Systems

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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The First Joint Medical-Surgery Conference

December 21, 2006
The First Joint Medical-Surgery Conference

The first monthly medical/surgery conference was a great success. Attended by resisdents and attendings from both departments the conference was a lively discussion regarding the controversies in caring for a 51 year old man who recently underwent a percutaneous coronary intervention with the placement of a Cypher stent after a non-st elevation myocardial infarction, who soon afterwards was found to have a gall bladder mass that needed to be resected. The complete slide presentation can be found here: Joint Medicine-Surgery Conference Slides
A…

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Mystery Quiz #1-The Answer…

December 20, 2006
Mystery Quiz #1-The Answer…

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

The Answer:

The chest film shows a probable mass in the area of the left hilum and associated complete collapse of the left upper lobe.  The key findings are loss of volume of the left hemithorax indicated by elevation of the left hemidiaphragm and shift of the mediastinum to the left side.  Additionally, the arrows indicate the major fissure, ordinarily not visible,…

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How do you approach a patient with Pneumomediastinum?

December 19, 2006
How do you approach a patient with Pneumomediastinum?

BH Morning Report Fast Facts

29 year old male presents with anuria, vomiting, and pneumomediastinum.  1 month prior to admission the patient traveled to South America and developed an upper respiratory infection.  He returned to the US after traveling for two weeks feeling well.   The patient used ecstasy and marijuana four days prior to presentation.  The next day he developed vomiting including one episode of hemetemesis.  For the next three days he had intermittent vomiting, no diarrhea.  On admission his BUN/CR was 68/7.5. …

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Does Circumcision Decrease the Transmission of HIV?

December 18, 2006
Does  Circumcision Decrease the Transmission of HIV?

Recently, two large clinical trials in Kenya and Uganda that examined the role of circumcision in men to prevent the spread of HIV were halted on the grounds that not offering circumcision to men taking part in the trial would be unethical.  The trials involved nearly 3,000 heterosexual men in Kenya and nearly 5,000 men in Uganda, none of whom were infected with HIV prior to starting the trial.  In the Kenayn trial, men who were circumcised had a 53% relative risk reduction (2%…

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When Can You Safely Anticoagulate a Patient after an Intracranial Hemorrhage?

December 15, 2006
When Can You Safely Anticoagulate a Patient after an Intracranial Hemorrhage?

55 year old white male falls down a flight of stairs and sustains a subdural hemorrhage and a subarachnoid hemorhage with significant neurological changes. Hospital course was notable for 1 episode of chest pain without ekg changes and negative cardiac enzymes.  The patient was seen several months later in medicine clinic with resolution of his neurologic findings but now with multiple episodes of chest pain.  He was sent for a stress test which showed a mild reversible anterior wall defect, with normal left ventricle and…

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Epogen and Anemia-Less is More (Part 2)

December 14, 2006
Epogen and Anemia-Less is More (Part 2)

Commentary By David Goldfarb, M.D. Professor of Medicine, NYU Medical Center, Chief Nephrology Section VA New York Harbor

 

2 weeks ago we reported on 2 lead articles in the New England journal that suggested that our targets for hemoglobin values when treating with erythropoietin were too high.

Last week, the New York Times reported that based on those NEJM articles (CHOIR and CREATE), the National Kidney Foundation, which publishes…

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Mystery Quiz-Radiology

December 13, 2006
Mystery Quiz-Radiology

Posted By Robert Smith, MD Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine 

62 year old male smoker with past medical history notable for hypertension, copd, comes to clinic complaining of chronic cough x 6 months with minimal sputum, no wheezing.  Lung exam shows decreased breath sounds throughout.  Pt had the following CXR performed:

    

Click on Thumbnail to Enlarge

What's your diagnosis and the next step in his evaluation?  Please submit your answers by clicking on the "comments" link below this post. …

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FDA Warns of Methadone Dangers When Used for Chronic Pain

December 12, 2006
FDA Warns of Methadone Dangers When Used for Chronic Pain

Last week, the FDA issued a public health advisory regarding the use of methadone (trade name Dolophine) for chronic pain. Death and life threatening side effects have been reported in patients newly starting methadone treatment and patients who have switched to methadone after taking other narcotics for pain control.  According to the advisory, prescribing methadone is complex and should only be used when moderate to severe pain is not relieved by other non-narcotic pain relievers.

Although pain relief from a…

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What Is Sezary Syndrome?

December 11, 2006
What Is Sezary Syndrome?

Morning Report-Tisch Hospital

Case Presentation: 83 year old with a past medical history of hypertension noted erytematous plaques with scale about 1 year ago.  The rash was associated with diffuse pruritis at that time.  The patient subsequently underwent several inconclusive biopsies.  She was eventially diagnosed with mycosis fungoides and treated with UV therapy.  Her rash progressed to a diffuse pruritic erythema covering the vast majority of her body, including palms and soles.  (erythroderma).  She was noted to have Sezary cells on peripheral smear and diagnosed…

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Outbreak: Toxic Tacos

December 7, 2006
Outbreak: Toxic Tacos

Update 12/12/06  Download new NY DOH Alert

Several Taco Bell restaurants in our area have been shut down recently due to an outbreak of E. Coli O157:H7.  At least 22 people are infected, and most are under age 18.  Interestingly, at least 2 Taco Bell employees have been found to carry the bacteria but are asymptomatic.

The vector is usually undercooked infected meat.  Symptoms usually present within 3-4 days of ingestion. The department of health has issued a warning to physicians to consider this diagnosis if…

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