Pulmonary/Critical Care

Mystery Quiz

September 19, 2008
Mystery Quiz

Posted by Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is a 76 year old man with history of moderate-to-severe COPD who presented with three days of fever, breathlessness, and productive cough. Past surgical history is significant for vagotomy and partial gastrectomy 16 years earlier and a cholecystectomy 10 months prior to admission. On exam, the patient appeared acutely ill with a blood pressure of 75/45 mmHg, tachycardia, marked hypoxemia and course breath sounds throughout all lung fields. Labs revealed …

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Grand Rounds: “Acute Respiratory Distress Syndrome and Acute Lung Injury”

September 17, 2008
Grand Rounds: “Acute Respiratory Distress Syndrome and Acute Lung Injury”

Commentary by Matthias Kugler MD, PGY-3

Please also see the Grand Rounds Clinical Vignette

Leonhard D Hudson, M.D., Professor of Medicine, Pulmonary and Critical Division, University of Washington, Seattle, spoke at Medical Grand Rounds about the Acute Respiratory Distress Syndrome (ARDS) and Acute Lung Injury (ALI). He started his lecture with a history of the disease, starting with the first published description of ARDS in The Lancet 1967, where it was defined by the presence of diffuse alveolar damage, increasing pulmonary capillary leak, non-cardiogenic pulmonary …

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Meeting Perspectives: 2008 American Thoracic Society Meeting

June 18, 2008
Meeting Perspectives: 2008 American Thoracic Society Meeting

Commentary by Laura Evans MD, NYU Division of Pulmonary and Critical Care Medicine 

The 2008 American Thoracic Society (ATS) meeting took place from May 16-21 in Toronto, Ontario.  Over 16,000 physicians, nurses and respiratory therapists attended the meeting.  There were more than 400 sessions, 800 speakers and 5,500 original research abstracts focusing on pulmonary, critical care and sleep medicine. 

The NYU Division of Pulmonary and Critical Care medicine was well represented.  The division presented more than 20 original research abstracts and symposia in areas such …

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Its okay to smoke…we’ll screen you

May 9, 2008
Its okay to smoke…we’ll screen you

Commentary by Shrujal Baxi MD, NYU Chief Resident

One of the first things you learn about critically analyzing a medical journal piece is to go to the end and see who sponsored the study. Corporate financing is known to have subtle effects on research which can lead to an unconscious bias. Disclosure of funding is paramount for a researcher in order to remain above reproach.

In a recent New York Times article, the impact of such relationships is investigated. In 2006, Dr. Claudia Hensheke, a …

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Corticosteroids in Sepsis Now Less Stimulating

April 30, 2008
Corticosteroids in Sepsis Now Less Stimulating

Commentary by Joe Philip MD, PGY-2

CORTICUS was the long-awaited trial addressing the use of corticosteroids in sepsis that was published in the NEJM this past January. Months prior to the leading auther Charles Sprung publishing it, the Tisch and Bellevue intensive care units halted corticotropin stimulation testing. Corticosteroids have warranted much publicity since CORTICUS came out—and rightly so as practice across the country has changed because of it. The Survinig Sepsis Campaign has now downgraded the recommendation on the use of corticosteroids in sepsis …

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Class Act: Are beta-blockers really contraindicated for patients with a diagnosis of reactive airway disease?

March 21, 2008
Class Act: Are beta-blockers really contraindicated for patients with a diagnosis of reactive airway disease?

Commentary by Katherine Khvilivitzky, NYU Medical Student

Class act is a feature of Clinical Correlations written by NYU 3rd and 4th year medical students. These posts focus on evidenced based answers to clinical questions related to patients seen by our students in the clinics or on the wards. Prior to publication, each commentary is thoroughly reviewed for content by a faculty member.

In the past, reactive airway disease was considered to be a contraindication to administration of all beta-blockers including ophthalmic preparations. Concern had been …

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Mystery Quiz- The Answer

February 6, 2008
Mystery Quiz- The Answer

Posted By: Vivian Hayashi, MD, Instructor of Clinical Medicine, Division of General Internal Medicine and Robert Smith, MD Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine

The answer to the mystery quiz is lung cancer, in particular, adenocarcinoma with a predominantly bronchoalveolar cell pattern (BAC).  The clue to the mystery was the “cough productive of voluminous frothy, watery sputum,” bronchorrhea, which is often the presenting complaint of patients with BAC. Other entries in the differential diagnosis are characterized by cough that is …

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Mystery Quiz

January 29, 2008
Mystery Quiz

Posted By: Vivian Hayashi, MD, Instructor of Clinical Medicine, Division of General Internal Medicine and Robert Smith, MD Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine

A 78 year old man with a history of ankylosing spondylitis and known cardiac disease associated with congestive heart failure, presented with breathlessness one year prior to admission.  Over the most recent months, the patient complained of cough productive of voluminous frothy, watery sputum.  Medications included digoxin, furosemide, irbesartan, isosorbide, metoprolol, spirinolactone, simvastatin, and warfarin.  The …

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