Clinical Questions

Is Vasopressin Indicated in the Management of Cardiac Arrest?

February 2, 2011
Is Vasopressin Indicated in the Management of Cardiac Arrest?

By Brandon Oberweis, MD

Faculty Peer Reviewed

Case Report:

A 65-year-old male with a past medical history significant for NYHA class IV heart failure was found by his wife to be unresponsive.  Emergency Medical Services was subsequently called and upon arrival, initiated chest compressions and defibrillation for cardiac arrest secondary to ventricular fibrillation.  Intravenous access was obtained and despite two episodes of defibrillation, the patient remained in ventricular fibrillation.  The patient was given one dose of 40 U of vasopressin followed by 1 mg …

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Should You Eradicate Helicobacter Pylori Prior to Chronic NSAID Treatment?

January 19, 2011
Should You Eradicate Helicobacter Pylori Prior to Chronic NSAID Treatment?

By Joshua Smith, MD

Faculty Peer Reviewed

CASE:  A 54-year-old Asian female with no significant past medical history presents to her primary care physician with the complaint of several weeks of pain in her fingers bilaterally along with pronounced, worsening morning stiffness.  She is subsequently diagnosed with rheumatoid arthritis (RA), and the decision is made to start her on long-term, high-dose non-steroidal anti-inflammatory drugs (NSAIDs).  Given the link between NSAIDs and peptic ulcer disease (PUD), should this patient first be tested, and if positive, treated …

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Is a Low Vitamin D Level a Risk Factor for Colon Cancer?

December 16, 2010
Is a Low Vitamin D Level a Risk Factor for Colon Cancer?

By Nelson Sanchez, MD and Fritz Francois, MD, MS

Faculty Peer Reviewed

Case: A 45-year-old woman presents to your office for an annual check-up.  She states that her grandmother was recently diagnosed with colon cancer at the age of 90, and she wants to know what she can do to reduce her own risk for the disease.  She recently read an article about the benefits of vitamin D and wants to know if they extend to protecting against colon cancer. In particular, she is concerned

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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 peculiar name.

The polymyxins (B and E – …

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Kayexalate: What is it and does it work?

December 1, 2010
Kayexalate: What is it and does it work?

By Todd Cutler, MD

Faculty Peer Reviewed

A 62-year-old male is hospitalized with an acute congestive heart failure exacerbation. On hospital day three, the patient’s symptoms have significantly improved with twice daily furosemide 80mg IV. He is continued on IV diuretics and aggressive electrolyte repletion. On day five of his admission, his basic metabolic panel is significant for a creatinine of 2.3 mg/dL (increased from 1.3 on admission) and a potassium concentration of 5.9 mEq/L. His EKG is unchanged from admission. His furosemide is discontinued

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How do you Manage the Adult with Perinatally Acquired Hepatitis B?

October 22, 2010
How do you Manage the Adult with Perinatally Acquired Hepatitis B?

Nathaniel Rosso Smilowitz, MD

Faculty Peer Reviewed

Hepatitis B virus is a DNA hepadnavirus affecting 1.25 million people in the United States and nearly 400 million worldwide.  The virus is transmitted perinatally, sexually, and percutaneously, and is endemic in many countries in South East Asia, Central Asia, and Africa.  When exposure occurs early in life, the likelihood of chronic infection is high; up to 90% of cases of vertical transmission result in the persistence of the viral envelope protein, the hepatitis B surface antigen (HBsAg), …

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From the Archives: Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

October 14, 2010
From the Archives: Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

Please enjoy a post from the Clinical Correlations Archives, first posted 1/22/09

Commentary by Melanie Maslow, MD, FACP, Associate Professor of Medicine, NYUSOM, Chief, Infectious Diseases, New York Harbor Healthcare System, NY

Faculty Peer Reviewed

Cellulitis is an acute spreading infection of the skin extending to the deep subcutaneous tissue characterized by pain, swelling, erythema and warmth. Cellulitis in the non-neutropenic patient, in the absence of bite wounds, salt or fresh water exposure, and coexisting ulcers is usually caused by Gram-positive pathogens, the most common …

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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 that lived in dry, sandy areas, …

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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 Lara 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 not find an increased prevalence of AS in …

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Why Does Multiple Myeloma Treat The Kidneys So Poorly?

September 22, 2010
Why Does Multiple Myeloma Treat The Kidneys So Poorly?

By Jon Emile Kenny, MD

Faculty Peer Reviewed

“You mean I’ve got cancer and my kidneys are failing, doc?” said my frail patient on the Bellevue oncology service shortly after a medical student had told him that his kidneys were damaged. Indeed, his new diagnosis of multiple myeloma was accompanied by an admission creatinine of 2.5 mg/dL.

About a quarter of patients with multiple myeloma have renal insufficiency at diagnosis . There are a number of clinicopathologic responses to multiple myeloma that occur within the …

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Polycythemia Vera Presenting as a Hypercoagulable State: What is the Pathophysiologic Role of JAK2 in the Mechanism, Manifestations, and Treatment of the Disease?

August 11, 2010
Polycythemia Vera Presenting as a Hypercoagulable State:  What is the Pathophysiologic Role of JAK2 in the Mechanism, Manifestations, and Treatment of the Disease?

By Emily Slater

Faculty Peer Reviewed

Mr. R is a 46-year-old man with a past medical history of polycythemia vera on hydroxyurea and chronic hepatitis B and C who presented with acutely worsening left upper-quadrant abdominal pain.  This occurred in the context of 3 months of worsening abdominal pain and 1.5 years of increasing abdominal distension.  His physical exam was remarkable for massive splenomegaly (18cm span) and a non-palpable liver.

Laboratory findings are significant for microcytic anemia with an elevated RDW, thrombocytopenia, elevated PT, PTT,

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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 at least once a …

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