Malignant pleural effusion causes dyspnoea in more than 1 million people annually and current guidelines recommend chest tube insertion and talc slurry as first-line treatment.

This unblinded randomised controlled trial aimed to determine whether indwelling pleural catheters (IPCs) are more effective at relieving dyspnoea in patients with malignant effusions than chest tube and talc pleurodesis. One hundred and six patients were recruited from 7 UK centres between April 2007 and February 2011 and were followed up for a year.

The primary outcome was mean daily dyspnoea over the first 42 days as measured by the patients by a 100-mm line visual analogue scale measured by two independent researchers. The study showed that patient reported dyspnoea improved in both groups, but there was no significant difference between the IPC group and the talc group.

No significant difference between the groups was shown for chest pain for the duration of the trial,...

The publication of several lung cancer screening trials has led to a need to identify who is most likely to benefit from screening. This study sought to validate the Liverpool Lung Project (LLP) risk model in three study populations and to demonstrate its predicted benefit for stratifying patients for CT screening as compared to a screen-all strategy.

The study generated a risk model from risk factor distributions in the LLP Case-Control study data. The performance of this model was assessed by measuring discriminative accuracy, through area under receiver operating characteristic curve. This showed an area under receiver operating characteristic curve of 0.67 to 0.82 in the three study data sets; a greater discrimination than smoking duration. The study also estimated clinical benefit given predicted absolute risk; for a given risk threshold of 5%, the model achieved a higher proportion of true-positive classifications than a screen-all strategy and strategies based...

Positive airway pressure is recognised as the first-line treatment for moderate to severe obstructive sleep apnoea (OSA) in many countries because of its low risks and high efficacy. Unfortunately, between 30% and 40% of OSA patients cannot tolerate positive airway pressure1 2 and may consider other options, including surgery. The most common surgical treatment is isolated palate surgery (often one of the available uvulopalatopharyngoplasty techniques, with tonsillectomy for patients with palatine tonsils). Palate surgery has demonstrated improvements in measures of sleep-disordered breathing severity, such as the apnoea-hypopnea index (AHI),3 and has been associated with clinical benefits, such as improved quality of life,4 reduction in cardiovascular events5 and decreased mortality6 in cohort studies. However, the role of palate surgery (really, all surgery) remains controversial, because surgical outcomes can vary widely.

Browaldh and colleagues present the largest randomised trial...

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The role of chest ultrasonography in the management of respiratory diseases: document II.

Multidiscip Respir Med. 2013 Aug 9;8(1):55

Authors: Smargiassi A, Inchingolo R, Soldati G, Copetti R, Marchetti G, Zanforlin A, Giannuzzi R, Testa A, Nardini S, Valente S

Abstract
Chest ultrasonography can be a useful diagnostic tool for respiratory physicians. It can be used to complete and widen the general objective examination also in emergency situations, at the patient's bedside. The aim of this document is to promote better knowledge and more widespread use of thoracic ultrasound among respiratory physicians in Italy.This document II is focused on advanced approaches to chest ultrasonography especially in diagnosing sonographic interstitial syndrome with physical hypotheses about the genesis of vertical artifacts, differential diagnosis of cardiogenic pulmonary edema and non-cardiogenic pulmonary edema, raising diagnostic suspicion of pulmonary embolism, ultrasound characterization of lung consolidations and the use of ultrasonography to guide procedural interventions in pulmonology.Finally, document II focuses on chest ultrasonography as useful diagnostic tool in neonatal and pediatric care.

PMID: 23937897 [PubMed - as supplied by publisher]