E Ferrari, T Chevallier, et al (Hopital Pasteur, Nice, France)
Travel as a Risk Factor for Venous Thromboembolic Disease: A case-control study.
Chest 115:440-444, 1999.
Back in 1940, a British surgeon noticed a significant increase in fatal pulmonary embolism in individuals who were forced to remain in a sitting position in cramped conditions for hours. Since then many reports have been published documenting cases of deep venous thrombosis or pulmonary embolism after prolonged travel. This has been dubbed as the economy class syndrome.
The study has involving 160 patients suffering from deep venous thrombosis and the history of recent travel was investigated. Consideration was given to all journeys during the preceding 4 weeks lasting more than 4 horus by whatever means of transportation.
This study provides a very strong evidence to date that travel is a risk factor for venous thromboembolism and that we should remember that a majority of venous thromboembolic diseases associted with travel are never suspected or diagnosed. Hence I recommend that we as a clinical physician should ask all our patients to get up and walk every 2 hours or so during prolonged travel.
S Tich, M Seidlitz, E Dodin, et al (rush-Presbyterian-St. Luke’s Med Ctr, Chicago; Univ of Illinois, Chicago; Univ of Minnesota, Minneapolis)
The Short-term Effects of Digoxin in Patients with Right Ventricular Dysfunction from Pulmonary Hypertension.
Chest 114: 787-792, 1998.
Digoxin as a treatment for congestive heart failure has been effectively proved in cases of patients with left ventricular systolic dysfunction. However, it is not recommended for patients with cor pulmonale because of the perception of increased toxic effects. The authors have studied a short-term gain with IV digoxin at 1mg and monitoring the patients after 2 hours in an invasive manner when neurohormonal studies were done.
In patients with pulmonary hypertension and right ventricular failure, they have shown that digoxin produced a modest increase in cardiac output and a significant reduction in circulating norepinephrine, but there were no detectable effects of digoxin on baroreceptor response.
The favorable results in this study encourage a trial of digoxin therapy in patients with pulmonary hypertension and right ventricular failure. However as the study was a very short term we need to see whether there are really any favourable effects on clinical outcome on a long-term basis.