Systems

Therapeutic Hypothermia

November 12, 2009
Therapeutic Hypothermia

Catherine Lucero, MD

Faculty peer reviewed

A recent article in the New York Times highlighted the remarkable recovery of a doctor who regained essentially all his mental function just six weeks after suffering a cardiac arrest with a post -resuscitation Glasgow coma score of 4.(1) Although the ambulance had originally rushed the doctor to the nearest hospital in Nassau County, he was quickly transferred to New York Presbyterian Hospital, where the receiving team induced hypothermia for the subsequent 24 hours. Five days later, the doctor …

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Breaking News: FDA issues new warning for Exenatide (Byetta®)

November 5, 2009
Breaking News: FDA issues new warning for Exenatide (Byetta®)

Kanika Ballani, Pharm.D.
Diana Hubulasvili, Pharm.D.

 Developed by Amylin Pharmaceuticals, Exenatide (Byetta®) is an incretin mimetic that is used as an adjunctive therapy with metformin, a sulfonylurea or a thiazolidinedione to improve glycemic control in type 2 diabetic patients. Mechanistically, Exenatide mimics the actions of endogenous incretin hormone, glucagon-like peptide (GLP-1), causing an increase in insulin secretion which slows gastric emptying and leads to a decrease in food intake. On November 3rd 2009, the FDA issued a safety warning on Exenatide associating it with the …

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How Does Alcohol Cause Cardiomyopathy?

November 4, 2009
How Does Alcohol Cause Cardiomyopathy?

Charles Levine

Faculty peer reviewed

Excessive consumption of ethanol (EtOH) has many deleterious effects on the human body. The heart is a target of damage from EtOH consumption, as chronic consumption of EtOH leads to decreased cardiac function and structural heart disease, including dilated cardiomyopathy.(1) The exact mechanism by which EtOH exerts its deleterious effects on the heart remains poorly understood and is an area of active research. This report will focus on some of the proposed mechanisms and some recent advances in the understanding …

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Tailoring Colon Cancer Screening

October 29, 2009
Tailoring Colon Cancer Screening

Guidelines for Colorectal Cancer Screening and the Recent Evidence Behind Them

 Nazia Hasan, MD MPH

Faculty peer reviewed

For most residents, screening for colorectal cancer (CRC) may seem as established as that for breast and cervical cancer. In reality, the use of CRC screening has only recently approached that of screening for those other malignancies. We have seen recently changes to the CRC screening guidelines last published by The American College of Gastroenterology in 2000. The updated screening guidelines for colorectal cancer became available in …

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Mystery Quiz- The Answer

October 27, 2009
Mystery Quiz- The Answer

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

The answer to the mystery quiz is thoracic splenosis. The key to the solution is the past medical history of a gunshot wound. Shrapnel is seen on the plain CXR (Image 1) as well as in the soft tissue of the back (Image 5). The CXR also shows a lateral diaphragmatic abnormality (Image 1, arrow) likely due to adhesions. The left upper quadrant is notable for colonic gas where one might expect a soft …

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Mystery Quiz

October 23, 2009
Mystery Quiz

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

A 61 year old man was referred to the pulmonary service for an abnormal pulmonary function test (PFT). The patient was a lifelong smoker and had symptoms suggestive of obstructive sleep apnea. The PFT showed a mixed obstructive and restrictive defect. The latter abnormality was considered to be out of proportion to the patient’s obesity, hence a chest CT scan was obtained to evaluate for possible parenchymal lung disease (shown below). Past history was …

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How to interpret troponins in renal disease?

October 21, 2009
How to interpret troponins in renal disease?

Ivan Saraiva MD

Case: A 68-year-old man, with a history of stable angina and end-stage renal disease treated by hemodialysis for the past three years, presents to the hospital with leg swelling and shortness of breath. He also complains of intermittent chest pain unrelated to exertion. Physical exam reveals bilateral pitting lower extremity edema, pulmonary crackles, and an elevated jugular venous pressure. Initial electrocardiogram is notable for some nonspecific repolarization abnormalities. Troponin I levels drawn at 0, 6, and 12 hours after initial presentation are …

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It’s Lyme Season: How Should You Manage the Tick-bitten Patient?

October 14, 2009
It’s Lyme Season:  How Should You Manage the Tick-bitten Patient?

Joshua Allen-Dicker

Faculty peer reviewed

A healthy 42-year old patient presents to your office after a day of hiking with his family in Upstate New York. This morning in the shower he found a “big black tick” on his right leg. He is currently asymptomatic and wants to know what his risk of Lyme disease is.

For New York City physicians, the end of summer and beginning of fall herald a spike in cases of Lyme Disease. Each year in the United States, over 19,000 …

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Medicine by the Numbers

October 9, 2009
Medicine by the Numbers

Chris Tully MD

Faculty peer reviewed

What is the number of patients needed to prophylax to prevent an episode of venous thromboembolism in a hospitalized medical patient?

 

 The use of prophylactic anticoagulation for venous thromboembolism (VTE) is considered standard of care in the inpatient medical setting in order to prevent deep venous thrombosis (DVT) and fatal and nonfatal pulmonary embolism (PE). While a majority of the knowledge stems of post-surgical patients, there has been an increasing volume of research emphasizing and illustrating the benefit in …

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What is Wellens’ Syndrome?

October 7, 2009
What is Wellens’ Syndrome?

Erin Ducharme MD

Faculty peer reviewed

Wellens’ syndrome refers to a pattern of ECG signs occurring during chest-pain free periods in patients with unstable angina, heralding critical, proximal left anterior descending artery (LAD) stenosis . The eponym honors Dr. Hein J.J. Wellens who first described this ECG phenomenon in 1982. Wellens and colleagues identified a subgroup of patients with unstable angina who demonstrated a pattern of inverted precordial T-waves which strongly correlated with early large anterior myocardial infarction (MI) and a poor prognosis . In …

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Sleep, Memory, and Medical Students

October 2, 2009
Sleep, Memory, and Medical Students

Megan Mulligan

Faculty peer reviewed by Dr. David Rapoport

The role of sleep in memory formation is an intriguing topic that has garnered widespread interest among researchers in recent years. The subject has seen a doubling in the number of publications every decade, yet the mechanism by which memories are formed remains elusive. There is little debate that sleep is important for memory, which begs the question: What does the role of sleep in memory imply for the infamously sleep-deprived medical trainee? This brief review …

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When Should You Obtain a Renal Biopsy? Indications, Risks, Follow-up and Value

September 30, 2009
When Should You Obtain a Renal Biopsy? Indications, Risks, Follow-up and Value

Frederick Gandolfo MD

Faculty peer reviewed

At a recent conference on renal transplantation, the importance of early renal biopsy for the diagnosis of acute rejection was emphasized. As busy practitioners of general internal medicine, we rarely have the opportunity to learn the details of a subspecialty procedure such as renal biopsy. However, knowing the details of these procedures is important in providing care for these specific patients. What are the indications, risks, and follow-up care required for the renal biopsy patient? In the native kidney …

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