Systems

Grand Rounds: “Behcet’s Disease: What It Is, and Isn’t”

October 16, 2008
Grand Rounds: “Behcet’s Disease: What It Is, and Isn’t”

Commentary by Jon-Emile Kenny MD, PGY- 2

Please also see the clinical vignette presented during last week’s grand rounds

Dr.  Yusuf Yazici of the NYU Behcet’s Syndrome Center opened his talk by discussing the classic triad of symptoms characteristic of Behcet’s Disease: aphthous ulcers, genital ulcers and uveitis.  This was originally characterized by the Turkish physician Hulusi Behcet in 1937.  While these symptoms are the most common of Behcet’s, other tissues may be affected as Behcet’s is a systemic vasculitic disorder.  GI symptoms, neurological sequelae, …

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Breaking News: USPSTF Recommends Against Routine Screening for Colorectal Cancer After Age 75

October 8, 2008

Commentary by Andrew McKinstry MD, PGY-1 (reviewed by Michael Poles, MD, Associate Editor Clinical Correlations, Assistant Professor of Medicine, Section of Gastroenterology)

Hot on the heels of its recommendation in August against routine screening for prostate cancer in men over 75, the US Preventive Services Task Force has issued recommendations against routine screening for colorectal cancer in patients over the age of 75- Yes, you read that correctly, NO routine screening for colorectal cancer past age 75.  In a report updating their recommendations from 2002, …

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Grand Rounds: Clinical Development of Anti-Cancer Drugs: Succeed Slowly or Fail Fast

October 3, 2008
Grand Rounds: Clinical Development of Anti-Cancer Drugs: Succeed Slowly or Fail Fast

Commentary by Daniel Egan MD, PGY2

Please also see the clinical vignette presented during last week’sgrand rounds

On Wednesday, September 24, 2008, the NYU Department of Medicine Grand Rounds featured guest speaker Hilary Calvert, MD, Professor of Medical Oncology at the University of Newcastle upon Tyne, England, with a lecture entitled “Clinical Development of Anti-Cancer Drugs: Succeed Slowly or Fail Fast.”

Dr. Calvert first oriented the audience by reviewing the traditional method in which new chemotherapeutic drugs have been developed and introduced to the market.  …

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Propofol Infusion Syndrome: An Unusual Case of Lactic Acidosis

October 1, 2008
Propofol Infusion Syndrome: An Unusual Case of Lactic Acidosis

Commentary by Bani Chander MD, PGY-3 and Reviewed by Laura Evans MD, NYU Division of Pulmonary and Critical Care Medicine

Case presentation:

The patient is a 26 year-old female with long-standing refractory epilepsy, status post corpus callosotomy, and vagus nerve stimulator placement, who was admitted to the intensive care unit for management of status epilepticus. The patient was initially admitted to the inpatient epilepsy unit and placed on multiple anti-epileptic medications with little response. However, after having more than ninety seizures over the course of …

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Mystery Quiz- The Answer

September 27, 2008
Mystery Quiz- The Answer

Posted by Vivian Hayashi MD and Robert Smith MD,

Mystery Quiz Section Editors

The answer to last week’s mystery quiz is pneumatocele/pseudocyst likely due to ventilator associated lung injury (VALI) in a patient with ARDS. The patient had

ARDS on the basis of diffuse infiltrates, hypoxemia with a PaO2/FiO2 <200mmHg, and no strong evidence of LV heart failure. His risk factor for ARDS was pneumonia, evident on his admission CXR with bibasilar infiltrates (R>L); Streptococcus pneumoniae grew on sputum culture. The overall clinical picture is …

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Meeting Perspectives: The ADA Scientific Sessions: Advances in the Pharmacologic Management of Type 2 Diabetes Mellitus

September 25, 2008
Meeting Perspectives: The ADA Scientific Sessions: Advances in the Pharmacologic Management of Type 2 Diabetes Mellitus

Commentary by  Howard Furst MD and Mitchell Charap MD

We will focus our review of the 2008 ADA meetings on new data regarding the GLP-1 analogues and the DPP 4 inhibitors. Before describing the clinical data, we will review the basic science that led to interest in these new classes of drugs for the treatment of diabetes mellitus.

