Systems

Safety of Long-Acting Beta-Agonists in the Treatment of Asthma: Should they be used?

February 21, 2007
Safety of Long-Acting Beta-Agonists in the Treatment of Asthma: Should they be used?

Commentary By: Sarah Huen, PGY-3 and David Chong, Director of Critical Care, Bellevue Hospital, Associate NYU Internal Medicine Residency Program Director

The role of long-acting b-agonists (LABAs) in the treatment of asthma continues to be controversial. Growing evidence that LABAs may cause an increased risk of asthma exacerbations and asthma-related deaths prompted the U.S. Food and Drug Administration (FDA) to approve “black box” safety warning labels for Serevent Diskus (salmeterol xinafoate), Advair Diskus (fluticasone propionate; salmeterol xinafoate), and Foradil (formoterol fumarate). Concern about…

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Should patients with Anemia and a Normal Ferritin Undergo Colonoscopy?

February 16, 2007
Should patients with Anemia and a Normal Ferritin Undergo Colonoscopy?

Commentary By: Joshua Olstein PGY-3

Second only to lung cancer, colon cancer claimed an estimated 55,000 lives in the United States in 2006. In an effort to reduce colon cancer morbidity and mortality, multiple screening tests have been developed to detect early disease among asymptomatic individuals. The 2003 American Gastroenterology Associations guidelines for screening asymptomatic individuals recommended colonoscopy as a preferred method of screening.

Due to a higher risk of colonic neoplasm, patients with unexplained iron-deficiency anemia are not included in these…

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PB&J Hold the P: Salmonella Outbreak Linked to Peanut Butter

February 15, 2007
PB&J Hold the P: Salmonella Outbreak Linked to Peanut Butter

Commentary By: Cara Litvin PGY-3

 

The CDC has issued a public health advisory regarding a large outbreak of Salmonella infections in 39 states since August. As of Tuesday February 14, 288 cases had been reported to the CDC. Among the 120 patients for whom clinical information is available, 31 patients have been hospitalized, and no deaths have been reported. The most cases have been reported in New York, Pennsylvania,…

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What Is XDR-TB?

February 12, 2007
What Is XDR-TB?

Commentary By: Marshall Fordyce, PGY-3

Extensively drug-resistant tuberculosis (XDR-TB) is as ominous as it sounds. As a second-year resident on the Chest service, you may have treated one or two patients with multi-drug resistant tuberculosis (MDR-TB), which is resistant to at least INH (Isoniazide) and RIF (Rifampin), the two most powerful first-line agents. However, when TB becomes designated as XDR-TB, it implies resistance to any and all Fluoroquinolones and at least one of the three injectable second-line drugs (Amikacin, Capreomycin, and Kanamycin).…

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More Smoke From the Tobacco Industry

February 8, 2007
More Smoke From the Tobacco Industry

Commentary By: Elizabeth Ross, PGY-3

Cigarette manufacturers have been steadily increasing the nicotine content in cigarettes over the last 7 years.  The news broke in August of this year when the Massachusetts Department of Public Health discovered that the level of nicotine that smokers typically consume per cigarette had risen about 10 percent.

The Harvard School of Public Health recently re-analyzed the data with the goal of ascertaining how the tobacco industry managed the increase in nicotine content.  The investigators found…

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How Should You Approach A Patient with an Incidental Finding of a Portal Vein Thrombosis?

February 7, 2007
How Should You Approach A Patient with an Incidental Finding of a Portal Vein Thrombosis?

A  70 year old man  with a history of prostate cancer, status post radiation treatment in August 2003, a history of abdominal surgery for unknown reasons, and a history of heavy alcohol use was seen at the VA.   The patient was referred for a complaint of bright red blood per rectum and was incidentally noted to have elevated liver enzymes. 

Colonoscopy revealed blood in the rectosigmoid, dilated vessels in the rectum and angioectasia, thought to be secondary to the radiation…

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Mystery Quiz #2-The Answer

February 6, 2007
Mystery Quiz #2-The Answer

Before you read the answer you will probably want to review the original post of the mystery quiz from last week.

The pathology has been correctly identified.  The photomicrograph shows lipoid pneumonia, which in fact was due to chronic mineral oil ingestion (aspiration). The patient suffered from constipation, due to long usage of oxycondone, and medicated himself with mineral oil. The pathology shows lipid material, some of it pooled into large coalescent droplets, some in macrophages.

Lipoid pneumonia…

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Ethics 101-How Do You Approach a Jehovah’s Witness Patient Who Needs a Transfusion?

February 5, 2007
Ethics 101-How Do You Approach a Jehovah’s Witness Patient Who Needs a Transfusion?

A 76 year old man with a history of coronary artery disease, diabetes and hypertension was brought in by his wife with two days of lethargy, slurred speech and right arm weakness. On presentation, the patient was awake and intermittently involved in conversation.  He was afebrile, with a pulse of 90 and blood pressure of 166/98  His exam was remarkable for dysarthria, orientation only to person, pinpoint pupils, left sided tongue deviation, 3/5 motor strength in the right upper extremity, 4/5 motor strength in…

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Bedside Rounds #1: Why is a pulsus paradoxus not a paradox?

February 1, 2007
Bedside Rounds #1: Why is a pulsus paradoxus not a paradox?

Welcome to our inaugural Bedside Rounds a new regular feature of Clinical Correlations.  Here you will learn not only practical physical diagnosis pearls, but also the historical context in which these findings were discovered.

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

When you take a deep breath in, what happens? Because of an increase in the negative intrathoracic pressure, blood is sucked into the right side of the heart. Temporarily, a filled right ventricle can bulge…

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Mystery Quiz #2 (with a hint…)

January 30, 2007
Mystery Quiz #2 (with a hint…)

Since we received little in the way of responses to our mystery quiz, we thought a hint might be in order, so here's the case again this time with a hint.  Please submit your answers by clicking on the "comments" link below this post.  As always, for those of you who are unwilling to attach your name,  you can post your comments anonymously. 

The patient is a 77 year old male whose chief complaint was severe left hip pain of five years duration.  As part of a…

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How Should You Treat Agitation in Patients with Dementia?

January 29, 2007
How Should You Treat Agitation in Patients with Dementia?

Case: A 74 year old male with a history of hyperthyroidism, now treated and euthyroid, and with longstanding slowly progressive Alzheimer’s, has now become increasingly agitated at home, pacing the floors and not sleeping. In light of side effects and the recent warning against the use of atypical antipsychotics and the side effects of the older medications, what kind of stepwise approach to medications would you recommend to use to treat his agitation?

Commentary By Brian Bronson, MD Clinical Assistant Professor of Psychiatry,

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A New Take on Quitting Smoking…

January 26, 2007
A New Take on Quitting Smoking…

Landing on the front page of the New York Times today is a study from Science that may turn addiction medicine on its head…no pun intended.   Of 32 smokers who had suffered a brain injury, they found that 16 who had suffered damage to the insula were easily able to quit smoking almost fully disrupting their smoking behavior in comparison to the other 16 who had suffered damage elsewhere.  The insula is a region of the brain that has been previously implicated in…

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