From the Archives

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

November 21, 2013
From The Archives: The Polymyxins: Why am I using them all the time, and what are they?

Please enjoy this post from the archives dated December 8, 2010

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…

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FROM THE ARCHIVES – Kayexalate: What is it and does it work?

November 7, 2013
FROM THE ARCHIVES – Kayexalate: What is it and does it work?

Please enjoy this post from the archives dated December 1, 2010

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

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From The Archives: Creatine Kinase: How Much is Too Much?

October 24, 2013
From The Archives: Creatine Kinase: How Much is Too Much?

Please enjoy this post from the archives dated November 3, 2010

By Jon-Emile Kenny, MD

Faculty Peer Reviewed

A 37-year-old man, with no past medical history and taking finasteride for male pattern baldness, is admitted to Medicine with profound lower extremity weakness after a weekend of performing multiple quadriceps exercises. His measured creatine phosphokinase (CPK) is over 35,000 IU/liter. I wonder to myself, what is the risk to his kidneys and can I mitigate the damage?

Rhabdomyolysis means destruction of striated muscle. Physical manifestations range from…

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From The Archives: Asking the Potentially Answerable Clinical Question

October 3, 2013
From The Archives: Asking the Potentially Answerable Clinical Question

Please enjoy this post from the Archives, dated October 1, 2010

By Dorice L. Vieira M.A., M.L.S.

Faculty Peer Reviewed

The title to this feature may seem a bit odd, but there is a proper way to ask evidence-based clinical questions.  “What is the treatment for diabetes?” is not a well-defined question.  A PubMed literature search using the terms “diabetes” and “treatment” retrieves a total of 167,843 citations covering a myriad of approaches to the treatment of diabetes:  type I (26,884…

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From The Archives: Does Heyde Syndrome Exist?

August 8, 2013
From The Archives: Does Heyde Syndrome Exist?

Please enjoy this post from the Archives dated September 29, 2010

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…

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From The Archives: Why Does Multiple Myeloma Treat The Kidneys So Poorly?

July 11, 2013
From The Archives: Why Does Multiple Myeloma Treat The Kidneys So Poorly?

Please enjoy this post from the Archives dated September 22, 2010

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…

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From The Archives – Myths and Realities: Heart and Wine

September 27, 2012
From The Archives – Myths and Realities: Heart and Wine

Please enjoy this post from the archives dated August 26, 2010

By Aditya Mattoo, MD

Faculty Peer Reviewed

Not too long ago, a patient came to my clinic and said (I’m paraphrasing of course), “I never cared for alcohol, doctor, so I haven’t had much to drink since my college days. Maybe champagne or wine on the rare special occasion, but I keep hearing about how wine is good for your heart, so I am thinking I should start drinking regularly.” For years I have…

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From The Archives: The Role of Serologic Testing in the Diagnosis of Celiac Disease

August 23, 2012
From The Archives: The Role of Serologic Testing in the Diagnosis of Celiac Disease

Please enjoy this post from the archives dated, August 18, 2010

By Todd Cutler

Faculty Peer Reviewed

A 31-year-old woman presents to the clinic with chronic fatigue. She was diagnosed with iron  deficiency anemia when she was 25 years old and has since taken oral contraceptives to limit bleeding during menstruation which she describes as minimal. She has a family history significant for an older brother with celiac disease. She is thin and her exam is significant for conjunctival pallor. Her laboratory findings are

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From The Archives – Ask a Librarian: What are the Key Resources for Clinical Decision Making?

August 9, 2012
From The Archives – Ask a Librarian: What are the Key Resources for Clinical Decision Making?

Please enjoy this post from the archives dated July 14, 2010

By Aileen McCrillis, MSLIS

Faculty Peer Reviewed

In order to ensure the best-quality healthcare for patients, it is important for clinicians to consult the highest level of evidence to guide them in the decision-making process. As the volume of biomedical literature increases over time, it becomes more and more difficult for the clinician to identify the best evidence.

Many different types of clinical decision-making resources are now available to clinicians through the Internet.…

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From The Archives – Evolution and Medicine: Why do we age?

July 19, 2012
From The Archives – Evolution and Medicine: Why do we age?

Please enjoy this post from the archives dated January 30, 2010.

Mark D. Schwartz and Julia Hyland Bruno

Jeanne Calment rode her bicycle until age 100, quit smoking at 117, and died in 1977 at 122 years of age in Arles, France. This news-worthy story raises some questions: Why do we age at all? Why don’t we live forever? And many of us are asked by our patients, is old age a disease we can cure?

First, some useful distinctions: Aging is getting chronologically older,…

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From The Archives: The Ethics of Electronic Health Records

June 21, 2012
From The Archives: The Ethics of Electronic Health Records

Please enjoy this post from the archives dated January 15, 2010

John J. Mercuri

Faculty peer reviewed

Introduction
The 111th Congress allocated $19 billion of the American Recovery and Reinvestment Act of 2009 toward the creation of an electronic health record (EHR) for each person in the United States by 2014.(1) The recent debate over EHRs has focused largely on the economic, logistical, and political consequences of implementing such a system; however, the country should also contemplate the ethical ramifications of EHRs. Addressing these concerns…

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From The Archives: How Does Alcohol Cause Cardiomyopathy?

April 19, 2012
From The Archives: How Does Alcohol Cause Cardiomyopathy?

Please enjoy this post from the archives dated November 4, 2009

Charles Levine

Faculty peer reviewed

Excessive consumption of ethanol (EtOH) has many deleterious effects on the human body. The heart is a target of damage from EtOH consumption, as chronic consumption of EtOH leads to decreased cardiac function and structural heart disease, including dilated cardiomyopathy.(1) The exact mechanism by which EtOH exerts its deleterious effects on the heart remains poorly understood and is an area of active…

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