Hot in CHEST December 2017

By: Dr. Deep Ramachandran

December 6, 2017

Deep Ramachandran 2017Each month, we ask Drs. Chris Carroll and Deep Ramachandran, Social Media Co-Editors of CHEST, to weigh in on the hot topics in CHEST. It's December, so let's hear from Dr. Ramachandran as he outlines his highlights. After reviewing the issue, be sure to share your hot list on our Facebook wall, tweet with the hashtag #journalCHEST, or discuss in the CHEST LinkedIn group.




Crotalaria (Monocrotaline) Pulmonary Hypertension

I love journal articles that tell the complicated backstory about how a medical therapy that we view as commonplace came to be. My favorite has been this article published in Annals of Internal Medicine describing the first use of penicillin in the United States. This article published in CHEST may be a close second.

It describes, in a first-hand account, the story of English researchers who made a breakthrough discovery in the field of pulmonary hypertension using seeds of a plant that grows in the American south. This accompanying editorial provides perspective on how this discovery helped change the field of pulmonary hypertension research and treatment.

Totally Implantable IV Treprostinil Therapy in PH Assessment

My first thought was that this article, “Totally Implantable IV Treprostinil,” might be authored by the honorable Dr. Pauly Shore. As in “Is it implantable?” “Yeah, TOTALLY, dude!” In retrospect, this might be why our social media team won’t give me the password to our Twitter account.

In reality, this paper was authored by some very clever people who worked out how to deliver continuous IV treprostinil via a fully implantable delivery system. They go on to describe the technique for implantation as well as key factors in a successful program. They also reported that the implantation was well tolerated. Or in other words, the patients totally dug it.

Pharmacotherapy for Non-Cystic Fibrosis Bronchiectasis

Non-cystic fibrosis bronchiectasis can be a challenging disease to manage. The fact that there  is little guidance in the way of guidelines or recommendations doesn’t help. Maybe this will. In this paper we see, if not guidelines, at least a description of practice patterns in the treatment of bronchiectasis.

The study reports useful information on what medications respondents were prescribed including the use of inhaled corticosteroids and azithromycin. The accompanying editorial provides a fantastic “where we are now” perspective on the state of treatment of non-cystic fibrosis bronchiectasis.

Effect of Statins on COPD

“Much controversy persists regarding the place of statin drugs in the treatment of patients with COPD,” say the first line researchers of this study looking at statins in COPD. The study performed a meta-analysis of 10 randomized trials including a total of 1,471 patients. The study found no dramatic differences, but did notice differences in subgroup analysis.

The authors go on to suggest a possible role for statins in patients with COPD and cardiovascular disease. While I’m guessing that the first line of the study will continue to apply, perhaps we are one step closer to an answer on whether statins can be helpful in COPD.

Pulmonary Infarction

On a personal note, I am thoroughly excited to tell you about this next article about pulmonary infarction. It gives me the opportunity to tell this joke that I’ve been telling to younger and younger looking med students, who increasingly don’t seem to get it. And it goes like this. . .

“Can anyone tell me the name of the wedge-shaped infarct you get with pulmonary embolism?”

“No, Dr. Ramachandran, what is it?”

“It’s called Hampton’s hump. Not to be confused with The Humpty Hump!”

OK, maybe it’s not that funny.

In any case, what is interesting is how this paper studied the development of pulmonary infarction. By studying the progression of infarction after balloon embolization of PAVMs in patients with hereditary hemorrhagic telangiectasia, they essentially were able to create a model of human pulmonary infarction. Thus they were able to report, in previously undescribed detail, the natural history of pulmonary infarction.

Deep Ramachandran, MD, is a pulmonary, critical care, and sleep medicine physician and the journal CHEST® Social Media Editor. He blogs at Caduceusblog and the CHEST Thought Leaders Blog. He is on Twitter @Caduceusblogger.


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