Systems

Appropriateness for Revascularization in Stable Angina

May 19, 2010
Appropriateness for Revascularization in Stable Angina

Introduction to Cases:

During the upcoming weeks, we will post a series of cases addressing the appropriate treatment for patients with stable coronary artery disease. We will be focus on indications for revascularization in stable angina. In all of the cases, the patients will be at high enough risk that stress tests and coronary angiography will be performed.

There has been recent data and recommendations on the appropriate indications for revascularization in stable angina. These recommendations are based on clinical symptoms, non-invasive imaging, and catheterization …

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Alzheimer’s Disease 2.0

May 12, 2010
Alzheimer’s Disease 2.0

Jeffrey Mayne MD

Faculty peer reviewed

Dr. Okonkwo’s post this past summer to PrimeCuts summarized ongoing research in Alzheimer’s Disease (AD), the most common cause of dementia affecting 15 million individuals worldwide and more than 5 million in the United States. It is a disease marked by cognitive deterioration that slowly breaks down one’s ability to perform activities of daily living and leaves individuals unable to care for themselves.

Briefly, the diagnosis of AD is based on clinical criteria and histologic confirmation at death. Based …

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Revisiting the USPSTF Breast Cancer Screening Guidelines: Ethics, and Patient Responsibilities

May 6, 2010
Revisiting the USPSTF Breast Cancer Screening Guidelines: Ethics, and Patient Responsibilities

David Shabtai

Faculty Peer Reviewed

 In a bold move, the U.S. Preventive Services Task Force recently changed their breast cancer screening guidelines – recommending beginning screening at age 50 and even then only every other year until age 75. Bold, because the Task Force members are certainly aware of the media circus that ensued when in 1997, an NIH group issued similar guidelines, prompting comparisons to Alice in Wonderland. The new guidelines, recommend “against routine screening mammography in women aged 40-49 years” as well as …

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Motivational Interviewing: Can You Really Change Behaviors?

April 27, 2010
Motivational Interviewing: Can You Really Change Behaviors?

Emily Stamell

Faculty peer reviewed

As a well-trained fourth year medical student, I inquire about smoking habits as part of almost all my patient encounters. Yet, I do not recall properly counseling a patient on smoking cessation aside from the one liner “You know you should quit, right?” During first and second year of medical school we are taught the stages of change model, which is just as obscure two years later as cell signaling pathways. I was recently introduced to what seemed like an …

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Alzheimer’s Disease 2.0

April 21, 2010
Alzheimer’s Disease 2.0

Jeffery Mayne MD

Faculty peer reviewed

Dr. Okonkwo’s post this past summer to PrimeCuts summarized ongoing research in Alzheimer’s Disease (AD), the most common cause of dementia affecting 15 million individuals worldwide and more than 5 million in the United States. It is a disease marked by cognitive deterioration that slowly breaks down one’s ability to perform activities of daily living and leaves individuals unable to care for themselves.

Briefly, the diagnosis of AD is based on clinical criteria and histologic confirmation at death. Based …

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Which Thyroid Antibody Assays Should be Checked in Patients with Thyroid Disease?

April 14, 2010
Which Thyroid Antibody Assays Should be Checked in Patients with Thyroid Disease?

Michael Chu MD

Faculty peer reviewed

Case:

A 44-year old female presented to the emergency room with complaints of a lower extremity rash and swelling.  The patient had been in her usual state of health when she presented to her primary care physician with complaints of palpitations, weight loss and insomnia.  Lab tests were performed and she was given a diagnosis of hyperthyroidism.  She was started on propranolol and methimazole, which the patient took intermittently due to intolerance of side effects, which she perceived as …

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Antimicrobial Therapy Geared at Pseudomonas aeruginosa for Bronchiectasis

April 7, 2010
Antimicrobial Therapy Geared at Pseudomonas aeruginosa for Bronchiectasis

Diana Hubulashvili, Pharm.D.

Edited by Tania Ahuja, Pharm.D., BCPS

Faculty peer reviewed

Bronchiectasis is an uncommon condition that is characterized by irreversible dilation of the bronchi. Chronic pulmonary infections and airway inflammation cause bronchial damage through destruction of the muscular and elastic layer of the bronchial wall leading to bronchiectasis. Bronchiectasis is associated with serious pulmonary infections, inflammation, chronic cough, and increased sputum production...

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Breaking News: The Crestor Controversy

April 1, 2010
Breaking News: The Crestor Controversy

Devyani Kothari, MD

Patients are already talking about a New York Times front page article highlighting the risks associated with statin use as a preventive measure for cardiovascular events in relatively “healthy” people. The piece examines the newest FDA indications for the use of Crestor along with the controversies surrounding the drug.

Last month, the FDA approved Rosuvastatin Calcium, marketed as Crestor by AstraZeneca for use in a new patient population , based on the JUPITER trial. Crestor now carries the indication for the primary …

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How Easily is Tuberculosis Spread?

March 31, 2010
How Easily is Tuberculosis Spread?

Molly Cason

Faculty peer reviewed

In a city of over 8 million people, New York City has an annual tuberculosis case rate of 11.4 per 100,000 people, which is more than twice the national average.  Seventy-one percent of these cases occur in people who were born outside the United States.1 As a student, I had a patient (Y) who was being evaluated for active tuberculosis because he is a household contact of a person (X) known to have active multi-drug resistant tuberculosis. I wondered what …

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Mystery Quiz- The Answer

March 28, 2010
Mystery Quiz- The Answer

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

The answer to the mystery quiz is progressive massive fibrosis. This condition is a severe form of silicosis. The chest radiograph (Image 3) shows bullous disease of the right upper lobe, increased density of the right hilum, increased density and upward retraction of the left hilum (also seen in Image 4), increased density in peripheral areas of both lungs, and an air crescent sign in the left upper lobe (also seen in Image 5). …

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The Evolution of Cardiac Biomarkers: What’s on the Horizon?

March 24, 2010
The Evolution of Cardiac Biomarkers:  What’s on the Horizon?

Rushi Parikh

Faculty peer reviewed

Cardiac biomarkers have historically been a mainstay of the diagnostic criteria of acute coronary syndrome (ACS). Previously utilized cardiac biomarkers include aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and myoglobin; now more often troponin and to a lesser extent creatine kinase-MB are the principal biomarkers used to diagnose ACS.1

Myocardial necrosis and the subsequent loss of cardiomyocyte membrane integrity lead to the release of cardiac biomarkers into the peripheral circulation. Biomarkers, however, do not indicate the cause of myocardial necrosis, and …

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Mystery Quiz

March 17, 2010
Mystery Quiz

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

The patient is a 39yo male followed in pulmonary clinic for chronic breathlessness and intermittent sputum production, sometimes blood tinged. Symptoms were first noted eleven years earlier at which time pulmonary function testing revealed mixed obstructive and restrictive defects. The patient experienced some improvement with bronchodilators, occasional courses of oral steroids and antibiotics, but was never entirely free of his symptoms. Over an interval of ten years, the patient required several hospitalizations for treatment …

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