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Arizona Thoracic Society Notes

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November 2018 Arizona Thoracic Society Notes
September 2018 Arizona Thoracic Society Notes 
July 2018 Arizona Thoracic Society Notes
March 2018 Arizona Thoracic Society Notes
January 2018 Arizona Thoracic Society Notes
November 2017 Arizona Thoracic Society Notes
September 2017 Arizona Thoracic Society Notes
March 2017 Arizona Thoracic Society Notes
January 2017 Arizona Thoracic Society Notes
November 2016 Arizona Thoracic Society Notes
July 2016 Arizona Thoracic Society Notes
March 2016 Arizona Thoracic Society Notes
November 2015 Arizona Thoracic Society Notes
September 2015 Arizona Thoracic Society Notes
July 2015 Arizona Thoracic Society Notes
May 2015 Arizona Thoracic Society Notes
March 2015 Arizona Thoracic Society Notes
January 2015 Arizona Thoracic Society Notes
November 2014 Arizona Thoracic Society Notes
September 2014 Arizona Thoracic Society Notes
August 2014 Arizona Thoracic Society Notes
June 2014 Arizona Thoracic Society Notes
May 2014 Arizona Thoracic Society Notes
April 2014 Arizona Thoracic Society Notes
March 2014 Arizona Thoracic Society Notes
February 2014 Arizona Thoracic Society Notes
January 2014 Arizona Thoracic Society Notes
December 2013 Arizona Thoracic Society Notes
November 2013 Arizona Thoracic Society Notes
October 2013 Arizona Thoracic Society Notes
September 2013 Arizona Thoracic Society Notes
August 2013 Arizona Thoracic Society Notes
July 2013 Arizona Thoracic Society Notes
June 2013 Arizona Thoracic Society Notes
May 2013 Council of Chapter Representatives Notes
May 2013 Arizona Thoracic Society Notes
April 2013 Arizona Thoracic Society Notes 
March 2013 Arizona Thoracic Society Notes
March 2013 Council of Chapter Representatives Meeting 
and “Hill Day” Notes
February 2013 Arizona Thoracic Society Notes
January 2013 Arizona Thoracic Society Notes
November 2012 Arizona Thoracic Society Notes
October 2012 Arizona Thoracic Society Notes
September 2012 Arizona Thoracic Society Notes
August 2012 Arizona Thoracic Society Notes
August 2012 Special Meeting Arizona Thoracic Society Notes
June 2012 Arizona Thoracic Society Notes
May 2012 Council of Chapter Representatives Meeting
May 2012 Arizona Thoracic Society Notes

 

For a complete list of the Arizona Thoracic Society notes click here.

The Arizona Thoracic Society meets every other month in Phoenix, usually on the fourth Wednesday of odd numbered months, from 6:30-8:00  PM at Scottsdale Healthcare Shea Hospital located at Shea and 90th Street in Phoenix. During these meetings dinner and case presentations occur.

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Saturday
Sep282013

September 2013 Arizona Thoracic Society Notes

The September Arizona Thoracic Society meeting was held on Wednesday, 9/25/2013 at Shea Hospital beginning at 6:30 PM. There were 13 in attendance representing the pulmonary, critical care, sleep, and pathology communities.

After a brief discussion, Gerry Swartzberg was selected as Arizona’s 2014 nominee for Clinician of the Year. 

There was 1 case presented:

Dr. Thomas Colby, pulmonary pathologist from Mayo Clinic Arizona, presented the case of a 67 year old woman with multiple pulmonary nodules. The largest was 1.2 cm CT scan. She had a fine needle aspiration of one of the nodules. The pathology revealed spindle-shaped cells which were synaptophysin + (also known as the major synaptic vesicle protein p38). Synaptophysin marks neuroendocrine tissue and on this basis the patient was diagnosed with multiple carcinoid tumors. Aguayo et al. (1) described six patients with diffuse hyperplasia and dysplasia of pulmonary neuroendocrine cells, multiple carcinoid tumorlets, and peribronchiolar fibrosis obliterating small airways. Miller and Müller (2) described a series of 25 patients that were mostly women. Eight had obliterative bronchiolitis. Many questions arose including PET positivity (variable), endobronchial spread (unknown), use of somatostatin receptor scintigraphy (unknown).

