Hospitalizations with TB, California, 2009-2017

BACKGROUND: Hospitalization is a costly event that affects more than half of all TB patients in the United States. State-level hospitalization data are crucial in estimating the cost of TB disease and the financial impact of preventing TB.METHODS: We used California administrative hospital discharge data from 2009 to 2017 to characterize TB hospitalizations in comparison with non-neonatal, non-maternal hospitalizations. TB hospitalization was defined as a hospitalization with a TB ICD-9/10 code as the primary diagnosis. We estimated hospitalization costs in 2017 dollars from reported charges using cost-to-charge ratios.RESULTS: In comparison to persons hospitalized for other conditions, persons hospitalized for TB in 2017 were more likely to be male, of working age, and Asian/Pacific Islander. The median cost for TB hospitalizations was US$22,807 vs. US$11,568 for other hospitalizations. The median length of stay for TB hospitalizations was 12 days compared to 3 days for other hospitalizations. Medicaid was expected to pay for 50% of TB hospitalizations costing US$21,438,208.CONCLUSIONS: Societal cost estimates of TB hospitalization should be updated to reflect long hospital stays and the disproportionate burden on working age persons. This analysis enhances our understanding of the high cost of TB care and underscores the costs averted if TB cases are prevented.

Testicular pain as the initial presentation of testicular neoplasms

OBJECTIVES

Testicular neoplasms are reported to present with testicular pain in 0.01-10% of patients. The diagnosis of tumour may, therefore, not be considered immediately with this mode of presentation, leading potentially to delays in diagnosis and poorer prognosis or scrotal exploration for suspected torsion. The objective of this study was to assess the incidence of pain as the presentation of testicular neoplasms.

PATIENTS AND METHODS

A retrospective case note analysis of all patients undergoing radical orchidectomy over an 11-year period in Hull, UK was performed. Data on presenting symptoms, histology and clinical stage were collected.

RESULTS

It was found that 23.5% of all patients analysed (27 of 115) presented with testicular pain, but that this did not appear to correlate with any particular histological sub-type of neoplasm or stage of disease. However, those presenting with germ cell tumours and testicular pain were more likely to suffer disease relapse than those presenting with painless testicular enlargement (1 6% compared to 2.6%).

CONCLUSIONS

Testicular neoplasms should be considered earlier in patients presenting with testicular pain, as this may be more common than previously reported.

Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography

OBJECTIVE

Considerable accrued evidence points to an association between testicular microlithiasis, intratubular germ cell neoplasia, and testicular tumor. This study assesses both the prevalence of testicular microlithiasis revealed on sonography in a referred population and the concurrent tumor risk.

MATERIALS AND METHODS

Over a 32-month period (April 1996 through November 1998), 4892 scrotal sonographic examinations were performed in 4819 patients at four referral centers. All patients underwent high-resolution (7- to 10-MHz) imaging. Using a computerized word search (n = 4102; testicular microlithiasis, calcification, microliths, calcific foci, tumor, neoplasm, cancer, hyperecho, hypoecho, heterogen, and carcinoma) and manual retrieval (n = 790), cases of tumor, testicular microlithiasis (>5 microliths per sonogram), and testicular microlithiasis plus tumor were pulled and retrospectively reviewed. The presence and type of tumor were confirmed at histology after orchidectomy.

RESULTS

Fifty-four tumors were found among 4892 scrotal sonograms (28 seminomas, 14 teratomas, 8 mixed germ cell tumors, 2 Leydig cell tumors, and 2 non-Hodgkin's lymphomas). Testicular microlithiasis was present in 33 patients, giving a prevalence of 0.68%. Concurrent tumor and testicular microlithiasis were detected in seven patients, a relative risk of tumor in testicular microlithiasis was 21.6-fold (95% confidence limits: 10. 6-fold, 44.2-fold). In one patient with testicular microlithiasis, a previous orchidectomy for mixed germ cell tumor had been performed (not included in the relative risk calculation).

CONCLUSION

In a referred population of 4819 patients the prevalence of testicular microlithiasis was 0.68% and the relative risk of concurrent tumor was 21.6-fold. Sonographic surveillance of testicular microlithiasis cases for tumor is mandatory.

Retroperitoneal malignancy masquerading as ureteric colic

This study reviews 6 patients who were referred with severe loin pain radiating to the groin and in whom a presumptive diagnosis of ureteric colic was made. Of these, 3 patients were found to have carcinoma of the pancreas and the remaining 3 had retroperitoneal lymph node metastases. Retroperitoneal malignancies rarely present with loin pain, but this diagnosis should be considered in patients with long-standing loin pain in whom an obvious diagnosis is not apparent.

The management of impotence in diabetic men by vacuum tumescence therapy

The treatment of impotence in diabetic men with vacuum tumescence therapy was studied in a specialist clinic. Of 54 diabetic men referred with impotence, seven declined treatment, three chose self-injection with papaverine, and 44 chose vacuum therapy. Patients underwent autonomic function testing (heart rate response to respiration), measurement of penile blood flow (duplex Doppler scanning), and estimation of serum prolactin and testosterone levels. After 2 months, 33 men (75%) were able to have satisfactory intercourse using vacuum therapy. Three others could produce a satisfactory erection with vacuum therapy but their partners found it unacceptable. Eight men (18%) were unable to have satisfactory intercourse; six of these were later treated by self-injection. The median frequency of use of vacuum therapy was 5.5 (1-26) times a month. Outcome was independent of penile blood flow, autonomic function or endocrine status. Impotent diabetic men should be given counselling and offered a choice of the available treatments. Vacuum tumescence therapy is an effective and simple treatment which requires little investigation.

A comparison of fine needle aspiration cytology and tru-cut tissue biopsy in the diagnosis of acute renal allograft rejection

Simultaneous Tru-cut biopsies and fine needle aspirations (FNAs) performed over a 2-year period on patients following renal transplantation were assessed by independent pathologists. When there was histological evidence of rejection, FNAs also demonstrated cellular features of rejection in 83% of cases, and this increased to 92% with repeated sampling. The presence of monocytes and histiocytes in FNAs correlated with vascular features of rejection on biopsy and failure to reverse the rejection process with steroids.

Natural killer cells in renal allograft rejection

Monoclonal antibody Anti Leu 7 has been used to enumerate peripheral blood NK cells in 20 renal allograft recipients. Blood was taken preoperatively and three times per week for the first month after transplantation; separated mononuclear cells were stained with Anti Leu 7 then analysed on a fluorescence activated cell sorter. Results were related to acute rejection episodes diagnosed clinically and confirmed by Trucut biopsy of grafts. A reduction in the number of Leu 7 positive cells occurred postoperatively. Nineteen out of 20 patients showed a rise in number of circulating NK cells during acute rejection episodes.

Tubular duplication of the rectum treated by mucosal resection

This is a case report of an infant with tubular duplication of the rectum, extra lobular lung sequestration, gut malrotation, and a Meckel's diverticulum. The duplication was removed by a mucosal sleeve resection similar to that used in a Soave procedure for Hirschsprung's disease.

Idiopathic retroperitoneal fibrosis a long-term review after surgical treatment

Eighteen patients who received surgical treatment for histologically proven idiopathic retroperitoneal fibrosis were reviewed retrospectively. In 6 patients, obstruction of one ureter recurred. In 3, histological evidence of invasion of the wall of the ureters by the fibrous plaque was found.