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March 2013 pulmonary case of the month: don't rein me in  [cached]
Viggiano RW
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. History of Present Illness A 70 year old man was referre for a pleural effusion. The patient had pitting edema of the lower extremities noted in March, 2013. At that time a myocardial perfusion study and an echocardiogram were interpreted as being normal with an ejection fraction of 55%. His primary care physician stopped the amlodipine he was taking for hypertension and his edema resolved. However, the amlodipine was restarted a few weeks later for blood pressure control. PMH, SH, FH He has a past medical history of hypertension and asthma. He was diagnosed with prostrate cancer in mid 2012. At that time a CT scan of his abdomen/pelvis and a MRI of his pelvis were negative for metastatic disease. He underwent robot assisted radical prostatectomy and bilateral pelvic lymph node dissection in August 2012. His final diagnosis was Gleason 4+5 disease present throughout the prostate with focal extraprostatic extension …
March 2013 imaging case of the month  [cached]
Gotway MB,Penulopu S,Mand J
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated after first page. Clinical History: A 54-year old Hispanic woman with no significant past medical history presented with complaints of cough and worsening dyspnea. She was in her usual state of health until 4-5 weeks prior to presentation when she started noticing gradually worsening dyspnea on exertion. She reported a dry cough initially which subsequently became productive of whitish, mucoid sputum. The patient denied chest pain, sore throat, sick contacts, or recent travel history. A chest x-ray was performed (Figure 1). Which of the following statements regarding the chest radiograph is most accurate?1.The chest radiograph shows bilateral linear and reticular abnormalities 2.The chest radiograph shows nodular interstitial thickening 3.The chest radiograph shows multiple, bilateral circumscribed nodules 4.The chest radiograph shows mediastinal and hilar lymph node enlargement 5.The chest radiograph shows mediastinal widening
March 2013 pulmonary journal club  [cached]
Mathew M
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, Clavel M, Frat JP, Plantefeve G, Quenot JP, Lascarrou JB; Clinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA. 2013;309(3):249-56. The March pulmonary journal club reviewed the article looking at the effect of gastric residual volume and ventilator associated pneumonia. Most of us would agree that enteral nutrition in the critically ill patient is important but how early and how much is still debatable. In many institutions gastric residual volumes are used to assess gastric motility and help guide rate and cessation of enteral nutrition. This study evaluated the effect of not monitoring gastric residual volume and its effect on ventilator associated pneumonia. The study was a randomized multicenter non- inferiority …
March 2013 critical care journal club
Stander P
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. Brill S. Bitter Pill: Why Medical Bills Are Killing Us. Time. February 20, 2013. PDF available at: http://livingwithmcl.com/BitterPill.pdf (accessed 4/2/13). Editor’s Note: We had a special journal club in March. First, we reviewed an article from Time magazine rather than a traditional medical journal. Second, Paul Stander MD, the chief medical officer at Banner Good Samaritan Regional Medical Center, led the discussion and agreed to author the journal club. This seemed appropriate since much of the article focuses on overbilling and administrative costs of care. The recent lengthy cover story article in Time Magazine described in great deal what many of us practicing physicians have realized for a long time – our health care system is highly dysfunctional and much of that dysfunction is a result of an arcane and outmoded financing mechanism. This payment system has a litany of perverse incentives that encourage wasteful and often ineffective care while not …
March 2013 Arizona thoracic society notes  [cached]
Robbins RA
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated after 150 words. A dinner meeting was held on Wednesday, 3/20/2013 at Scottsdale Shea beginning at 6:30 PM. There were 14 in attendance representing the pulmonary, critical care, sleep, infectious disease, nursing, and radiology communities.Copies of the book “Breathing in America: Diseases, Progress, and Hope” were distributed.Three cases were presented:1.Tim Kuberski, infectious diseases from Maricopa, presented a 49 year old woman with a history of alcoholism who presented with RML pneumonia. Despite azithromycin and cephtriaxone she developed progressive respiratory failure and a right pleural effusion. A right chest tube was placed. Cultures of blood and the pleural fluid were negative. She was suspected of having an anaerobic infection. Follow-up CT scan showed abscess formation in her RML with areas of dense consolidation on the left and a left pleural effusion. Discussion focused on whether RML resection should be performed. Most favored a surgical approach. 2.Andrew Goldstein, thoracic surgery, presented a …
March 2013 council of chapter representatives meeting and "hill day" notes  [cached]
Robbins RA
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. March 18, 2013As part of “Hill Day” the Council of Chapter Representatives meant on March 18, 2012 in Washington, D.C. beginning at 2:00 PM. 1. Welcome/Open meeting: Dona Upson 2:00 PMRoll call determined there were representatives present from Arizona, Colorado, DC-Metro, Louisiana, Michigan, Mississippi, New York, and Washington. Linda Nicci, CCR Chair from Rhode Island, was delayed by weather and attended by conference call. 2. ATS Leadership Update 2:15pm Presentations were given by Monica Kraft, ATS president, and Steven Crane, ATS executive director. Highlights of their presentations included – A discussion of hospitalists eligibility for critical care boards The ATS bottom line oPositive beginning in 2010 and growing in 2011 and 2012. oReserves have also increased (about 2/3 of a year). Ken Adler will serve 3 more years as editor of the “Red Journal” Annals of the ATS will be published shortly. It …
