Systems

Mystery Quiz

November 10, 2010
Mystery Quiz

Dana Clutter, MD

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

A 25 year old woman infected with HIV presents to an HIV/AIDS clinic in Kampala, Uganda, for evaluation of cutaneous lesions on her face, arms and back. Aside from the disfiguring nature of her lesions, she reports being in her usual state of health. She denies any constitutional symptoms and all of her vital signs are stable. Her current CD4+ T cell count is 1 cell/cmm and she has …

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Breaking News: Lung Cancer Screening Shows Mortality Benefit

November 5, 2010
Breaking News: Lung Cancer Screening Shows Mortality Benefit

By David Hormozdi, MD

The weather outside may be cooling off but the debate surrounding lung cancer screening is heating up once again as preliminary results released from The National Lung Screening Trial (NLST) showed 20% fewer lung cancer deaths in individuals that underwent screening with low-dose helical CT scans compared to chest X-ray. This is the first study to show a mortality benefit from lung cancer screening and could impact millions of people considered high-risk for lung cancer.  The study’s initial findings were released …

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Creatine Kinase: How Much is Too Much?

November 3, 2010
Creatine Kinase: How Much is Too Much?

By Jon-Emile Kenny, MD

Faculty Peer Reviewed

A 37-year-old man, with no past medical history and taking finasteride for male pattern baldness, is admitted to Medicine with profound lower extremity weakness after a weekend of performing multiple quadriceps exercises. His measured creatine phosphokinase (CPK) is over 35,000 IU/liter. I wonder to myself, what is the risk to his kidneys and can I mitigate the damage?

 Rhabdomyolysis means destruction of striated muscle. Physical manifestations range from an asymptomatic illness with an elevation in the CPK level, …

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Nephrogenic Systemic Fibrosis-An Evolving Disease Entity

October 27, 2010
Nephrogenic Systemic Fibrosis-An Evolving Disease Entity

By Kevin Hsueh, MD

Faculty Peer Reviewed

In 2006 and 2007, Clinical Correlations reported on the FDA’s announcement of a link between Nephrogenic Systemic Fibrosis (NSF), a rare progressive condition identified in some patients with kidney disease, and exposure to gadolinium-based contrast agents (GBCAs).  The initial lesion of NSF is classically a large “brawny” hyperpigmented nodular plaque that appears fixed to the underlying tissues when palpated.  It most often develops on the lower extremities, often mimicking chronic venous stasis changes, but the fibrosis itself can …

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How do you Manage the Adult with Perinatally Acquired Hepatitis B?

October 22, 2010
How do you Manage the Adult with Perinatally Acquired Hepatitis B?

Nathaniel Rosso Smilowitz, MD

Faculty Peer Reviewed

Hepatitis B virus is a DNA hepadnavirus affecting 1.25 million people in the United States and nearly 400 million worldwide.  The virus is transmitted perinatally, sexually, and percutaneously, and is endemic in many countries in South East Asia, Central Asia, and Africa.  When exposure occurs early in life, the likelihood of chronic infection is high; up to 90% of cases of vertical transmission result in the persistence of the viral envelope protein, the hepatitis B surface antigen (HBsAg), …

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From the Archives: Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

October 14, 2010
From the Archives: Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

Please enjoy a post from the Clinical Correlations Archives, first posted 1/22/09

Commentary by Melanie Maslow, MD, FACP, Associate Professor of Medicine, NYUSOM, Chief, Infectious Diseases, New York Harbor Healthcare System, NY

Faculty Peer Reviewed

Cellulitis is an acute spreading infection of the skin extending to the deep subcutaneous tissue characterized by pain, swelling, erythema and warmth. Cellulitis in the non-neutropenic patient, in the absence of bite wounds, salt or fresh water exposure, and coexisting ulcers is usually caused by Gram-positive pathogens, the most common …

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Circumcision as Primary Protection?

October 8, 2010
Circumcision as Primary Protection?

Emily Taylor, MD

Faculty Peer Reviewed

The earliest documented evidence of circumcision is in artwork from the Sixth Dynasty in Egypt (2345-2181 BC) found in a wall relief from Saqqara in Lower Egypt. Circumcised North Americans were described by Columbus upon arrival to the continent; circumcision was practiced by Australian aboriginals, native South Americans, and Pacific Islanders. It is unknown if circumcision was common amongst some earlier ancestor of all these peoples, or if it evolved independently in societies that lived in dry, sandy areas, …

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Does Vitamin D Supplementation Reduce the Risk of Cardiovascular Events?

October 6, 2010
Does Vitamin D Supplementation Reduce the Risk of Cardiovascular Events?

By Karina Vivar, MS4

Faculty Peer Reviewed

Vitamin D deficiency is highly prevalent in the U.S. and worldwide, and the problem appears to be worsening.  By definition, vitamin D deficiency is a serum 25-hydroxyvitamin D (25-OH D) level of less than 20 ng/mL.  Vitamin D insufficiency is defined as a serum 25-OH D level from 20 to 30 ng/mL.  Unless there is a high risk for fracture and a clinical suspicion of deficiency, it is not routine to screen for vitamin D deficiency, due to …

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