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Treatment of obesity with bariatric surgery: evidence and implications

November 15, 2007
Treatment of obesity with bariatric surgery: evidence and implications

Commentary by Jatin Roper MD PGY-3 and Christine Ren MD Associate Professor, Department of Surgery

Bariatric procedures to treat obesity involve the restriction of the gastric reservoir, bypass of part of the gastrointestinal tract, or both. Worldwide, an estimated 300 million people are obese, and in the United States, the percentage of adults who are obese increased from 15% in 1995 to 24% in 2005. (Obesity is defined as a Body Mass Index or BMI of 30 or more, measured as kg /…

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Why Does Hypertriglyceridemia Lead to Pancreatitis?

October 4, 2007
Why Does Hypertriglyceridemia Lead to Pancreatitis?

Commentary by Daniel Frenkel, PGY-2

Case: A 46 year old male with diabetes on oral hypoglycemic medications is admitted to the hospital with one day of constant epigastric pain, nausea, vomiting, and an inability to tolerate oral intake. You are concerned about pancreatitis but laboratory analysis reveals amylase levels that are within the normal reference range. You notice that his glucose level is 410mg/dL and that the specimen is described as lactescent. Should you still be concerned about acute pancreatitis?

Lactescent or lipemic blood samples…

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X Ray Visions Mystery Quiz- The Answer

August 30, 2007
X Ray Visions Mystery Quiz- The Answer

Before you read the answer, you may want to review the initial Mystery Quiz posted last week.

Commentary by Andrew Hardie MD, Fellow, NYU Department of Radiology

Although this patient’s symptoms were not the most typical of this entity, the CT findings in this case are diagnostic of a perforated anterior duodenal ulcer. The most essential observation, and the one that alters management, is the presence of intraabdominal free air (arrows). The small collections of air in this case are not unusual for bowel perforations,…

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Are beta blockers indicated in cirrhotics with small varices?

August 1, 2007
Are beta blockers indicated in cirrhotics with small varices?

Commentary by Bani Chander MD, PGY-2

Esophageal varices are a common complication of cirrhosis and approximately one-third of all cirrhotic patients with varices will develop a variceal bleed . Each episode of variceal hemorrhage is associated with a 15 to 20 percent risk of mortality in patients with severe liver dysfunction.  The risk of bleeding is related to the location, size, and appearance of the varix, presence of red wale markings, variceal pressure, prior history of variceal bleeding, as well as the severity…

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A Case of Celiac Disease and Diagnostic Clues

July 12, 2007
A Case of Celiac Disease and Diagnostic Clues

Commentary by Josh Olstein MD, Chief Resident NYU Internal Medicine

Mr. J is a 56 year old Caucasian gentleman who presented with complaints of “I just can’t do what I used to be able to do. I just don’t have the energy.” He describes himself as a hearty fellow who had never had a problem with his energy level until around a year ago. Though he has not noticed any weight loss, he denied any weight gain despite the lumberjack-like portions he eats…

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Should All Patients with Hepatitis C Be Screened for Hepatocelluar Carcinoma?

July 3, 2007
Should All Patients with Hepatitis C Be Screened for Hepatocelluar Carcinoma?

Should patients with Hepatitis C (HCV) with no evidence of cirrhosis undergo screening for hepatocellular carcinoma (HCC)? Is there any reason to check for HCC when the liver associated enzymes (LAEs) are normal?

-Sandeep Mangalmurti, PGY-2

Commentary by Mike Poles MD, Associate Editor Clinical Correlations and Assistant Professor, Division of Gastroenterology

HCC continues to be one of the most common solid malignancies worldwide. Further, almost all cases of HCC occur in the background of a histologically-abnormal liver; approximately 90% of cases of HCC occur in…

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Meeting Perspectives: Digestive Disease Week (DDW) 2007

June 20, 2007
Meeting Perspectives: Digestive Disease Week (DDW) 2007

Commentary by Milini Sahu, MD Fellow, Division of Gastrotenterology, Gina Sam-DeRiggs, Fellow, Division of Gastroenterology, and Michael Poles MD,  Assistant Professor, NYU Division of Gastroenterology and Associate Editor, Clinical Correlations

Close to 17,000 gastroenterologists attended Digestive Disease Week (DDW) from May 19-24 in Washington DC. While I stayed behind (someone has to help with emergency endoscopies), the majority of NYU’s gastroenterology fellows and attendings were there for a week of learning, presenting, and making NYU proud.  Two of our fellows, Malini…

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Morning Report-How Do You Approach a Patient with a Significant Transaminitis?

March 23, 2007
Morning Report-How Do You Approach a Patient with a Significant Transaminitis?

Consultant: Robert Raicht, MD Professor of Medicine, Chief Division of Gastroenterology

Clinical Vignette:
The patient is a 50 year old male with a past medical history notable for type II diabetes, hypertension and recently treated right foot cellulitis and c.difficile colitis who presented to the emergency room with the complaint of fevers and malaise for 1 week. His labs were notable for a significant transaminitis (AST 1997, ALT 1620, alkaline phosphatase 365, total bilirubin 3.1), INR wnl. An abdominal ultrasound was ordered with outpatient follow-up…

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Should patients with Anemia and a Normal Ferritin Undergo Colonoscopy?

February 16, 2007
Should patients with Anemia and a Normal Ferritin Undergo Colonoscopy?

Commentary By: Joshua Olstein PGY-3

Second only to lung cancer, colon cancer claimed an estimated 55,000 lives in the United States in 2006. In an effort to reduce colon cancer morbidity and mortality, multiple screening tests have been developed to detect early disease among asymptomatic individuals. The 2003 American Gastroenterology Associations guidelines for screening asymptomatic individuals recommended colonoscopy as a preferred method of screening.

Due to a higher risk of colonic neoplasm, patients with unexplained iron-deficiency anemia are not included in these…

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How Should You Approach A Patient with an Incidental Finding of a Portal Vein Thrombosis?

February 7, 2007
How Should You Approach A Patient with an Incidental Finding of a Portal Vein Thrombosis?

A  70 year old man  with a history of prostate cancer, status post radiation treatment in August 2003, a history of abdominal surgery for unknown reasons, and a history of heavy alcohol use was seen at the VA.   The patient was referred for a complaint of bright red blood per rectum and was incidentally noted to have elevated liver enzymes. 

Colonoscopy revealed blood in the rectosigmoid, dilated vessels in the rectum and angioectasia, thought to be secondary to the radiation…

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A drug for NASH that may work?

January 24, 2007
A drug for NASH that may work?

Commentary By: Sandra D'Angelo, PGY-3

Nonalcoholic steatohepatitis (NASH) is a disease in which patients have features of alcoholic hepatitis on liver biopsy without a prior history of significant alcohol consumption and negative hepatitis serologies. It is unclear how prevalent this disease is because most patients with liver function abnormalities do not undergo liver biopsy.  In those that have had a liver biopsy, the prevalence is estimated to be 7-9%.  It is most common in women between the ages of 40-60 and…

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To Lavage or Not to Lavage?

January 10, 2007
To Lavage or Not to Lavage?

Case and Commentary by Minisha Sood PGY-3 and Ilseung Cho Fellow, Division of Gastroenterology

The patient is a 57 year-old man with a past history of hypetension, hyperlipidemia, hepatitis B/C cirrhosis and coronary artery disease status/post a non-st-elevation mi in August 2006, during which time he was on a heparin drip and developed an upper gastrointestinal bleed. Upper endoscopy at that time revealed non-bleeding esophageal varices and he was discharged on a beta blocker. He again presented to Tisch hospital in December 2006 with complaints…

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