Ethambutol-induced bullous skin lesions in mycobacterium kansasii lung infection.

Mycobacterium kansasii is the second most common cause of nontuberculous mycobacterial (NTM) lung disease after Mycobacterium avium complex infection in the United States.[1] The first-line therapy for M. kansasii is a three-drug regimen including rifampin, isoniazid, and ethambutol. We present a case of a patient with pulmonary M. kansasii who developed bullous skin lesions while receiving this regimen and again after rechallenge with ethambutol. In patients with intolerance to one of the first-line antibiotics, a multidisciplinary team approach to starting second-line agents is needed. Ethambutol should be included in the differential diagnosis of drug-induced bullous skin lesions in treated patients with NTM, who develop new onset rash with blisters or ulceration.

When to consider Pneumocystis jirovecii prophylaxis in HIV-negative patients.

ABSTRACT: Clinicians should be aware of the risk of opportunistic infections in patients who are immunocompromised. Opportunistic infections such as Pneumocystis jirovecii commonly are associated with HIV/AIDS, but less commonly considered in patients receiving immunosuppressive and/or immunomodulating therapies. This case report focuses on the management of an opportunistic infection in an HIV-negative patient on immunosuppressive medications for lymphoma and exacerbation of pulmonary fibrosis.

The Sanford Lorraine Cross Award for medical innovation: Advancing a rigorous and repeatable method for recognizing translational research leaders who today are bringing emerging transformative innovations to patients.

Medical innovation awards stand out as an important means to focus public attention on what matters in medical advancement. Traditional awards typically focus on celebrating medical innovators with either a track record of proven successes in new treatments or promising basic science breakthroughs still years away from reaching patients. Perhaps one of the greatest challenges for medical innovation that is not sufficiently addressed by these traditional awards is celebrating translational research efforts on the cusp of major advancements where medical innovators are demonstrating success in bringing emerging transformative medical innovations to patients. As a part of its award process, the Sanford Lorraine Cross Award has developed a unique method to fill this gap in the landscape of medical innovation awards for ongoing translational research efforts by identifying promising medical innovations within a narrow spectrum of the research pipeline on the verge of having transformative impact for patients in the near term. The Sanford Lorraine Cross Award addresses the challenges of identifying emerging transformative medical innovations making their way through development by deploying a rigorous, analytically-based "early signals analysis" to identify emerging transformative medical innovations in its selection process independent of the medical innovators who are succeeding in bringing them forward. It also stands apart from traditional medical innovation awards in focusing on identifying award candidates that have significant roles in bringing the emerging transformative medical innovation across the finish line to patients, and their efforts in overcoming challenges, forging collaborations, and ensuring a successful outcome. The data-driven award selection process used for the Lorraine Cross award ultimately inverts the standard medical award selection paradigm - truly innovative areas of discovery and breakthrough science are identified independently of candidates and used to then focus candidate selection on the areas with the most promising transformative potential for patients. This article sets out the details of how the Sanford Award makes use of leading tools and methods in identifying transformative innovations currently in translational research to provide another important focus of what matters in medical innovation. RELEVANCE FOR PATIENTS: The Sanford Lorraine Cross Award identifies the most successful application of translational research that ultimately expedited the development of a treatment or cure of a disease.

Detection of esophageal varices using CT and MRI.

BACKGROUND AND AIMS: The development of esophageal varices in cirrhotic patients carries a significant risk of hemorrhage and associated morbidity/mortality. Universal endoscopic screening, however, is invasive and expensive. Conversely, cirrhotic patients often have imaging findings which suggest portal hypertension. The aim of this study was to evaluate the ability of CT and/or MRI to detect esophageal varices compared to EGD. METHODS: Medical records from 2000 to 2007 were retrospectively reviewed. CT and/or MRI images were included if performed within 90 days of EGD. Two blinded, experienced radiologists were asked to review images for the presence of esophageal varices, as well as other findings associated with portal hypertension. Sensitivity, specificity, PPV and NPV were calculated using EGD findings as the gold standard. RESULTS: A total of 195 patients and 142 patients met criteria for CT and MRI, respectively. The sensitivity of CT to detect EGD varices was 58-89%, but increased to 65-100% when specifically looking at large endoscopic varices. Overall specificity was 68-82%, but increased to 97-100% when applying ≥4 mm varices criteria. CT was superior to MRI in the detection of endoscopic varices; the addition of other portal hypertension stigmata did not improve results. CONCLUSIONS: The exclusion of large endoscopic varices by CT, using standardized criteria, may obviate the need or frequency of EGD screening in select patient populations. Alternatively, CT findings highly suggestive of esophageal varices in cirrhotic patients may warrant further investigation and/or treatment. Further studies are needed to validate these findings.

Multi-detector row CT urography in the evaluation of hematuria.

Hematuria can be well evaluated with a comprehensive contrast material-enhanced multi-detector row computed tomography (CT) protocol that combines unenhanced, nephrographic-phase, and excretory-phase imaging. Unenhanced images are obtained from the kidneys to the bladder and allow optimal detection of renal calculi, a common cause of hematuria. Renal parenchymal abnormalities, particularly masses, are best visualized on nephrographic-phase images, which also provide excellent evaluation of the other abdominal organs. Thin-section delayed images obtained from the kidneys to the bladder demonstrate the urinary tract distended with contrast material and are useful in detecting urothelial disease. Intravenous urography, ultrasonography, CT, retrograde ureterography and pyelography, cystoscopy, and ureteroscopy can all be used to evaluate patients with hematuria. In the past, a combination of several of these examinations was necessary to fully evaluate these patients. Now, however, this CT protocol may permit evaluation of hematuria patients with a single comprehensive examination, although more experience and data are needed to determine its efficacy in this setting.