Systems

Mystery Quiz- The Answer

May 1, 2009
Mystery Quiz- The Answer

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

The answer to the mystery quiz is sarcoidosis. The CXR shows diffuse, bilateral infiltration with a predominantly nodular pattern. The pulmonary hila are also prominent. The CT image shows innumerable 2-3mm nodules, many of which have a perilymphatic distribution. The lymphatics, in parallel with the pulmonary vasculature, course through the interstitium. Hence, the perilymphatic nodularity has an interstitial distribution and appears as “studding” along the interstitium which is…

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Should we treat asymptomatic autoimmune hepatitis?

April 30, 2009
Should we treat asymptomatic autoimmune hepatitis?

Bani Chander MD

Faculty Peer Reviewed

Autoimmune hepatitis (AIH) is a progressive, inflammatory disease of the liver of unknown etiology and may progress to cirrhosis. While it is does have a predilection for women, this disease entity crosses genders and ethnic groups, and may occur in both adults and children. AIH is characterized by a fluctuating course and is often associated with autoimmune features including hypergammaglobulinemia, circulating serum autoantibodies, and hepatitis with lymphoplasmacytic infiltration on liver biopsy . Autoimmune…

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Mystery Quiz

April 28, 2009
Mystery Quiz

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

The patient is a 42 year old man with a history of non-productive cough for several weeks. Three weeks prior to evaluation by the pulmonary service, the patient presented to the ER with a presumed vasovagal syncopal event that occurred on a subway platform. The patient’s prior medical history included allergic sinusitis and nasal polypectomy. Other than cough, the patient denied constitutional symptoms. The patient was not taking any medications.…

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Breaking News: Swine Flu Reaches New York

April 26, 2009
Breaking News: Swine Flu Reaches New York

Eunice Kang, MD

The Centers for Disease Control (CDC) has confirmed eight cases of swine influenza A (A/H1N1) virus infection in New York City, in addition to a dozen cases caused by the same strain scattered throughout California, Texas, Ohio, and Kansas. The eight confirmed cases in New York are in students who just returned from a trip to Mexico, where officials began reporting three separate outbreaks of influenza-like illness beginning March 18th. According to the New York Times there have…

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The Skinny on Cachexia…Can it be Treated?

April 22, 2009
The Skinny on Cachexia…Can it be Treated?

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 patient does have an underlying etiology, this likely represents progression.…

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Clinical Questions: How do you dose argatroban?

April 16, 2009
Clinical Questions: How do you dose argatroban?

Frederick Gandolfo, MD

Case: An 85 year-old woman admitted to the hospital with pneumonia and after a prolonged hospital course developed heparin-induced thrombocytopenia (HIT). She is currently being treated with argatroban and her platelet counts are recovering. You are the covering physician and are called by the lab for an INR of 12 on her routine labs. The patient shows no signs of bleeding and she is not on warfarin. The PTT at the time…

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Grand Rounds: Gastroesophageal Reflux Disease (GERD)

April 15, 2009
Grand Rounds: Gastroesophageal Reflux Disease (GERD)

Summary by Daniel Frenkel MD

Please also see the clinical vignette presented before grand rounds on the 1st of April.

In his grand rounds lecture on April 1st 2009, Dr. Fritz Francois enlightened us to some novel aspects of gastroesophageal reflux disease (GERD). Despite simple and effective treatment approaches such as acid suppression medication, Dr. Francois explored “why the issues are still burning?” by discussing the changing face of GERD, the connection to obesity, and it’s association with Helicobacter Pylori.…

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Grand Rounds: Purines, Alcohol, and Fatty Liver Disease

April 8, 2009
Grand Rounds: Purines, Alcohol, and Fatty Liver Disease

Commentary by Peter Shue MD, PGY-3

The medical grand rounds presentation on March 4, 2009 was delivered by a distinguished NYU faculty member and research investigator, Dr. Bruce Cronstein.  Although his training and research is primarily in rheumatology, he breathed new insight into mechanisms of fatty liver disease.  In his talk, he reviewed his own published experiments showing that fatty liver disease, similar to gout, is potentiated by elevations in adenosine. …

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Bedside to Bench: Clubbing Revisited

April 3, 2009
Bedside to Bench: Clubbing Revisited

Commentary by Judith Brenner MD, Associate Editor, Clinical Correlations 

Faculty Peer Reviewed 

For an internist, discovering a patient with clubbing is so rewarding since it appeals to the core of our profession, a profession which can often be very similar to that of a detective. The physical finding of clubbing was first described by the ancient Greeks, who recognized it to be a clue to much more.

When a clinician discovers clubbing of the fingers, he must consider that hypoxemia may…

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BREAKING NEWS: Another Nut that You’d Rather Not…

March 31, 2009
BREAKING NEWS: Another Nut that You’d Rather Not…

FDA ALERTS CONSUMERS TO RECALL OF PISTACHIO PRODUCTS

Commentary by Rebecca Hall MD, PGY-1

Growing concerns over Salmonella  contamination of pistachio products sold by Setton Pistachio of Terra Bella Inc in California have lead the manufacturer to voluntarily recall about a million pounds of its pistachio containing products. 1  The recall involves bulk lots o f roasted shelled pistachios and roasted inshell pistachios shipped on or after September 1st 2008. 2 Because pistachios are a component of numerous other products including many baked…

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Deciphering Fact from Fiction in Hypoglycemia

March 26, 2009
Deciphering Fact from Fiction in Hypoglycemia

Commentary by Melissa Price, MD PGY3

Faculty Peer Reviewed

A 42 year-old male phlebotomist with a history of anxiety presented to the emergency room complaining of four hours of dizziness and diaphoresis. He denied taking any medications. His vitals were stable, his physical exam was significant for a lethargic, diaphoretic young man without focal findings, and his fingerstick value was 43mg/dL. His chest X-ray, EKG, and laboratory results, with the exception of plasma glucose, were within normal limits.

Why is this…

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Salmonella Update

March 21, 2009
Salmonella Update

Commentary by Sherley Abraham MD, PGY-3

The CDC reports there have been 666 cases and 9 deaths associated with Salmonella Typhimurium infections. The outbreak began September 1st, 2008 and has spread across 45 states, including 30 cases in New York. The source has been traced back to peanut butter and peanut paste made at the production company in Blakely, Georgia which is owned and operated by the Peanut Corporation of America. There is a nationwide product recall which can be found on the…

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