OBJECTIVE. The purpose of this study was to determine the usefulness of MRI with ultrashort TEs on a 3-T system and of thin-section MDCT for pulmonary function assessment and clinical stage classification of chronic obstructive pulmonary disease (COPD) in smokers.

SUBJECTS AND METHODS. Forty smokers (24 men and 16 women; mean age ± SD, 68.0 ± 9.3 years) underwent MRI with ultrashort TEs and thin-section MDCT. Pulmonary function testing was also performed to determine the following: the ratio of forced expiratory volume in 1 second to forced vital capacity (percentage predicted) (FEV_1/FVC%), percentage predicted forced expiratory volume in 1 second (%FEV₁), and percentage predicted diffusing capacity of lung for carbon monoxide corrected for alveolar volume (%DLCO/V_A). All subjects were classified into one of four groups as follows: smokers without COPD, with mild COPD, with moderate COPD, and with severe or very severe COPD. T2^* maps were expressed using proprietary software. Regional T2^* values were determined by region of interest measurements and were averaged to determine a mean T2^* value for each subject. CT-based functional lung volume and the ratio of the wall area to the total airway area were also determined. All indexes were statistically correlated with pulmonary function parameters. Then, all indexes were compared among all groups by means of Tukey's honest significance test.

RESULTS. All indexes had significant correlation with FEV₁/FVC%, %FEV₁, and % DLCO/V_A (p < 0.05). All indexes except WA% of smokers without COPD and smokers with mild COPD differed significantly from those of smokers with moderate COPD and smokers with severe or very severe COPD (p < 0.05). Moreover, the mean T2^* value of the moderate COPD group was significantly different from that of the severe or very severe COPD group (p < 0.05).

CONCLUSION. MRI with ultrashort TEs is potentially as useful as quantitatively assessed MDCT for pulmonary function loss assessment and clinical stage classification of COPD in smokers.

OBJECTIVE. The purpose of this article is to prospectively compare visualization of central and peripheral pulmonary arteries on simultaneously acquired low-energy and standard pulmonary CT angiography.

SUBJECTS AND METHODS. Thirty-three consecutive patients (20 women and 13 men; mean age, 55.6 years; range, 21–92 years) with suspected pulmonary embolism (PE) were scanned (140 kVp; 250–300 mA) on a single-source dual-layer dual-energy MDCT scanner. Attenuation and image noise were measured at the main and segmental pulmonary arteries. Signal-to-noise ratios were calculated. Two blinded experienced radiologists assessed segmental and subsegmental artery visibility in consensus, using slab maximum-intensity-projection (MIP) reconstructions. Nonparametric sign test and kappa statistic were used for statistical analysis.

RESULTS. PE was detected in three patients (9.1%); two segmental vessel and subsegmental emboli were seen in the low-energy images only. Higher attenuation was noted in low-energy versus standard images for all arteries evaluated, with a mean (± SD) increase of 66.6 ± 4.4 HU (p < 0.0001). Low-energy images improved visualization of segmental and subsegmental arteries from 97.0% to 99.2% and from 88.0% to 93.9%, respectively. A larger number of subsegmental vessels was seen on low-energy MIP reconstructions in 69.7% (95% CI, 36.5–71.89%) of studies compared with 9.1% on the standard images. Visualization of subsegmental vessels was superior in 55.5% of cases using low-energy imaging. The mean image noise increased by 9.7 ± 0.6 HU (p < 0.0001). The mean signal-to-noise ratio showed no significant difference in the low-energy (8.2) versus standard (8.1) CT images (p = 0.7759).

CONCLUSION. Improved visualization of central and peripheral arteries can be obtained with low-energy pulmonary CT angiography, without a substantial decrease in image quality.

Palliative care in patients with chronic obstructive pulmonary disease.

Nurs Older People. 2011 May;23(4):32-9

Authors: Scullion JE, Holmes S

This article considers the place of palliative and end of life care in the management of people with end-stage chronic obstructive pulmonary disease (COPD). This respiratory disease has considerable morbidity and mortality, which affect patients, their families and carers, and healthcare provision. Many nurses working with older people will encounter patients with advancing COPD which may be their main problem or part of multiple comorbidities. This article aims to help nurses recognise declining respiratory status and understand the challenges faced by this particular group of patients, their families and carers. It follows recommendations that end of life care should be considered and dealt with in this group of patients (Department of Health 2008, National Clinical Guideline Centre 2010). It explores palliation and end of life and then considers more practical applications to support nursing care at the end stage of the disease.

PMID: 21675167 [PubMed - indexed for MEDLINE]

Lambert-Eaton myasthenic syndrome in brief.

Prescrire Int. 2011 Jun;20(117):161

Authors:

Lambert-Eaton myasthenic syndrome is a rare neurological syndrome of autoimmune origin. It is usually associated with small-cell lung cancer but may be idiopathic. The main clinical feature is potentially disabling limb muscle weakness. Clinical signs of autonomic nervous system involvement are frequent. The muscle weakness often improves with physical exercise, which distinguishes this syndrome from myasthenia. Tendon reflexes are reduced or absent but reappear temporarily after brief muscle contraction. Diagnosis is confirmed by electromyographic findings. Management is generally based on treatment of the underlying malignancy. Immunosuppressants are used in severe disease and in cases not associated with cancer, but they have limited efficacy. Symptomatic treatments are available but their efficacy is poorly documented.

PMID: 21678709 [PubMed - indexed for MEDLINE]