There being no further business the meeting was adjourned at about 7:30 PM. The next meeting is scheduled for Wednesday, October 23, 6:30 PM in Phoenix at Scottsdale Shea Hospital.  

Richard A. Robbins, M.D.

References

  1. Aguayo SM, Miller YE, Waldron JA Jr, Bogin RM, Sunday ME, Staton GW Jr, Beam WR, King TE Jr. Brief report: idiopathic diffuse hyperplasia of pulmonary neuroendocrine cells and airways disease. N Engl J Med. 1992;327(18):1285-8. [CrossRef] [PubMed]
  2. Miller RR, Müller NL. Neuroendocrine cell hyperplasia and obliterative bronchiolitis in patients with peripheral carcinoid tumors. Am J Surg Pathol. 1995;19(6):653-8. [CrossRef] [PubMed]

Reference as: Robbins RA. September 2013 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2013;7(3):205. doi: http://dx.doi.org/10.13175/swjpcc132-13 PDF

Thursday
Aug292013

August 2013 Arizona Thoracic Society Notes

The August Arizona Thoracic Society meeting was held on Wednesday, 8/28/2013 at Shea Hospital beginning at 6:30 PM. There were 23 in attendance representing the pulmonary, critical care, sleep, and pathology communities.

A brief discussion was held about the audio-visual aids available. It was generally agreed that our current projector is inadequate. Judd Tillinghast will inquire about using a hospital overhead projector. If that is not possible, it was agreed to purchase a new projector.Plans for telecasting the meeting between Phoenix and Tucson continue. A trial of a link between Shea and the University in Tucson failed. Once the link is successfully established, it is hoped that the meeting can be telecasted.

There were 6 cases presented:

1. Dr. Thomas Colby, pulmonary pathologist from Mayo Clinic Arizona, presented the case of a 10 year old boy with chronic dyspnea for > 4 yrs. He had growth retardation since age 1, a skin rash since age 2 on the limbs, nail dystrophy since age 3 on hands and feet, lacrimal duct stenosis, erythematous lesions on the pinnae, phimosis, interstitial lung disease on radiography, weakly positive p-ANCA, elevated erythrocyte sedimentation rate, and hypergammaglobulinemia. He came to lung biopsy. The patient was diagnosed with dyskeratosis congenita which is a disorder of poor telomere maintenance (1). Specifically, the disease is related to one or more mutations which directly or indirectly affect the vertebrate telomerase RNA component (TERC). This patient’s manifestations are fairly typical of the disease. Short telomere length was confirmed.

2. Dr. Colby presented a second case of a 14 year old boy with a history of osteosarcoma. Pulmonary nodules developed and biopsy showed metastatic osteosarcoma. He was given systemic chemotherapy but now has residual nodules that were biopsied. One of the pulmonary nodule resembled bronchoalveolar cell carcinoma.  This is an apparent complication following chemotherapy in adolescent patients (2).

3. Dr. Colby presented the pathology of a patient from the Phoenix VA who underwent lung biopsy for interstitial disease. The pathology was typical for IgG4-related disease with a plasma cell rich lymphohistiocytic infiltrate in the bronchovascular sheath and histopathology showing diffusely stained positive for IgG4 plasma cells (3).

