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Overview

Chest. 2009;136(5_suppl):e1. doi:10.1378/chest.09-2261
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Congratulations to the ACCP on its seventy-fifth anniversary and celebration of inspiring leadership, education, communication, and clinical practice. Since 1935, tens of thousands of health professionals worldwide have joined the ACCP to promote patient care in chest medicine. The accomplishments of these members—past and present—link through time to write an impressive and proud history for our organization.

Chest. 2009;136(5_suppl):e2-e14. doi:10.1378/chest.09-2256
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In 1935, Murray Kornfeld had an inspiration that would prove historical. As a young man recuperating from tuberculosis, Kornfeld realized, firsthand, the need to educate general practitioners and the public about tuberculosis prevention and treatment. He envisioned a society of physician specialists who could share clinical knowledge to advance patient care. He envisioned what would become the American College of Chest Physicians (ACCP).

Chest. 2009;136(5_suppl):e15. doi:10.1378/chest.09-2258
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The initial publication foray in March 1935 by the ACCP was Diseases of the Chest, edited by C. M. Hendricks, from El Paso, TX, who ensured 10,000 copies of the inaugural issue were distributed to potentially interested physicians. In the foreword of the second issue, it is clear that there was, and still is, much interest in conditions and diseases that affect the chest.

Chest. 2009;136(5_suppl):e16-e18. doi:10.1378/chest.09-2262
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In its 75-year history, Diseases of the Chest/CHEST has had only seven editors in chief. During that time, the journal changed names, moved from all paper to electronic, and changed focus from tuberculosis to all diseases related to pulmonary, critical care, and sleep medicine. Past Editors in Chief Alfred Soffer, MD, Master FCCP, and A. Jay Block, MD, Master FCCP, and current CHEST Editor in Chief Richard S. Irwin, MD, Master FCCP, shared their thoughts on what has made the journal so successful for the last 75 years and where the journal is headed in the future.

Original Research: 75 Seminal Studies, 1935–2009

Chest. 2009;136(5_suppl):e19. doi:10.1378/chest.09-2263
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Diseases of the Chest “cut its teeth” in the emerging field of TB in the 1930s, when the complex milieu included poor social conditions, improved understanding of epidemiology, changing dietary habits, and, later, the advent of chemotherapeutic agents, such as sulfa drugs and other more toxic agents. Diseases of the Chest embraced this theme from many different aspects and provided a wonderful vehicle for practitioners to improve the management of this complex disease. Several papers described new individual agents and their activity against Mycobacterium tuberculosis; however, it was the work by Frederic J. Hughes and colleagues1 in 1952 that raised the possible use of a combined intermittent regimen in the treatment of nonmiliary pulmonary TB. The appreciation that optimal therapy for TB would require a regimen not previously considered was beginning to emerge in the late 1940s, with this Colorado-based group conducting an intriguing comparison of daily vs every-3-days combination of two agents, streptomycin and para-aminosalicyclic acid (PAS). The balance of eradication of the tubercle bacillus and the acknowledged toxicity profile of these agents was clearly crucial. Following a well-controlled, although numerically small study, these researchers established that intermittent streptomycin with daily PAS provided good clinical responses and reduced development of drug resistance.

Topics: tuberculosis
Chest. 2009;136(5_suppl):e20-e21. doi:10.1378/chest.09-2264
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The treatment of bacterial pneumonia acquired in the community has posed major clinical challenges. Even with the introduction of penicillin in the early 1940s, it was clear that optimal therapy was still elusive. The effective management of “the old man's friend” was still actively being sought. Although Austrian and Gold,1 in their seminal 1964 paper, demonstrated the benefits of antibiotic therapy as compared with no antibiotic or serum therapy several years earlier, Volini and colleagues2 from Chicago sought to identify the best regimen from the agents available. This group from Cook County Hospital compared sulfadiazine with penicillin with a combination of the two drugs. The rationale behind this study was that mortality rates for community-acquired pneumonia (CAP) treated with sulfathiazole was 12.7% compared with 11.1% with parenteral penicillin, while Collen et al3 reported a 6.7% mortality with a combination of the two drugs. Volini and colleagues2 evaluated four regimens: sulfadiazine alone, penicillin given intramuscularly, oral penicillin, and a combination of penicillin and sulfadiazine. Almost 250 patients were evaluated across the four cohorts. They examined mortality rates, adverse events, duration of therapy, and effect of therapy on vital signs. They observed that penicillin was superior to sulfadiazine, that the combination was not more effective and, indeed, was probably antagonistic. Interestingly, they noted that the average duration of therapy was 5.5 to 7.7 days, thus bringing into question why we “drifted” toward 14-day courses of antibiotics for CAP?

Topics: pneumonia
Chest. 2009;136(5_suppl):e22. doi:10.1378/chest.09-2265
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In 1954, chronic bronchitis was considered “rare and [was] often described as a problem of the elderly and aged.” Today, in the United States, > 15 million patients struggle on a daily basis with this condition, more appropriately known as COPD. Chronic bronchitis was regarded by Phillips and colleagues1 as a neglected disease entity in 1954. This assessment remains true today, considering that in 2009, there are several national and global initiatives aimed at improving our understanding and management of this complex condition.

