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Pleuroscopy with pleural biopsy has a high sensitivity for malignant pleural effusion (MPE). Because MPEs tend to recur, concurrent diagnosis and treatment of MPE during pleuroscopy is desired. However, proceeding directly to treatment at the time of pleuroscopy requires confidence in the on-site diagnosis. The study's primary objective was to create a predictive model to estimate the probability of MPE during pleuroscopy.A prospective observational multicentre cohort study of consecutive patients undergoing pleuroscopy was conducted. We used a logistic regression model to evaluate the probability of MPE with relation to visual assessment, rapid on-site evaluation (ROSE) of touch preparation and presence of pleural nodules/masses on computed tomography (CT). To assess the model's prediction accuracy, a bootstrapped training/testing approach was utilized to estimate the cross-validated area under the receiver operating characteristic curve.Of the 201 patients included in the study, 103 had MPE. Logistic regression showed that higher level of malignancy on visual assessment is associated with higher odds of MPE (OR = 34.68, 95% CI = 9.17-131.14, p 0.001). The logistic regression also showed that higher level of malignancy on ROSE of touch preparation is associated with higher odds of MPE (OR = 11.63, 95% CI = 3.85-35.16, p 0.001). Presence of pleural nodules/masses on CT is associated with higher odds of MPE (OR = 6.61, 95% CI = 1.97-22.1, p = 0.002). A multivariable logistic regression model of final pathologic status with relation to visual assessment, ROSE of touch preparation and presence of pleural nodules/masses on CT had a cross-validated AUC of 0.94 (95% CI = 0.91-0.97).A prediction model using visual assessment, ROSE of touch preparation and CT scan findings demonstrated excellent predictive accuracy for MPE. Further validation studies are needed to confirm our findings.

Rationale: When stereotactic ablative radiotherapy is an option for patients with non–small cell lung cancer (NSCLC), distinguishing between N0, N1, and N2 or N3 (N2|3) disease is important.Objecti...

Background The use of pleuroscopy has expanded over the last decade due to its higher diagnostic yield and low complications rate. Whether the infectious complications of pleuroscopy performed in negative pressure rooms is similar to that of pleuroscopy performed in positive pressure rooms remain unclear. To assess the safety of pleuroscopy performed in negative pressure rooms, we sought to determine the rate of infectious complications in patients who underwent pleuroscopy in negative pressure bronchoscopy rooms at our institution. Methods This was a retrospective cohort study of all patients who underwent pleuroscopy in our institution's negative pressure bronchoscopy rooms between January 2005 and January 2018. The primary outcome was the incidence of infectious complications at 14 and 30 days after the procedure. Results We identified 318 patients. Of the 318 patients, 47 (15%) had hematological malignancies, 118 (37%) had lung cancer, 121 (38%) had solid non-lung cancers, and 32 (10%) had no cancer diagnosis before the procedure. At the end of pleuroscopy, 255 patients (80%) had an indwelling pleural catheter placed, 63 patients (20%) had only a chest tube placed, and 31 patients (9%) had both an indwelling pleural catheter and chest tube placed. No patients developed empyema within 14 days. Three patients (0.9%) developed empyema within 30 days after the procedure and was presumed to be due to pleural catheter infection in all cases. Conclusion Our findings show that pleuroscopy performed in negative pressure rooms has a low incidence of infectious complications, provided that proper sterile precautions are maintained.

For some international medical graduates (IMGs), becoming an American Board of Medicine Diplomate (ABIM) may sound extremely hard or perhaps impossible. Those who think this way forget the obvious fact that almost 25 percent of the medical workforce in the United States started exactly like them as international medical graduates (1). It may also come to everyone's surprise that the number of non-US citizens IMGs continues to grow, and has been the highest ever last year based on the latest National Residency Matching Program Report (2). Moreover, the match rate for non-U.S. citizen IMGs continues to grow to reach 50.5% in 2016, up from 49.4% in 2015. In this paper, we reflect on our own journey from being international medical graduates preparing for the United States Medical Licensing Exams (USMLEs) to American board certified physicians and will take you a step further through the initial steps of fellowship. We hope this will help guide other IMG's and make their dream one day come true. Keywords: Postgraduate Education, International Medical Graduates, Residency

Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm that may arise in soft tissues of nearly every organ. Although IMTs are the most common lung tumors in pediatric populations, these tumors are extremely rare in adults, constituting less than 1% of adult lung tumors. IMTs are characterized by proliferating spindle cells with variable inflammatory component. The biological behavior of lung IMTs in adults is highly unpredictable, which confounds diagnosis and treatment. We retrospectively investigated patients with pulmonary lesions and the histopathologic diagnosis of inflammatory myofibroblastic tumor or its synonymous names (Plasma Cell Granuloma, xanthogranuloma, inflammatory pseudotumor, fibroxanthoma, and fibrous histiocytoma) at the MD Anderson Cancer Institute in the period between August 2000 and August 2016. We describe 7 adult cases of IMT of the lung that were diagnosed at MD Anderson Cancer Center. These cases highlight the tumor's variability in terms of clinical presentation, histopathology, and biologic behavior, and underscore the challenges in the management of these rare lung neoplasms.

Ethylene glycol toxicity is a known cause of anion gap metabolic acidosis, with the presence of an osmolar gap and the right clinical context suggesting to the diagnosis. Rapid recognition and early treatment is crucial. Unfortunately, ethylene glycol levels are not readily available and must be performed at a reference laboratory. We present a case where recognising the significance of the 'lactate gap' assisted in identifying ethylene glycol poisoning.

A 38-year-old woman underwent an outpatient L5/S1 discectomy. The procedure was complicated by intraoperative bleeding, and haemostasis was achieved using a thrombin-based haemostatic matrix (TBHM). She presented to our facility on postoperative day 5 with left-sided chest pain and dyspnoea. CT pulmonary angiography (CTPA) showed a heterogeneous filling defect with mixed attenuation and a ‘pseudoair pattern’ in the left main pulmonary artery (figure 1). Duplex ultrasound of the upper and lower extremities was negative for venous thrombus. An echocardiogram was normal. Pulmonary angiography showed occlusion of the basal branches of the left pulmonary artery (figure 2). Therapeutic …

Objectives: To evaluate the practical knowledge of final year medical students as it relates to care of patients with diabetes. Methods: A convenient sample of 325 students (2006) from the Faculty of Medicine at Al-Fateh University, Tripoli, Libya was studied. An Arabic “Short Diabetes Knowledge Test” consisting of 24 multiple choice questions (14 general questions and 10 questions specific to insulin-treatment issues) was used. Results: The mean total score was 76.7% [18.4/24 (range 9-24)], 71.4% [10.0/14 (range 4-10)] for the general questions and 85% [8.5/10 (range 4-10)] for insulin-treatment related questions. The highest scores (>90% correct) were related to clinical management issues such as hypoglycemia, insulin-dosing, driving, and complications. Whereas, the lowest scores (