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Pulmonary

Last 50 Pulmonary Postings

(Click on title to be directed to posting, most recent listed first, CME offerings in Bold)

Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia in a Patient
with Multiple Pulmonary Nodules: Case Report and Literature Review
Necrotizing Pneumonia: Diagnosis and Treatment Options
December 2017 Pulmonary Case of the Month
First Report of Splenic Abscesses Due to Coccidioidomycosis
November 2017 Pulmonary Case of the Month
Treatment of Lymphoma and Cardiac Monitoring during Pregnancy
October 2017 Pulmonary Case of the Month
September 2017 Pulmonary Case of the Month
August 2017 Pulmonary Case of the Month
Tip of the Iceberg: 18F-FDG PET/CT Diagnoses Extensively Disseminated 
Coccidioidomycosis with Cutaneous Lesions
July 2017 Pulmonary Case of the Month
Correlation between the Severity of Chronic Inflammatory Respiratory
   Disorders and the Frequency of Venous Thromboembolism: Meta-Analysis
June 2017 Pulmonary Case of the Month
May 2017 Pulmonary Case of the Month
April 2017 Pulmonary Case of the Month
March 2017 Pulmonary Case of the Month
February 2017 Pulmonary Case of the Month
January 2017 Pulmonary Case of the Month
December 2016 Pulmonary Case of the Month
Inhaler Device Preferences in Older Adults with Chronic Lung Disease
November 2016 Pulmonary Case of the Month
Tobacco Company Campaign Contributions and Congressional Support
   of the Cigar Bill
October 2016 Pulmonary Case of the Month
September 2016 Pulmonary Case of the Month
August 2016 Pulmonary Case of the Month
July 2016 Pulmonary Case of the Month
June 2016 Pulmonary Case of the Month
May 2016 Pulmonary Case of the Month
April 2016 Pulmonary Case of the Month
Pulmonary Embolism and Pulmonary Hypertension in the Setting of
   Negative Computed Tomography
March 2016 Pulmonary Case of the Month
February 2016 Pulmonary Case of the Month
January 2016 Pulmonary Case of the Month
Interval Development of Multiple Sub-Segmental Pulmonary Embolism in
   Mycoplasma Pneumoniae Bronchiolitis and Pneumonia
December 2015 Pulmonary Case of the Month
November 2015 Pulmonary Case of the Month
Why Chronic Constipation May be Harmful to Your Lungs
Traumatic Hemoptysis Complicating Pulmonary Amyloidosis
Staphylococcus aureus Sternal Osteomyelitis: a Rare Cause of Chest Pain
Safety and Complications of Bronchoscopy in an Adult Intensive Care Unit
October 2015 Pulmonary Case of the Month: I've Heard of Katy
   Perry
Pulmonary Hantavirus Syndrome: Case Report and Brief Review
September 2015 Pulmonary Case of the Month: Holy Smoke
August 2015 Pulmonary Case of the Month: Holy Sheep
Reducing Readmissions after a COPD Exacerbation: A Brief Review
July 2015 Pulmonary Case of the Month: A Crazy Case
June 2015 Pulmonary Case of the Month: Collapse of the Left Upper
   Lobe

 

For complete pulmonary listings click here.

The Southwest Journal of Pulmonary and Critical Care publishes articles broadly related to pulmonary medicine including thoracic surgery, transplantation, airways disease, pediatric pulmonology, anesthesiolgy, pharmacology, nursing  and more. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.

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Tuesday
Nov012016

November 2016 Pulmonary Case of the Month

November 2016 Pulmonary Case of the Month

 

Anjuli M. Brighton, MB, BCh, BAO

Tania Jain, MBBS

Alan H. Bryce, MD

Ramachandra R. Sista, MD

Robert W. Viggiano, MD

Lewis J. Wesselius, MD

 

Pulmonary and Hematology/Oncology Departments

Mayo Clinic Arizona

Scottsdale, AZ USA

 

Pulmonary Case of the Month CME Information

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive 0.25 AMA PRA Category 1 Credits™ for each case they complete. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours

Lead Author(s): Anjuli M. Brighton, MB.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives:
As a result of this activity I will be better able to:

  1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
  2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
  4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine at Banner University Medical Center Tucson

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None

 

History of Present Illness

Our patient is a 76-year-old gentleman  who was referred based on an abnormal CT scan. He has a history of metastatic melanoma and had begun immunotherapy with pembrolizumab 10 months prior to admission. He had low grade fevers and chills and some dyspnea on exertion and dry cough. He also had a 6-8 pound weight loss over 4 weeks.

