Multilocular thymic cyst with epithelioid granulomata of unknown etiology: a radiologic and histopathologic correlation.

Thymic cysts (congenital or acquired) are believed to account for 3% to 5% of all mediastinal masses. Multilocular thymic cysts are an acquired reactive inflammatory process arising within the thymus gland and are less common than the congenital unilocular type. Multilocular cysts have been reported in association with a variety of neoplastic, autoimmune, and infectious conditions. We report a case of a 23-year-old white man who presented with a 2-week history of progressive right-sided shoulder and chest pain. He was found to have an anterior mediastinal mass involving the thymus. This case of multilocular thymic cyst is particularly unique due to the presence of abundant epithelioid granulomata within the cyst, a finding that has not previously been emphasized as a histologic feature of these lesions, and one that expands the histopathologic differential diagnosis, warranting exclusion of infectious and autoimmune etiologies.

The Emeritus Clinical-Researcher Program.

BACKGROUND: For some physicians, retirement means leaving their practice and severing ties with their institution, while others may wish to maintain a more active role within their institution. Many institutions have designed programs that enable these individuals to maintain an academic relationship and provide services to their institution. OBJECTIVES: This manuscript provides a brief experience of the Marshfield Clinic (MC) and Marshfield Clinic Research Foundation (MCRF) recent development of an emeritus program for research and education. RESULTS: The program is designed to provide opportunities for physicians, clinical PhDs, dentists, and other clinicians with terminal degrees and the necessary qualifications as researchers, to continue to contribute to the MC/MCRF research mission after retirement from clinical practice. Assignment to various aspects of the program is determined by the individual's expertise, experience and institutional needs. Expectations and performance of each individual is evaluated. The infrastructure of the program was assembled by reviewing institutes that have had an emeritus program in operation and integrating the unique aspect of MC/MCRF resources. CONCLUSION: Alignment of the unique skills, expertise, knowledge, and wealth of experience of emeritus faculty along institutional needs has provided added value to the institution without major financial investment.

Rhabdomyolysis-induced acute kidney injury secondary to Anaplasma phagocytophilum and concomitant statin use.

We report the case of a patient with rhabdomyolysis-induced acute renal failure occurring in the setting of Anoplasma phagocytophilum infection based on the presence of morulae in neutrophils and concomitant statin use. Although the pathogenesis is unknown, we believe the combination of concurrent statin use in the setting of the infection promoted this complication. We describe proposed mechanisms including cytokine activation, alteration of the muscle membrane components, and ionic balance as contributing factors.

The impact of serum glucose on clinical outcomes in patients hospitalized with community-acquired pneumonia.

PURPOSE: Community-acquired pneumonia (CAP) is a common medical condition resulting in excess morbidity, mortality, and high rates of hospitalization. Despite high hospitalization rates for CAP, the relationship between abnormal glucose levels (hyperglycemia and hypoglycemia) and the seriousness of the illness as measured by length of stay (LOS) is not well established. We examined relationships of CAP to multiple factors that impact predictability and severity of the disease process. They include glycemic control; hospital utilization, including LOS; 30-day hospital readmission; intensive care unit (ICU) admissions, adjusting for comorbidities; illness severity; and timing of antibiotic treatment. METHODS: We conducted a retrospective observational cohort study of adult patients hospitalized for CAP between January 1, 1992 and June 23, 2007. Case screening was conducted electronically using International Classification of Diseases, 9th Revision (ICD-9) codes 480.0-487.9. Subsequent medical record abstraction yielded 969 qualifying cases with comprehensive data on past and current medical problems. RESULTS: Serum glucose levels at admission were independently associated with LOS for CAP patients. Patients with levels between 90 mg/dL and 140 mg/dL on admission had shorter LOS compared to those with levels of < 90 mg/dL and > 140 mg/dL (median 3.9 vs 4.2 days, P = .04). Multivariate analyses confirmed the univariate results. Serum glucose levels at initial hospitalization were not associated with 30-day hospital readmission (P =.34) or ICU admission (P = .48). CONCLUSIONS: Abnormal glucose levels are an independent predictor of increased LOS for CAP. Control of blood glucose may lead to improved outcomes, including shortened LOS, and should be a priority in CAP management.