Heme/Onc

Anal cancer screening – A case for screening anal paps

January 24, 2013
Anal cancer screening – A case for screening anal paps

By Nelson Sanchez, MD

Faculty Peer Reviewed

Case:

A 56 year-old homosexual male presents to your clinic to ask whether or not he should have an anal Pap smear. The patient is HIV positive, has been on HAART for five years, and has no history of opportunistic infections. He denies any anal pain, bleeding or masses.

While efforts to improve knowledge about colorectal cancer in various communities continues to grow, awareness of and misconceptions about anal cancer remain. Over the past couple of years…

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Breaking News: The Downfall of the PSA

May 23, 2012
Breaking News: The Downfall of the PSA

The United States Preventive Services Task Force stands their ground in this week’s Annals of Internal Medicine and recommends against the routine use of the PSA as a screening tool for prostate cancer. This Class D recommendation is grounded in data that suggests a “very small” mortality benefit at the risk of significant over-diagnosis and unnecessary treatment. The PSA should still be used to follow response to treatment in those already diagnosed with prostate cancer. This recommendation has already set off a media frenzy and…

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Should Patients With Nephrotic Syndrome Receive Anticoagulation?

May 9, 2012
Should Patients With Nephrotic Syndrome Receive Anticoagulation?

By Jennifer Mulliken

Faculty Peer Reviewed

Case 1:

A 30-year-old African-American male with a history of bilateral pulmonary emboli presents with a 1-week history of bilateral lower extremity edema. Blood pressure is 138/83, cholesterol 385, LDL 250, albumin 2.9. Urinalysis shows 3+ protein. Twenty-four hour urinary protein is 7.2 grams.

Case 2:

A 47-year-old Hispanic male with a history of mild hypertension and venous insufficiency presents with a 3-month history of bilateral lower extremity edema. BP is 146/95, cholesterol 241, LDL 165, albumin 1.9.…

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What are the Barriers to Using Low Dose CT to Screen for Lung Cancer?

February 23, 2012
What are the Barriers to Using Low Dose CT to Screen for Lung Cancer?

By Benjamin Lok

Faculty Peer Reviewed

Lung cancer is the most common cause of cancer deaths globally and responsible for an estimated 221,120 new cases and 156,940 deaths in 2011 in the United States. Presently, the United States Preventive Services Task Force, the National Cancer Institute (NCI), the American College of Chest Physicians, and most other evidence-based organizations do not recommend screening for lung cancer with chest x-ray or low-dose helical computed tomography (CT) due to inadequate evidence to support mortality reduction. This…

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To Premed or Not to Premed: Are Tylenol and Benadryl Really Necessary Prior to All Transfusions?

January 19, 2012
To Premed or Not to Premed: Are Tylenol and Benadryl Really Necessary Prior to All Transfusions?

By Robert Gianotti, MD

Faculty Peer Reviewed

Case: Mr. T is a 32-year-old male being treated by the oncology service for Acute Myelogenous Leukemia. You are the night float intern covering overnight when you are called by the nurse to inform you that his CMV negative platelets have finally arrived from the blood bank. The nurse notices that the day team has not ordered Benadryl or Tylenol to be given prior to the transfusion, and asks if you could place the order. As you start…

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What Is the Significance of Monoclonal Gammopathy of Undetermined Significance (MGUS)?

December 22, 2011
What Is the Significance of Monoclonal Gammopathy of Undetermined Significance (MGUS)?

By Maryann Kwa, MD

Faculty Peer Reviewed

Clinical Case:

A.D. is a healthy 65-year-old African American male with no prior medical history who presents to his primary care physician for an annual check up. He feels well and has no complaints. Physical exam is normal. Common laboratory tests are ordered which are significant for an elevated total serum protein with normal albumin. A serum protein electrophoresis (SPEP) is then performed. The patient is found to have a monoclonal protein (M protein) of 12 g/L, IgG…

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Mystery Quiz- The Answer

December 14, 2011
Mystery Quiz- The Answer

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors
The answer to the mystery quiz is Kaposi’s sarcoma. The CXR shows bilateral confluent airspaceopacities which have a wide differential diagnosis in this case. The CT narrows the differential.  Specifically, the opacities appear to emanate from the central hilar areas, cuff the airways, and fan out into the more distal airspaces (Images 3 and 4).  This appearance is very suggestive of Kaposi’s sarcoma. CT scans may also reveal mediastinal lymphadenopathy and large

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Breast Self-Examination: Worth the Effort?

October 5, 2011
Breast Self-Examination: Worth the Effort?

By Katherine Husk

Faculty Peer Reviewed

A healthy 40-year-old woman comes into your office for a routine health exam.  After you have performed a clinical breast exam, she asks you whether she should be examining her breasts on her own at home…

Breast self-exam (BSE) seems sensible. Empowering a patient to develop a sense of a personal norm could allow for easier recognition of breast changes, and could perhaps lead to earlier evaluation by a medical professional. There is a great deal of controversy,…

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What is Sister Mary Joseph’s Nodule And Why Is It Significant?

September 15, 2011
What is Sister Mary Joseph’s Nodule And Why Is It Significant?

By Keri Herzog, MD
Faculty Peer Reviewed

The patient is a 62-year-old male who presented to an outpatient medical clinic complaining of a growing, slightly painful, periumbilical mass, and mild lower gastrointestinal discomfort over the last 4 months. On examination, the patient appeared cachectic with an erythematous soft nodule within the umbilicus. Laboratory evaluation revealed anemia (Hct: 28%) and colonoscopy detected a tumor in the sigmoid colon. Both biopsies of the sigmoid mass and the umbilical nodule revealed the presence of adenocarcinoma. Due to the…

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Avastin and the Meaning of Evidence

September 9, 2011
Avastin and the Meaning of Evidence

By Antonella Surbone MD PhD and Jerome Lowenstein MD

The recent hearings at the Food and Drug Administration regarding the revocation of approval for the use of Avastin in the treatment of breast cancer bring into sharp focus several very important issues in medicine today.

The pharmaceutical industry, armed with powerful new tools for deciphering the signaling mechanisms and mutations responsible for the development and progression of malignancies, has developed new therapies for treating cancer and other malignancies. The cost of development of each new…

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Should My Patient with a Solid Tumor be Anticoagulated in the Absence of Venous Thromboembolism?

September 8, 2011
Should My Patient with a Solid Tumor be Anticoagulated in the Absence of Venous Thromboembolism?

By David Altszuler, Class of 2012

Faculty Peer Reviewed

An empiric association between occult malignancy and thrombophlebitis has been recognized since Trousseau first reported the syndrome in 1865.  The mechanism by which cancer predisposes to thrombophilia has not been fully elucidated; however, it is now clear that this is a symbiotic relationship.  The second leading cause of death in hospitalized cancer patients (and a leading cause of death in ambulatory cancer patients) is venous thromboembolism.  There are algorithms to identify cancer patients at high risk…

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Low Dose Vitamin K Supplementation and Anticoagulation Control

July 21, 2011
Low Dose Vitamin K Supplementation and Anticoagulation Control

By Joanna Becker

Faculty Peer Reviewed

Patients who are placed on long-term warfarin (Coumadin) therapy are sent home with a lengthy list of restrictions to minimize variations in warfarin efficacy. The agents that can alter warfarin levels can be divided into 2 categories: (1) those that interact with cytochrome P450, which metabolizes warfarin and (2) those that alter phytonadione (vitamin K) levels.  The majority of inter- and intra-individual warfarin dose variability is attributable to the agents in category 1 above, which include everything from…

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