PMH, SH and FH

He has a history of hairy cell leukemia since 2009; squamous and basal cell cancers; and diabetes on insulin. He is a retired commercial banker and has a 15 pack-year smoking history.

Physical Examination

Physical examination showed and SpO2 of 90% on room air. His lungs were clear. He had numerous depigmented lesions on his skin.

Radiography

A thoracic CT scan was performed (Figure 1) and compared to a scan done 3 months prior which was considered unremarkable.

Figure 1. Video of representative images of contrast-enhanced thoracic CT scan in lung windows.

Which of the following best describe the CT scan? (Click on the correct answer to proceed to the second of four pages)

  1. Normal
  2. Mosaic pattern of lung attenuation
  3. Numerous bronchial-associated ground glass opacities
  4. Numerous pulmonary nodules
  5. Numerous pulmonary nodules with a halo sign

Cite as: Brighton AM, Jain T, Bryce AH, Sista RR, Viggiano RW, Wesselius LJ. November 2016 pulmonary case of the month. Southwest J Pulm Crit Care. 2016:13(5):191-5. doi: http://dx.doi.org/10.13175/swjpcc098-16 PDF

Tuesday
Nov012016

Tobacco Company Campaign Contributions and Congressional Support of the Cigar Bill

Richard A. Robbins, MD

Phoenix Pulmonary and Critical Care Research and Education Foundation

Gilbert, AZ USA

Abstract

Although it is widely held that campaign contributions influence support for legislation, the impact of contributions is unclear. Despite lack of a tobacco growing or manufacturing constituency, many members of Congress (MOC) in the Southwest support the pro-tobacco Traditional Cigar Manufacturing and Small Business Jobs Preservation Act of 2015 (HR 662/S 441), aka the "Cigar Bill". The association between campaign contributions from tobacco companies (2006-16) with cosponsor for the Cigar Bill were examined. There was a highly significant correlation with 92% of Southwest MOC who cosponsored the Cigar Bill having received campaign contributions. In contrast, 31% of those who did not cosponsoring the bill had received tobacco company campaign contributions (p<0.001 by Fisher's Exact Test). These data demonstrates a highly significant correlation between campaign contributions and legislative support for the "Cigar Bill".

Introduction

It is generally accepted that campaign donations buy influence from elected legislators. However, in a review Powell (1) states that "political scientists have had great difficulty determining whether and how much influence contributions have on the legislative process". Studies have been inconsistent with some demonstrating a linkage between campaign contributions and influence while others do not, suggesting that there are other influences in addition to contributions. Powell (1) has pointed out that the influence of donations is likely to occur early in the legislative process such as during cosponsorship for legislation or earmarks.

The Traditional Cigars Manufacturing and Small Business Jobs Preservation Act of 2015 (HR 662/S 441, aka the "Cigar Bill"), would permanently exempt hand-rolled and certain machine-rolled cigars from any sort of FDA regulation. This legislation is opposed by at least 20 medial and public health organizations including the American Thoracic Society (ATS), the parent organization of the state thoracic societies including those in the Southwest US (2). The ATS states that  “HR 662 would undermine the science-based process created by the Tobacco Control Act for determining the appropriate level of oversight of tobacco products. The bill would prohibit FDA from promulgating any public health protections related to 'traditional large and premium cigars'. The bill would specifically exempt from FDA oversight some machine made cigars, including those which can cost as little as $1.00. It also could allow some flavored cigars to qualify for an exemption. Inexpensive and flavored cigars such as strawberry, grape, cherry, and chocolate, are exactly the type of cigars attractive to young people.” Furthermore, the bill would create a giant regulatory loophole for the cigar industry to exploit, including advertising to children, growing the candy-flavored cigar market and returning to false advertising tactics such as "light" or "low tar", and allowing certain machine rolled cigars to be widely distributed.

