Interdepartmental Consultation Research Articles

Evolution of interconsultal activity to endocrinology and nutrition in hospitalization floor in a third level hospital

IntroductionEndocrinology and Nutrition (EyN) is an outpatient and hospital medical specialty. This study aims to understand the evolution of the activity of interdepartmental consultation (IC) carried out by EyN in hospitalization floor of a third level hospital, comparing its evolution with other medical specialties, and comparing endocrine IC with nutritional IC. Material and methodsLongitudinal and retrospective study which analyzes IC notes of EyN and other medical specialties between 01-01-2013 and 31-12-2022. ResultsA total of 76093 IC notes (12623 patients) were performed by the EyN service (average age 65.4 years; 59% male) with an average of 4.8 notes per patient. Average annual growth was 7% in notes and 4% in patients (versus 6% and 3% of all other medical services, differences statistically significant). Of all patients hospitalized for 4 or more days, EyN went from attending 7.9% (2013) to 12.3% (2022). 66% of the IC performed by EyN was for nutritional cause and 34% for other pathologies. ConclusionsThe EyN service is the one that most patients attend in hospital IC activity, with growth over the last few years greater than other medical specialties. Nutritional pathology is the main reason for IC

Evolución de la actividad de interconsultas a Endocrinología y Nutrición en planta de hospitalización en un hospital de tercer nivel

IntroductionEndocrinology and Nutrition (EyN) is an outpatient and inpatient medical specialty. This study aims to understand the evolution of the activity of interdepartmental consultation (IC) carried out by EyN in hospitalization floor of a third-level hospital, comparing its evolution with other medical specialties, and comparing endocrine IC with nutritional IC. Material and methodsLongitudinal and retrospective study which analyzes IC notes of EyN and other medical specialties between 01-01-2013 and 31-12-2022. ResultsA total of 76,093 IC notes (12,623 patients) were performed by the EyN service (average age 65.4 years; 59% male) with an average of 4.8 notes per patient. Average annual growth was 7% in notes and 4% in patients (versus 6% and 3% of all other medical services, differences statistically significant). Of all patients hospitalized for 4 or more days, EyN went from attending 7.9% (2013) to 12.3% (2022). 66% of the IC performed by EyN was for nutritional cause and 34% for other pathologies. ConclusionsThe EyN service is the one that most patients attend in hospital IC activity, with growth over the last few years greater than other medical specialties. Nutritional pathology is the main reason for IC.

Myelomatous Ascitis, a Rare Presenting Symptom of Multiple Myeloma

Abstract Introduction/Objective In 2022, plasma cell neoplasms accounted for approximately 1.8% of all new cancers in the United States with an estimated 34,470 new cases of multiple myeloma. Diagnosis is often straight forward in ~80% of cases by performing serum protein electrophoresis (SPEP), serum immunofixation (SIFE), and/or urine immunofixation (UIFE) with M-spike quantification. The diagnostic challange is in the remainder of asymptomatic myeloma cases (~20%) which are found incidentally. Specialized laboratory technicians are often the first step in identifying plasma cells in body fluids and/or peripheral blood smears. These incidental findings on routine labs, paired with the keen eye of a specialist, are one of the first steps in early detection of multiple myeloma. Methods/Case Report A 62 year-old male, originally from Cambodia, presented to an outside hospital emergency department with abdominal distention and pain. His past medical history was significant for dialysis-dependent end- stage renal disease and insulin-dependent diabetes mellitus type 2. Abdominal CT showed ascites with no other diagnostic findings. Cardiac, renal and hepatic etiologies of ascites were ruled out. Body fluid analysis of the ascites in the Clinical Pathology laboratory revealed numerous plasma cells. Cytologic examination, after consultation with Clinical Pathology, also revealed numerous plasma cells. Subsequent SPEP and SIFE disclosed an IgA lambda monoclonal protein. A diagnosis of multiple myeloma was confirmed by bone marrow biopsy with FISH studies. Results showed several high-risk abnormalities including translocations of 4::14, 14::16, and 14::20, denoting a “triple hit” multiple myeloma. Results (if a Case Study enter NA) NA Conclusion Plasmacytosis in ascites is an extremely rare initial presentation for multiple myeloma. With only a few cases reported in the literature, many technicians and pathologists might easily overlook plasma cells on routine cytology, especially with normal imaging and no previous diagnosis of myeloma. In this case, flagged peritoneal fluid by a skilled medical laboratory technician was key to making a diagnosis. Without any signs of a plasmacytoma or lytic bone lesions on imaging, a normal CBC with non-specific labs, and an unsuspecting surgical pathology report, multiple myeloma was not on the differential. Fast interdepartmental consultation, communication, and teamwork between surgical pathology and clinical pathology, lead to a rapid diagnosis and prompt treatment of this patient.

