The efficacy of treatment with anti-inflammatory agents for sepsis depends on the severity of the underlying disease as manifested by risk of death, according to National Institutes of Health investigators publishing in the American Thoracic Society's peer-reviewed journal. (Sepsis is a disease involving excess bacteria in the bloodstream that, if not treated early, can lead to other severe infections at various sites throughout the body.) The biomedical scientists performed a retrospective analysis of 22 published clinical studies and 38 pre-clinical animal trials, along with a prospective large confirmatory animal investigation. The researchers were testing their hypothesis that anti-inflammatory agents were more efficacious in sepsis patients who had a higher risk of death and harmful in those with low risk. They believe that the consistency among the trials strongly supported their hypothesis that risk of death alters the effects of anti-inflammatory agents during sepsis. After looking at the published human clinical trials and pre-clinical animal data, they tested their ideas on 1,296 rats at varying doses of infectious agents. They found that regardless of the type of anti-inflammatory agents used, the drugs were more effective at a severity associated with higher death rates. The research appears in the first issue for November 2002 of the American Journal of Respiratory and Critical Care Medicine.
Lung cancer--where are we today?
Spiral computed tomography (CT) of the chest performed in middle-aged smokers can help identify two to four times more lung cancers than chest x-ray, with more than 70 percent of the tumors still in Stage 1, according to a "State of the Art" article on lung cancer in the first issue for November of the American Thoracic Society's peer-reviewed journal. The authors note that since spiral CT detects a high percentage of benign nodules, positron emission tomography scanning is used to confirm the disease stage since the latter procedure is more sensitive, specific, and accurate. The article states that, worldwide, lung cancer is the commonest cancer in men and women. It has a greater total incidence than that of colorectal, cervical, and breast cancer combined. In 2001, lung cancer caused more than 1 million deaths worldwide. In the United States, the disease accounts for 28 percent of all cancer deaths each year. The authors point out that by year 2000 the disease had become one of the leading causes of preventable death, since smoking has been known as its major cause for over 40 years. Because surgical resection or radical radiotherapy can cure only 10 percent of all patients with non-small cell lung cancer (NSCLC), 90 percent will either be first diagnosed with or develop advanced disease from which they will ultimately die. Virtually no evidence exists that chemotherapy can cure NSCLC. Small cell lung cancer (SCLC) comprises about 20 percent of the disease. Since it is sensitive to several chemotherapeutic agents, it will elicit a 50 percent or more reduction in tumor size in greater than 30 percent of previously untreated patients. Limited disease SCLC is treated by both chemotherapy and chest irradiation. The three-year survival rates from this process have climbed to between 20 and 30 percent. The authors stress that communities and countries that institute a smoking ban probably would achieve far more in the long-term than physicians can currently with all available treatments for the disease. The study appears in the first issue for November of the American Journal of Respiratory and Critical Care Medicine.
For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society's twice monthly journal news mailing list (please select either postal or electronic delivery), contact Cathy Carlomagno at (212) 315-6442, or by e-mail at ccarlomagno@thoracic.org.
Journal
American Journal of Respiratory and Critical Care Medicine