Pancreaticopleural Fistula: A Rare Presentation of Bilateral Pleural Effusions and Trapped Lung.

A pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis secondary to a pancreatic pseudocyst or any disruption of the main pancreatic duct. It commonly presents as a recurrent left-sided pleural effusion after multiple thoracentesis. We present a rare case of a 41-year-old woman with numerous flares of chronic pancreatitis presenting with large bilateral serosanguinous pleural effusions and trapped lung secondary to a PPF. To our knowledge, this is the first documented case of a PPF leading to bilateral pleural effusions resulting in a trapped lung.

Paraneoplastic Cushing's syndrome and hypercalcemia arising from metastatic endometrioid endometrial adenocarcinoma: A case report.

•Paraneoplastic Cushing's syndrome is rarely seen in gynecologic cancers, appearing only in case reports•It almost universally results in acute decompensation and portends a poor prognosis•We describe a patient with metastatic endometrial carcinoma with both paraneoplastic Cushing's syndrome and hypercalcemia•High clinical suspicion for malignancy is essential, as these syndromes improve with treatment of the underlying malignancy.

Barriers to Early Hospital Discharge: A Cross-Sectional Study at Five Academic Hospitals.

BACKGROUND: Understanding the issues delaying hospital discharges may inform efforts to improve hospital throughput. OBJECTIVE: This study was conducted to identify and determine the frequency of barriers contributing to delays in placing discharge orders. DESIGN: This was a prospective, cross-sectional study. Physicians were surveyed at approximately 8:00 AM, 12:00 PM, and 3:00 PM and were asked to identify patients that were "definite" or "possible" discharges and to describe the specific barriers to writing discharge orders. SETTING: This study was conducted at five hospitals in the United States. PARTICIPANTS: The study participants were attending and housestaff physicians on general medicine services. PRIMARY OUTCOMES AND MEASURES: Specific barriers to writing discharge orders were the primary outcomes; the secondary outcomes included discharge order time for high versus low team census, teaching versus nonteaching services, and rounding style. RESULTS: Among 1,584 patient evaluations, the most common delays for patients identified as "definite" discharges (n = 949) were related to caring for other patients on the team or waiting to staff patients with attendings. The most common barriers for patients identified as "possible" discharges (n = 1,237) were awaiting patient improvement and for ancillary services to complete care. Discharge orders were written a median of 43-58 minutes earlier for patients on teams with a smaller versus larger census, on nonteaching versus teaching services, and when rounding on patients likely to be discharged first (all P < .003). CONCLUSIONS: Discharge orders for patients ready for discharge are most commonly delayed because physicians are caring for other patients. Discharges of patients awaiting care completion are most commonly delayed because of imbalances between availability and demand for ancillary services. Team census, rounding style, and teaching teams affect discharge times.