April 2013 critical care case of the month: too many diagnoses
Poulos E,Baratz DM
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. History of Present Illness A 71 year old diabetic woman was admitted for 6-8 weeks of progressive dyspnea, non-productive cough, orthopnea, generalized edema and intermittent fevers. She has a history of living-related donor renal transplant from her husband in 1999 and was diagnosed with locally advanced pancreatic adenocarcinoma in October 2012. She was treated with insulin for diabetes; the immunosuppressants tacrolimus, mycophenolate and low-dose prednisone for her renal transplant; and weekly gemcitabine beginning in 11/2012 for her pancreatic cancer. Her course was complicated by left lower extremity deep venous thrombosis in January 2013 and she was treated with full dose enoxaparin at 1 mg/kg BID. She was tolerating her chemotherapy poorly with a myriad of complaints including fatigue, skin ulcerations, poor appetite, weakness, dysphagia, malaise, nausea and intermittent chest pains. Her most recent chemotherapy was held because of pancytopenia. She was admitted to our hospital in early March 2013 with …
Describing the population structure of Rhincodon typus occurring in the waters of Oslob– Cebu, Philippines– between March 2012 and June 2013, during the provisioning interaction hours.  [PDF]
Gonzalo Araujo,Alessandro Ponzo,Daniel Geary,Samantha Craven,Sally J Snow,Anna R Lucey
PeerJ , 2015, DOI: 10.7287/peerj.preprints.70v1
Abstract: Background: Prior to this study, the aggregation of whale sharks in the waters of Oslob had never been described. Provisioning (Orams, 2002) activities started in late 2011, and systematic data collection in March 2012, attracting over 100,000 tourists in the first year, and is currently the most reliable aggregation of R. typus in the Philippines. Methods: Daily in--‐water photographic identification was used as a non--‐invasive means to describe the population throughout the study period. A total of 135 sharks were identified, and IDs were independently matched by three researchers to minimize error. Photogrammetry (Rohner, 2011) was adopted to complement population description. Results: Daily sightings ranged from 2 to 23 different animals in the interaction area (mean=11.14). A total of 109 males, 15 females and 11 R. typus of undetermined sex were described. The size was estimated for 73.3% of the population, with an average of 5.36m ±1.3m. Photogrammetry posed a mean of 5.63m ±0.59m on 14 sharks, 6.75% >than researchers’ estimates. Resighting (>1d) was observed in 66.7% of the population. Five individuals were present for >300d (n=443) in the interaction area, with a maximum of 420d. Nine individuals were successfully matched across regional hotspots including Donsol and Southern Leyte. Conclusion: Despite the presence of animals in Oslob year round and the influence of the provisioning, there appears to be a seasonal influx of animals, with a maximum of 46 different animals present in the month of June 2012 and again in May 2013, contrasting with a monthly average of 28.9. It appears these waters are important to the species and it’s paramount to fully investigate the impact of the provisioning on the population of R. typus in the Philippines.
May 2013 pulmonary case of the month: the cure can be worse than the disease
Wesselius LJ,Colby TV
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated after 150 words. History of Present Illness A 65 year old man from Colorado presented for evaluation of “lung masses.” He had a prior diagnosis of dermatomyositis made in 2010 and had been with intravenous immunoglobulin (IVIG), prednisone and methotrexate. He had been previously seen in January, 2011 with a 5 mm left lower lobe nodule on thoracic CT which was unchanged compared to August, 2010. A thoracic CT scan done in July, 2011 in Colorado was interpreted as stable. Over the prior month had been having chest discomfort. He had a history of pulmonary embolism (PE) and felt the pain was similar in quality to his prior PE. This prompted a chest x-ray and he was told of “lung masses”. He had also experienced 20 pound weight loss. His current medications included methotrexate 25 mg weekly, prednisone 3 mg every other day and warfarin 7 mg daily. PMH, SH, FH In addition …
Rapid Gamma-ray flux variability during the 2013 March Crab Nebula flare  [PDF]
M. Mayer,R. Buehler,E. Hays,M. Dutka,C. C. Cheung,M. S. Dutka,J. E. Grove,M. Kerr,R. Ojha
Physics , 2013, DOI: 10.1088/2041-8205/775/2/L37
Abstract: We report on a bright flare in the Crab Nebula detected by the Large Area Telescope (LAT) on board the Fermi Gamma-ray Space Telescope. The period of significantly increased luminosity occurred in 2013 March and lasted for approximately 2 weeks. During this period, we observed flux variability on timescales of approximately 5\,hours. The combined photon flux above 100 MeV from the pulsar and its nebula reached a peak value of $(12.5\pm 0.8)\cdot 10^{-6}$\,cm$^{-2}$\,s$^{-1}$ on 2013 March 6. This value exceeds the average flux by almost a factor of 6 and implies a $\sim20$ times higher flux for the synchrotron component of the nebula alone. This is the second brightest flare observed from this source. Spectral and temporal analysis of the LAT data collected during the outburst reveal a rapidly varying synchrotron component of the Crab Nebula while the pulsar emission remains constant in time.

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