4. Dr. Suresh Uppalapu, a second year pulmonary fellow from Good Samaritan/VA, presented a 59 year old Sudanese male who was transferred to the Good Samaritan ICU in shock. His presenting complaints to the transferring hospital were acute mental status changes, weakness, and chills. He was intubated for hypercarbic respiratory failure. His brother related that the patient had just returned from Sudan three weeks earlier. He had a prior history of a splenectomy. He was hypothermic with a temperature of 32.3°C and a SpO2 of 91% on 100% FiO2 and PEEP of 8. His Glasgow Coma Scale was 3 (lowest possible score). He had many abnormalities on laboratory evaluation, most notably a creatinine of 5.1 mg/dL and a lactic acid of 26.3 mg/dL. The peripheral smear showed malaria parasites typical of falciparum malaria (figure 1).

Figure 1. Peripheral smear showing a gametocyte (red arrow) and trophozoites in various stages from falciparum malaria.

He developed hemoptysis and eventually expired. A preliminary autopsy report has detected aspergillosis in the lung. Invasive aspergillosis has been reported in cases of severe falciparum malaria (4).

5. Dr. Heemesh Seth, also a second year pulmonary fellow from Good Samaritan/VA, presented a case of a 57 year old man with cirrhosis secondary to hepatitis C diagnosed in 1998. He presented with a large right hydrothorax.  Multiple thoracentesis were performed (Table 1).

Table 1. Summary of multiple thoracentesis.

Blood cultures were positive for acinetobacter as was the initial culture from the thoracentesis. He was treated with cephepime. It was felt that his effusion and empyema were most likely secondary to translocation of bacteria to the pleural space from spontaneous bacterial peritonitis. A discussion ensued regarding whether to perform tube thoracostomy. Data is sparse with most literature not favoring a chest tube (5). However, in this patient’s case a chest tube was eventually inserted when he failed to improve. It drained about 2 liters of fluid but the drainage then became minimal and the tube was removed. The patient developed hepato-renal syndrome but was felt not to be a liver transplant candidate. He was transferred to hospice.

6. Dr. Seth also presented a second case of a 66 year old Hispanic man who presented with a large left pleural effusion.  He had a past medical history of systemic lupus erythematosis (SLE) with possible rheumatoid arthritis and was being treated with adalimumab, methotrexate, and prednisone. A thoracentesis was done and 2 liters of clear amber fluid was removed. Although be developed fever to 102°F he felt much better the next morning and was discharged. However, his coccidioidomycosis serologies were positive for both IgG and IgM and his complement fixation test were positive at 1:4. Pleural fluid cytology was positive for LE cells. He was continued on prednisone and treated with fluconazole. A discussion developed of whether the effusion was secondary to SLE, coccidioidomycosis, or both. No one knew data but it was felt that it was most prudent to continue the present course while following the patient and awaiting cultures.

There being no further business the meeting was adjourned at about 8:15 PM. The next meeting is scheduled for Wednesday, September 25, 6:30 PM in Phoenix at Scottsdale Shea Hospital.  

Richard A. Robbins, M.D.

References

  1. Dokal I. Dyskeratosis congenita in all its forms. Br J Haematol. 2000;110(4):768-79. [CrossRef] [PubMed] 
  2. Travis WD, Linnoila RI, Horowitz M, Becker RL Jr, Pass H, Ozols R, Gazdar A. Pulmonary nodules resembling bronchioloalveolar carcinoma in adolescent cancer patients. Mod Pathol. 1988;1(5):372-7. [PubMed]
  3. Hurley JR, Leslie KO. IgG4-Related systemic disease of the pancreas with involvement of the lung: a case report and literature review. Southwest J Pulm Crit Care. 2013;7(2):117-130. [CrossRef]
  4. Hocqueloux L, Bruneel F, Pages CL, Vachon F. Fatal invasive aspergillosis complicating severe Plasmodium falciparum malaria. Clin Infect Dis. 2000;30(6):940-2. [CrossRef] [PubMed] 
  5. Alonso JC. Pleural effusion in liver disease. Semin Respir Crit Care Med. 2010;31(6):698-705. [CrossRef] [PubMed] 

Reference as: Robbins RA. August 2013 Arizona Thoracic Society notes. Southwest J Pulm Crit Care. 2013;7(2):114-6. doi: http://dx.doi.org/10.13175/swjpcc117-13 PDF

Thursday
Jul252013

July 2013 Arizona Thoracic Society Notes

The first Arizona Thoracic Society meeting in Tucson was held on Wednesday, 7/24/2013 at Kiewit Auditorium on the University of Arizona Medical Center campus beginning at 6:30 PM. There were 36 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. Dinner was sponsored by Accredo Health Group.

