Quick Thinking #1

March 30, 2007
Quick Thinking #1

Welcome to Quick Thinking a new feature of Clinical Correlations. A case will be presented piece by piece to a faculty expert who will comment on their approach to the case as it unfolds. Differential diagnoses and diagnostic workups will form the basis of these posts of difficult clinical cases. So for the next 4 Fridays we present our first case to our discussant Mitchell Charap:

The Case Presented by Elizabeth Ross, PGY-3: The patient is a 35 year old African American male…

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First Direct Renin Inhibitor Approved for Hypertension

March 29, 2007
First Direct Renin Inhibitor Approved for Hypertension

Commentary By: Josh Olstein, PGY-3

Earlier this month the FDA approved Tekturna (aliskiren) the first drug in a novel class of antihypertensives that work by directly inhibiting renin. While Novartis has yet to release pricing information, don’t expect to see this new addition on the Bellevue or VA formulary any time soon.

The idea of treating hypertension by blocking the actions of renin has been toyed with by pharmaceutical companies for over twenty years with little success. Aliskiren is the first agent…

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The COURAGE Trial: PCI is not superior to medical therapy in patients with stable coronary disease

March 27, 2007
The COURAGE Trial:  PCI is not superior to medical therapy in patients with stable coronary disease

Commentary by Cara Litvin, PGY-3

The results of one of the more remarkable studies from the meeting of the American College of Cardiology were presented on Monday, along with the simultaneous early publishing of the study online in the New England Journal of Medicine. As a result the study results captured a front page article in today’s New York Times.

The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial was a randomized trial involving 2287 patients with stable but significant coronary artery disease…

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Notice: Med-Surg Conference Thursday 3/29 in the Saul Farber Auditorium, Bellevue Hospital

March 27, 2007
Notice: Med-Surg Conference Thursday 3/29 in the Saul Farber Auditorium, Bellevue Hospital

Our next med-surg conference is Thursday March 29 at 4:30pm. It will be comprised of two heated debates. The first will be a debate over the need for surgery in asymptomatic patients with a severe carotid artery stenosis featuring Greg Mints, MD and vascular surgeon, Thomas Riles, MD The second debate will answer the question of whether there is a need for bone biopsy in the treatment of osteomyelitis. Pro: Harold Horowitz, MD from ID Con: Nirmal Tejwani, MD from orthopedics. We look forward to seeing you there.…

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ShortCuts-This Week in the Journals

March 26, 2007
ShortCuts-This Week in the Journals

It seemed to be a slow week in the medical literature, but that will likely change as the 2007 American College of Cardiology Scientific Session is now underway. Theheart.org has an excellent summary about what to expect from the meetings. (free registration required).

The annals has an interesting prospective observational study that looks at a prediction rule to determine whether a patient with a minor head injury with or without loss of consciousness should have a catscan done. The prediction rule includes age,…

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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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Conflicts of Interest

March 21, 2007
Conflicts of Interest

The debate about the ethically questionable relationship between physicians and the pharmaceutical industry opened up again this morning on the front page of the New York Times. Although the article is heavy on interview and anecdote and a little short on evidence, it is difficult to avoid casting a critical eye on this relationship. The impetus for the article is the new laws in a handful of states requiring drug makers to disclose all payments made to doctors. These laws have made public previously…

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Will my breast cancer patient need adjuvant chemotherapy? Gene Micro array technology may help answer this question��

March 20, 2007
Will my breast cancer patient need adjuvant chemotherapy?  Gene Micro array technology may help answer this question��

Commentary By Sandra D’Angelo, PGY-3

Breast cancer is the most common cancer diagnosed in women, second only to lung cancer as a leading cause of death from cancer. Experts state that approximately 210, 000 women will be diagnosed in 2006 and about 40,000 will die from the disease.1 According to data compiled by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, 61% of breast cancer cases are diagnosed while the cancer is still confined to the primary site (localized stage);…

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