Clinical Features and Risk Factors for Complications of Facial Herpes Zoster in Inpatients

Background: Few studies have been reported on facial herpes zoster and the risk factors for its complications. Objective: This study aimed to investigate the clinical features and risk factors with facial herpes zoster. Methods: We examined the medical records of 676 patients with facial herpes zoster during a 10-year-period from 2011 to 2020. We assessed the proportion of ocular complications, Ramsay-Hunt syndrome, and postherpetic neuralgia in patients with facial herpes zoster according to several clinical factors including age, sex, dermatomes, underlying disease, and time to initiate antiviral treatment. Results: The incidence of ocular complications was significantly higher in males (Odds ratia [OR], 2.59; 95% CI, 1.26~5.32), and with involvement of ophthalmic branches of the trigeminal nerve (V1: OR, 14.28; 95% CI, 3.62~56.29; V1 inclusion: OR, 20.68; 95% CI, 7.99~53.55), underlying diseases (OR, 1.70; 95% CI, 1.08~2.68) and positive Hutchinson's sign (OR, 3.59; 95% CI, 1.72~7.49). Ramsay-Hunt syndrome was significantly correlated with involvement of VII dermatome (OR, 24.68; 95% CI, 2.97~204.75), and showed considerable significant with otalgia (OR, 3.31; 95% CI 0.98~11.22). Postherpetic neuralgia was significantly higher in those over 60 years of age (OR, 2.03; 95% CI, 1.48~2.78), ocular complications (OR, 2.28; 95% CI, 1.57~3.30), and ear involvement (OR 1.94; 95% CI 1.17~3.20). Conclusion: These results demonstrated that facial herpes zoster was associated with ocular complications, Ramsay-Hunt syndrome, and postherpetic neuralgia. The incidence of these complications was related to risk factors such as sex, age, dermatome, underlying disease, Hutchinson's sign and otalgia. To decrease the risk of complications associated with facial herpes zoster, patients should receive appropriate antiviral therapy and interdepartmental consultations immediately.

The Provisional Government and “Chinese Question” in Russia in 1917

The article analyzes the changes that took place during the solution of the so-called Chinese question on the basis of the journals of the Interdepartmental Consultation under the board of the Chinese Eastern Railway, which have been preserved in the Russian State Historical Archive. The peak of activity in this direction first of the tsarist government, and then of the Provisional government was from the second half of 1916 to the autumn of 1917. Documents show that the labor of recruited Chinese workers was used in many sectors of the economy. But the most important it received in the railway construction. Russia's military operations had slowed down the colonization of the Far East. Under these conditions, the arrival of tens of thousands of Chinese workers in the European part of the country became a peculiar reflection of the eastern direction of Russia's domestic and foreign policy. The attitude toward this phenomenon in social and political circles has changed since the formation of the Provisional Government. While pursuing the course of tsarism in solving the problem of the crisis of workers' hands, the Provisional Government simultaneously made a number of concessions to the Chinese mission in Petrograd. In particular, its representatives were given the opportunity to become acquainted with the working and living conditions of the Chinese workers. Rising unemployment and protest moods in Russian society eventually forced the Provisional Government, shortly before its fall, to abandon the transportation of foreign laborers to Russia.

