Systems

Mystery Quiz

May 3, 2007

Posted By Robert Smith, MD Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine

The patient is an 81 year old male with severe obstructive lung disease who was referred to the pulmonary service for an abnormal chest x-ray prior to femoral-popliteal bypass surgery. The patient complained of chronic dyspnea on exertion but specifically denied hemoptysis, increased cough, fever or night sweats. Initial cxr revealed the following:

A chest ct showed only a spiculated appearing mass in the left upper lobe…

Is the PPD obsolete?

May 1, 2007

In February of this year the New York City Department of Health released a new policy paper indicating that they will no longer use the PPD as a screening tool for tuberculosis in their clinics.They have switched to the QuantiFERON-TB Gold, (QFT-G), a blood test. This test is an ELISA, which measures interferon-gamma secretion by t-lymphocytes in response to tuberculosis specific antigens. The test requires heparinized whole blood and must be processed within 12 hours of the blood draw.

The test exposes the…

Statin Pleiotropy: Unique Roles for a Common Medication

April 26, 2007

By: Melissa Freeman, MD, PGY1

For over a decade now, statins, or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, have facilitated millions of patients in the management of their atherosclerosis. Statins are known for their ability to reduce hepatic lipoproteins, up-regulate hepatic LDL receptors, and increase apoprotein E- and B-containing lipoproteins. They have become a household name in the genre of lipid-lowering and a touted hero in cardiovascular risk reduction amongst physicians. Excitingly, research has found that statins may be valuable in disease…

How Do You Estimate Stroke Risk After a Transient Ischemic Attack?

April 24, 2007

By: Alana Choy-Shan, MD PGY-3
Transient ischemic attacks (TIAs) are known to be a harbinger of stroke, however it is difficult for physicians to estimate individual stroke risk. Previously, the two systems used to predict short-term risk of stroke after a TIA were the California and ABCD scores. Both scores are based on clinical factors with several key elements in common. However, neither scoring system was devised to predict stroke within 48 hours of TIA, a time period which may be most clinically relevant.…

Quick Thinking Part 4-The Conclusion

April 20, 2007

Welcome to Quick Thinking. A case is presented in short sections to a faculty expert who will comment on their approach to the patient as the case unfolds. These posts will focus on determining the initial differential diagnoses and diagnostic workups of complicated patient presentations.

Part 1 can be found here. Part 2 can be found here. Part 3 can be found here.

Part 3 Case Presentation by Elizabeth Ross, PGY-3:

The patient continued to complain of headache and dizziness and given the patient’s persistent and intermittent fevers…

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…

Don’t Pass the Olives…

April 18, 2007

This week, olives from several different companies were found to contain Clostridium Botulinum. No cases of botulism have been reported to date, but this is an opportunity to review the pertinent clinical findings.

Botulism is caused by exposure to the botulinum neurotoxin in clostridium botulinum. There are eight toxin strains identified, 4 are known to cause disease in humans. The toxin is produced only in an anaerobic environment, so bottled or canned food products are a good source of infection. Food may smell…

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…

Does Screening for Lung Cancer Improve Mortality?

April 10, 2007

Commentary By: Anna Dvorak, MDPGY-3

Lung cancer is the number one cause of cancer mortality in both men and women. Screening patients at risk for lung cancer might reduce mortality if it helps find cancers at an early stage while they are still resectable. Randomized studies done in the 1970s showed that screening for lung cancer with chest x-ray did not support this theory. Chest x-rays identified more small tumors, but resecting them did not improve mortality. The question of whether screening with…

Meeting Perspectives: The 2007 American College of Cardiology Scientific Session

April 5, 2007

Commentary By: Steven Sedlis, MD Associate Professor of Medicine, Chief, Division of Cardiology Manhattan Veterans Administration Medical Center

The 56th annual scientific session of the American College of Cardiology was held in New Orleans on March 24-27. The site of the meeting had been selected before hurricane Katrina; the ACC re-affirmed its commitment last year when the devastation caused by the storm was still fresh and when future prospects for southern Louisiana were still uncertain. The ACC meeting was by far the largest…

First Direct Renin Inhibitor Approved for Hypertension

March 29, 2007

Commentary By: Josh Olstein, PGY-3

Earlier this month the FDA approved Tekturna (aliskiren) the first drug in a novel class of antihypertensives that work by directly inhibiting renin. While Novartis has yet to release pricing information, don’t expect to see this new addition on the Bellevue or VA formulary any time soon.

The idea of treating hypertension by blocking the actions of renin has been toyed with by pharmaceutical companies for over twenty years with little success. Aliskiren is the first agent…

The COURAGE Trial: PCI is not superior to medical therapy in patients with stable coronary disease

March 27, 2007

Commentary by Cara Litvin, PGY-3

The results of one of the more remarkable studies from the meeting of the American College of Cardiology were presented on Monday, along with the simultaneous early publishing of the study online in the New England Journal of Medicine. As a result the study results captured a front page article in today’s New York Times.

The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial was a randomized trial involving 2287 patients with stable but significant…

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Clinical Correlations