Heme/Onc

Future Medicine: The Search for a New Anticoagulant

April 16, 2008
Future Medicine: The Search for a New Anticoagulant

Future Medicine is a new section of Clinical Correlations devoted to hot areas of research and development in various fields of medicine. In tihis series, we will highlight treatments in their infancy, from basic research opening up new targets for treatment, to following small molecules throughout their clinical investigation. We will also bring you the latest on technology and devices, as well as perspectives on drug discovery from a business point of view. Watch out – the future is just around the corner!

Commentary by Aaron Lord

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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 non-productive such as…

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Grand Rounds: Breast Cancer Genomics

November 20, 2007
Grand Rounds: Breast Cancer Genomics

Commentary by Jonathan Willner MD, PGY-2

This week’s Medicine Grand Rounds speaker was Lisa Carey, MD, Associate Professor in Hematology/Oncology at the University of North Carolina and Medical Director of the UNC Breast Center.  Much of Dr. Carey’s research focuses on how an understanding of breast cancer genomics may tailor clinical therapy.

While the incidence of breast cancer has plateaued over the past few years, there has been a decline in the number of breast cancer deaths. The reason is thought to…

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

November 2, 2007
Grand Rounds: “Towards Biologically Rational Therapy for Myelodysplastic Sydrome.”

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…

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Elevated Total Protein and the Interpretation of Serum Protein Electrophoresis

November 1, 2007
Elevated Total Protein and the Interpretation of Serum Protein Electrophoresis

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.…

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Tumor Lysis Syndrome and the Role of Urinary Alkalinization

September 13, 2007
Tumor Lysis Syndrome and the Role of Urinary Alkalinization

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…

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

July 6, 2007
How do you assess a patient’s risk for recurrent DVT?

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…

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Should All Patients with Hepatitis C Be Screened for Hepatocelluar Carcinoma?

July 3, 2007
Should All Patients with Hepatitis C Be Screened for Hepatocelluar Carcinoma?

Should patients with Hepatitis C (HCV) with no evidence of cirrhosis undergo screening for hepatocellular carcinoma (HCC)? Is there any reason to check for HCC when the liver associated enzymes (LAEs) are normal?

-Sandeep Mangalmurti, PGY-2

Commentary by Mike Poles MD, Associate Editor Clinical Correlations and Assistant Professor, Division of Gastroenterology

HCC continues to be one of the most common solid malignancies worldwide. Further, almost all cases of HCC occur in the background of a histologically-abnormal liver; approximately 90% of cases of HCC occur in…

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Meeting Perspectives-ASCO 2007

June 26, 2007
Meeting Perspectives-ASCO 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…

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Recent Developments in the Treatment of Renal Cell Carcinoma

May 31, 2007
Recent Developments in the Treatment of Renal Cell Carcinoma

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…

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

April 19, 2007
New Guidelines on the Diagnosis and Treatment of Venous Thromboembolism-Part 2

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 heparin (LMWH), as opposed to unfractionated

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

April 12, 2007
New Guidelines on the Diagnosis and Treatment of Venous Thromboembolism-Part 1

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.

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

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