Thomas F. Morley

Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial

BackgroundThe Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) is a registered, double-blinded, randomized, controlled trial designed to assess the efficacy of osteopathic manipulative treatment (OMT) as an adjunctive treatment in elderly patients with pneumonia.Methods406 subjects aged ≥ 50 years hospitalized with pneumonia at 7 community hospitals were randomized using concealed allocation to conventional care only (CCO), light-touch treatment (LT), or OMT groups. All subjects received conventional treatment for pneumonia. OMT and LT groups received group-specific protocols for 15 minutes, twice daily until discharge, cessation of antibiotics, respiratory failure, death, or withdrawal from the study. The primary outcomes were hospital length of stay (LOS), time to clinical stability, and a symptomatic and functional recovery score.ResultsIntention-to-treat (ITT) analysis (n = 387) found no significant differences between groups. Per-protocol (PP) analysis (n = 318) found a significant difference between groups (P = 0.01) in LOS. Multiple comparisons indicated a reduction in median LOS (95% confidence interval) for the OMT group (3.5 [3.2-4.0] days) versus the CCO group (4.5 [3.9-4.9] days), but not versus the LT group (3.9 [3.5-4.8] days). Secondary outcomes of duration of intravenous antibiotics and treatment endpoint were also significantly different between groups (P = 0.05 and 0.006, respectively). Duration of intravenous antibiotics and death or respiratory failure were lower for the OMT group versus the CCO group, but not versus the LT group.ConclusionsITT analysis found no differences between groups. PP analysis found significant reductions in LOS, duration of intravenous antibiotics, and respiratory failure or death when OMT was compared to CCO. Given the prevalence of pneumonia, adjunctive OMT merits further study.

Benign Metastasizing Leiomyoma A Case Report and Review of the Literature

This is a case report of an asymptomatic, 65-year-old white female who was evaluated for multiple pulmonary nodules. This patients presentation, clinical course and pathologic specimens are consistent with benign metastasizing leiomyoma. A review of this rare disorder is included in this report with emphasis on past cases, clinical overview and treatment.

Computed tomography for diagnosis of tracheoesophageal fistula.

Two patients developed tracheoesophageal fistula after prolonged nasotracheal intubation and tracheostomy. The use of computed tomography, a noninvasive technique, to document the size and location of tracheoesophageal fistula may be preferable to endoscopic examination in critically ill, ventilator-dependent patients.

Capnography in the Intensive Care Unit

Recent technical innovations have made portable cap nographic monitoring systems available for intensive care unit use. Some of these systems require little tech nical expertise to operate. Capnography has several clin ically relevant applications. It may be used as a monitor of respiration (apnea monitor), of wasted ventilation, or as a reflection of arterial carbon dioxide tension. In some clinical settings, it may provide information about changes in lung perfusion or carbon dioxide produc tion. Because this technique is noninvasive and con tinuous, it offers certain advantages over intermittent arterial blood gas monitoring. The advantages and limi tations of this technique are discussed.

Sarcomatoid Lung Carcinoma Case and Clinicopathologic Review

Lung cancer remains the leading cause of cancer deaths in both men and women in the United States. Lung cancers are broadly divided into non–small cell lung carcinomas and small cell carcinomas for treatment purposes; non–small cell carcinoma is by far the most common type of bronchogenic malignancy. Rare primary pulmonary malignancies include adenosquamous carcinoma, carcinoid tumors, minor salivary gland tumors, and poorly differentiated lung malignancies with sarcomatoid differentiation; the latter are referred to under the umbrella term “sarcomatoid carcinomas.” Sarcomatoid lung carcinomas account for 0.1% to 0.3% of all lung cancer diagnoses. These malignancies often present at imaging as nonspecific peripherally located masses that may be associated with chest wall invasion. Sarcomatoid carcinomas are aggressive cancers associated with a poor prognosis. Although they may present with clinical features resembling other non–small cell lung malignancies, the pathologic features, response to treatment, and prognosis of sarcomatoid carcinomas often differ from other non–small cell lung malignancies.

Diffuse Parenchymal Lung Diseases

Diffuse parenchymal lung diseases (DPLD) encompass a wide variety of disorders. They share many features including clinical presentation, radiographic appearance, physiologic features, and even histological findings. Thus, identifying a specific cause is challenging. The diagnosis can be made in many patients based on history, physical examination, and noninvasive testing. However, transbronchial, thoracoscopic, or open lung biopsy may be required for definitive diagnosis.