Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis.

INTRODUCTION: Ultrasonography is being increasingly utilized in acute care settings with expanding applications. Pneumothorax evaluation by ultrasonography is a fast, safe, easy and inexpensive alternative to chest radiographs. In this review, we provide a comprehensive analysis of the current literature comparing ultrasonography and chest radiography for the diagnosis of pneumothorax. METHODS: We searched English-language articles in MEDLINE, EMBASE and Cochrane Library dealing with both ultrasonography and chest radiography for diagnosis of pneumothorax. In eligible studies that met strict inclusion criteria, we conducted a meta-analysis to evaluate the diagnostic accuracy of pleural ultrasonography in comparison with chest radiography for the diagnosis of pneumothorax. RESULTS: We reviewed 601 articles and selected 25 original research articles for detailed review. Only 13 articles met all of our inclusion criteria and were included in the final analysis. One study used lung sliding sign alone, 12 studies used lung sliding and comet tail signs, and 6 studies searched for lung point in addition to the other two signs. Ultrasonography had a pooled sensitivity of 78.6% (95% CI, 68.1 to 98.1) and a specificity of 98.4% (95% CI, 97.3 to 99.5). Chest radiography had a pooled sensitivity of 39.8% (95% CI, 29.4 to 50.3) and a specificity of 99.3% (95% CI, 98.4 to 100). Our meta-regression and subgroup analyses indicate that consecutive sampling of patients compared to convenience sampling provided higher sensitivity results for both ultrasonography and chest radiography. Consecutive versus nonconsecutive sampling and trauma versus nontrauma settings were significant sources of heterogeneity. In addition, subgroup analysis showed significant variations related to operator and type of probe used. CONCLUSIONS: Our study indicates that ultrasonography is more accurate than chest radiography for detection of pneumothorax. The results support the previous investigations in this field, add new valuable information obtained from subgroup analysis, and provide accurate estimates for the performance parameters of both bedside ultrasonography and chest radiography for pneumothorax evaluation.

A home telemonitoring program reduced exacerbation and healthcare utilization rates in COPD patients with frequent exacerbations.

RATIONALE: As the impact of home telemonitoring on patients with chronic obstructive pulmonary disease (COPD) is not fully understood and reduction in healthcare utilization is not proven, we attempt to evaluate the effects of home telemonitoring on healthcare utilization in patients with COPD. SUBJECTS AND METHODS: We conducted a retrospective cohort study using the Veterans Health Administration database of COPD patients enrolled in the Care Coordination Home Telehealth (CCHT) program. We evaluated the effects of monitoring through this program in patients with moderate to severe COPD and frequent exacerbations. Numbers of emergency department (ED) visits, urgent care (UC) visits, and hospitalizations were all evaluated before and after enrollment. The differences in average pre-enrollment and during-enrollment numbers of hospital admissions, ED/UC visits, and exacerbations were tested for significance among all patients enrolled in the program who had one or more exacerbations at pre-enrollment; results were expressed on a per-year basis. RESULTS: Data were available on a total of 1,133 patients with COPD enrolled in the CCHT program between 2005 and 2009. Given the objectives of our study, we only included 369 patients who had at least one exacerbation per year in the year prior to enrollment. Of these, 71.5% had a reduction in numbers of ED visits and exacerbations requiring hospitalizations after enrollment in the program. The average number of hospital admissions, ED visits, and total exacerbations were all reduced (0.41 ± 1.68, 0.15 ± 1.65, and 0.56 ± 2.3, respectively; all with p<0.01). The pre-enrollment number of exacerbations was the only factor observed to be significantly associated with the reduction in number of exacerbations. CONCLUSIONS: In patients with COPD and frequent exacerbations, enrollment in a home telemonitoring program may decrease healthcare utilization.

ANNA-2: an antibody associated with paraneoplastic opsoclonus in a patient with large-cell carcinoma of the lung with neuroendocrine features--correlation of clinical improvement with tumor response.

This report describes a case of large-cell lung carcinoma with neuroendocrine features, presenting with the full clinical picture of paraneoplastic opsoclonus-myoclonus syndrome. The patient had an unexpectedly dramatic resolution of the neurologic dysfunction after receiving antineoplastic treatment. Symptom improvement paralleled a progressive decline of serum ANNA-2 antibody titers to undetectable levels.