The Southwest US is not a major center for tobacco growing or manufacturing (3). Furthermore, tobacco consumption tends to be low in Southwest US (4). Therefore, the Southwest is a good area to study the influence of campaign contributions on legislative behavior because of the lack of the confounding influence of a constituency that makes a living by tobacco growing or manufacturing and even has a low prevalence of smokers. In this context, we examined the correlation between prior campaign contributions to MOC and their cosponsorship of the "Cigar Bill".

Methods

Campaign Contributions

Tobacco company political action committee (PAC) contributions to Congressional candidates was obtained from the Campaign for Tobacco-Free Kids website (5). Contributions from the years listed (2006-14) were summed and no effort was made to separate recent from more past contributions. The data was examined for Southwest US Congressmen from Arizona, New Mexico, Colorado, California, Nevada and Hawaii. Appendix A shows contributions to individual Congressmen.

Cosponsorship of the "Cigar Bill"

HR 662 and S 441 were introduced in the 2015 Congress by Rep. Bill Posey (R-FL-8) and Sen. Bill Nelson (D-FL) respectively. Cosponsorship was obtained from Congress.gov (6,7). The bill was cosponsored by 165 members of the US House and 20 members of the US Senate. MOC who did or did not the "Cigar Bill" from Arizona, New Mexico, Colorado, California, Nevada and Hawaii are identified in Appendix B.

Statistics

The relationship between cosponsorship for the "Cigar Bill" and tobacco campaign contributions was done by Fisher's exact test using a 2X2 contingency table. Amounts of campaign contributions were expressed as mean + SD. The Mann-Whitney U test was used to calculate comparisons of the amounts of campaign contributions.

Results

Eighty-four percent of Southwest MOC who cosponsored the "Cigar Bill" had received tobacco campaign contributions. In contrast, only 31% of Southwest MOC not cosponsoring the "Cigar Bill" had received tobacco company campaign contributions (p<0.001 by Fisher's Exact Test). Furthermore, the amount of contributions was larger for those cosponsoring the bill $14024 + $18384 compared to those who did not $4165 + $11240 (p<0.01 by Mann-Whitney U test).

Discussion

This manuscript shows a relationship between tobacco campaign contributions and cosponsorship of the pro-tobacco "Cigar Bill". Furthermore, the campaign amounts tended to be larger to those supporting the legislation compared to those who did no cosponsor the bill. Taken together these data suggest an influence of campaign contributions on legislation.

There is no doubt that cigarette smoking is harmful. Cigarette use among adults and high school students is decreasing compelling US tobacco companies to search for new markets (8). The cigar market, especially the flavored cigar market, represents one strategy to increase tobacco consumption and profits. Flavored cigar and cigarette use is increasing in US middle and high school students (9). Tobacco manufacturers have a history of modifying their products to avoid public health protections or attain lower tax rates (2). Therefore, tobacco companies supporting the "Cigar Bill" is not surprising. By removing regulation the tobacco companies can increase advertising to children and grow the candy-flavored cigar market. Furthermore, it seems likely that cigar manufacturers will modify their products or change their manufacturing processes to qualify for the exemptions provided by the "Cigar Bill" thus increasing the number of cigars on the market.

The title of the HR 662/S 441 is deceiving. The Traditional Cigar Manufacturing and Small Business Jobs Preservation Act is titled to conjure up images of small businesses hand-rolling premium cigars. However, many of the cigars being manufactured would not appear to be the large, thick, and expensive cigars manufactured with fine tobacco but rather small, thin, cheap cigars that are often flavored. There is little tobacco growing or manufacturing in the Southwest US making it difficult for the Congressmen to claim that they are supporting local small business. The lack of a constituency raises the question of why Southwest Congressmen are supporting this bill.  

