Pneumoparotitis: a case report.

BACKGROUND: Pneumoparotid is a rare cause of parotid enlargement. Pneumatic enlargement of the gland is caused by retrograde insufflation via Stensen's duct. Most reported cases have been managed conservatively, thus running a short course. METHODS AND RESULTS: We report on a case of a 48-year-old man with a chronic painful right facial swelling and symptoms of repeated infection. Clinical examination found a parotid swelling with surgical emphysema and a dilated Stensen's duct. Pneumoparotitis with cystic changes and dilated intraparotid ducts was confirmed by CT. The patient proceeded to undergo excision of the gland, with subsequent resolution of symptoms. CONCLUSION: Repeated retrograde movement of air and contaminated saliva leads to chronic infection and sialectasis. Management is aimed at preventing these sequelae by identifying and addressing the insult early; however, repeated pneumoparotid leads to chronic pneumoparotitis, the management of which is excision of the gland.

Improving the safety and effectiveness of parenteral nutrition: results of a quality improvement collaboration.

Parenteral nutrition (PN) is a high-risk nutrition support modality. This article describes the approach taken by 1 hospital to improve safety and quality of this therapy as well as the challenges and obstacles to success. Process improvement strategies included revisions to the PN order form, education of clinicians (including physicians), increased collaboration between pharmacists and registered dietitians, and initiation of PN rounds during which PN patients were reviewed by the rounding team twice weekly. These strategies were spearheaded by clinicians with advanced certifications in nutrition support. These process changes positively impacted quality and costs. Comparison of baseline and follow-up data showed improvement in compliance to mandatory safe practice standards, percentage of patients with appropriate indication for PN, adequote glycemic management, number of patients receiving PN within 10% of calorie needs, and appropriate laboratory monitoring. In addition to quality improvement, substantial cost savings were realized through decreased inappropriate PN use and timely transition to oral or enteral feeding. The average number of patients receiving PN decreased from approximately 15 to less than 5 per day. Overall, this translated into a $5.3 million decrease in PN charges. Actual pharmacy expenses decreased by $107,000. This quality improvement project demonstrated that implementing practice guidelines published by the American Society for Parental and Enteral Nutrition can result in quality improvement and cost savings. Clinicians with advanced certifications in nutrition support were pivotal to the success of the project.