Systems

Morning Report: How Do You Approach a Patient With Bronchiectasis

January 16, 2007
Morning Report: How Do You Approach a Patient With Bronchiectasis

Chief complaint: 85 year old female presents with worsening shortness of breath for one day.

History of present illness:

The patient’s history of present illness begins at the age of 60 when she was diagnosed with asthma, for which she had been treated with inhaled anticholinergics, beta agonists and intermittent oral steroids.  Twelve years prior to admission, the patient was diagnosed with diabetes, which was managed with oral medications.  Two years prior to admission, the patient was diagnosed with Mycobacterium avium complex (MAC) at an…

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To Lavage or Not to Lavage?

January 10, 2007
To Lavage or Not to Lavage?

Case and Commentary by Minisha Sood PGY-3 and Ilseung Cho Fellow, Division of Gastroenterology

The patient is a 57 year-old man with a past history of hypetension, hyperlipidemia, hepatitis B/C cirrhosis and coronary artery disease status/post a non-st-elevation mi in August 2006, during which time he was on a heparin drip and developed an upper gastrointestinal bleed. Upper endoscopy at that time revealed non-bleeding esophageal varices and he was discharged on a beta blocker. He again presented to Tisch hospital in December 2006 with complaints…

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Why Are Breast Cancer Rates Trending Down?

January 9, 2007
Why Are Breast Cancer Rates Trending Down?

The recent finding of decreasing breast cancer rates made headlines throughout the media; including a NY Times article entitled, Reversing Trend, Big Drop is seen in Breast Cancer on December 15, 2006.

Striking epidemiological facts tells us that breast cancer is the most common cancer in women in the U.S., and only second to lung cancer as the most common cause of cancer deaths. It is estimated that approximately 212,920 American women will be diagnosed with breast cancer in the year…

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A Bad Break for the Purple Pill…

January 8, 2007
A Bad Break for the Purple Pill…

Commentary By Josh Remick, PGY-2

In the December 27th 2006 issue of JAMA, Yang et al. reported the results of a nested case-control study of United Kingdom patients entitled “Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture.” Using the General Practice Research Database (GPRD), a computerized medical record system used by several of the general medical practices in the UK, new hip fracture cases were found in patients at least 50 years old (n=13,556) and matched them with…

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Links: Dermis.net-An Online Dermatology Atlas

January 5, 2007
Links: Dermis.net-An Online Dermatology Atlas

The best online dermatology atlas I have come across is dermIS.net.  The site originates from Germany and includes an excellent, easily searchable database with terrific pictures and clinical information. The most useful feature of the site however is the differential diagnosis list which appears next to the pictures that are displayed.  So if you have an educated guess what the rash you're looking at is, then you can easily review similar rashes and quickly compare and contrast them to your original diagnosis. Then you can make the fancy diagnosis, sound smart…

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Do Statins Get Along With Hepatitis C?

January 4, 2007
Do Statins Get Along With Hepatitis C?

A 53 year old male with chronic hepatitis C and type 2 diabetes is found to have a moderately elevated cholesterol.

1. Is it safe to start a statin?

2. Do statins have any effect on viral replication?

Comentary By Ed Bini, M.D. Associate Professor/Director Gastroenterology and Hepatology Research

The many benefits of statins far outweigh the risks associated with this class of medications. However, statins are known to have the potential to cause hepatotoxicity. The most common form of statin-induced hepatotoxicity is elevations in…

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Does the Existence of Community Acquired MRSA Change Empiric Therapy for Skin and Soft Tissue Infections?

January 3, 2007
Does the Existence of Community Acquired MRSA Change Empiric Therapy for Skin and Soft Tissue Infections?

A 58 year old man with type 2 diabetes and chronic venous insufficiency/recurrent lower extremity cellulitis presents with fever and a left lower extrmity ulcer with purulent drainage. He’s been successfully treated in the past with both Unasyn/Augmentin or Levaquin.  In the face of community acquired methicillin resistant staph aureus (CA-MRSA),  have guidelines for skin and soft tissue infections changed?

Commentary By Howard Leaf, M.D. Assistant Professor, Division of Infectious Diseases and Immunology

 

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How Frequently Should You Perform a Follow-Up Colonoscopy-A multiple choice quiz

January 2, 2007
How Frequently Should You Perform a Follow-Up Colonoscopy-A multiple choice quiz

Commentary By Michael Poles, M.D. Gastroenterologist, Assistant Professor of Medicine, Mircrobiology and Pathology.

Every once in a while I will be feeding this new blorganism (or is it bloganism?) with content from the world of gastroenterology. Today I would like to review an article of importance to both gastroenterologists and internists. There is likely no topic in gastroenterology more important than that of colorectal cancer screening. Colorectal cancer is the second most common cause of cancer death in the U.S., and it takes up…

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Morning Report-A Frequently Overlooked Diagnosis

December 28, 2006
Morning Report-A Frequently Overlooked Diagnosis

A 57 year old female  with a past medical history of hypertension, obesity, remote intravenous drug use and several years of chronic low back pain, with both intermittent radiation to her lower extremities  and decreased sensation in her lower extremities  presented with an acute worsening of the pain in her lower back.  The patient reported that she was awakened from sleep and "had to crawl to the bathroom," because of the pain.  She was febrile on admission with moderate lower spine tenderness.  She was…

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Breaking News: FDA Advises Caution with Gadolinium Based Contrast

December 27, 2006
Breaking News: FDA Advises Caution with Gadolinium Based Contrast

Commentary By: Minisha Sood PGY-3

The FDA has received reports of 90 patients with moderate to end-stage kidney disease who have undergone MRI or MRA with a gadolinium-based contrast agent and subsequently developed a new disease known as Nephrogenic Systemic Fibrosis (NSF).

Scientists first identified NSF, also known as Nephrogenic Fibrosing Dermopathy (NFD), in 1997 and its cause has not yet been identified.  There have been approximately 200 reports of NSF/NFD only in people with kidney disease.  Neither the duration of kidney disease nor its…

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Who Should Receive Prophylaxis for Gout?

December 26, 2006
Who Should Receive Prophylaxis for Gout?

A 70 year old male, former alcoholic, with a past history of gout diagnosed by joint aspiration, presents with his second episode of right 1st metatarsal erythema, swelling and severe pain in the last 6 months.

Commentary By Pamela Rosenthal, MD Assistant Professor of Medicine, Division of Rheumatology

 

Question 1. Is there any specific rule you follow when deciding to start someone on colchicine prophylaxis? e.g. >x # episodes

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Should we recommend mammography screening for women between the ages of 40-50?

December 22, 2006
Should we recommend mammography screening for women between the ages of 40-50?

In a recent article in the Lancet, this question was addressed by a group of investigators led by Sue Moss, Ph.D. from the University of Leeds.  Currently, the  National Cancer Institute, U.S. Preventative Health Services Task Force and the American Cancer Society all recommend screening at a younger age(those between 40-50).  The task force, however, does recommend educating your patients about the potential risks/benefits regarding mammography at a younger age.  Screening women older than 50 has been shown to reduce mortality from breast cancer by…

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