Morning Report-A Frequently Overlooked Diagnosis

December 28, 2006
Morning Report-A Frequently Overlooked Diagnosis

A 57 year old female  with a past medical history of hypertension, obesity, remote intravenous drug use and several years of chronic low back pain, with both intermittent radiation to her lower extremities  and decreased sensation in her lower extremities  presented with an acute worsening of the pain in her lower back.  The patient reported that she was awakened from sleep and "had to crawl to the bathroom," because of the pain.  She was febrile on admission with moderate lower spine tenderness.  She was…

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Breaking News: FDA Advises Caution with Gadolinium Based Contrast

December 27, 2006
Breaking News: FDA Advises Caution with Gadolinium Based Contrast

Commentary By: Minisha Sood PGY-3

The FDA has received reports of 90 patients with moderate to end-stage kidney disease who have undergone MRI or MRA with a gadolinium-based contrast agent and subsequently developed a new disease known as Nephrogenic Systemic Fibrosis (NSF).

Scientists first identified NSF, also known as Nephrogenic Fibrosing Dermopathy (NFD), in 1997 and its cause has not yet been identified.  There have been approximately 200 reports of NSF/NFD only in people with kidney disease.  Neither the duration of kidney disease nor its…

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Who Should Receive Prophylaxis for Gout?

December 26, 2006
Who Should Receive Prophylaxis for Gout?

A 70 year old male, former alcoholic, with a past history of gout diagnosed by joint aspiration, presents with his second episode of right 1st metatarsal erythema, swelling and severe pain in the last 6 months.

Commentary By Pamela Rosenthal, MD Assistant Professor of Medicine, Division of Rheumatology

 

Question 1. Is there any specific rule you follow when deciding to start someone on colchicine prophylaxis? e.g. >x # episodes

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Should we recommend mammography screening for women between the ages of 40-50?

December 22, 2006
Should we recommend mammography screening for women between the ages of 40-50?

In a recent article in the Lancet, this question was addressed by a group of investigators led by Sue Moss, Ph.D. from the University of Leeds.  Currently, the  National Cancer Institute, U.S. Preventative Health Services Task Force and the American Cancer Society all recommend screening at a younger age(those between 40-50).  The task force, however, does recommend educating your patients about the potential risks/benefits regarding mammography at a younger age.  Screening women older than 50 has been shown to reduce mortality from breast cancer by…

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The First Joint Medical-Surgery Conference

December 21, 2006
The First Joint Medical-Surgery Conference

The first monthly medical/surgery conference was a great success. Attended by resisdents and attendings from both departments the conference was a lively discussion regarding the controversies in caring for a 51 year old man who recently underwent a percutaneous coronary intervention with the placement of a Cypher stent after a non-st elevation myocardial infarction, who soon afterwards was found to have a gall bladder mass that needed to be resected. The complete slide presentation can be found here: Joint Medicine-Surgery Conference Slides
A…

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Mystery Quiz #1-The Answer…

December 20, 2006
Mystery Quiz #1-The Answer…

Before you read the answer you will probably want to review the original post of the mystery quiz from last week.

The Answer:

The chest film shows a probable mass in the area of the left hilum and associated complete collapse of the left upper lobe.  The key findings are loss of volume of the left hemithorax indicated by elevation of the left hemidiaphragm and shift of the mediastinum to the left side.  Additionally, the arrows indicate the major fissure, ordinarily not visible,…

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How do you approach a patient with Pneumomediastinum?

December 19, 2006
How do you approach a patient with Pneumomediastinum?

BH Morning Report Fast Facts

29 year old male presents with anuria, vomiting, and pneumomediastinum.  1 month prior to admission the patient traveled to South America and developed an upper respiratory infection.  He returned to the US after traveling for two weeks feeling well.   The patient used ecstasy and marijuana four days prior to presentation.  The next day he developed vomiting including one episode of hemetemesis.  For the next three days he had intermittent vomiting, no diarrhea.  On admission his BUN/CR was 68/7.5. …

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Does Circumcision Decrease the Transmission of HIV?

December 18, 2006
Does  Circumcision Decrease the Transmission of HIV?

Recently, two large clinical trials in Kenya and Uganda that examined the role of circumcision in men to prevent the spread of HIV were halted on the grounds that not offering circumcision to men taking part in the trial would be unethical.  The trials involved nearly 3,000 heterosexual men in Kenya and nearly 5,000 men in Uganda, none of whom were infected with HIV prior to starting the trial.  In the Kenayn trial, men who were circumcised had a 53% relative risk reduction (2%…

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