This manuscript has several limitations. First, it seems likely that more recent campaign contributions might have greater legislative influence. However, we do not have campaign contributions after 2014 and made no effort to separate more recent from past tobacco company campaign contributions. Second, receiving tobacco company campaign contributions and cosponsoring the "Cigar Bill" does not necessarily represent cause and effect. It seems likely that tobacco companies would be more likely to support legislators that they perceive are sympathetic. Third, as pointed out by Powell (1), the issue of buying influence is likely more complex. For example, at least 2 of the legislators in Arizona object to smoking on religious grounds but have taken tobacco company contributions.  

Political support for any candidate is a complex issue. However, during this election year voters might wish to examine the behavior of their elected representatives and factor in support of pro-tobacco legislation when casting their ballot.

References

  1. Powell LW. The influence of campaign contributions on legislative policy. The Forum: A Journal of Applied Research in Contemporary Politics 2013;11(3):339-55. [CrossRef]
  2. American Thoracic Society. ATS opposes cigar bill in Congress. ATS Perspectives. Available at: https://www.thoracic.org/about/ats-perspectives/ats-opposes-cigar-bill-in-congress.php (accessed 8/9/16).
  3. Statistica. Statistics and facts about the tobacco industry. Available at: http://www.statista.com/topics/1593/tobacco/ (accessed 8/9/16).
  4. Campaign for tobacco-free kids. Key state-specific tobacco-related data & rankings. Available at: https://www.tobaccofreekids.org/research/factsheets/pdf/0176.pdf (accessed 8/9/16).
  5. Campaign for Tobacco-Free Kids. Tobacco company political action committee (pac) contributions to Federal candidates. Available at: https://www.tobaccofreekids.org/what_we_do/federal_issues/campaign_contributions/ (accessed 8/9/16).
  6. Congress.gov. H.R.662 - Traditional cigar manufacturing and small business jobs preservation act of 2015. Available at: https://www.congress.gov/bill/114th-congress/house-bill/662/cosponsors (accessed 8/9/16).
  7. Congress.gov. S.441 - Traditional cigar manufacturing and small business jobs preservation act of 2015. Available at: https://www.congress.gov/bill/114th-congress/senate-bill/441/cosponsors?q=%7B%22search%22%3A%5B%22S441%22%5D%7D&resultIndex=1 (accessed 8/9/16).
  8. Centers for Disease Control. Trends in current cigarette smoking among high school students and adults, United States, 1965–2014. Available at: http://www.cdc.gov/tobacco/data_statistics/tables/trends/cig_smoking/ (accessed 8/9/16).
  9. King BA, Tynan MA, Dube SR, Arrazola R. Flavored-little-cigar and flavored-cigarette use among U.S. middle and high school students. J Adolesc Health. 2014 Jan;54(1):40-6. [CrossRef] [PubMed]

Cite as: Robbins RA. Tobacco company campaign contributions and congressional support of the cigar bill. Southwest J Pulm Crit Care. 2016;13(4):187-90. doi: http://dx.doi.org/10.13175/swjpcc076-16 PDF

Saturday
Oct012016

October 2016 Pulmonary Case of the Month

Coya T Lindberg, BS1

Ryan R Nahapetian, MD2

F Zahra Aly, MD, PhD, FRCPath3

 

1University of Arizona College of Medicine Tucson, Tucson, AZ

2Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona, Tucson, AZ

3Brody School of Medicine at East Carolina University, NC

 

Pulmonary Case of the Month CME Information

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive 0.25 AMA PRA Category 1 Credits™ for each case they complete. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours

Lead Author(s): Coya Lindberg, BS.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives:
As a result of this activity I will be better able to:

  1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
  2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
  4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine at Banner University Medical Center Tucson

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None

 

A 49-year-old man presented with chest discomfort to an outside medical facility in Arizona. He was previously healthy and had no chronic medical diseases. Physical examination was unremarkable and he was afebrile. A chest X-ray was performed (Figure  1).

