July 2024 Medical Image of the Month: Vocal Cord Paralysis on PET-CT

By: Abdulmonam Ali, MD

Abstract: No abstract available. Article truncated after 150 words. A 60-year-old woman with a past medical history of hypertension, rheumatoid arthritis, and a significant smoking history (40+ pack-years) presented with a 3-month history of hoarseness of voice as well as a 10 lb weight loss over a 5-month period.  Chest CT revealed a spiculated left upper lobe nodule (Figure 1A). Additionally, there was evidence of bulky mediastinal and left hilar lymphadenopathy (Figure 1B). A subsequent 17-FDG PET-CT (Figure 2) demonstrated marked metabolic activity in the left upper lobe nodule with an SUV maximum of 9.1. Metabolically active mediastinal and left hilar lymphadenopathy was also noted with an SUV maximum of 5.9.

Interestingly, increased metabolic activity of the right vocal cord compared to the left was noted on the PET scan (Figure 2B). Direct laryngoscopy, performed during intubation for a diagnostic bronchoscopy and endobronchial ultrasound, confirmed left vocal cord paralysis. EBUS sampling of multiple mediastinal hilar lymph node stations, including …

URL: https://www.swjpcc.com/imaging/2024/7/2/july-2024-medical-image-of-the-month-vocal-cord-paralysis-on.html

July 2024 Critical Care Case of the Month: Community-Acquired Meningitis

By: Robert A Raschke MD

Abstract: 

No abstract available. Article truncated after 150 words.

History of Present Illness

A 62-year-old woman was brought to our emergency department at 0300 with a possible stroke. She was last known well at 2230 the previous evening, when she complained of severe headache and took some acetaminophen before going to bed. Her daughter (who provided all history) noted that the patient awoke about midnight, vomited and took some naproxen. The daughter next heard the patient awake at 0230, and found her back in the bathroom vomiting again, slow to respond, “mumbling” and confused. The daughter was able to get the patient into their car with some difficulty and drove her to the ER.

Past Medical History, Social History, Family History

Only minimal past medical history was elicited. There was no known trauma, no fever and no recent illnesses. The patient took no prescription medications. She did not have any history of neurological disease and no known history of …

URL: https://www.swjpcc.com/critical-care/2024/7/1/july-2024-critical-care-case-of-the-month-community-acquired.html 

A Call for Change in Healthcare Governance

By: Robbins RA

Abstract: 

No abstract available. Article truncated after 150 words. Over the past 30-40 years many healthcare organizations have gradually shifted from a charitable, not-for-profit organization to a not-for-profit in name only business. Accompanying this shift, has been a shift in hospital governance away from a benevolent organization directed by charitable organizations such as religious organizations to businessman focused on revenue and profits. Of course, this does not mean that not-for-profit organizations are for loss. Small or modest profits are necessary to continue to operate.

Accompanying this change in organizational goals from a charitable to a more business focus, has been changes in the hospital board of directors or trustees (1). The mission of a publicly traded corporation is to return economic value to their shareholders and is the primary fiduciary focus of that board. On the other hand, the mission of a not-for-profit, 501c, charitable healthcare system is to provide health services improving the well-being of the community.

The …

URL: https://www.swjpcc.com/editorials/2024/6/29/a-call-for-change-in-healthcare-governance.html