Patient load and spectrum of dental problems amongst the population attending outpatient services of a tertiary care medical college hospital, Arunachal Pradesh

Background: Evidences suggest relationship between periodontitis and systemic diseases such as cardiovascular diseases, diabetes mellitus, adverse pregnancy outcome, osteoporosis and chronic kidney diseases. Except for acute toothache and complicated local infection, other dental problems are often considered trivial, hence dental health is often neglected or omitted in health related discourses. Aims and Objectives: (1) To assess the patient load in dental OPD compared to other outpatient departments and (2) examine the distribution of dental diseases among different age, gender and caste of dental patients in a tertiary care hospital over a 5 year period. Materials and Methods: A hospital based retrospective study was conducted using data from Medical Record department of all OPD attendees (1,174,605) during the period from January 2016 to December 2020 in the tertiary care hospital of Arunachal Pradesh. The total number of dental OPD patients (57,198) was compared with the total and department wise OPD attendees during the same period. Out of all Dental patients , data of 11,225 were found to be complet ( cross checked MRD record with OPD register) hence analysed for distribution of disease as per age/ sex/ ethnicity. Results: Emergency and Casualty department reported highest patient load, lowest in cardiology. Overall dental patient OPD load was highest in 2019 and lowest in 2020. Common dental problems were caries and its complications, root stamp/retained tooth, dental calculus, stain, and trauma related dental problems. Most of the trauma related cases were males, whereas other conditions like dental caries, root stamp, complication of caries, and dental calculus/stain were more common in females. Conclusion: Data shows that the number of dental patients among all OPD attendees is high and the dental problems they present with are diverse in nature. The treatment provisions available in most health care centres are largely inadequate. Inclusion of Oral and Dental health in Planning of community health programs, sensitisation of all health care providers the importance of interdepartmental consultation with dental department and education of the masses in oral and dental care/hygiene are of paramount importance.

Prevalence of incivility between ophthalmology and emergency medicine residents during interdepartmental consultations.

ObjectivesSince incivility is linked to adverse effects in patient care and health care worker well‐being, evaluation of the prevalence of incivility during the formative years of residency training is warranted. The aim of this study was to determine the perceived presence and degree of incivility between emergency medicine (EM) and ophthalmology residents during emergency department (ED) consultations.MethodsWe conducted a single‐site, survey‐based study, targeted to ophthalmology and EM residents. The survey we distributed included questions adapted from validated and widely used surveys measuring incivility in the workplace (Workplace Incivility Scale) and incivility within the ED.ResultsOphthalmology (13/15, 86.7%) and EM (42/48, 87.5%) residents participated, with an overall response rate of 55 of 63 (87.3%). Most residents (47/55, 85.5%) reported some degree of incivility during consultations, with a greater proportion of females reporting incivility (100%) than males (77.4%, p = 0.033). A total of 52.7% of respondents reported occurrence of incivility on a quarterly basis; 21.8% reported monthly, 10.9% weekly, and none daily. Incivilities were reported most commonly during nonurgent consults (85.5%). The two most common incivilities reported by trainees were when the other party paid little attention to their statements or opinions (80% of residents) or doubted their professional judgment (74.5% of residents). More female trainees reported jokes being told at their expense compared to males (15.8% vs. 0%, p = 0.049). Residents most often attributed incivility to stress (78.2%), loss of empathy/burnout (63.6%), or attempts to shift responsibility to another party (60.0%). Among EM residents surveyed, incivility was identified as occurring most often during consultations with surgical specialties.ConclusionsIncivility during interdepartmental consultations between EM and ophthalmology is commonly reported by physicians‐in‐training. It occurs more often during consultations deemed as nonurgent and is more commonly reported by females. Given its associations with adverse outcomes, interventions to decrease incivility early in training may be warranted.

