Systems

Reemergence of the Great Imitator: Overview of the Diagnosis and Treatment of Syphilis

August 17, 2007
Reemergence of the Great Imitator: Overview of the Diagnosis and Treatment of Syphilis

Commentary by Rosemary Adamson, PGY2,  Deena Altman PGY-1 and Harold Horowitz, Professor of Medicine, Section of Infectious Diseases 

Syphilis is back! You know the drill: an 80-something year old man presents with dementia and you send the TSH, B12 and RPR and get a head CT, all the while expecting some microvascular disease & age-related cortical volume loss. Imagine my surprise when my VA patient had a positive RPR and then the lumbar puncture returned a positive VDRL. To be fair, he wasn’t…

Read more »

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

August 8, 2007
Part II- Subclinical Thyroid Dysfunction: To Treat or Not to Treat?

Commentary by Melissa Freeman MD, PGY2

Please also see Part I of this series

In 2002, the American Association of Clinical Endocrinologists (AACE), the American Thyroid Association (ATA), and The Endocrine Society (TES) sponsored an evidence- based Consensus Development Conference with a panel of thirteen experts to address unresolved issues about subclinical thyroid dysfunction. Though these sponsors agreed with many of the recommendations made by the consensus, they felt that they relied too heavily on evidence-based medicine that did not yet exist. Two years later,…

Read more »

Atrial Fibrillation Part 2: Additional Words of Wisdom

August 3, 2007
Atrial Fibrillation Part 2: Additional Words of Wisdom

Commentary by William Slater, MD Associate Professor of Medicine, Divsion of Cardiology

The vast majority of patients with persistent AF can be rendered asymptomatic with AV nodal blocking drugs and don’t require ablation. Digitalis is underused but is often of major benefit, either
alone, or in combination with beta blockers or calcium channel blockers.

Of paroxysmal fibrillators, most can be managed by reassurance that the episodes are harmless with a normal heart and of minimal risk if brief even in context of…

Read more »

Management and Consequences of Atrial Fibrillation

August 2, 2007
Management and Consequences of Atrial Fibrillation

Commentary by Timothy Wong, MD

A group of short articles focusing on the consequences and management of atrial fibrillation (AF) recently appeared in the July 7th issue of the Health section of the New York Times. In brief, the articles highlighted the risks of thromboembolism, the lack of very successful medical therapies, and the growing demand for catheter-based atrial fibrillation ablation procedures.

As a cardiology fellow on the consultation service at a teaching hospital in western Pennsylvania, I find that atrial fibrillation…

Read more »

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…

Read more »

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…

Read more »

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…

Read more »

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…

Read more »

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…

Read more »

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…

Read more »

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.…

Read more »

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…

Read more »