize fluoroscopic guided biopsies or fluid sampling which would of likely increased the diagnostic yield in the non EBUS group. The study however does point out a seldom used approach to transbronchial biopsy by using EBUS to look for air bronchograms and tissue echogenicity. Perhaps utilizing EBUS in more centrally located infiltrates or nodules may offer a benefit over performing blind biopsies or biopsies in which fluoroscopy may be of limited view.

Geake J, Hammerschlag G, Nguyen P, Wallbridge P, Jenkin GA, Korman TM, Jennings B, Johnson DF, Irving LB, Farmer M, Daniel P. Steinfort DP. Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: a multicentre Australian experience. J Thorac Dis 2015;7 (3):439-48. [CrossRef]

This was a retrospective study that evaluated the utility of EBUS guided mediastinal lymph node biopsy and culture in patients with suspected mediastinal tuberculosis. Mediastinal tuberculosis was based on clinical suspicion with no lung parenchymal lesions seen on CT scan. 159 patients received EBUS guided biopsy and culture. A total of 39 patients were diagnosed with mediastinal tuberculosis either based on culture (23 patients) or pathology showing granulomatous inflammation with negative cultures and response to tuberculosis treatment. 120 patients were negative for tuberculosis but did receive an alternative diagnosis. Alternative diagnosis of sarcoidosis (78 patients) and reactive lymphoid tissue (20 patients) were the most common alternative diagnosis. Although no mediastinoscopy was performed to confirm truly negative specimens, the presence of alternative diagnosis is reassuring that the combination of negative culture and pathology could results in the reported 98% negative predictive value. The study was limited by its design and smaller sample size, however using EBUS as a first line diagnostic modality makes sense as it may yield either the suspected or an alternative diagnosis in a large proportion of the cases.

Manoj Mathew MD, FCCP, MCCM

Banner University Good Samaritan Medical Center

Phoenix, AZ

Reference as: Mathew M. April 2015 Phoenix pulmonary journal club: endo-bronchial ultrasound in diagnosing tuberculosis. Southwest J Pulm Crit Care. 2015;10(4):197-8. doi: http://dx.doi.org/10.13175/swjpcc061-15 PDF

Monday
Jan282013

January 2013 Pulmonary Journal Club

Kartalija M, Ovrutsky AR, Bryan CL, Pott GB, Fantuzzi G, Thomas J, Strand MJ, Bai X, Ramamoorthy P, Rothman MS, Nagabhushanam V, McDermott M, Levin AR, Frazer-Abel A, Giclas PC, Korner J, Iseman MD, Shapiro L, Chan ED. Patients with nontuberculous mycobacterial lung disease exhibit unique body and immune phenotypes. Am J Respir Crit Care Med. 2013;187(2):197-205. Abstract

Among patients with nontuberculous mycobacterial (NTM) lung disease is a subset of previously healthy women with a slender body morphotype, often with scoliosis and/or pectus excavatum. The authors enrolled 103 patients with NTM and 101 uninfected control subjects of similar demographics. Patients with

NTM had significantly lower body mass index and body fat and were significantly taller than control subjects. Scoliosis, pectus excavatum and gastroesophageal reflux were significantly more prevalent in patients with NTM. The normal relationships between the adipokines and body fat were lost and IFN-g and IL-10 levels were significantly suppressed in stimulated whole blood of patients with NTM.

The description in this article extends the description of the “Lady Windermere syndrome” first described in the early 1990’s by Reich and Johnson (1). They described 6 elderly women who were immunocompetent, had no significant smoking history or underlying pulmonary disease, and developed Mycobacterium avium complex (MAC). They hypothesized that these women could have had the habit of voluntary suppression of cough, responsible for the inability to clear secretions from the lung. However, it is now known that the adiopectins have immunomodulatory functions and the findings suggest that the underlying pathophysiology may be an immune deficit.

Søyseth V, Bhatnagar R, Holmedahl NH, Neukamm A, Høiseth AD, Hagve TA, Einvik G, Omland T. Acute exacerbation of COPD is associated with fourfold elevation of cardiac troponin T. Heart. 2013;99(2):122-6. Abstract

The authors investigated if acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with myocardial injury, expressed as elevated cardiac troponin T (Trop). In a cross-sectional study, Trops in patients hospitalized for AECOPD were compared with COPD patients in their stable state. Mean Trops were elevated in the AECOPD group (25.8 ng/l) compared to the reference group (4.55 ng/l).  Higher Trops were associated with the presence of pathological q-waves (p=0.012) and electrocardiographic left ventricular hypertrophy (p=0.039), long-term oxygen treatment (p=0.002) and decreasing forced expiratory volume in 1 s (p=0.014).

Slight elevations of Trops in patients admitted to the hospital are common, including AECOPD patients. This study suggests that elevated Trops do no necessarily indicate underlying cardiac disease and that cardiac consultation and/or workup is not necessarily indicated in every AECOPD patient with a slight elevation in Trops. Clinical judgment as to whether a cardiac condition coexists with the AECOPD must be used.

Richard A. Robbins, MD

References

1. Reich JM, Johnson RE. Mycobacterium avium complex pulmonary infection presenting as isolated lingular or middle lobe pattern: the lady Windermere Syndrome. Chest 1992;101:1605-9.

Referece as: Robbins RA. January 2013 pulmonary journal club. Southwest J Pulm Crit Care 2013:6(1):41-42. PDF