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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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Entries in hypoxemia (2)

Thursday
Nov172016

November 2016 Arizona Thoracic Society Notes

The November 2016 Arizona Thoracic Society meeting was held on Wednesday, November 17, 2016 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 14 in attendance representing the pulmonary, critical care, sleep, and radiology communities.

Two cases were presented:

  1. Dr. Lewis Wesselius presented a case of a 29-year-old man from India on a work visa who complained of right pleuritic pain. Chest x-ray showed a large right pleural effusion. CT scan confirmed the presence of effusion with minimal lung parenchyma changes or mediastinal adenopathy. Gold quantiferon was positive and coccidioidomycosis serology was negative. Thoracentesis showed a lymphocytic predominant effusion and adenosine deaminase was borderline high. No acid-fast bacilli (AFB) were seen in the fluid. PCR for M. tuberculosis was negative. The pleural biopsy did show AFB and eventually grew M. tuberculosis. The patient was started on a 4 drug regimen. Dr. Wesselius gave a short presentation on the sensitivity of the various diagnostic tests for M. tuberculosis.
  2. Dr. Richard Robbins presented the case of a 45-year-old Iraqi war veteran who was referred for COPD based on abnormal blood gases. The arterial blood gases showed a PaO2 40 mm Hg, PaCO2 82 mm Hg, pH 7.12, HCO3 34 mEq/L, and SaO2 76. The patient was diagnosed with hypoventilation probably secondary to narcotic abuse which he took for chronic back pain. He was admitted to the ICU but unfortunately administered high flow oxygen and was intubated. He was subsequently given naloxone but became awake and combative. After sedation and small doses of morphine, he was quickly liberated from mechanical ventilation, transferred to the floor and discharged. He did complain to the patient advocate on discharge about the smaller doses of narcotics he was give. A discussion followed regarding narcotic abuse, patient satisfaction, and mortality.

Dr. Parides has been approached regarding having the Arizona Thoracic Society meetings at Select Hospital in Scottsdale. In addition, he has been in contact with Dr. Rajeev Saggar at Banner University Medical Center Phoenix regarding having Arizona Thoracic Society meetings with a video link to Tucson.

Dr. Parides presented a plaque to Dr. Lewis Wesselius who is the Arizona Thoracic Society clinician of the year (Figure 1).

Figure 1. Dr. George Parides (left) presented a plaque to Dr. Lewis Wesselius as Arizona Thoracic Society Clinician of the Year.

A discussion was held regarding the recent American College of Graduate Medical Education (ACGME) decision to allow first year house officers to work 28 hours while on call rather than 16 (1). This is based on a study published in the New England Journal of Medicine in February, 2016 (2). After much discussion, a motion was made by Dr. Parides and seconded by Dr. Alp Umar to draft a letter to the ACGME during this public comment period favoring that ACGME decisions on resident work hours being made on data rather than emotion or politics.

There being no further business, the meeting was adjourned about 8 PM. The next meeting will be in Phoenix on Wednesday, January 25, 2016 at 6:30 PM location to be announced prior to the meeting.

Richard A. Robbins, MD

Editor, SWJPCC

References

  1. Robbins RA. ACGME proposes dropping the 16 hour resident shift limit. Southwest J Pulm Crit Care. 2016;13(5):216-7. [CrossRef]
  2. Bilimoria KY, Chung JW, Hedges LV, et al. National cluster-randomized trial of duty-hour flexibility in surgical training. N Engl J Med. 2016 Feb 25;374(8):713-27.  [CrossRef] [PubMed]

Cite as: Robbins RA. November 2016 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2016;13(5):246-7. doi: https://doi.org/10.13175/swjpcc119-16 PDF 

Thursday
Sep242015

September 2015 Arizona Thoracic Society Notes

The September 2015 Arizona Thoracic Society meeting was held on Wednesday, September 23, 2015 at the Scottsdale Shea Hospital beginning at 6:00 PM. This was a dinner meeting with case presentations. There were 13 in attendance representing the pulmonary, critical care, sleep, and radiology communities.

