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BACKGROUND When patients present with pleural effusion and structural abnormalities consistent with malignancy on imaging, the traditional approach has been to perform a thoracentesis and await the results before proceeding to more invasive diagnostic procedures. The objective of this study was to evaluate whether concurrent thoracentesis and tissue biopsy is superior to sequential sampling. METHODS Retrospective chart review was performed for patients who had a pleural cytology from May 2014 until January 2017. Patients without parenchymal, pleural, or mediastinal abnormalities and those with a prior primary thoracic malignancy were excluded. Patients with an effusion and additional suspect findings were grouped based upon whether initial approach was concurrent versus sequential. The following outcomes were documented: lag time to diagnosis from thoracentesis, lag time to hematology/oncology (HONC) service consult, time to molecular study results, lag time to therapy, and time to death. RESULTS Of 565 cases, 45 met criteria, 28 (62%) having undergone concurrent and 17 (38%) sequential sampling. The median lag time to biopsy for the concurrent group, 3 days, was significantly shorter than the 9-day lag time for the sequential group (P=0.006). Five patients in the sequential group and one in the concurrent group were lost to follow-up. Patients in the concurrent group had earlier diagnosis and oncology visits (2 d, 7 d) than those in the sequential group (6.5 d, 16 d) (P

A complex para-pneumonic effusion is a descriptive term for exudative effusions, which complicate or are likely to complicate the anatomy of the pleural space after pneumonia. We performed an online search was performed using the resources PubMed and Google Scholar to provide an update on the management of such effusions based on review of published literature. Search terms including pleural effusion (PE), parapneumonic effusion, and empyema were used. Relevant studies were identified and original articles were studied, compared and summarized. References in these articles were examined for relevance and included where appropriate. Studies involving pediatric patients were excluded. Management of para-pneumonic PE has changed tremendously over the last decade. As we accumulate more evidence in this area, approach to pleural fluid drainage is becoming more specific and guideline based. An example of a practice changing study in this aspect is the Multi-center Intrapleural Streptokinase Trial (MIST) 2 trial which demonstrated that a combination of intra-pleural tPA and DNAse improved outcomes in pleural infections compared to DNase or t-PA alone. More randomized control trials are needed to describe the role of surgical techniques like VATS (video-assisted thoracoscopic surgery) when MIST 2 protocol fails; this combination has revolutionized the management of empyema in recently.

Introduction: Patients with Cystic Fibrosis (CF) have increasing rates of hospitalization. We analyzed the burden and predictors of thirty-day readmission among patients with CF in the U.S. Material and methods: Nationwide Readmission Database (NRD) 2013 was used to identify adults with CF who were hospitalized. These individuals were followed to determine the prevalence of readmission within thirty days of index discharge. Cox proportional hazard regression was used to identify independent predictors of readmission. Results: There were 14,616 index admissions of adults with CF in 2013. Of these, 2606 (17.8%) patients were readmitted within 30 days of discharge. Female sex and chronic anemia were independent predictors of readmission. The most common causes of readmission were pulmonary exacerbation (31%), lung transplant complications (5.2%), and septicemia (3.4%). Conclusion: Readmissions are frequent among adults with CF and contribute to significant healthcare burden and cost among this population.

Wstęp: Częstość hospitalizacji chorych na mukowiscydozę rośnie. Przeprowadziliśmy analizę częstości zjawiska 30-dniowych readmisji i jego predyktorów u chorych na mukowiscydozę w Stanach Zjednoczonych. Materiał i metody: Wykorzystano dane bazy readmisji NRD (Nationwide Readmission Database) z 2013 roku w celu identyfikacji dorosłych chorych na mukowiscydozę leczonych w szpitalu. Pacjenci byli poddani obserwacji prospektywnej w celu oceny występowania readmisji w ciągu 30 dni od dnia wypisu. Wykorzystano analizę regresji w celu identyfikacji niezależnych predyktorów readmisji. Wyniki: Współczynnik przyjęć do szpitala dorosłych chorych na mukowiscydozę w 2013 roku wynosił 14,616. Spośród chorych hospitalizowanych 2606 pacjentów (17.8%) przyjęto ponownie w ciągu 30 dni od wypisu. Płeć żeńska i przewlekła niedokrwistość były niezależnymi predyktorami readmisji. Najczęstsze przyczyny readmisji stanowiły zaostrzenia oddechowe (31%), powikłania po przeszczepieniu płuca (5.2%) oraz bakteriemia (3.4%). Wnioski: Readmisje są częste u dorosłych chorych na mukowiscydozę i przyczyniają się do obciążenia systemu ochrony zdrowia i zwiększenia kosztów leczenia.