Chest. 2009;136(5_suppl):e23. doi:10.1378/chest.09-2266
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Diseases of the Chest steadily expanded its remit to include more cardiovascular reports, as the interrelationship between heart and lung function became ever more intertwined. The Framingham Study, published in Diseases of the Chest in 1969, has been the source of so many milestone publications resulting in major changes to public health that it is difficult to select one study to represent its overarching impact.

Chest. 2009;136(5_suppl):e24. doi:10.1378/chest.09-2270
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In 1967, Professor Christian Barnard conducted the world's first heart transplant in South Africa. Even today, many people can recall the name of the recipient, Louis Washkansky. Sadly, Mr. Washkansky did not live too long, but surgical and medical practice had turned a major corner. Today, > 10,000 heart transplants are conducted annually worldwide,1 along with a quarter of a million other organ transplants.

Chest. 2009;136(5_suppl):e25. doi:10.1378/chest.09-2259
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Lung cancer is the leading cause of cancer-related mortality in the United States, with > 175,000 new cases expected this year—most victims will eventually succumb to the disease.1 Indeed, non-small cell lung cancer is the leading cause of cancer-related deaths worldwide and remains a pandemic.2 As the diagnosis and treatment of new cases of lung cancer became more frequent in the 1930s and beyond, the need to predict the response to treatments and survival became evident, and, thus, efforts to develop a staging systems intensified. The TNM system, as originally proposed by Denoix,3 was designed to “provide a consistent, reproducible, description for the anatomic extent of disease in cancer patients at a specific time in the life history of the cancer.” The landmark article by C.F. Mountain4 was a significant step toward this goal.

Topics: lung cancer
Chest. 2009;136(5_suppl):e26-e27. doi:10.1378/chest.09-2260
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In the first of two surgical articles, Reynders1 chronicles the development of mediastinoscopy and its use in the staging of lung cancer in patients with the disease. This report of the experience of the Surgical Department of the Wilhelmina Gasthuis in Amsterdam looks at mediastinoscopy performed on 122 patients with lung cancer who were scheduled to undergo surgical exploration between 1960 and 1964. Of these, 45 (36.9%) were found to have carcinoma within the mediastinal lymph nodes and 77 (63.1%) were devoid of tumor in these nodes. All 77 patients with negative findings went on to thoracic exploration, of which, 70 (91%) had curative resections. The author compared this with the experience prior to routine mediastinoscopy and found that the complete resection rate rose from 60% to 91%. In addition, he found that, with the routine use of mediastinoscopy, the pneumonectomy rate dropped from 84% to 60%, with a corresponding rise in lobectomy rate from 16% to 40%.

Chest. 2009;136(5_suppl):e28. doi:10.1378/chest.09-2267
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The 1980s comprised a period in which our understanding of the immunology of infection and, specifically, severe conditions known as ARDS, was being expanded. It was the 1980 classic study by Hammerschmidt and colleagues1 in Lancet that described the association between complement activation and elevated plasma C3a levels with ARDS that alerted many clinicians to this syndrome and an ability to better diagnose it. Management was an altogether different matter.

Chest. 2009;136(5_suppl):e29. doi:10.1378/chest.09-2268
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Although many of us have spent years training in increasingly complex medical and scientific fields, it is often the pearls of wisdom from our mothers or grandmothers that resonate. Natural remedies, although not patently based on known science, have benefits not seen with some pharmaceutical products. One such remedy in which most of us have partaken is chicken soup as a cure for a cold. Such is the strength of this household remedy that boiling cauldrons of poultry-enhanced vegetable broths bubble on stoves in readiness for the inevitable upper respiratory tract infection, aka, the common cold. The > 100 rhinoviruses have not manipulated their genes to overcome the best broths our maternal caretakers brew each winter. Is this the ultimate placebo effect or is there more to this than “hubble-bubble, toil, and trouble?”

Chest. 2009;136(5_suppl):e30. doi:10.1378/chest.09-2269
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Finally, in keeping with the edict of Diseases of the Chest/CHEST, we include a salutary article from the Father of Medicine, whose prescience is remarkable and relevant, even in today's medical practice. Sir William Osler, who has been attributed with many of our diagnoses and epithets, gave the commencement speech at the University of Minnesota in 1892.1 His speech, while portentous in parts, has many remarkable implications in today's rapidly evolving medical world. Though lengthy, his talk has several key parts relevant to educators. He espouses a global perspective with “the necessity to know the best that is taught in this branch [of science], the world over,” and by stating, “To avoid mistakes, [the investigator] must know what is going on in the laboratories of England, France, and Germany, as well as those of his own country.” Sir William Osler professed the responsibilities of teaching medicine, stating, “There are two aspects in which we may view the teacher—as a worker and instructor in science and as practitioner and professor of the art.” These are tenets that still hold true today and embody much of the work published in CHEST.

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  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543