An Aggressive Form of Medullary Thyroid Carcinoma-Melanocytic Subtype: A Case Report.

Medullary thyroid cancer (MTC) represents a small proportion of thyroid cancers. In MTC, melanin production is extremely uncommon. Few case reports have documented this rare variant, and follow-up on these cases has been very limited.

Continuous positive airway pressure usage in hospitalized patients with known obstructive sleep apnea: discrepancy between admission pressure settings and laboratory-determined settings.

Purpose: The aim of this study was to determine the frequency and predictors of correctly initiated continuous positive airway pressure (CPAP) settings on the initial night of hospitalization in patients with known obstructive sleep apnea-hypopnea syndrome (OSAHS).

Methods: Hospital records of all patients who underwent an outpatient therapeutic polysomnogram (PSG) at our institution between January 2005 and December 2010 were retrospectively reviewed. Data collected included initial CPAP settings on hospital admission, latency to hospitalization (from sleep study), hospital length of stay, demographic variables, and PSG variables.

Polysomnographic Measurement of Sleep Duration and Bodily Pain Perception in the Sleep Heart Health Study.

Study Objectives: To determine whether total sleep time (TST) and specific sleep stage duration are associated with bodily pain perception and whether sex, age, or subjective sleepiness modifies this relationship.

Methods: Data from adults ages 39-90 y (n = 5,199) who took part in the Sleep Heart Health Study Exam 1 were analyzed. TST, rapid eye movement (REM) sleep time, and slow wave sleep (SWS) time were measured by unattended, in-home nocturnal polysomnography.

Severe hypoxemic respiratory failure: part 1--ventilatory strategies.

Approximately 16% of deaths in patients with ARDS results from refractory hypoxemia, which is the inability to achieve adequate arterial oxygenation despite high levels of inspired oxygen or the development of barotrauma. A number of ventilator-focused rescue therapies that can be used when conventional mechanical ventilation does not achieve a specific target level of oxygenation are discussed. A literature search was conducted and narrative review written to summarize the use of high levels of positive end-expiratory pressure, recruitment maneuvers, airway pressure-release ventilation, and high-frequency ventilation.

Analysis of hospitalizations for COPD exacerbation: opportunities for improving care.

Background: Little is known about the actual treatment of patients with chronic obstructive pulmonary disease (COPD), either in the inpatient or outpatient settings. We hypothesized that there are substantial opportunities for improvement in adherence with current guidelines and recommendations.

Methods: We reviewed the medical records of all patients hospitalized with acute exacerbation of COPD between January 2005 and December 2006 at 5 New York City hospitals.

Tracheobronchial manifestations of aspergillosis.

Objective: The purpose of this article is to describe 3 patients each of whom developed a different form of tracheobronchial aspergillosis.

Methods: We describe our clinical experience with 3 patients who developed significant respiratory symptoms secondary to Aspergillus infection. All patients were followed closely until there was resolution of pulmonary problems or they succumbed to respiratory insufficiency.

Clavicular tuberculosis following trivial trauma.

Tuberculosis of the clavicular bone is a very rare clinical entity, with limited cases reported in the United States. Furthermore, sparing of the sternoclavicular joint is exceedingly unusual. A literature review of the prevalence of clavicular tuberculosis identified fewer than 80 cases reported since the discovery of the tubercular bacillus, over a century ago.

Transthyretin as a marker to predict outcome in critically ill patients.

Background: A determination of serum Transthyretin (TTR, Prealbumin) level is an objective method of assessing protein catabolic loss of severely ill patients and numerous studies have shown that TTR levels correlate with patient outcomes of non-critically ill patients. We evaluated whether TTR level correlates with the prevalence of PEM in the ICU and evaluated serum TTR level as an indicator of the effectiveness of nutrition support and the prognosis in critically ill patients.

Methods: We studied PEM prevalence in 118 patients admitted to a community hospital's medical intensive care unit and the association between TTR, low albumin (ALB) concentration and high-risk disease (HRD), i.

Update on pleural diseases--2007.

Background: New information is available on pleural diseases. The authors selected articles to make recommendations on diagnostic and treatment aspects of pleural diseases.

Materials And Methods: Eleven articles published in the English language between 2004 and 2007 were chosen.

Dyspnea with slow-growing mass of the left hemithorax.

We report a case of a 65-year-old male patient who presented with gradually worsening dyspnea over 2 years. History was significant for smoking and the absence of any hazardous occupational exposure. The clinical findings at presentation included absent breath sounds and stony dullness on the left side, with tracheal deviation contralaterally and clubbing.

Amniotic fluid embolism.

Amniotic fluid embolism is a rare syndrome that can have debilitating and lethal consequences. It is a difficult and somewhat intangible diagnosis that warrants a high index of suspicion by physicians. Prompt and aggressive supportive treatment is required to lessen an otherwise dismal outcome, which may include death and permanent disability.

New therapies: plasmapheresis, intravenous immunoglobulin, and monoclonal antibodies.

Rheumatologic emergencies may pose a serious threat to life, and the treatment of patients with these illnesses continues to be challenging. In the last decade extensive animal and human research has led to development of new therapies. Considerable progress has been made in the therapy for RA.