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Purpose Bronchoscopic biopsy of pulmonary carcinoid tumors has been controversial, and no study to date is dedicated to investigate diagnostic yield or safety. We reviewed our single center experience with pulmonary carcinoid tumors over a 10-year time period and assessed the diagnostic yield and safety of bronchoscopic biopsy of these tumors. Methods A retrospective analysis was conducted of all bronchopulmonary carcinoid tumors from January 2003 through January 2014 for patients treated at or referred to our tertiary care facility, including patient and tumor characteristics, diagnostic yield, and complications of bronchoscopy. Results Forty-nine patients with bronchopulmonary carcinoid tumors were identified. 75.5 % of our patients were female, and the median age was 60.7 years. 85.7 % patients were white, and 53.1 % were smokers. 83.7 % had typical carcinoid tumors or tumorlets, and 85.7 % had centrally located tumors. The median tumor size was 2.0 cm. Thirty patients underwent bronchoscopy for diagnostic evaluation. 76.7 % were diagnosed via bronchoscopic biopsy. Bronchoscopic yield was calculated at 65.7 % yield, and two complications of moderate to severe bleeding occurred with no emergent thoracotomies, transfusions, or deaths. No other complications occurred from bronchoscopy. Conclusion The diagnosis of pulmonary carcinoid tumors via bronchoscopic biopsy is safe and effective, and bronchoscopy is recommended as the initial diagnostic modality for these tumors., Author(s): Renee K. Dixon[sup.1] , Edward James Britt[sup.1] , Giora A. Netzer[sup.2] , Majid Afshar[sup.3] , Allen Burke[sup.4] , Sandy Liu[sup.4] , Jeudy Jean[sup.5] , Nirav G. Shah[sup.1] Author Affiliations: [...]

Background Pleural fluid is typically drawn directly from the pleural space for diagnostic studies, but occasionally analyses are desired when a chest tube is already in place and a traditional approach is not feasible. The diagnostic value of analyzing fluid samples obtained from the pleural fluid collection system after chest tube insertion is unknown. Methods We performed a prospective observational study of patients in whom chest tube placement was planned for clinical indications. Diagnostic studies were performed on fluid obtained from the pleural space at the time of tube insertion and then repeated 2, 6, and 24 h later on samples obtained from the fluid collection system. Results Fifty-five percent of the 23 effusions studied met light's criteria for exudate at baseline. Lactate dehydrogenase (LDH) varied considerably over time from baseline measures with only 25% of measures at 24 h falling within 25% of baseline levels. The sensitivity for exudate by LDH remained 100% with poor specificity ranging 50-69% with repeat measures. Total protein exhibited less variability with 85% of measures at 24 h falling within 25% of baseline measure. Sensitivity and specificity at 24 h were 88 and 82%, respectively. Repeat measures of cholesterol, albumin, and triglycerides generally correlated well (Spearman's rho > 0.90) with baseline values. Measures of glucose and cell counts varied considerably from baseline. Conclusions Analysis of pleural fluid from a chest tube collection system is feasible and can provide useful diagnostic information. Practitioners should consider the test characteristics of each measure when interpreting samples obtained. Keywords Diagnostic techniques * Respiratory system * Routine * Diagnostic techniques and procedures * Pleural disease * Pleural effusion, Introduction One and a half million pleural effusions are diagnosed annually in United States alone [1]. Over recent years, technical advances in the management of pleural effusions have reduced the [...]

Purpose The acute host response to histoplasma capsulatum infection varies according to exposure and susceptibility. Late sequelae include calcifications in the lung, thoracic lymphatics, and spleen. Determinants of calcified granuloma formation are poorly studied and may differ from those affecting acute response. We examined the occupational associations and familial aggregation of radiographic calcified granulomatous disease to characterize the determinants of calcified granuloma formation. Methods We analyzed prospectively collected cross-sectional data including computed tomograms from 872 adult members of the Old Order Amish of Lancaster County. Results Granulomas were present in 71 % of participants. Granulomas were present in the lung of 57 % of participants, in the hilar or mediastinal lymph nodes of 55 % of participants, and in the spleen of 29 % of participants. No significant differences were observed in the presence of granulomas between men and women. Each year of age was associated with 4 % higher odds of splenic calcifications, and a primary occupation of farming was associated with an 84 % higher odds of splenic calcifications. A compelling pattern of familial aggregation was not observed. Conclusions Calcified granulomatous disease does not appear to aggregate in families. Determinants influencing patterns of granulomatous disease include occupation, age, and geographic location., Author(s): Robert M. Reed[sup.1] , Anthony Amoroso[sup.2] , Salman Hashmi[sup.1] , Seth Kligerman[sup.3] , Alan R. Shuldiner[sup.4] [sup.5] [sup.6] , Braxton D. Mitchell[sup.4] [sup.5] [sup.6] , Giora Netzer[sup.1] [sup.6] Author [...]

Purpose Properly regulated circadian rhythm supports physical and immunologic function. This rhythm is disrupted in patients with critical illness. We assessed the association between ambient light and circadian melatonin release, measured by urinary 6-sulfatoxymelatonin (6-SMT), in medical intensive care unit (MICU) patients with severe sepsis. Methods After excluding patients for renal failure or hepatic failure, blindness, and intracranial disease, seven patients were studied. No environmental manipulation was performed. Urinary 6-SMT specimens were obtained every 4 h. Light was measured in 1-min epochs for two sequential 24-h periods and compared to 6-SMT levels. Results No significant differences among urinary 6-SMT levels were found across 4-h time periods or between the 2 days (range 1,190.26 ± 1,040.81-4,738.57 ± 5,543.08 ng, 4-h period p = 0.09, 24-h day p = 0.50). Light levels were low and differed among 4-h periods, but not 24-h averages (minimum 2.32 ± 3.65 lux/min 00:01-04:00, maximum 70.11 ± 79.12 lux/min from 12:01-16:00, 4 h period p = Conclusions Circadian rhythm was disrupted in patients with severe sepsis, as reflected by disordered diurnal variation of urinary 6-SMT excretion. Light levels were low, exhibited limited diurnal variation, and did not entrain circadian rhythms in these patients., Author(s): Avelino C. Verceles [sup.1], Leann Silhan [sup.1], Michael Terrin [sup.1] [sup.2], Giora Netzer [sup.1] [sup.2], Carl Shanholtz [sup.1], Steven M. Scharf [sup.1] Author Affiliations: (1) grid.411024.2, 0000000121754264, Division of [...]