Effect of IV Push Antibiotic Administration on Antibiotic Therapy Delays in Sepsis.

Objectives: Timeliness of antibiotic administration is recognized as an important factor in reducing mortality associated with sepsis. According to guidelines, antibiotics should be administered within 1 hour of sepsis presentation and the Centers for Medicare & Medicaid Services mandates administration within 3 hours. This study evaluates the difference in time from sepsis diagnosis to first-dose completion of β-lactam antibiotics between IV push and IV piggyback administration.

Hepatoid Adenocarcinoma Presenting as Pancreatitis.

Hepatoid adenocarcinoma (HAC) is an uncommon and aggressive type of adenocarcinoma, typically affecting the middle-aged and elderly. The morphological features of the HAC resemble hepatocellular carcinoma. Presenting symptoms may include upper abdominal pain, hematemesis, back pain, and palpable abdominal mass.

Correlations of morphology and molecular alterations in traditional serrated adenoma.

Traditional serrated adenoma was first reported by Longacre and Fenoglio-Presier in 1990. Their initial study described main features of this lesion, but the consensus diagnostic criteria were not widely adopted until recently. Traditional serrated adenoma presents with grossly protuberant configuration and pinecone-like appearance upon endoscopy.

Low risk TAVR: Long- term considerations and appropriate patient selection.

Recent trials have shown impressive results in low-risk patients undergoing Transcatheter Aortic Valve Replacement (TAVR) with low procedural complication rates, short hospital length of stay, zero mortality, and zero disabling stroke at 30 days and have led to a Food and Drug Administration indication for TAVR in these patients. The long-term data on subclinical leaflet thrombosis, valve durability, effects of pacemaker implantation, right ventricular pacing, and progressive paravalvular leak is unclear. We describe clinical and procedural considerations for patient selection and introduce future potential procedural challenges.

Primary yolk sac tumour of the prostate mimicking small round blue cell tumour.

Prostatic yolk sac tumour is a germ cell tumour with a wide range of age of occurrence, unusual anatomic locations, diverse morphologic patterns, and aggressive biologic behavior, posing challenges both to diagnosis and clinical management. We report a rare case of primary yolk sac tumour of the prostate with extensive local and liver metastasis, the latter of which exhibited sheets of small blue cells expressing CD99 and focal sall4 on biopsy. Positivity for CD99 and gata3 in the initial biopsy raised the differential diagnosis of Ewing sarcoma and poorly differentiated carcinoma.

Sternal wound complications in patients undergoing orthotopic heart transplantation.

Purpose: The incidence and management of sternal wound complications in patients undergoing orthotopic heart transplantation (OHT) is not well studied. We report outcomes in heart transplant patients who developed sternal infections requiring reoperations.

Methods: From 2004 to 2013, 437 patients underwent OHT at a single institution.

Hybrid arch surgery challenges other forms of arch treatment.

Introduction: The gold standard for aortic arch replacement remains total arch replacement (TAR) procedure. Hybrid techniques, utilizing a combination of open and endovascular approaches, have been developed with goal of lowering postoperative mortality and morbidity, as well as providing an alternative therapy for patients who are elderly, have significant comorbid burden, or patients in whom circulatory arrest may pose significant risk.

Evidence Acquisition: To date, there are no prospective randomized trials comparing hybrid aortic ach procedures to TAR.

Tricuspid valve endocarditis in the era of the opioid epidemic.

Background And Aim: We reviewed our institutional experience with tricuspid valve endocarditis to understand the impact of the opioid epidemic on the incidence of right heart endocarditis.

Methods: We retrospectively reviewed all cases of tricuspid endocarditis managed surgically from January of 2011 to May of 2017. There were no exclusion criteria.

United States Preventive Services Task Force Overstates Cosmetic Harms of Skin Cancer Screening.

The United States Preventive Services Task Force (USPSTF) 2016 recommendation for skin cancer screening in asymptomatic healthy adults concluded that current evidence is "insufficient to assess the balance and harms of visual skin examination." One contributing factor leading to the insufficient grade was a concern for cosmetic harms resulting from unnecessary biopsies or excisions. This commentary briefly highlights the pertinent studies and currently accepted methods for pigmented lesion biopsy.

Pulmonary hypertension in chronic hemolytic anemias: Pathophysiology and treatment.

Pulmonary hypertension has emerged as a major cause of morbidity and mortality in patients with hemoglobinopathies and chronic hemolytic anemias. These hematological diseases include - but are not limited to - sickle cell disease (SCD), thalassemia, paroxysmal nocturnal hematuria, and hereditary spherocytosis. Although most studies have been based on the use of echocardiography as a screening tool for pulmonary hypertension as opposed to the gold standard of right heart catheterization for definitive diagnosis, the association between chronic hemolytic anemia and pulmonary hypertension is evident.

Amyloidosis diagnosed in cytology specimen of pleural effusion: A case report.

Amyloidosis is a rare condition resulting from extracellular deposition of amyloid, a fibrillary material derived from various precursor proteins. Involvement of the pleura by amyloidosis is a rare but serious complication. Pleural amyloidosis is primarily diagnosed by identifying amyloid deposition by histology on pleural biopsy specimens.