Figure 1. Initial chest x-ray

Which of the following is most likely? (Click on the correct answer to proceed to the second of five panels)

  1. There is a large right chest mass
  2. There is a loculated pleural effusion in the minor fissure
  3. There is a right ventricular aneurysm
  4. There is right lower lobe consolidation
  5. There is right middle lobe consolidation

Cite as: Lindberg CT, Nahapetian RR, Aly FZ. October 2016 pulmonary case of the month. Southwest J Pulm Crit Care. 2016;13(4):152-8. doi: http://dx.doi.org/10.13175/swjpcc096-16 PDF

Thursday
Sep012016

September 2016 Pulmonary Case of the Month

Lewis J. Wesselius, MD

Department of Pulmonary Medicine

Mayo Clinic Arizona

Scottsdale, AZ

Pulmonary Case of the Month CME Information

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive 0.25 AMA PRA Category 1 Credits™ for each case they complete. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours

Lead Author(s): Lewis J. Wesselius, MD.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives:
As a result of this activity I will be better able to:

  1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
  2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
  4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine at Banner University Medical Center Tucson

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None

 

History of Present Illness

The patient is a 52 year-old woman with prior renal transplant in 1998 due to complications of pre-eclampsia. She had a recent decline in renal function leading to re-transplant on June 23 of this year. She was admitted to the hospital on July 8th with ventricular tachycardia. Treatment with amiodarone was begun with no further ventriuclar tachycardia. She is also taking usual anti-rejection medications.

Past Medical History, Social History and Family History

Other than the renal transplantation she has no other significant past medical history and has never smoked. Family history is noncontributory.

Physical Examination

Physical examination was unremarkable other than the surgical wounds associated with her renal transplants.

Radiography

Her chest x-ray is shown in Figure 1.

Figure 1. Admission chest radiograph.

What should be done at this time? (Click on the correct answer to proceed to the second of four panels)

  1. Discontinue the amiodarone
  2. Empiric antibiotics
  3. Plasma brain naturetic peptide (BNP)
  4. 1 and 3
  5. All of the above

Cite as: Wesselius LJ. September 2016 pulmonary case of the month. Southwest J Pulm Crit Care. 2016;13(3):101-7. doi: http://dx.doi.org/10.13175/swjpcc086-16 PDF

 

Monday
Aug012016

August 2016 Pulmonary Case of the Month

Anjuli M. Brighton, MB, BCh, BAO

Kathryn E. Williams, MB, BCh, BAO

Lewis J. Wesselius, MD

 

Pulmonary Department

Mayo Clinic Arizona

Scottsdale, AZ USA

 

Pulmonary Case of the Month CME Information

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive 0.25 AMA PRA Category 1 Credits™ for each case they complete. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours

Lead Author(s): Anjuli M. Brighton, MB.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives:
As a result of this activity I will be better able to:

  1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
  2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
  4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine at Banner University Medical Center Tucson

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None

 

History of Present Illness

The patient is 54-year-old man with type 1 diabetes mellitus admitted for diabetic ketoacidosis (DKA). He complained of somnolence, nausea and vomiting and right foot pain. He had been admitted 2 weeks earlier for right foot gangrene. He had been receiving daptomycin for his right foot gangrene.

PMH, SH and FH

He had a previous history of osteomyelitis, perianal abscess, maxillary abscess, Candida esophagitis, transient ischemic attack, and peripheral vascular disease. He had previous amputations along with thrombectomy/ embolectomy/bypass. He was a former Marine and construction worker with ongoing cigarette use. Family history was noncontributory.

Physical Examination

  • Febrile to 38.2ºC
  • Crackles bilaterally
  • Transmetatarsal stump with dry gangrene

Radiography

An admission chest x-ray was performed (Figure 1).

Figure 1. Admission portable AP of chest.

Which of the following are appropriate at this time? (Click on the correct answer to proceed to the second of four panels)

  1. Blood and wound cultures
  2. Empiric antibiotics including coverage for Staphylococcus aureus
  3. Intravenous insulin and fluids
  4. Serially monitor renal function and electrolytes
  5. All of the above

Cite as: Brighton AM, Williams KE, Wesselius LJ. August 2016 pulmonary case of the month. Southwest J Pulm Crit Care. 2016;13(2):40-5. doi: http://dx.doi.org/10.13175/swjpcc070-16  PDF