There were 6 case presentations:

  1. Dr. Gerald Schwartzberg presented a case of a 58-year-old woman with a history of Mycobacterium avium presented with cough and malaise. CT revealed a history of lower love centrilobular nodules and scattered ground glass opacities and some bronchiectasis. Sputum revealed Aspergillus fumigatus. IgE was normal but IgA was deficient at 20 mg/dl (normal 80-350 mg/dl). She was started on itraconazole and clinically improved. Many questioned whether the Aspergillus was the cause of her pneumonia and some questioned the association of the IgA deficiency with her overall clinical picture.
  2. Dr. Schwartzberg presented a second case of a 92-year-old former opera singer who had a past diagnosis of asthma but without airflow obstruction, gastroesophageal reflux disease, and myelodysplastic syndrome. CT scan revealed mosaic areas most consistent with hypoperfusion secondary to air trapping. Complete pulmonary function testing revealed only a markedly decreased DLco. She had oxygen desaturation with exercise. Clinically she did not respond to a bronchodilator. Most were perplexed as the cause of her overall clinical picture.
  3. Dr. Schwartzberg presented a third case of a morbidly obese 61-year-old woman who presented with shortness of breath. CT scan showed some scattered lung nodules in her lower lobes. Laboratory evaluation including cocci serologies were negative. A needle biopsy of one of the lung nodules was nondiagnostic and she was empirically begun on fluconazole. She clinically improved. Many thought this could be possibly Valley fever and she should be followed.
  4. Dr. Alan Thomas presented a 66-year-old man with a history of lymphoma about 10 years earlier who presented with some enlarging lymph nodes. Thoracic CT scan was performed as part of his evaluation and showed some areas of emphysema with scattered ground glass opacities. It was felt the radiologic pattern was most consistent with respiratory bronchiolitis with fibrosis (2).
  5. Dr. Thomas also presented a case of an 82-year-old former smoker who quit about a year ago who presented with weight loss and minimal cough. Thoracic CT scan showed a large pleural mass with pleural effusion surrounding the right lung as well as pleural plaques. He did have a history of asbestos exposure in the Navy. Thoracentesis showed a nondiagnostic exudative effusion. A biopsy was performed which was consistent with a large cell neuroendocrine tumor.
  6. Dr. Lewis Wesselius presented a 65-year-old man with exertional dyspnea and possible interstitial lung disease. He has a history of a Ross procedure (replacement of a bicuspid aortic valve with the pulmonic valve) and obstructive sleep apnea. Chest x-ray was unremarkable. Complete pulmonary function testing was normal. Thoracic CT scan showed peripheral reticulations especially in the lower lobes. A video-assisted thorascopic biopsy (VATS) was performed. Histology showed scattered fibroblast foci with scattered fibrosis with airway centricity. It was unclear whether this was usual interstitial fibrosis or chronic hypersensitivity pneumonitis. He was started on prednisone because his picture was felt to be most consistent with chronic hypersensitivity pneumonitis (1). Unfortunately, chronic hypersensitivity pneumonitis with features of UIP appears to carry a worse prognosis.

There being no further business, the meeting was adjourned about 7:30 PM. The next meeting will be in Phoenix at Scottsdale Shea on Wednesday, November 18 at 6:30 PM.

Richard A. Robbins, MD

Editor, SWJPCC

References

  1. Reddy TL, Mayo J, Churg A. Respiratory bronchiolitis with fibrosis. High-resolution computed tomography findings and correlation with pathology. Ann Am Thorac Soc. 2013;10(6):590-601. [CrossRef] [PubMed]
  2. Myers JL. Hypersensitivity pneumonia: the role of lung biopsy in diagnosis and management. Mod Pathol. 2012;25 Suppl 1:S58-67. [CrossRef] [PubMed]

Cite as: Robbins RA. September 2015 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2015;11(3):117-8. doi: http://dx.doi.org/10.13175/swjpcc124-15 PDF