Availability, timeliness, documentation and quality of consultations among hospital departments: a prospective, comparative study

BackgroundMany in-patients require care from practitioners in various disciplines. Consultations most probably have significant implications for hospitalization outcomes.PurposeTo determine key aspects of consultations provided by various departments to formulate an optimal policy.MethodsThis study comprised two methods: first, a questionnaire was completed in 2019 by 127 physicians interns, residents and senior doctors) from the medical and surgical departments (64 from the surgical wards, 43 from the medical wards and 22 from the emergency room and General ICU) regarding the availability, timeliness and documentation rate of the consultations they received from different disciplines. The investigators rounded through the various departments that were included in the study and they accosted a sample of interns, residents and attending physicians, who were then asked to fill the questionnaire. Overall compliance of filling the questionnaire was 95%. Residents accounted for 72% of the filled questionnaires, seniors and interns accounted for 15 and 13% respectively. Second, a convenience sample of 300 electronic records of hospitalized patients (135 from the surgical wards, 129 from the Medical wards and 36 from the emergency room and General ICU) of actually carried out consultations was reviewed for validated indicators of quality for both the consultation request and response. We used a 5-point Likert scale, ranging from poor (1) to superb (5), to grade the measured parameters.ResultsThe availability, timeliness and documentation rate for medical consultations were 4 ± 0.9, 4.1 ± 0.9 and 4.3 ± 0.9 respectively, as compared with surgical consultations 3.2 ± 1.1, 3.4 ± 1.2 and 3.6 ± 1.2 respectively (P < 0.001). The mean time (in hours) from the consultation request till documentation (of the requested consultation) by consultants in the medical and surgical departments was 3.9 ± 5.9 and 10.0 ± 15.6, respectively (P < 0.001). The quality of requests of consultations from the medical and surgical departments was 3.4 ± 1.1 and 2.8 ± 1.2, respectively (P < 0.001). Two different models of consultations are employed: while each medical department adopts several departments for medical consultations, each day’s on-call surgeon provides all the hospital’s surgical consultations.ConclusionWe detected significant differences in key aspects of consultations provided by the departments. The medical model of consultations, in which each medical department adopts several other wards to which it provides consulting services upon request, should probably be adopted as a major policy decision by hospitals directors to enhance inter-departmental consultations.

Evaluation of Multidisciplinary Treatment Relationship between Orthodontics and Periodontology Departments by Examining Inter-Departmental Consultation Notes.

The aim of this study is to evaluate the multidisciplinary treatment relationship between the two specialties of Dentistry, Departments of Periodontology and Orthodontics, by examining consultation request notes between the two departments. The consultation request notes of 1685 patients who were treated at Erciyes University Faculty of Dentistry were included in the study. All notes were analyzed retrospectively and divided into categories. While the consultation request notes of 446 patients from the Department of Periodontology (DP) to the Department of Orthodontics (DO) were evaluated, the consultation request notes of 1239 patients from DO to DP were evaluated. Pearson's Chi-Squared test was used in the cloud-based TURCOSA statistical software for the statistical analysis of the obtained data. The highest number of requests for consultation from DP to DO was due to "Evaluation of the patient for orthodontic treatment (n = 203; 45.5%)," and the highest number of requests from DO to DP was "Gingival/Periodontal Treatment and Providing Motivation of Oral Hygiene (n = 558; 45.0%)". It was observed that most patients for whom consultation was requested were women (P < 0.05). This study determined the most common reasons for consultation requests between DP and DO and the sex which was the most prevalent. It was concluded that requests were made for the expertise of the other department for problems that could not be solved by the first department.

Factors Affecting Length of Stay in the Emergency Department in Patients Who Presented with Abdominal Pain.

Objective We aimed to identify factors affecting length of stay in the emergency department in patients who presented with abdominal pain. Methods A retrospective cohort study was conducted from 1 January 2017 to 31 December 2017. The medical records were reviewed from 217 patients older than 15 years with the chief complaint of abdominal pain. The patients were divided into emergency department length of stay (EDLOS) < 4 hours and ≥4 hours. The two groups were compared in terms of baseline characteristics, physical examination, time of presenting, attending physicians, interdepartmental consultations, investigations, ED disposition, final diagnosis, and mortality. The significant factors affecting longer EDLOS were examined using univariate and multivariate analyses by logistic regression. Results Factors affecting longer EDLOS were age ≥50 (odds ratio (OR) 3.17, 95% confidence interval (CI) 1.36–7.42), interdepartmental consultation ≥2 specialists (OR 71.82, 95% CI 5.67–909.51), blood testing ≥2 rounds (OR 85.6, 95% CI 4.22–1734.6), and ultrasonography (OR 8.28, 95% CI 1.84–37.26). Conclusion The study found that the statistically significant factors that prolonged EDLOS in patients with the chief complaint of abdominal pain were age, rounds of blood test, interdepartmental consultation, and the need for ultrasonography.

