Systems

Why Does Hypertriglyceridemia Lead to Pancreatitis?

October 4, 2007
Why Does Hypertriglyceridemia Lead to Pancreatitis?

Commentary by Daniel Frenkel, PGY-2

Case: A 46 year old male with diabetes on oral hypoglycemic medications is admitted to the hospital with one day of constant epigastric pain, nausea, vomiting, and an inability to tolerate oral intake. You are concerned about pancreatitis but laboratory analysis reveals amylase levels that are within the normal reference range. You notice that his glucose level is 410mg/dL and that the specimen is described as lactescent. Should you still be concerned about acute pancreatitis?

Lactescent or lipemic blood samples …

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Bedside Rounds: How Do You Diagnose and Treat Diabetic Neuropathy

October 3, 2007
Bedside Rounds: How Do You Diagnose and Treat Diabetic Neuropathy

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

Diabetic neuropathy is one of the most commonly encountered complications of diabetes mellitus. It is seen in up to 20% of diabetics. Patients typically present with neuropathic pain in a “glove and stocking” distribution with the earliest signs in the feet. Night time complaints of “my feet are on fire” are common. Relying on a patient’s complaint of “pain” or “numbness” is inadequate in the diagnosis of peripheral neuropathy since almost half …

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Rifaximin: A useful drug for travelers’ diarrhea

September 28, 2007
Rifaximin: A useful drug for travelers’ diarrhea

Commentary by Sumathi Sivapalasingam MD, NYU Division of Infectious Diseases

Rifaximin is an oral semi-synthetic analog of rifampin which is essentially not absorbed (bioavailability <0.4%) making it useful for the treatment of intra-luminal intestinal infections, while having little systemic side effects. There are several advantages to using rifaximin: it does not appear to lead to bacterial resistance, a problem frequently encountered with rifampin; colonic fecal flora is minimally altered; and it has a safety profile similar to placebo. Like other rifamycins, it exerts its activity …

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Inpatient Diabetes Management: Case 3

September 27, 2007
Inpatient Diabetes Management: Case 3

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center 

Welcome to Case 3 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. For the next several weeks, we plan to present individual cases followed by some management questions and answers.

Case 3: The case of Mr. Mejia

3A. Mr. Mejia is a 30 year old man with Type 1 diabetes who is admitted for shortness of …

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Breaking News: FDA Issues New Warnings for Haldol

September 21, 2007
Breaking News: FDA Issues New Warnings for Haldol

Commentary by Helen Kourlas, PharmD

On September 17th 2007, the FDA issued an advisory warning healthcare professionals to avoid the use of higher than recommended doses of haloperidol, marketed as Haldol, Haldol Decanoate and Haldol Lactate. In addition to this warning, the FDA also emphasized that the injectable form of haloperidol is only approved to be administered as an intramuscular injection. Common off – label intravenous administration of haloperidol has led to numerous case reports of QT prolongation, Torsades de Piontes (TdP) and sudden death. …

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Recent Legionella Outbreak in the Bronx

September 20, 2007
Recent Legionella Outbreak in the Bronx

Commentary by Elizabeth Hackett MD, PGY-3

On July 25th, 2007, the NYC Department of Health released an advisory requesting that all New York City physicians maintain a high index of suspicion for Legionnaires’ disease in patients presenting with community acquired pneumonia. This advisory was prompted by 27 cases of Legionella pneumonia reported in the Parkchester neighborhood of the Bronx during the fall of 2006 (zip code 10462 ). This cluster of cases represented an increase in incidence of the disease to 16.6 cases/100,000 in the …

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Inpatient Diabetes Management: Case 2

September 14, 2007
Inpatient Diabetes Management: Case 2

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center 

Welcome to Case 2 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. For the next several weeks, we plan to present individual cases followed by some management questions and answers.

Case 2: The case of Mr. Jones
Mr. Jones is a man with (insulin requiring) type 2 diabetes who is admitted for pneumonia. He has had …

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Tumor Lysis Syndrome and the Role of Urinary Alkalinization

September 13, 2007
Tumor Lysis Syndrome and the Role of Urinary Alkalinization

Commentary by Bani Chander MD, PGY-2, and Sergio Obligado MD, Attending Physician, Nephrology

Tumor lysis syndrome (TLS) is characterized by a group of metabolic abnormalities including hyperkalemia, hyperuricemia, and hyperphosphatemia with secondary hypocalcemia, following the initiation of cytotoxic therapy. Although there is no well established definition for this syndrome, the Cairo-Bishop definition is a commonly used classification system that stratifies the degree of severity by utilizing specific laboratory data and clinical features. The constellation of abnormalities that occurs in TLS is due to a …

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X Ray Visions Mystery Quiz- The Answer

August 30, 2007
X Ray Visions Mystery Quiz- The Answer

Before you read the answer, you may want to review the initial Mystery Quiz posted last week.

Commentary by Andrew Hardie MD, Fellow, NYU Department of Radiology

Although this patient’s symptoms were not the most typical of this entity, the CT findings in this case are diagnostic of a perforated anterior duodenal ulcer. The most essential observation, and the one that alters management, is the presence of intraabdominal free air (arrows). The small collections of air in this case are not unusual for bowel perforations, …

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Inpatient Diabetes Management: Case 1

August 28, 2007
Inpatient Diabetes Management: Case 1

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center

Welcome to our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. For the next several weeks, we plan to present individual cases followed by some management questions and answers.

Case 1: The case of Mr. Smith
Mr. Smith is a 65 year old obese male admitted to the hospital with acute renal failure. He reports a recent history …

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X-Ray Visions: Mystery Quiz

August 22, 2007
X-Ray Visions: Mystery Quiz

A 46 year old male with a past medical history of hypertension presents to the emergency room complaining of constant throbbing epigastric pain for one day. He rates the pain as 7/10, with some radiation to his chest. He reports some mild nausea, but denies diarrhea or constipation.  He does endorse a bloated sensation for the past few days. He has not had any fevers and denies melana or hematochezia.  He is an avid biker and reports unlimited exercise tolerance. He denies any previous history …

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An Update on Multiple Sclerosis

August 21, 2007
An Update on Multiple Sclerosis

Commentary by Jacqueline Friedman, MD, Clinical Associate Professor of Neurology,  Director, New York Region Veterans Administration Multiple Sclerosis Center of Excellence

Multiple sclerosis (MS), a chronic disease of the central nervous system, is thought to be initiated by an inflammatory phase followed by degeneration of both white and grey matter. While there is no cure, great strides have been made in the past ten years—we now believe that the earlier a diagnosis is suspected and treatment is initiated, the better the long-term course of the …

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