Heme/Onc

Grand Rounds: “Towards Biologically Rational Therapy for Myelodysplastic Sydrome.”

November 2, 2007

Welcome to our new Grand Rounds Series. Each week, we plan to post a summary of the week’s Medicine Grand Rounds lecture. The summaries are reviewed and approved by the grand rounds speaker prior to posting. Enjoy.

Commentary by Marshall Fordyce MD, Senior Chief Resident

This week’s Medicine Grand Rounds guest lecturer was Dr. Steven Gore, currently Associate Professor of Oncology, and Faculty Member of Cell and Molecular Medicine, at the Johns Hopkins University School of Medicine. Dr. Gore’s research focuses on improving…

Elevated Total Protein and the Interpretation of Serum Protein Electrophoresis

November 1, 2007

Commentary by Jamie Hoffman, MD

A healthy 54 year old man without past medical history presents for a routine physical exam for his insurance company. His blood work reveals a total protein (TP) of 9.4 g/dl and an albumin of 3.0 g/dl. What should be included in this patient’s diagnostic workup?

An elevated TP:Albumin ratio often necessitates finding the protein(s) responsible for such an elevation. Plasma proteins largely consist of albumin and globulins such as immunoglobulins, carrier proteins, and acute phase reactants.…

Tumor Lysis Syndrome and the Role of Urinary Alkalinization

September 13, 2007

Commentary by Bani Chander MD, PGY-2, and Sergio Obligado MD, Attending Physician, Nephrology

Tumor lysis syndrome (TLS) is characterized by a group of metabolic abnormalities including hyperkalemia, hyperuricemia, and hyperphosphatemia with secondary hypocalcemia, following the initiation of cytotoxic therapy. Although there is no well established definition for this syndrome, the Cairo-Bishop definition is a commonly used classification system that stratifies the degree of severity by utilizing specific laboratory data and clinical features. The constellation of abnormalities that occurs in TLS is due…

How do you assess a patient’s risk for recurrent DVT?

July 6, 2007

Commentary by Sean Cavanaugh MD, Associate Editor, Clinical Correlations

A 51-year-old man with a history of DVT diagnosed seven months ago presents to your clinic for follow up. He has no family history of blood clots. He has been on coumadin since his DVT was diagnosed. No testing for thrombophilia has been done. How do you proceed?

Recently, The Annals of Internal Medicine released an excellent statement about the treatment of venous thrombosis (see prior post). Unfortunately, it does not address the more interesting questions…

Meeting Perspectives-ASCO 2007

June 26, 2007

Commentary By: Theresa Ryan, M.D. Assistant Professor, Division of Oncology

During the first five days in June, the American Society of Clinical Oncology met in Chicago for their 43rd annual meeting. The theme of this meeting was “Translating Research into Practice,” emphasizing the society’s goal of enhancing patient care by creating a forum wherein the latest advances in translational and clinical cancer research are presented in the context of our current understanding of cancer biology. Many abstracts presented will lay the groundwork for…

Recent Developments in the Treatment of Renal Cell Carcinoma

May 31, 2007

Commentary by Michael Seidman MD, Chief Oncology Fellow

New treatment options for both early and advanced Renal Cell Cancer have recently been published. Traditionally, treatment for early stage disease was partial or radical nephrectomy. In the metastatic setting, treatment options were limited to toxic cytokine therapy with IFN or IL-2.

Some recent literature has suggested that small, incidentally found renal tumors can safely be watched without the need for invasive surgery. Remzi et al retrospectively reviewed 287 tumor bearing kidneys 4cm or…

New Guidelines on the Diagnosis and Treatment of Venous Thromboembolism-Part 2

April 19, 2007

Commentary By: Margaret Horlick, MD, PGY-3

New guidelines on the diagnosis and treatment of venous thromboembolism (VTE) were recently jointly issued by the American Academy of Family Physicians and the American College of Physicians. The guidelines are based on a systematic review of the evidence and are published, along with the systematic reviews, in the 2/2007 and 3/2007 issues of the Annals of Internal Medicine.

Part 1-Diagnosis

Part 2 Treatment

The treatment recommendations are summarized as follows:

Low-molecular-weight…

New Guidelines on the Diagnosis and Treatment of Venous Thromboembolism-Part 1

April 12, 2007

Commentary By: Margaret Horlick, MD, PGY-3

According to the reviews, there are 600,000 cases of VTE in the US annually, and the…

Will my breast cancer patient need adjuvant chemotherapy? Gene Micro array technology may help answer this question��

March 20, 2007

Commentary By Sandra D’Angelo, PGY-3

Breast cancer is the most common cancer diagnosed in women, second only to lung cancer as a leading cause of death from cancer. Experts state that approximately 210, 000 women will be diagnosed in 2006 and about 40,000 will die from the disease.1 According to data compiled by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, 61% of breast cancer cases are diagnosed while the cancer is still confined to the primary site…

Why Are Breast Cancer Rates Trending Down?

January 9, 2007

The recent finding of decreasing breast cancer rates made headlines throughout the media; including a NY Times article entitled, Reversing Trend, Big Drop is seen in Breast Cancer on December 15, 2006.

Striking epidemiological facts tells us that breast cancer is the most common cancer in women in the U.S., and only second to lung cancer as the most common cause of cancer deaths. It is estimated that approximately 212,920 American women will be diagnosed with breast cancer in…

Should we recommend mammography screening for women between the ages of 40-50?

December 22, 2006

In a recent article in the Lancet, this question was addressed by a group of investigators led by Sue Moss, Ph.D. from the University of Leeds. Currently, the National Cancer Institute, U.S. Preventative Health Services Task Force and the American Cancer Society all recommend screening at a younger age(those between 40-50). The task force, however, does recommend educating your patients about the potential risks/benefits regarding mammography at a younger age. Screening women older than 50 has been shown to reduce mortality from breast cancer…

The First Joint Medical-Surgery Conference

December 21, 2006

The first monthly medical/surgery conference was a great success. Attended by resisdents and attendings from both departments the conference was a lively discussion regarding the controversies in caring for a 51 year old man who recently underwent a percutaneous coronary intervention with the placement of a Cypher stent after a non-st elevation myocardial infarction, who soon afterwards was found to have a gall bladder mass that needed to be resected. The complete slide presentation can be found here: Joint Medicine-Surgery Conference Slides
A…

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