Clinical Questions

The Polymyxins: Why am I using them all the time, and what are they?

December 8, 2010
The Polymyxins: Why am I using them all the time, and what are they?

By Jon-Emile S Kenny

Faculty Peer Reviewed

A 65-year-old female with locally advanced rectal cancer is admitted to the ICU, hypotensive and febrile.  Her PICC line is removed and blood cultures drawn.  Fourty-eight hours later all cultures return ESBL Klebsiella with susceptibility only to polymyxin.

 I sat on the venerable call-room couch staring mindlessly at the cluttered, nauseating walls repeating the word ‘polymyxin’ like an endless antimicrobial mantra.  What strange dosing it has, and an even more…

Read more »

Circumcision as Primary Protection?

October 8, 2010
Circumcision as Primary Protection?

Emily Taylor, MD  

Faculty Peer Reviewed

The earliest documented evidence of circumcision is in artwork from the Sixth Dynasty in Egypt (2345-2181 BC) found in a wall relief from Saqqara in Lower Egypt. Circumcised North Americans were described by Columbus upon arrival to the continent; circumcision was practiced by Australian aboriginals, native South Americans, and Pacific Islanders. It is unknown if circumcision was common amongst some earlier ancestor of all these peoples, or if it evolved independently in societies…

Read more »

Does Heyde Syndrome (The Association Between Aortic Stenosis And Intestinal Angiodysplasia) Exist?

September 29, 2010
Does Heyde Syndrome (The Association Between Aortic Stenosis And Intestinal Angiodysplasia) Exist?

By Laura Dunn, MD

Faculty Peer Reviewed 

In 1958, EC Heyde published 10 cases of aortic stenosis (AS) and arteriovenous malformations (AVMs) of the gastrointestinal tract in the New England Journal of Medicine .  Thus, the association between aortic stenosis and intestinal angiodysplasia became known as Heyde Syndrome.  Yet the existence of this syndrome has been controversial. 

 Contrasting conclusions have been obtained by studies conducted to evaluate this association.  In a prospective study, Bhutani and colleagues did…

Read more »

Myths & Realities: Is Shiftwork Tumorgenic?

June 23, 2010
Myths & Realities: Is Shiftwork Tumorgenic?

By David Ecker, MD

Faculty Peer Reviewed

Over the last several decades, Westernized countries have become 24-hour societies.  Approximately 21 million workers in the US are on non-standard work shifts, including almost 4 million on regular overnight shifts.  In 1972, Taylor and Pocock published a mortality study, in which they reported a significantly increased incidence of neoplasms in shift workers compared to the general population.  After several published cancer incidence studies, Kerenyi explicitly proposed that changes in light exposure could be…

Read more »

Does Dietary Modification Help GERD?

June 18, 2010
Does Dietary Modification Help GERD?

By Ramya Srinivasan, MD

Faculty Peer Reviewed

 The patient is a 29 year old overweight male presenting to clinic with complaints of reflux symptoms. He says that spicy foods aggravate these symptoms. In addition to weight loss counseling, he is given a prescription for esomeprazole along with a patient handout containing recommendations on foods to avoid and other behavior modifications that may ameliorate his symptoms.

 Gastroesophageal reflux disease (GERD) is defined as the abnormal reflux of gastric contents into the esophagus…

Read more »

Oral Contraceptive Pills: Is It Really Safe to Eliminate Your Period?

May 21, 2010
Oral Contraceptive Pills: Is It Really Safe to Eliminate Your Period?

By Rachel Edlin, MD  

Faculty peer reviewed

A 29-year-old female patient with a history of iron deficiency anemia and heavy menstrual periods comes into the clinic for a regular visit. She is tired of iron supplementation and its associated constipation. As she is currently on oral contraceptive pills, you recommend using these to reduce her menstrual period to four times a year. She asks, “Is that really safe?”

 Is menstruation necessary?

Read more »

Motivational Interviewing: Can You Really Change Behaviors?

April 27, 2010
Motivational Interviewing: Can You Really Change Behaviors?

Emily Stamell

Faculty peer reviewed

As a well-trained fourth year medical student, I inquire about smoking habits as part of almost all my patient encounters. Yet, I do not recall properly counseling a patient on smoking cessation aside from the one liner “You know you should quit, right?” During first and second year of medical school we are taught the stages of change model, which is just as obscure two years later as cell signaling pathways. I was recently…

Read more »

What is the Role of Drug Therapy in Treating Obesity?

November 19, 2009
What is the Role of Drug Therapy in Treating Obesity?

Arlene Chung

Faculty Peer Reviewed

Despite the high prevalence of obesity1 and its associated morbidity2 and mortality 3,4, it represents one of the most difficult chronic conditions to treat. Barriers include a metabolically toxic environment, a history of ill-fated weight-loss regimens, and a general view of obesity as primarily a social, not a medical problem. 5 Deep down, the belief that obesity really is the result of gluttony and sloth probably persists. However, as we learn more about the…

Read more »

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…

Read more »

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.…

Read more »

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…

Read more »

Real Time Clinical Question: Rheumatology

February 13, 2009
Real Time Clinical Question: Rheumatology

Commentary by Jon-Emile Kenny MD, PGY- 2 

Faculty Peer Reviewed

At morning report, the case of a 55 F with known dermatomyositis (DM), and interstitial lung involvement who had presented to the hospital with increasing dyspnea was presented.  The discussion of the case opened with the cardinal manifestations of DM including proximal muscle weakness as diagnosed with EMG, cutaneous manifestations such as the heliotrope rash, the shawl sign, Gottron’s papules, Reynaud’s, and ‘Mechanics Hand’, and the systemic manifestations such as interstitial lung disease.…

Read more »