Chief Residents for 2016-2017 Announced

Without further ado (I know, you’ve been waiting!), we are happy to announce the 2016-2017 UT Southwestern Internal Medicine Chief Residents! Please join us in congratulating these outstanding individuals!

New Chiefs

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Pre-ops for cataract surgery?

Cataract Surgery Fast And Safe, But Many On Medicare Get Costly Pre-Testing

Requiring patients to get blood work and other tests before undergoing cataract surgery hasn’t been recommended for more than a dozen years. There’s good reason for that: The eye surgery generally takes less time than watching a rerun of “Marcus Welby, MD” — just 18 minutes, on average. It’s also incredibly safe, with a less than 1 percent risk of major cardiac problems or death.

cataract surgery 570

Yet more than half of Medicare patients received at least one pre-operative test in the month before undergoing surgery to remove cataracts in 2011, a recent study found.

Some doctors were much more likely than others to order a complete blood count, urinalysis, cardiac stress test and the like. Thirty-six percent of ophthalmologists ordered pre-operative tests for more than 75 percent of their patients, according to the study, which was published last month in the New England Journal of Medicine.

“Their patients were no sicker or older,” says Catherine Chen, an anesthesiologist at the University of California, San Francisco, and the lead author of the study. “It suggests that it’s habit or practice patterns.”

The study compared the prevalence and cost of pre-operative testing in the month before 440,857 Medicare beneficiaries had cataract surgery. Testing expenditures for Medicare patients during the 30 days prior to cataract surgery were 42 percent higher than the average monthly Medicare spending for testing on those patients during the previous 11 months, a difference of $4.8 million.

Cataract surgery used to take a few hours and require general anesthesia. In those days, preoperative testing made more sense, says Chen. Now people often receive only a topical anesthetic eye drop to numb the eye or sometimes a local anesthetic that may include a sedative for relaxation.

But research shows that today, pre-operative testing for cataract surgery doesn’t result in fewer adverse events or better surgical outcomes, regardless of a patient’s health, says Chen.

“It’s so low risk it’s almost like saying you’re going to get your nails done,” she says. “There’s always a chance you’ll get hit by a car or have a heart attack on the way,” but it’s unlikely to happen at the nail salon.

Kaiser Health News (KHN) is a nonprofit national health policy news service.

Indications for Rituximab

  • Non-Hodgkin’s Lymphoma (NHL): alone or with other chemotherapy medicines
  • Chronic Lymphocytic Leukemia (CLL): with the chemotherapy medicines fludarabine and cyclophosphamide
  • Rheumatoid Arthritis (RA): with another prescription medicine called methotrexate, to reduce the signs and symptoms of moderate to severe active RA in adults, after treatment with at least one other medicine called a Tumor Necrosis Factor (TNF) antagonist has been used and did not work well enough
  • Granulomatosis with Polyangiitis (GPA) (Wegener’s Granulomatosis) and Microscopic Polyangiitis (MPA): with glucocorticoids, to treat GPA and MPA

AIDS Related Lymphomas

  • Since the implementation of HAART therapy, a cancer diagonsis is made in over 40% of HIV infected patients during the course of the HIV infection
  • Over 28% of HIV related deaths are attributable to malignancy
  • Three AIDS defining malignancies
    • Kaposi’s sarcoma
    • High grade non-Hodgkin lymphoma
    • Invasive cervical carcinoma
  • AIDS related NHL can be subdivided into systemic NHL, primary CNS lymphoma, and primary effusion lymphoma
  • Lymphoma in HIV positive patient is characterized by B symptoms, extranodal disease, involvement of unusual locations (body cavity, rectum, soft tissue) and advanced disease
  • Most common NHL subtypes seen in HIV patients: DLBCL, Burkitt lymphoma, plasmablastic lymphoma
  • EBV positivity is seen in Burkitt lymphoma, primary effusion lymphoma, plasmablastic lymphoma, primary CNS lymphoma
  • HHV positivity seen in primary effusion lymphoma, multicentric Castleman’s disease, Kaposi’s Sarcoma