Medical Image of the Week: Neuromyelitis Optica and Sarcoidosis

By: El-Aini T, Natt B

Abstract: No abstract available. Article truncated after 150 words. A 33-year old woman presented to the emergency room with progressive vision loss of the left eye. A diagnosis of optic neuritis was made clinically and on magnetic resonance imaging MRI (Figure 1). With high anti-aquaporin 4 antibody titers, and compatible lesions on the MRI of the spinal cord, she was diagnosed with neuromyelitis optica (NMO). After dialysis catheter placement for plasmapheresis, an enlarged mediastinal shadow was seen. Fearing a complication of the catheter placement, a CT scan of the chest was obtained, confirming mediastinal lymphadenopathy (Figure 2).

An endobronchial ultrasound (EBUS) guided transbronchial needle aspiration of the mediastinal lymph nodes showed non-caseating granulomas, consistent with sarcoidosis in the absence of infectious work up and no known beryllium exposure.

NMO, also known as Devic's disease or Devic's syndrome, is a heterogeneous condition consisting of the inflammation and demyelination of the optic nerve (optic neuritis) and the spinal cord (myelitis). NMO …

URL: http://www.swjpcc.com/imaging/2018/6/20/medical-image-of-the-week-neuromyelitis-optica-and-sarcoidos.html 

Gilbert Hospital and Florence Hospital at Anthem Closed (News)

By: Robbins RA

Abstract: No abstract available. Article truncated after 150 words. Gilbert Hospital and Florence Hospital at Anthem, two medical centers owned by parent company New Vision Health LLC, will close according to the Arizona Republic (1). Gilbert Hospital's emergency room will stay open until 1 p.m. Saturday and the Florence ER will close 8 a.m. Monday. Anyone receiving care was to be transferred or discharged, according to company spokesman Alex Stevenson.

The two hospitals and the parent company have been plagued with financial troubles. Creditors filed for involuntary Chapter 11 bankruptcy protection this spring, the second time they had faced bankruptcy in four years. A Maricopa County Superior Court judge on June 7 appointed a receiver, who concluded that the financial problems "were simply too significant to overcome." Bankruptcy court documents show the two medical centers owe creditors at least $13.1 million in unpaid loans. Both hospitals were operating under terminated leases because they could not pay rent, according to …

URL: http://www.swjpcc.com/news/2018/6/16/gilbert-hospital-and-florence-hospital-at-anthem-closed.html 

CMS’ Star Ratings Miscalculated

By: Robbins RA

Abstract: No abstract available. Article truncated after 150 words. Modern Healthcare is reporting that the Centers for Medicare and Medicaid Services (CMS) has miscalculated hospitals star ratings since they were first released in 2016 (1). Officials at Rush University Medical Center in Chicago exclusively disclosed their analysis and correspondence to Modern Healthcare. The investigators found that instead of evenly weighting the eight measures in the safety of care group, the CMS' star ratings formula relied heavily on one measure— The Patient Safety and Adverse Events Composite, known as PSI 90 —for the first four releases of the ratings and then complication rates from hip and knee replacements for the latest release. The single measure accounted for about 98% of a hospital's performance in the safety group, according to Rush's analysis. The safety group can also greatly influence a hospital's overall star rating, the analysis concluded. Rush's findings likely prompted the CMS to announce this week that it would postpone …

URL: http://www.swjpcc.com/news/2018/6/15/cms-star-ratings-miscalculated.html 

Medical Image of the Week: Pulmonary Amyloidosis in Primary Sjogren’s Syndrome

By: Sen P, Chang B

Abstract: No abstract available. Article truncated after 150 words. A 69-year-old woman with past medical history of Sjögren's syndrome presented with pleuritic chest pain and shortness of breath for a month. Review of systems revealed worsening dysphagia and dryness of eyes over the last one year. Physical exam was significant for a palpable left axillary node and mild rhonchi bilaterally in the lower lung bases. Laboratory work was positive for Sjogren’s Syndrome antibodies. Chest x-ray revealed multiple nodules in bilateral lung fields. HRCT showed interlobular septal thickening and multiple cystic areas throughout the lung parenchyma which had progressed over 1 year (Figure 1). Wedge resection and thorough lymph node dissection were performed via video-assisted thoracic surgery (VATS). Biopsy of the lung nodules revealed thickened alveolar septate with acellular eosinophilic homogenous materials, which took up Congo Red stain. Based on these pathological findings, the final diagnosis was - diffuse septal alveolar pulmonary amyloidosis secondary to Sjogren’s Syndrome. bortezomib. However, the …

URL: http://www.swjpcc.com/imaging/2018/6/13/medical-image-of-the-week-pulmonary-amyloidosis-in-primary-s.html 

The VA Mission Act: Funding to Fail?

By: Robbins RA

Abstract: No abstract available. Article truncated after 150 words. Yesterday on D-Day, the 74th anniversary of the invasion of Normandy, President Trump signed the VA Mission Act. The law directs the VA to combine a number of existing private-care programs, including the so-called Choice program, which was created in 2014 after veterans died waiting for appointments at the Phoenix VA (1). During the signing Trump touted the new law saying “there has never been anything like this in the history of the VA” and saying that veterans “can go right outside [the VA] to a private doctor”-but can they? Although the bill authorizes private care, it appropriates no money to pay for it. Although a bipartisan plan to fund the expansion is proposed in the House, the White House has been lobbying Republicans to vote the plan down (2). Instead Trump has been asking Congress to pay for veteran’s programs by cutting spending elsewhere (2).

We in Arizona are …

URL: http://www.swjpcc.com/editorials/2018/6/8/the-va-mission-act-funding-to-fail.html