Monday, March 25, 2013

18F-FDG Highly Specific in Malignant Pleural Effusions

BACKGROUND: malignant pleural effusions are common in oncology patients and of great clinical significance. 18F-fluorodeoxyglucose PET/CT is useful in the evaluation and detection of primary and metastatic tumors, but its precise value in malignant pleural effusions is not well known.

METHODS: 50 patients with cancer and a pleural effusion were studied. 18F-FDG PET/CT findings were correlated with cytopathology.

RESULTS: The SUV in malignant effusions were about twice as high as benign ones (3.7 vs 1.7). When using a cutoff SUV of 2.2, there were 12 positive PET/CT studies and 38 negative ones. The sensitivity was 53% and specificity was 91%. For patients with non-small cell lung cancer (n = 24), the sensitivity was 83% and specificity 89%.

CONCLUSION: 18F-FDG PET/CT has reasonable specificity in the evaluation of malignant pleural effusion when using a cutoff SUV of 2.2

COMMENT: This study provides a suggested cutoff SUV to maximize overall accuracy, however, it probably is better to utilize a higher cutoff SUV in order to maximize specificity, ideally to 100%.

 Nuklearmedizin. 2012;51(5):186-93. doi: 10.3413/Nukmed-0470-12-01. PMID: 22584348

 2013 ICD-10-CM Diagnosis Code J91.0, malignant pleural effusion, PET/CT, oncology, FDG

Thursday, March 21, 2013

97% of UK Family Physicians Prescribe Placebos

A recent study has found that the vast majority of UK family physicians (97% of those polled) had prescribed a placebo to a patient at at least one point in their career. Placebo pills contain inert substances that have no biological effect on the physiology, but they have been shown to strongly influence the mind.

Some bioethicists believe that prescribing placebos is wrong, because when doing so, the physician intentionally tricks the patient into believing that the placebo is strong and powerful, so much so that it will cure their disease. Thus, the principle of truth-telling between physician and patient is compromised.

However, others believe that placebos are not only good, but that they should be used more often. Most pharmaceutical drugs have serious and unwanted side-effects. Although rare, these side-effects can end up being worse than the disease. Placebos, by definition, do not have any physiological side-effects but through the power of suggestion, often improve healing and wellness.

What do you think? Should doctors prescribe placebos? Is this good or bad?

keywords: placebo, placebos, bioethics, physician-patient relationship, family physicians, medicine, medical, well being, health

Antibiotics not worth risk in most chest colds

This study recently published in the Annals of Family Medicine found that the use of antibiotics in many upper respiratory infections is of very little benefit, and that antibiotics for this condition may be over-utilized.