Background
Incretins are peptides released from the gastrointestinal tract in response to nutrient ingestion. They enhance glucose-dependent insulin secretion from the pancreas and aid in the overall …

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Grand Rounds: Thyroid Disease and the Heart

September 24, 2008
Grand Rounds: Thyroid Disease and the Heart

 Commentary by Sarika Modi MD, PGY-2  

Dr. Irwin Klein MD, Professor of Medicine and Cell Biology, of North Shore University Hospital, gave grand rounds on “Thyroid Disease and the Heart” on September 17, 2008.  He began his talk by giving an overview of the broad spectrum of cardiac manifestations seen in hyperthyroidism.  Palpitations are seen in 90% of patients with hyperthyroidism.  Atrial fibrillation is seen in 5-15%, especially in the elderly.  In fact, as Dr Klein pointed out, former president George Bush Senior was diagnosed …

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Mystery Quiz

September 19, 2008
Mystery Quiz

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

The patient is a 76 year old man with history of moderate-to-severe COPD who presented with three days of fever, breathlessness, and productive cough. Past surgical history is significant for vagotomy and partial gastrectomy 16 years earlier and a cholecystectomy 10 months prior to admission. On exam, the patient appeared acutely ill with a blood pressure of 75/45 mmHg, tachycardia, marked hypoxemia and course breath sounds throughout all lung fields. Labs revealed …

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Grand Rounds: “Acute Respiratory Distress Syndrome and Acute Lung Injury”

September 17, 2008
Grand Rounds: “Acute Respiratory Distress Syndrome and Acute Lung Injury”

Commentary by Matthias Kugler MD, PGY-3

Please also see the Grand Rounds Clinical Vignette

Leonhard D Hudson, M.D., Professor of Medicine, Pulmonary and Critical Division, University of Washington, Seattle, spoke at Medical Grand Rounds about the Acute Respiratory Distress Syndrome (ARDS) and Acute Lung Injury (ALI). He started his lecture with a history of the disease, starting with the first published description of ARDS in The Lancet 1967, where it was defined by the presence of diffuse alveolar damage, increasing pulmonary capillary leak, non-cardiogenic pulmonary …

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Grand Rounds: “Bacterial Meningitis”

September 11, 2008
Grand Rounds: “Bacterial Meningitis”

Commentary by  Stephen Carpenter MD, PGY-2

Dr. Vincent Quagliarello, Professor of Medicine at Yale University, delivered his Medicine Grand Rounds lecture entitled “Bacterial Meningitis in Adults: Principles and Practice in 2008” on Wednesday, September 3rd, 2008. He began with some of the history of the disease and noted that despite all the medical advances, bacterial meningitis still has a mortality rate of 27% and an even higher rate of 54% in poorer nations where high rates of HIV infection confound the problem. A quick review …

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Perioperative Beta-blockade: Will POISE Change Management?

September 10, 2008
Perioperative Beta-blockade: Will POISE Change Management?

Commentary by Michael LoCurcio MD, Michael Janjigian MD and Michael C Brabeck MD, FACP, NYU Division of General Internal Medicine

Cardiovascular complications continue to be a major cause of morbidity and mortality in the perioperative period. Although progress has been made in terms of risk stratification, an effective invasive or pharmacologic intervention that decreases this risk remains elusive. Well designed studies have shown that prophylactic invasive measures are not effective in decreasing this risk, leaving clinicians uncertain as to the best way to maximize the …

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Addiction 2.0 Part 2

September 4, 2008
Addiction 2.0 Part 2

Commentary by Joshua Lee MD, Ellie Grossman MD and Marc Gourevitch MD, NYU Division of General Internal Medicine

Please also see Part 1 of this series, posted last week

Alcohol treatment in primary care: evidence for effectiveness and neharmacotherapies

Brief interventions by primary care physicians to address unhealthy alcohol use have been shown in multiple studies and settings to promote reduced drinking and engagement in other treatment, although long-term impact on alcohol-related morbidity and mortality is not clear.(Saitz 2005) Standard brief intervention techniques are based …

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