Systems

Should we treat asymptomatic autoimmune hepatitis?

April 30, 2009
Should we treat asymptomatic autoimmune hepatitis?

Bani Chander MD

Faculty Peer Reviewed

Autoimmune hepatitis (AIH) is a progressive, inflammatory disease of the liver of unknown etiology and may progress to cirrhosis. While it is does have a predilection for women, this disease entity crosses genders and ethnic groups, and may occur in both adults and children. AIH is characterized by a fluctuating course and is often associated with autoimmune features including hypergammaglobulinemia, circulating serum autoantibodies, and hepatitis with lymphoplasmacytic infiltration on liver biopsy . Autoimmune hepatitis is a heterogeneous disease with …

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Mystery Quiz

April 28, 2009
Mystery Quiz

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is a 42 year old man with a history of non-productive cough for several weeks. Three weeks prior to evaluation by the pulmonary service, the patient presented to the ER with a presumed vasovagal syncopal event that occurred on a subway platform. The patient’s prior medical history included allergic sinusitis and nasal polypectomy. Other than cough, the patient denied constitutional symptoms. The patient was not taking any medications. His social history was …

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Breaking News: Swine Flu Reaches New York

April 26, 2009
Breaking News: Swine Flu Reaches New York

Eunice Kang, MD

The Centers for Disease Control (CDC) has confirmed eight cases of swine influenza A (A/H1N1) virus infection in New York City, in addition to a dozen cases caused by the same strain scattered throughout California, Texas, Ohio, and Kansas. The eight confirmed cases in New York are in students who just returned from a trip to Mexico, where officials began reporting three separate outbreaks of influenza-like illness beginning March 18th. According to the New York Times there have been 81 deaths and …

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The Skinny on Cachexia…Can it be Treated?

April 22, 2009
The Skinny on Cachexia…Can it be Treated?

Michael T. Tees, MD, MPH

On the wards and in the clinic, the physician is frequently presented with a patient with a decreased appetite and alarming weight loss. The patient is likely frustrated with their own fraility, the family is upset at the poor nutritional state of their loved one, but the healthcare provider should be the most concerned. This clinical presentation without a prior diagnosis is worrisome, and if the patient does have an underlying etiology, this likely represents progression.

Caring for the cachectic …

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Clinical Questions: How do you dose argatroban?

April 16, 2009
Clinical Questions: How do you dose argatroban?

Frederick Gandolfo, MD

Case: An 85 year-old woman admitted to the hospital with pneumonia and after a prolonged hospital course developed heparin-induced thrombocytopenia (HIT). She is currently being treated with argatroban and her platelet counts are recovering. You are the covering physician and are called by the lab for an INR of 12 on her routine labs. The patient shows no signs of bleeding and she is not on warfarin. The PTT at the time is 160 seconds. What is the appropriate course of action?…

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Grand Rounds: Gastroesophageal Reflux Disease (GERD)

April 15, 2009
Grand Rounds: Gastroesophageal Reflux Disease (GERD)

Summary by Daniel Frenkel MD

Please also see the clinical vignette presented before grand rounds on the 1st of April.

In his grand rounds lecture on April 1st 2009, Dr. Fritz Francois enlightened us to some novel aspects of gastroesophageal reflux disease (GERD). Despite simple and effective treatment approaches such as acid suppression medication, Dr. Francois explored “why the issues are still burning?” by discussing the changing face of GERD, the connection to obesity, and it’s association with Helicobacter Pylori.

What is GERD? As Dr. …

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Grand Rounds: Purines, Alcohol, and Fatty Liver Disease

April 8, 2009
Grand Rounds: Purines, Alcohol, and Fatty Liver Disease

Commentary by Peter Shue MD, PGY-3

The medical grand rounds presentation on March 4, 2009 was delivered by a distinguished NYU faculty member and research investigator, Dr. Bruce Cronstein.  Although his training and research is primarily in rheumatology, he breathed new insight into mechanisms of fatty liver disease.  In his talk, he reviewed his own published experiments showing that fatty liver disease, similar to gout, is potentiated by elevations in adenosine.  In gout, excess adenosine is ultimately metabolized to uric acid which is then deposited …

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Bedside to Bench: Clubbing Revisited

April 3, 2009
Bedside to Bench: Clubbing Revisited

Commentary by Judith Brenner MD, Associate Editor, Clinical Correlations 

Faculty Peer Reviewed 

For an internist, discovering a patient with clubbing is so rewarding since it appeals to the core of our profession, a profession which can often be very similar to that of a detective. The physical finding of clubbing was first described by the ancient Greeks, who recognized it to be a clue to much more.

When a clinician discovers clubbing of the fingers, he must consider that hypoxemia may be present, whether secondary …

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