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We provided a detailed description of our TLBC technique and highlighted areas of similarity and differences among comparative studies and attest that TBLC is a safe alternative to SLB in the diagnosis of ILD. Our data also indicated the tendency for moderate-to-severe bleeding occurred more in the endoscopy suite.

Background. Prolonged air leak is defined as an ongoing air leak for more than 5 days. Intrabronchial valve (IBV) treatment is approved for the treatment of air leaks. Objective. To analyze our experience with IBV and valuate its cost-effectiveness. Methods. Retrospective analysis of IBV from June 2013 to October 2014. We analyzed direct costs based on hospital and operating room charges. We used average costs in US dollars for the analysis not individual patient data. Results. We treated 13 patients (9 M/4 F), median age of 60 years (38 to 90). Median time from diagnosis to IBV placement was 9.8 days, time from IBV placement to chest tube removal was 3 days, and time from IBV placement to hospital discharge was 4 days. Average room and board costs were $14,605 including all levels of care. IBV cost is $2750 per valve. The average number of valves used was 4. Total cost of procedure, valves, and hospital stay until discharge was $13,900. Conclusion. In our limited experience, the use of IBV to treat prolonged air leaks is safe and appears cost-effective. In pure financial terms, the cost seems justified for any air leak predicted to last greater than 8 days.

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Rheumatoid disease may take many forms, and at times degeneration may be quite out of proportion to the other features. Sometimes a quiet atrophy of bone may lead to "main-en-lorgnette" and at other times tendon atrophy may cause rupture (Kersley 1948, Harris 1951). In a third type degeneration may be associated with proliferation and the formation of multiple nodules which break down and ulcerate. In one such case recently observed, hydrocortisone applied locally on a dressing, with continuation of antibiotics that had previously been in use, caused temporary healing. Three cases have been investigated in which massive cysts filled with pus-like material were found. When first seen, the destruction was such that the differential diagnosis of a tuberculous abscess or a breaking-down sarcoma was suggested. Four examples of necrosis of 238 THE JOURNAL OF BONE AND JOINT SURGERY CASE REPORTS Case 1-A man aged forty-five, whose brother had severe rheumatoid arthritis, developed typical arthritis after a quinsy. Two years later he was treated with gold, which produced a rash. In the next year his left knee first became swollen. When he the usual picture of advanced rheumatoid disease. the American Rheumatism Association.