Timing and Outcomes of Tracheostomy Performed by Pulmonary and/or Critical Care Physicians.

Background: Although pulmonary and/or critical care (P/CC) physicians perform percutaneous tracheostomy in mechanically ventilated patients, the trends, timing, and outcomes of this procedure have not been well described. This study aims to describe the trends, timing, and outcomes of this procedure.

Methods: Using 5% medicare data, we retrospectively examined a cohort who had tracheostomy performed after initiation of mechanical ventilation during acute hospitalization to describe the timing of tracheostomy placement by pulmonary and/or critical care (P/CC) physicians and associated outcomes.

Removal of Self-Expanding Metallic Stents.

Background: Despite their safety profile, self-expanding metallic stents (SEMS) have been difficult to remove. We aim to describe our experience in removal of SEMS at Henry Ford Hospital with a specific emphasis on safety.

Methods: We reviewed the charts of all patients who underwent removal of a SEMS at Henry Ford Hospital between 2003 and 2013.

Muddying the water for a clear diagnosis.

Pulmonary sporotrichosis, such as other chronic fungal and mycobacterial infections, can be difficult to diagnose. We present a novel twist on the old technique of bronchoalveolar lavage that leads to improved diagnostic yield.

Outcomes of patients on multiple vasoactive drugs for shock.

Introduction: Vasoactive drugs are routinely used in critically ill patients with shock to optimize the hemodynamic state while evaluating and treating potentially reversible causes. Limited data exist on the use of multiple vasoactive drugs in the intensive care unit. We hypothesize that the use of 3 or more vasoactive drugs is associated with worse outcomes.

Management of calcium channel antagonist overdose with hyperinsulinemia-euglycemia therapy: case series and review of the literature.

Calcium channel antagonists (CCAs) are commonly involved in drug overdoses. Standard approaches to the management of CCA overdoses, including fluid resuscitation, gut decontamination, administration of calcium, glucagon, and atropine, as well as supportive care, are often ineffective. We report on two patients who improved after addition of hyperinsulinemia-euglycemia (HIE) therapy.

Rapid response team in an academic institution: does it make a difference?

Background: Although data remain contradictory, rapid response systems are implemented across US hospitals. We aimed to determine whether implementation of a rapid response team (RRT) in a tertiary academic hospital improved outcomes.

Methods: Our hospital is a tertiary academic medical center with 24-h in-house resident coverage.

Pulmonary alveolar proteinosis in a 67-year-old woman with Wegener's granulomatosis.

Mycophenolate mofetil (MM) is commonly used in patients with autoimmune diseases or who have undergone transplantation. Common side effects of MM include anemia, leukopenia, mucositis and opportunistic infections. We report an unusual case of pulmonary alveolar proteinosis (PAP) in a 67-year-old woman on MM for Wegener's granulomatosis (WG).

Symptomatic persistent sciatic artery in a newborn.

Persistent sciatic artery is an unusual anatomical anomaly first noted in 1832. Approximately 60 to 70 cases have been documented in the literature, but none described symptomatic persistent sciatic artery presenting in the neonate. We report a case of a newborn infant who presented after birth with an atrophic right lower extremity and ischemia.

Current regulations and modest proposals regarding disposal of unused opioids and other controlled substances.

There are no uniform protocols in the United States for safe, environmentally acceptable disposal of controlled substances by patients. In addition, there are conflicting protocols used by various institutions for the disposal of narcotic medications. Although the US Drug Enforcement Administration oversees the prescribing, acquisition, and distribution of controlled substances and works to prevent the illegal diversion of these products, it stops short of recommending specific mechanisms for consumers to dispose of unused medications.

Periodontal disease and control of diabetes mellitus.

Data from the Centers for Disease Control and Prevention indicate that more than 20 million people (approximately 7% of the population) in the United States have diabetes mellitus. Physicians often fail to examine the mouths and teeth of their patients, even though the condition of the mouth and teeth have clinical relevance for the treatment of patients with diabetes mellitus. The authors examine the current state of knowledge regarding periodontal disease and the effect of periodontal disease on worsening of glycemic control.

Current role of magnetic resonance imaging in breast imaging: a primer for the primary care physician.

Magnetic resonance imaging (MRI) is a widely used imaging tool. Interest in the applicability of this modality in the realm of breast imaging has been steadily increasing over the past 25 years. The purpose of this article is to explore the use of contrast-enhanced MRI in breast imaging as it relates to the primary care physician.