Assessment of the July Effect on Bronchoscopies in Teaching Hospitals Across the United States.

BACKGROUND: The July effect is the perceived notion that at the start of each academic year there is an increase in medical complications as the novice physician begins their new respective roles. Our study evaluated complication rates in the beginning versus end of the academic year with regards to bronchoscopy. METHODS: This is a retrospective cohort study using the 2016 and 2017 Nationwide Inpatient Sample. Patients in the database that underwent bronchoscopy at teaching hospitals were determined using ICD-10 procedure codes. Our outcomes included length of hospital stay and several bronchoscope complications. We compared our outcomes in the first quarter of the academic year (July, August, and September) to the last quarter (April, May, and June). Multivariable logistic and linear regression analysis were used accordingly to adjust for confounders. RESULTS: There was a total of 189,720 admission for bronchoscopy. Of these hospitalization 89,020 bronchoscopies were done in first academic Quarter (Q1) while 100,700 bronchoscopies were done in fourth academic Quarter (Q4) in 2016 to 2017 academic year. After adjusting for confounders, there was no difference in any postprocedural complications between Q1 and Q4 or length of stay. CONCLUSION: Within the limitation of the national data set provided, there appears to be similar procedural complication rates for patients admitted Q1 compared with Q4 of the academic year in respect to bronchoscopy, signaling the possibility of lack of the July effect. Prospective studies with improved data granularity is needed to further verify the absence or presence of the July effect regarding bronchoscopy.

Autoimmune Hepatitis: Diagnostic Dilemma When It Is Disguised as Iron Overload Syndrome.

Elevated serum ferritin level is a common finding in iron overload syndrome, autoimmune and viral hepatitis, alcoholic and nonalcoholic fatty liver diseases. High transferrin saturation is not a common finding in above diseases except for iron overload syndrome. We encountered a challenging case of 73-year-old female who presented with yellowish discoloration of skin, dark color urine and dull abdominal pain. Initial laboratory tests reported mild anemia; elevated bilirubin, liver enzymes, and transferrin saturation. We came to the final diagnosis of autoimmune hepatitis after extensive workups. Autoimmune hepatitis is a rare disease, and the diagnosis can be further complicated by a similar presentation of iron overload syndrome. Markedly elevated transferrin saturation can simulate iron overload syndrome, but a liver biopsy can guide physicians to navigate the diagnosis.

Hemoptysis in a previously healthy elderly patient with an unrecognized tracheal bronchus: A case report.

A 83-year-old healthy female with no past medical history presented with persistent hemoptysis and respiratory failure. She was found to have a tracheal bronchus on bronchoscopy. Patient underwent pulmonary lavage and sterile irrigation. Patient was stable, but developed excessive hemoptysis which prompted a repeat, emergent, bronchoscopy was performed to advance the ET tube to isolate the left lung from the bleeding right lung. Despite the effort taken, the patient became pulseless from the hypoxia caused by blood spillover into the entire tracheobronchial field. ACLS protocol initiated without successful ROSC. Tracheal bronchus is uncommon but when present patients usually develop recurrent pulmonary symptoms at a younger age which require extensive workup which can lead to discovery of pulmonary anomalies. In our patient, she has no recurrent pulmonary symptoms as a child nor as an adult. We suspect the reason to this is the normal size diameter of the bronchus that connects the accessary lobe to the trachea. There are a few Medical conditions that may present with hemoptysis. When there is persistent, new onset hemoptysis in an otherwise healthy individual there should be no hesitation in performing the necessary procedural studies to reach a diagnosis.

Comparative analysis on the diagnosis and treatments of multisegment intramedullary spinal cord tumors between the different age groups.

Multisegment intramedullary spinal cord tumors (MSICT) are a special type of spinal cord tumor. Up to now, no comparative clinical study of MSICT has been performed according to different age groups. Seventy-seven patients underwent microsurgery for MSICT. As grouped with two different methods, the parametric and nonparametric data of MSICT and patients were comparatively analyzed using statistically correlative methods. Forty-eight patients were males and 29 were females, ranging in age from 4 to 64 years (mean, 32.9 years). Among the six groups, being divided with intervals of 10 years, the whole difference in the initial symptoms of patients (Z = 17.4, P = 0.004) and in the histological classification of tumors (Z = 12.5, P = 0.03) was statistically significant, respectively. Neurodevelopmental tumor and benign glioma predominated in adolescents and decreased in frequency into adulthood where ependymoma became more predominant. In the 25 years old grouping method, there were 27 adolescent and 50 adult patients. The difference in initial symptoms of patients (Z = -2.08, P = 0.04) was statistically significant between the two groups. Pain with motor weakness and gait deterioration predominated in adolescents and decreased in frequency into adulthood where sensory disturbances became more predominant.

Malignant peripheral nerve sheath tumours of the spine: clinical manifestations, classification, treatment, and prognostic factors.

BACKGROUND AND OBJECTIVES: To summarise our experience treating patients with spinal malignant peripheral nerve sheath tumours (MPNSTs). METHODS: We retrospectively reviewed the records of patients diagnosed with spinal MPNSTs who received surgical treatment from January 1998 to December 2009. RESULTS: Postoperative follow-up data were available for 14/16 patients with spinal MPNSTs (7 men, 7 women; median age = 44 years [range: 23-68 years]). Eight of 14 (57.1%) patients had primary and 6/14 (42.9%) recurrent MPNSTs. A total of 12/14 (85.7%) patients underwent total tumour resection, whereas 2/14 (14.3%) patients underwent subtotal tumour resection. Malignancies were graded low in 4 (28.6%) and high in 10 (71.1%) cases. A total of 12/14 (85.7%) patients experienced tumour recurrence and 10/14 (71.4%) patients died during the course of follow-up. The 0.5- 1-, 3-, and 5-year survival rates were 64.3, 48.2, 32.1, and 21.4%, respectively. Overall survival was significantly associated with tumour malignant degree (P = 0.012). CONCLUSION: Diagnosis of spinal MPNSTs should be made with reference to clinical, radiological, and pathological findings. Surgical resection is the best available option for treating spinal MPNST; however, postoperative prognosis is poor.