A brief discussion was held of plans to have the December 2013 meeting in Tucson on a weekend as part of the University of Arizona winter pulmonary meeting.

There were 4 cases presented:

  1. Mohammad Dalabih presented a case of a 48 yo woman with respiratory failure cared for by Gordon Carr, Linda Snyder, and himself. Radiology findings were discussed by Isabel Oliva. Lung biopsy showed acute fibrinous and organizing pneumonia rather than ARDS and was presented by Richard Sobonya.
  2. Franz Rischard presented a case of a 61 year old with progressive dyspnea and moderate COPD with evidence of pulmonary hypertension. Radiologic work up was presented by Dr. Oliva. It was determined the patient had primary hypertension and Dr. Rischard discussed how to separate pulmonary hypertension from COPD from primary pulmonary hypertension.
  3. Nathaniel Reyes presented a 50 year old woman with a history of granulomatous polyangiitis (GPA, formerly known as Wegener’s granulomatosis) who was pANCA+ but cANCA-. She developed diffuse alveolar hemorrhage. Dr. Soboyna reviewed pathology of GPA. Dr. Reyes discussed the ANCA+ vasculities. Some rheumatologists no longer consider GPA and microscopic polyangitis separate diseases but part of the same spectrum.
  4. Gordon Carr presented a case of a 65 year old man who died of an exacerbation of idiopathic pulmonary fibrosis (IPF). Dr. Sobonya reviewed the autopsy and pathology findings of IPF.

There being no further business the meeting was adjourned at about 8:15 PM. The next meeting is scheduled for Wednesday, August 28, 6:30 PM in Phoenix at Scottsdale Shea Hospital.  

Richard A. Robbins, M.D.

Reference as: Robbins RA. July 2013 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2013;7(1):50. doi: http://dx.doi.org/10.13175/swjpcc095-13. PDF 

Thursday
Jun272013

June 2013 Arizona Thoracic Society Notes

A dinner meeting was held on Wednesday, 6/26/2013 at Scottsdale Shea beginning at 6:30 PM. There were 16 in attendance representing the pulmonary, critical care, sleep, and radiology communities.

Rick Robbins, editor of the Southwest Journal of Pulmonary and Critical Care, announced that the journal had begun using digital object identifiers (DOI) through the CrossRef service. In addition, the content of the journal will be stored in the CLOCKSS Archive.

The Mayo Clinic in Rochester has asked to partner with the Southwest Journal of Pulmonary and Critical Care. The Arizona Thoracic Society endorsed this association.

Rick Robbins is stepping down as the Arizona representative to the Council of Chapter (CCR) Representatives. Dr. George Parides was unanimously elected CCR representative.

Dr. Lewis Wesselius presented the case of an 80 year old Asian man with a history of the recent onset of cough, weight loss, headache and an abnormal chest x-ray. He was a nonsmoker. Physical exam revealed a thin man but was otherwise unremarkable.  Laboratory showed only an elevated erythrocyte sedimentation rate. CBC was normal. Chest x-ray showed increased right perihilar densities and a small right pleural effusion. CT scan showed areas of dense consolidation in the right upper and middle lobes. Bronchoscopy was performed. No bronchial abnormality was noted. However, the cultures grew Crytococcus. Lumbar puncture showed elevated protein, slightly low glucose and slightly increased lymphocytes. A CD4 count was performed and was low at 150 cells/mm3. HIV was negative.