Diagnosis and treatment considerations of atypical oral pain in tuberous sclerosis

Diagnosis and management of non-specific, atypical, and non-dental pain are challenging. We hereby report a case of a 23-year-old female who presented with a complaint of intermittent dull ache over her lower front anterior teeth with no radiographic findings. She was diagnosed after history, imaging, and neurology consultation and treated conservatively with complete remission of symptoms. Proper history and counseling are mandatory for all patients. It is important to recognize patients with underlying neurological conditions and take adequate interdepartmental consultation before labeling complaints psychogenic or carrying out unwarranted dental treatment.

Consultation liaison psychiatry in Talavera's hospital during the year 2014

IntroductionAnalyze the number of interdepartmental consultations carried out at Department of Psychiatry, Hospital Nuestra Señora del Prado from other areas of hospitalization during 2014.ObjectivesThe goal is to evaluate the prevalence of psychiatric disorders in patients who are hospitalized for other reasons, and which services are needed the most.MethodsRetrospective cross-sectional descriptive study. A record of consultations carried out by the psychiatry service in 2014 was collected. The data were analyzed according to the origin of the consultation service, the month when it was performed and the sex of the patient. The monthly percentage of interconsultations and the percentage represented by each interconsultation service were calculated. They classified according to sex.ResultsIn 2014, 211 interconsultations were carried out, 104 men and 86 women. Surgery 16, 11%, pneumology 13, 74%, internal medicine 12, 32%, traumatology 8, 06%, digestive 7, 11%), I.C.U. 6, 64%, cardiology 6, 16%, hematology 5, 69%, oncology 5, 21%, pediatrics 4, 27%, gynecology 2, 84%, emergency 1, 90%, palliative1, 90%, endocrinology 1, 42%, urology 1, 42, nephrology 0, 95%, E.N.T. 0, 95%, obstetrics 0, 47%, dermatology 0%, ophthalmology 0%, rheumatology 0%. January 12, 8%, February 13%, March 9, 5%, April 6, 2%, May 5, 7%, June 8, 1%, July 6, 2%, August 4, 3%, September 8, 1%, October 12%, November 7, 6%, December 6, 2%.ConclusionsMost of the interconsultations were carried out in January, February and October. However, August was the least busy month. The busiest service was the Surgery service, followed by the Pneumology and Internal Medicine one. There were no interconsultations of the Ophthalmology, Rheumatology and Dermatology services. The consults were in demand mainly by men rather than women.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pattern of physician consultations from different departments of smhs and associated hospitals for the months of November 2011 and December 2011- medical council of India (mci) dercognition is not too far

The study was conducted to assess the pattern of inter hospital and inter-departmental consultations for in-patients and to ascertain whether the consultations made were desirable as per our setup in various hospitals of GMC Srinagar and avoid medico legal pitfalls and to conserve resources. All the consultations made from 10.0 am to 4.0 pm from various departments and associated hospitals of GMC Srin agar were recorded and analyzed . The consultations were attended by the consultant in -charge medical casualty. The consultations made from Nov 2, 2011 to Dec 31, 2011 were included in the study. After the first month restraint was shown by a circular from the head of the department of medicine to various departments and hospitals to ensure involvement of senior staff whether a second opinion is desirable and avoid involvement of patient care-givers i.e., attendants in the consultation procedure. Obstetrics and gynecology department had 82% consultations of undesirable nature and less than 10% where those with consultant involvement.

Perception and knowledge of dental interns toward interdepartmental coordination for successful prosthodontic treatment: A pilot study.

