Systems

Are beta blockers indicated in cirrhotics with small varices?

August 1, 2007
Are beta blockers indicated in cirrhotics with small varices?

Commentary by Bani Chander MD, PGY-2

Esophageal varices are a common complication of cirrhosis and approximately one-third of all cirrhotic patients with varices will develop a variceal bleed . Each episode of variceal hemorrhage is associated with a 15 to 20 percent risk of mortality in patients with severe liver dysfunction.  The risk of bleeding is related to the location, size, and appearance of the varix, presence of red wale markings, variceal pressure, prior history of variceal bleeding, as well as the severity…

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Part I- Subclinical Thyroid Dysfunction: To Treat or Not to Treat?

July 31, 2007
Part I- Subclinical Thyroid Dysfunction: To Treat or Not to Treat?

Commentary by Melissa Freeman MD, PGY2

Modern day science has revealed to us the intricate relationships that thyroid hormones have with multiple systems of the human body.  Many of today’s physicians find themselves checking patients’ thyroid function tests (TFTs) almost as reflexively as a baseline basic metabolic panel. Yet, what seems to the physician to be a harmless bit of thoroughness can often turn into hours of inquisitive head scratching if the TFTs reveal subclinical thyroid dysfunction, especially since automated assays for TFTs are more…

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X-Ray Visions: Update on Nephrogenic Systemic Fibrosis and Gadolinium Contrast MRI

July 24, 2007
X-Ray Visions: Update on Nephrogenic Systemic Fibrosis and Gadolinium Contrast MRI

Commentary by Andrew Hardie MD, Body MRI Fellow, NYU Dept of Radiology

The recent discovery of a link between Nephrogenic Systemic Fibrosis (NSF) and the administration of gadolinium contrast for MRI examinations has sent the imaging world scrambling. NSF is a debilitating fibrosing reaction primarily involving the skin and, to a variable degree, internal organs. While longitudinal studies currently do not exist to help determine which patients can be safely administered gadolinium, it is clear that severe renal dysfunction, including those patients on…

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Clinical Question: How do you manage plantar fasciitis?

July 19, 2007
Clinical Question: How do you manage plantar fasciitis?

Commentary by Cathy Cruise, M.D. Director Department of Veterans Affairs Care Coordinator, Chair Rehabilitation Council

Case: A 25 year old woman with no significant past medical history presents to walk-in clinic complaining of several days of right heel pain. She notes that the pain is quite sharp and worst when walking. It is so severe that she has skipped her morning run for three consecutive days. She has tried taking acetaminophen which has provided minimal symptom relief. Physical exam reveals mild swelling and…

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Class Act: Is there evidence to support chiropractic care of low back pain?

July 18, 2007
Class Act: Is there evidence to support chiropractic care of low back pain?

Welcome to Class Act, a new feature of Clinical Correlations. Class act will feature posts written by NYU 3rd and 4th year medical students. These posts will focus on evidenced based answers to clinical questions related to patients seen by our students in the clinics or on the wards. Prior to publication, each commentary is thoroughly reviewed for content by a faculty member. Enjoy…

Commentary by Brian Liem, MSIV

A 52 year old male with no medical problems presents to your clinic with a…

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A Case of Celiac Disease and Diagnostic Clues

July 12, 2007
A Case of Celiac Disease and Diagnostic Clues

Commentary by Josh Olstein MD, Chief Resident NYU Internal Medicine

Mr. J is a 56 year old Caucasian gentleman who presented with complaints of “I just can’t do what I used to be able to do. I just don’t have the energy.” He describes himself as a hearty fellow who had never had a problem with his energy level until around a year ago. Though he has not noticed any weight loss, he denied any weight gain despite the lumberjack-like portions he eats…

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Bedside Rounds: What is Lasegue’s Sign?

July 10, 2007
Bedside Rounds: What is Lasegue’s Sign?

Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program

A 66 year old woman with a history of dyslipidemia and remote tobacco use presents with a sudden onset of pain located in her posterior left thigh radiating down her left leg below the knee. The pain began during the course of an upper respiratory illness with a cough. The pain is burning in quality and is bothersome day and night. NSAIDs have been taken and relieve the pain temporarily.…

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How do you assess a patient’s risk for recurrent DVT?

July 6, 2007
How do you assess a patient’s risk for recurrent DVT?

Commentary by Sean Cavanaugh MD, Associate Editor, Clinical Correlations

A 51-year-old man with a history of DVT diagnosed seven months ago presents to your clinic for follow up. He has no family history of blood clots. He has been on coumadin since his DVT was diagnosed. No testing for thrombophilia has been done. How do you proceed?

Recently, The Annals of Internal Medicine released an excellent statement about the treatment of venous thrombosis (see prior post). Unfortunately, it does not address the more interesting questions…

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

July 5, 2007
Meeting Perspectives: The ADA Scientific Sessions:  Advances in the Pharmacologic Management of Type 2 Diabetes Mellitus


Commentary by Mitchell Charap MD, Senior Associate Program Director, NYU Internal Medicine Residency Program

Caveat: What follows below reflects my perspective on new and old pharmacologic approaches to Type 2 Diabetes. It is not intended to be a comprehensive review of this topic.

TZDs

The ADA did not mount a serious attack on the Nissen NEJM metanalysis of Rosiglitazone. They suggested that patients speak to their physicians regarding the drug. I missed the Nissen/ADA debate that occurred, but gather…

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Should All Patients with Hepatitis C Be Screened for Hepatocelluar Carcinoma?

July 3, 2007
Should All Patients with Hepatitis C Be Screened for Hepatocelluar Carcinoma?

Should patients with Hepatitis C (HCV) with no evidence of cirrhosis undergo screening for hepatocellular carcinoma (HCC)? Is there any reason to check for HCC when the liver associated enzymes (LAEs) are normal?

-Sandeep Mangalmurti, PGY-2

Commentary by Mike Poles MD, Associate Editor Clinical Correlations and Assistant Professor, Division of Gastroenterology

HCC continues to be one of the most common solid malignancies worldwide. Further, almost all cases of HCC occur in the background of a histologically-abnormal liver; approximately 90% of cases of HCC occur in…

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How Do you Approach a Patient with Primary Hyperaldosteronism?

June 28, 2007
How Do you Approach a Patient with Primary Hyperaldosteronism?

An 80 year old male with atrial fibrillation, hypertension, hypokalemia is diagnosed with hyperaldosteronism with an aldosterone to renin ratio of 34.5/0.15=230 . CT scan reveals a right adrenal 1 cm presumed adenoma

Questions:
1. How do you accurately diagnose primary hyperaldosteronism?
2. Do medications which the patient is taking influence the work-up?
3. Can you have primary hyperaldosteronism in the absence of hypokalemia?
4. Can the adrenal mass be incidental? Should the patient have additional testing?

-Anna Dvorak PGY-3

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Meeting Perspectives-ASCO 2007

June 26, 2007
Meeting Perspectives-ASCO 2007

Commentary By: Theresa Ryan, M.D. Assistant Professor, Division of Oncology

During the first five days in June, the American Society of Clinical Oncology met in Chicago for their 43rd annual meeting. The theme of this meeting was “Translating Research into Practice,” emphasizing the society’s goal of enhancing patient care by creating a forum wherein the latest advances in translational and clinical cancer research are presented in the context of our current understanding of cancer biology. Many abstracts presented will lay the groundwork for…

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