Systems

Meeting Perspectives: Digestive Disease Week (DDW) 2007

June 20, 2007
Meeting Perspectives: Digestive Disease Week (DDW) 2007

Commentary by Milini Sahu, MD Fellow, Division of Gastrotenterology, Gina Sam-DeRiggs, Fellow, Division of Gastroenterology, and Michael Poles MD,  Assistant Professor, NYU Division of Gastroenterology and Associate Editor, Clinical Correlations

Close to 17,000 gastroenterologists attended Digestive Disease Week (DDW) from May 19-24 in Washington DC. While I stayed behind (someone has to help with emergency endoscopies), the majority of NYU’s gastroenterology fellows and attendings were there for a week of learning, presenting, and making NYU proud.  Two of our fellows, Malini…

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Hyperparathyroidism in Chronic Kidney Disease

June 13, 2007
Hyperparathyroidism in Chronic Kidney Disease

Commentary by Sarah Berry MD, PGY-3 and Joseph Weisstuch, MD Clinical Assistant Professor of Medicine, Divsion of Nephrology

Case: Mr. K is a 59 year old gentleman with a past medical history of hypertension, non-insulin dependent diabetes mellitus, dyslipidemia and worsening chronic kidney disease (CKD) over the last six years, despite compliance with his medications and optimized glucose and blood pressure control. His current medication regimen includes metoprolol, hydrochlorothiazide, aspirin, simvastatin, glyburide, and monopril. Mr. K’s most recent lab work indicates that his…

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Clinical Commentary: The Travesty of Grinding Axes with Science: Rosiglitazone and Cardiac Risk

June 12, 2007
Clinical Commentary: The Travesty of Grinding Axes with Science: Rosiglitazone and Cardiac Risk

Welcome to our first blog commentary. One of the purposes of the blog is to generate discussion about issues in health care. This “Clinical Commentary” section is an invitation to our housestaff and faculty to submit their own thoughts and viewpoints on current issues. The views expressed in this section are soley those of the authors and do not necessarily represent the views of Clinical Correlations.

Commentary by Gregory Mints MD and Nirav Shah MD, MPH

The meta-analysis of Rosiglitazone’s effect on cardiovascular events…

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Can you switch a patient from insulin to oral agents?

June 6, 2007
Can you switch a patient from insulin to oral agents?

  A 48 year old male is diagnosed with type 2 Diabetes Mellitus after presenting to the emergency room with symptoms of hyperglycemia. He was immediately started on insulin and has been very compliant with his regimen. His initial Hemoglobin A1C at the time of diagnosis was 15.  However, over the past few months, due to hypoglycemia, his insulin dosage has been titrated down. He is currently on low doses of NPH and aspart, with an A1C of 6.6. Would it be possible to

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Meeting Perspectives: 2007 American Thoracic Society International Conference

June 5, 2007
Meeting Perspectives: 2007 American Thoracic Society International Conference

Commentary by Doreen Addrizzo-Harris MD, Associate Professor, Division of Pulmonary and Critical Care Medicine

The 2007 American Thoracic Society (ATS) meeting took place between May18-23 in San Francisco, California at the Moscone Conference center.  There were more than 400 sessions, 800 speakers and 5,500 original research abstracts.  The meeting is concentrated in the areas of pulmonary, critical care and sleep medicine.

The NYU Division of Pulmonary and Critical Care medicine, under the direction of Dr. William N. Rom, presented more than 30…

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Recent Developments in the Treatment of Renal Cell Carcinoma

May 31, 2007
Recent Developments in the Treatment of Renal Cell Carcinoma

Commentary by Michael Seidman MD, Chief Oncology Fellow

New treatment options for both early and advanced Renal Cell Cancer have recently been published. Traditionally, treatment for early stage disease was partial or radical nephrectomy. In the metastatic setting, treatment options were limited to toxic cytokine therapy with IFN or IL-2.