Background:The graduating dentist should be trained in providing treatment utilizing the interdisciplinary approach because of the rapid advancements and increase in patient expectations, which demands for collaboration between the different specialists.Purpose:A pilot study was undertaken with an aim to assess the perception and knowledge of dental interns toward interdepartmental coordination for successful prosthodontic treatment.Subjects and Methods:Dental interns from two dental colleges in Sangli (India) participated in the study. A 24-item self-administered, structured closed-ended questionnaire was used to collect the data. Four questions assessed the perception and 20 questions assessed the knowledge, which were based on the four domains viz.: General, Endodontics, Orthodontics, and Prosthodontics. They were framed from case scenarios reporting to the Department of Prosthodontics, which required interdepartmental consultation. The questionnaire was validated before its application and reliability were also assessed. The final score for each question was calculated based on the correct responses. Descriptive analysis was calculated using the frequencies, percentages, and mean values by using SPSS 16 software.Results:Among 117 interns who participated in the study, 79.5% reported that they lacked training in an interdisciplinary approach. Approximately, 96% reported that the curriculum should be designed to include interdisciplinary training. Nearly, 88% reported that specialist from different specialty should be posted in one interdisciplinary department. Around 60% reported that they did not have the confidence of treating the patient as a whole. When the overall mean scores were considered, the highest scores were obtained for the general domain (95.3) and the lowest for the prosthodontic domain (83.6).Conclusion:The dental interns perceived that they lacked training in interdisciplinary approach, and the curriculum should include interdisciplinary training.

Análisis costo-efectividad de retornar a diálisis peritoneal los pacientes con hemodiálisis previa

IntroductionDialysis presents a financial challenge for health institutions. The overall objective of this study was to identify the cost of investment in re-admissions to peritoneal dialysis (PD) after prior hemodialysis (HD). Material and methodsCross-sectional, open study conducted from January to October 2013. Demographic variables included: initial and subsequent dialysis, cause of admission to HD, time on HD, cost of the return to PD process (lab tests, meetings, inter-departmental consultations, surgical time, intermittent PD, bed days, and total cost); substitution and internal HD sessions that could be added to the estimated economic investment. ResultsA total of 10 patients, 6 male and 4 female, mean age 49.4 years (range: 26-75), all with type 2 diabetes mellitus, were included. The tests performed included; 6 abdominal ultrasounds, 11 X-rays (mean: 1.1; range: 0-2), 11 electrocardiograms (mean: 1.1; range: 0-2), and 135 laboratory tests, with a mean of 13.5 per patient (range: 7-26). One abdominal CT scan was performed. Peritoneal catheters were inserted surgically. There were 89 sessions of Intermittent peritoneal dialysis (mean: 8.9; range: 0-14) using 210 bed days (mean: 21; range: 13-27). The resolution of the cases was one entry to substitution HD program, 1 death, 1 dropout, 2 continuous ambulatory, 4 automated, and 1 intermittent peritoneal dialysis. The total cost of comprehensive care was 1,381,810.79 Mexican pesos, average per patient of 138,181.07 (range: 101,094.38 to 197,710.38). ConclusionsThe return of hemodialysis substitution patients to peritoneal dialysis did not prove to be cost effective for the hospital.

Inpatient Dermatology Consultation in a Spanish Tertiary Care Hospital: A Prospective Cohort Study

Background and objectiveAlthough dermatology has traditionally been practiced through outpatient consultation, hospitalized patients often have dermatologic problems. The aim of this study was to describe and quantify the volume of interdepartmental consultation of the dermatology department of Hospital Universitario Virgen del Rocío. Material and methodsIn this year-long prospective observational cohort study of 429 patients we used a specific data collection form to record information on consultations for patients admitted between July 2010 and June 2011. ResultsThe 429 consultations over the 12 months of study accounted for 1.56% of all first consultations with a dermatologist during the period. A mean of 1.75 new patients were attended each day. The mean (SD) age of the patients was 52.63 (19) years, and the ratio of men to women was 1.21. Immunocompromised patients accounted for more than a third of the cohort. The medical specialties consulting most often were internal medicine (n=115) and hematology (n=66). The most frequent diagnoses were inflammatory skin conditions (36.2%) and infectious skin diseases (26.5%). Discussion and conclusionsTo date, the role of interdepartmental consultation in dermatology has been little studied. Our results suggest that dermatology plays a fundamental role within the hospital. We have identified the most common skin problems in hospitalized patients and their clinical course.