It was felt he had idiopathic CD4 lymphocytopenia which is a severe CD4 T-cell depletion resulting in a predisposition to opportunistic infections (1). The epidemiologic data do not suggest that the condition is caused by a transmissible agent. Unlike HIV infection, the decrease in the CD4 cell counts is often slow. The clinical spectrum ranges from an asymptomatic laboratory abnormality to life-threatening opportunistic infections. There cause is unknown and there is no proven treatment.

There being no further business the meeting was adjourned at about 8 PM. The next meeting is scheduled for Wednesday, July 24, 6:30 PM in Tucson at the Kiewit Auditorium on the University of Arizona campus.  

Richard A. Robbins, M.D.

Reference

  1. Luo L, Li T. Idiopathic CD4 lymphocytopenia and opportunistic infection--an update. FEMS Immunol Med Microbiol. 2008;54(3):283-9. [CrossRef] [PubMed]  

Reference as: Robbins RA. June 2013 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2013;6(6):306-7. doi: http://dx.doi.org/10.13175/swjpcc085-13 PDF

Saturday
May182013

May 2013 Council of Chapter Representatives Notes

The Council of Chapter Representatives met in conjunction with the ATS meeting in Philadelphia on May 18, 2012.

Roll Call. The meeting was called to order at 11 AM. Representatives from Arizona, California, DC Metro, Louisiana, Michigan, New Mexico, New York, Oregon, and Rhode Island were in attendance, and by telephone from Washington.

Chapter Updates. Information on chapter activities and a chapter brochure. There are currently 19 active chapters. Most are having annual meetings.

Advocacy. Gary Ewart from ATS Government Relations gave a presentation on Washington activities. Highlights included activities on the SGR, a number of air pollution regulations and a letter campaign advocating regulation of cigars.

ATS President 2013-14-vision for the coming year. Patrician Finn gave a summary of what she hopes to accomplish over the next year. The theme of her presidency will be health equality.

ATS Executive Director-update. Steve Crane gave a positive presentation on the financial status. Although not as well attended as last year’s ATS in San Francisco, this year’s Philadelphia meeting has better attendance than expected. The reserve has increased to nearly 75% of the yearly budget. The ATS is offering free maintenance of certification modules.

2013 Outstanding Clinician Award. The finalists for the ATS 2013 Outstanding Clinician Award; Allen Thomas (Arizona), Amine Temmar (New Mexico) and Steve Kirtland (Washington) will be recognized at the Clinician’s Center, Monday, 3:30-4:30 PM, Pennsylvania Convention Center, Hall C, 200 level.

Presentation of CCR Officers 2013-4

  • Linda Nici-Immediate Past Chair
  • Samya Nasr-Chair
  • Robin Gross-Chair-elect
  • Steve Kirtland-Secretary

ATS Foundation. Jim Donahue, Foundation president, gave a presentation of the activities of the ATS Foundation. Currently, all monies designated for research are used to support research. The ATS is also holding a meeting with the ALA to discuss joint grants.

Great Cases Symposium. The Great Cases Symposium organized by CCR will be held on Sunday, May 19, 2:00-4:30 PM.

A Look at the Coming Year. Samya Nasr, incoming CCR Chair, reviewed plans for the upcoming year.

Important Dates

  • May 16-21, 2014-ATS International Conference, San Diego
  • July 1, 2013-Call for input for 2014 International Conference
  • November 6, 2013-Abstract deadline for the 2014 International Conference

CCR Committee Representatives 2013-4

  • Clinicians Advisory: Robin Gross
  • Education: Carol Welsh
  • Ethics and Conflicts of Interest: Samya Nasr
  • Health Policy: Dona Upson
  • Planning and Evaluation: Linda Nici
  • Quality Improvement: Rick Robbins
  • Research Advocacy: Linda Nici
  • Training: Samya Nasr

Adjournment. The meeting was adjourned at 1:00 PM.

Richard A. Robbins

Arizona Chapter Representative

Reference as: Robbins RA. May 2013 council of chapter representatives notes. Southwest J Pulm Crit Care. 2013:6(5):239-40. PDF