Heme/Onc

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, however, …

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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 …

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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 antibiotics, …

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From The Archives: Myths and Realities: Do Power Lines Cause Cancer?

April 14, 2011
From The Archives: Myths and Realities: Do Power Lines Cause Cancer?

Please enjoy this post from the Clinical Correlations archives first posted May 20, 2009

By Aditya Mattoo, MD

Faculty Peer Reviewed

Prompted by personal experience, I thought I would explore the alleged causative role of power lines in hematologic malignancies for the next installment of Myths and Realities. In recent years, two close family friends living at separate locations but in homes adjacent to lots with electrical transformers were diagnosed with Multiple Myeloma and Non-Hodgkin’s Lymphoma. Naturally, the coincidence was not unnoticed, so I decided …

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From The Archives: The Skinny on Cachexia…Can it be Treated?

March 24, 2011
From The Archives: The Skinny on Cachexia…Can it be Treated?

Please enjoy this post from the Clinical Correlations archives first posted April 22, 2009

Michael T. Tees, MD, MPH

On the wards and in the clinic, the physician is frequently presented with a patient with a decreased appetite and alarming weight loss. The patient is likely frustrated with their own fraility, the family is upset at the poor nutritional state of their loved one, but the healthcare provider should be the most concerned. This clinical presentation without a prior diagnosis is worrisome, and if the …

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Medicine by the Numbers: Blood Count

March 4, 2011
Medicine by the Numbers: Blood Count

By Michael Ford, MD

Faculty Peer Reviewed

  

                                             

2.65 x 10 # of erythrocytes in circulation, assuming Hematocrit 45%         120 Lifespan in days of an erythrocyte         2.5 million # of new erythrocytes produced each second to replace dying cells†         5.3 million # of erythrocytes per microliter of blood†,*         4,000 – 11,000 # leukocytes per microliter of blood         150,000 – 400,000 # platelets per microliter of blood         15.9 Grams of Hemoglobin A per deciliter of blood†         64,400 Molecular mass in grams of Hemoglobin A (protein tetramer)        …

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