Interconsulta hospitalaria en Dermatología sobre una cohorte prospectiva en un hospital español de tercer nivel

Background and objectiveAlthough dermatology has traditionally been practiced through outpatient consultation, hospitalized patients often have dermatologic problems. The aim of this study was to describe and quantify the volume of interdepartmental consultation of the dermatology department of Hospital Universitario Virgen del Rocío. Material and methodsIn this year-long prospective observational cohort study of 429 patients we used a specific data collection form to record information on consultations for patients admitted between July 2010 and June 2011. ResultsThe 429 consultations over the 12 months of study accounted for 1.56% of all first consultations with a dermatologist during the period. A mean of 1.75 new patients were attended each day. The mean (SD) age of the patients was 52.63 (19) years, and the ratio of men to women was 1.21. Immunocompromised patients accounted for more than a third of the cohort. The medical specialties consulting most often were internal medicine (n=115) and hematology (n=66). The most frequent diagnoses were inflammatory skin conditions (36.2%) and infectious skin diseases (26.5%). Discussion and conclusionsTo date, the role of interdepartmental consultation in dermatology has been little studied. Our results suggest that dermatology plays a fundamental role within the hospital. We have identified the most common skin problems in hospitalized patients and their clinical course.

Giant cell tumor of the anterior rib masquerading as a breast mass: a case report and review of current literature

IntroductionGiant cell tumor (GCT) is an aggressive, but usually benign bone neoplasm most commonly arising in the metaphysis/epiphyses of long bones. While they are categorized as benign tumors, they can be locally aggressive and clinically have metastatic potential. The most common locations of this tumor include the distal femur, proximal tibia, and distal radius. We report a GCT arising in an atypical location and mimicking a breast mass.Case PresentationThis case was diagnosed at a large cancer center in Florida. Pertinent clinical findings were obtained from chart review and inter-departmental consultation. Radiologically, the initial impression included a deep-seated breast cancer with local chest wall invasion. Further evaluation revealed the mass to be an expansile rib lesion with extraosseous soft tissue invasion. Histological examination of the biopsy specimen showed bland multi-nucleated giant cells and mononuclear cells whose nuclei were morphologically similar. No necrosis, pleomorphism or mitotic activity was identified. No chondroid or osseous elements were present.ConclusionThe histological features of bland mononuclear and multinucleated giant cells along with the lack of any additional mesenchymal elements led to the diagnosis of giant cell tumor. Resection of tumor was performed. The patient is disease free as of the last follow-up visit. This case is important as it shows where the physician must keep this diagnosis in mind whenever a deeply located breast mast is present.

Iliopsoas Bursitis following Total Hip Replacement Arthroplasty - A Case Report -

Purpose : To report the clinical, radiological and surgical findings of iliopsoas bursitis, and to suggest an indication for diagnosis and treatment. Materials and Methods : We report two patients with iliopsoas bursitis who underwent THA in between June 1998 to June 2003. All presented with late onset hip joint discomfort, and their diagnosis were confirmed after interdepartmental consultations and with the help of investigations such as interventional angiography and MRI. Their signs, symptoms, investigations and surgical findings were reviewed retrospectively. Results : Iliopsoas bursitis presented with hip pain, leg edema, palpable inguinal mass and ecchymosis, femoral nerve irritation and flexion contracture of hip. The radiographs provided no diagnostic clues but the MRI revealed a well marginated cystic lesion filled with fluid signals. Ultrasonography revealed the anatomic location that enabled guided aspiration and even ruled out vascular compromise. Two patients were treated with USG guided aspiration. One aspirate was serosanguinous and the other was old blood tinged fluid. One patient underwent surgical debridement of the cyst. Surgery revealed an intrapelvic hemorrhagic bursa with an ill-defined cystic wall and intramuscular extension into the iliacus. Conclusion : It is important for surgeons to rule out iliopsoas bursitis when a patient presents with vague hip pain after total hip arthroplasty without any evidence of infection or loosening. A diagnosis of iliopsoas bursitis can be made from the clinical features and ultrasonography.

Comparison of Disagreement and Error Rates for Three Types of Interdepartmental Consultations

Comparison of Disagreement and Error Rates for Three Types of Interdepartmental Consultations