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Objective: 1) Evaluate the accuracy of financial disclosures reporting by research presenters and moderators at the American Neurotology Society Spring meetings between 2014 and 2016. 2) Tabulate the reported monetary value of undisclosed financial relationships. 3) Determine the degree of compliance to the standards put forth by the Accreditation Council for Continuing Medical Education. Study Design: Cross-sectional analysis. Setting: N/A. Patients: N/A. Interventions: N/A. Main Outcome Measures: The number of undisclosed payments, the accuracy of reporting, and the value of undisclosed payments were measured to test the hypothesis. Results: At the 2014 American Neurotology Society Spring Meeting, the organizers maintained a median amount of $950 and $6,525.89 for the presenters. 2015 showed a median amount of undisclosed payment of $7,134.74 for organizers and $12,256.46 for presenters. Likewise, 2016 showed a median of $4,165.14 in undisclosed payment for the organizers and $12,031.70 for the presenters. Conclusions: It is promising to see improvement in disclosure rates as organizers and presenters are effectively complying with the requirements set by Accreditation Council for Continuing Medical Education. However, there is a substantial difference in disclosures by the presenters group compared with the organizers. The presenters had more undisclosed financial relationships than the organizers and although, not all undisclosed financial relationships are actual conflict of interest, it is safer and better practice to avoid the potential for undisclosed conflict of interest altogether. Presenters should be encouraged to fully disclose all relationships in the manner that organizers are required to do so.

Tumor lysis syndrome (TLS) is the phenomenon of metabolic derangements that typically follows the initiation of cytotoxic chemotherapy. Metabolic disturbances include hyperphosphatemia, hyperkalemia, hyperuricemia and hypocalcemia. Hematological malignancies are associated with spontaneous TLS (STLS), which is cell lysis in the absence of chemotherapy. STLS is extremely rare in chronic lymphocytic leukemia (CLL). This has been documented only once in the medical literature, making this an extraordinarily uncommon case. We present here a 68-year-old male with a history of benign prostatic hyperplasia (BPH) who is admitted for a two-week history of abdominal pain and three days of anuria, despite adequate fluid intake. Laboratory values yielded a greatly elevated leukocyte count with a lymphocytic predominance and smudge cells. Potassium, phosphorus, and uric acid were also significantly increased. EKG revealed peaked T-waves. Flow cytometry confirmed the presence of an abnormal B-cell population consistent with B-cell chronic lymphocytic leukemia, with the following markers: CD19+, CD20+, CD23+, CD5+, CD10-. He was diagnosed with CLL and treated with aggressive fluid resuscitation, allopurinol and rasburicase. The patient had another similar episode within one month. His CLL fluorescence in-situ hybridization (FISH) showed complex cytogenetics with unmutated IgVH and he was subsequently started on ibrutinib.