Some recent literature has suggested that small, incidentally found renal tumors can safely be watched without the need for invasive surgery. Remzi et al retrospectively reviewed 287 tumor bearing kidneys 4cm or…

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New Guidelines on the Management of Intracerebral Hemorrhage

May 30, 2007
New Guidelines on the Management of Intracerebral Hemorrhage

Commentary by Dr. Daniel Labovitz, Director of the NYU Stroke Center

After an 8-year hiatus, the American Heart Association/American Stroke Association has at last published a fresh set of guidelines on the management of acute spontaneous intracerebral hemorrhage (ICH) . ICH represents between 10 and 20% of all first strokes, depending on the population, but carries a mortality rate of 35% to 50%, with hemorrhage volume, hemorrhage location, intraventricular extension and age all contributing independently to the risk of death.…

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How should you approach a pregnant patient with chronic kidney disease?

May 25, 2007
How should you approach a pregnant patient with chronic kidney disease?

A 31 year old female with hypertension and proteinuria secondary to IgA nephropathy, currently treated with an ARB, presents to clinic stating that she would like to become pregnant.

What is the risk of fetal morbidity in the setting of ARBs/ACE-inhibitors? What antihypertensive medications are used during pregnancy? At what point would you switch a patient’s medications if she is trying to become pregnant? What is the natural course of IgA nephropathy during pregnancy?

-Minisha Sood MD, PGY-3

Pregnancy and Chronic Kidney

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FDA Black Box Warning on Gadolinium

May 24, 2007

Back in December we reported on the FDA cautioning practioners about the use of gadolinium (an mri contrast agent) in patients with chronic kidney disease.  The FDA is now requesting a black box warning  stating “that patients with severe kidney insufficiency who receive gadolinium-based agents are at risk for developing a debilitating, and a potentially fatal disease known as nephrogenic systemic fibrosis (NSF). In addition, it would state that patients just before or just after liver transplantation, or those with chronic liver disease, are also at risk…

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Not So Rosi…

May 24, 2007
Not So Rosi…

Commentary by Seagram Villagomez MD, Chief Resident

Since its approval in 1999, nearly 1 million Americans have used the thiazolidinedione (TZD) rosiglitazone (Avandia – GlaxoSmithKline) for the treatment of Type 2 Diabetes.  However, in a drug class which seems plagued by concerns, the safety profile associated with rosiglitazone has been brought to question. Previously, troglitazone (Rezulin) was pulled off the market secondary to hepatoxicity, while muraglitazar was not approved by the FDA given adverse cardiovascular events during early clinical trials.  In a…

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Mystery Quiz #3-The Answer

May 15, 2007
Mystery Quiz #3-The Answer

Before you read the answer you should read the orginal post form last week

The Final Poll Results (26 votes): metastatic disease (26%) , mycobacterial disease (22%) ,fungal disease (22%), bronchiolitis obliterans with organizing pneumonia (boop) (13%), septic emboli (9%) ,vasculitis, e.g. wegener’s (4%), thromboembolic disease (4%), sarcoid (0%)

The patient had granulomatous inflammation on pathology with acid-fast organisms seen. The culture grew mycobacterium avium (MAC). After treatment with azithromycin, ethambutol and rifabutin for eighteen months, the follow-up imaging showed significant clearing…

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The HPV vaccine: Recommended in the U.S., but required in Virginia

May 8, 2007
The HPV vaccine: Recommended in the U.S., but required in Virginia

Commentary By: Marshall Fordyce, PGY-3

Now that the dust has settled in Texas and Virginia, let’s clarify the role of the human papilloma virus (HPV) vaccine in our clinics. An excellent article in last week’s JAMA by its Editor-In-Chief, Dr. Catherine DeAngelis, and Lawrence Gostin, JD, highlights how the recent push for compulsory vaccination – a significant step beyond CDC recommendations – defied precedent and threatened public confidence in our national vaccine policy. Now, after the tussle of aggressive pharmaceutical lobbying and the public outcry…

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