October 2024 Critical Care Case of the Month: Respiratory Failure in a Patient with Ulcerative Colitis

By: Wesselius LJ

Abstract: 

No abstract available. Manuscript truncated after 150 words. History of Present Illness

The patient is a 57-year-old woman with a history of ulcerative colitis (UC) complicated by toxic megacolon with subsequent colectomy. She presented to the emergency department with cough, shortness of breath and hypoxemia (87% on RA).

PMH, SH

• UC with history of toxic megacolon (4 years prior) with a total colectomy
• History of a prior episode of respiratory failure a year earlier thought possibly medication induced (ustekinumab, Stelara®) which she was taking for her UC. She was treated with steroids at that time with good response.
• Pyoderma gangrenosum of both ankles (attributed to UC).
• Anemia of chronic disease.
• She is a lifelong non-smoker.
• No exposures to toxic dusts, birds, down, humidifiers, mold or other antigens associated with hypersensitivity pneumonitis.

Physical Exam

• Afebrile, Oxygen saturation 94% on 2 lpm supplemental oxygen.
• Chest: crackles noted at left base.
• CV regular rhythm, no murmur.

Ext: scarring and erythema on …

URL: https://www.swjpcc.com/critical-care/2024/10/1/october-2024-critical-care-case-of-the-month-respiratory-fai.html 

September 2024 Medical Image of the Month: A Curious Case of Nasal Congestion

By: Swenson G, Herber S, Jokerst C

Abstract: No abstract available. Article truncated after 150 words. A 79-year-old man presented to our institution for evaluation of intermittent fevers, profound nasal pain with congestion, cough, sore throat, voice changes, fatigue, generalized weakness, and loose stools which had been progressively affecting the patient for the last 6 months.  The patient has a past medical history of ulcerative colitis, hypothyroidism, atrial fibrillation, and hypertension. Just preceding the onset of symptoms, the patient had gone on a month-long trip through Africa and Asia. His symptoms were presumed infectious in the outpatient setting and had responded somewhat to an extended course of ciprofloxacin and metronidazole.

The patient had an outpatient head and neck CT that demonstrated significant mucosal thickening of the maxillary sinuses (Figure 3A). An outside hospital CT of the abdomen/pelvis was unremarkable aside from sigmoid diverticulosis. The patient’s significant nasal pain and congestion along with the fevers was suggestive of granulomatosis with polyangiitis (GPA). The differential also included hematologic …

URL: https://www.swjpcc.com/imaging/2024/9/2/september-2024-medical-image-of-the-month-a-curious-case-of.html 

September 2024 Pulmonary Case of the Month: An Ounce of Prevention Caused a Pound of Disease

By: Von Essen SG

Abstract: 

No abstract available. Manuscript truncated after 150 words. History of Present Illness: A 55-year-old woman is self-referred for dizziness, fatigue, and difficulty concentrating. She was well until 2 months prior to this visit. She says she feels like she is in a “fog”.  She also complains of a “tight chest”.

PMH, SH, and FH: She has a past medical history of hypertension and presently takes metoprolol. She has had a tubal ligation and a breast lumpectomy in the past. There is a questionable history of a positive Cardiolite nuclear stress test.

She is divorced and lives alone in a small town in Iowa. She does not smoke, drink to excess or used illicit drugs.

She has worked assembling bird houses for 20 years. She attributes her problems to a workplace exposure because she seems worse when opens the large shipping containers with the birdhouse parts. Although she worked 20 years previously without problems, her symptoms began 2 months …

URL: https://www.swjpcc.com/pulmonary/2024/9/1/september-2024-pulmonary-case-of-the-month-an-ounce-of-preve.html

August 2024 Image of the Month: Lymphomatoid Granulomatosis

By: Herber S, Swenson G, Jokerst C

Abstract: 

No abstract available. Article truncated after 50 words. A 72-year-old man with a history of hypertension and diabetes and a remote smoking history (10 pack-years) presented to our institution with approximately 1 year of poor appetite, night sweats, and progressive weakness as well as ~ 70 lb. weight loss over the past 6 months. He had also developed multiple intramuscular tumors within his extremities, with rapid growth of a right forearm tumor requiring fasciotomy and debridement. He denied recent foreign travel and his family history was significant for non-Hodgkin lymphoma in his father. Extensive prior clinical and laboratory investigation yielded a negative rheumatological workup, hypercalcemia and an elevated CRP, but was otherwise unremarkable.

Outside imaging studies had shown abdominal adenopathy with numerous intramuscular masses as well as several visceral masses involving the liver, pancreas, spleen and kidneys. Histopathology from several sources including his right forearm debridement surgical specimen and biopsy specimens from lesions in his lung, liver, and …

URL: https://www.swjpcc.com/imaging/2024/8/2/august-2024-image-of-the-month-lymphomatoid-granulomatosis.html 

CMS Proposes Increased Reimbursement for Hospitals but a Decrease for Physicians in 2025

By: Robbins RA

Abstract: No abstract available. Article truncated after 150 words. The Centers for Medicare & Medicaid Services (CMS) released its proposed changes to the fee schedule for 2025 on July 10. Hospital compensation will increase by 2.6% from 2024 for hospital outpatient services and 2.8% for inpatient services (1). In contrast, physician payment will DECREASE 2.8% (2). This continues the trend in CMS reimbursement. Over the past 20 years, physician pay has plummeted by 26% when adjusted for inflation while hospital reimbursement has surged by 70% (3).

The proposal drew quick criticism from the American Medical Association (AMA) and the Medical Group Management Association (MGMA) (3). "With CMS estimating a fifth consecutive year of Medicare payment reductions — this time by 2.8 percent —  it's evident that Congress must solve this problem," AMA President Bruce Scott, MD, said. "In addition to the cut, CMS predicts that the Medicare Economic Index — the measure of practice cost inflation — will increase by 3.6 percent. Facing …

URL: https://www.swjpcc.com/news/2024/7/12/cms-proposes-increased-reimbursement-for-hospitals-but-a-dec-1.html