Mystery Quiz-Radiology

December 13, 2006
Mystery Quiz-Radiology

Posted By Robert Smith, MD Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine 

62 year old male smoker with past medical history notable for hypertension, copd, comes to clinic complaining of chronic cough x 6 months with minimal sputum, no wheezing.  Lung exam shows decreased breath sounds throughout.  Pt had the following CXR performed:

    

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What's your diagnosis and the next step in his evaluation?  Please submit your answers by clicking on the "comments" link below this post. …

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FDA Warns of Methadone Dangers When Used for Chronic Pain

December 12, 2006
FDA Warns of Methadone Dangers When Used for Chronic Pain

Last week, the FDA issued a public health advisory regarding the use of methadone (trade name Dolophine) for chronic pain. Death and life threatening side effects have been reported in patients newly starting methadone treatment and patients who have switched to methadone after taking other narcotics for pain control.  According to the advisory, prescribing methadone is complex and should only be used when moderate to severe pain is not relieved by other non-narcotic pain relievers.

Although pain relief from a…

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What Is Sezary Syndrome?

December 11, 2006
What Is Sezary Syndrome?

Morning Report-Tisch Hospital

Case Presentation: 83 year old with a past medical history of hypertension noted erytematous plaques with scale about 1 year ago.  The rash was associated with diffuse pruritis at that time.  The patient subsequently underwent several inconclusive biopsies.  She was eventially diagnosed with mycosis fungoides and treated with UV therapy.  Her rash progressed to a diffuse pruritic erythema covering the vast majority of her body, including palms and soles.  (erythroderma).  She was noted to have Sezary cells on peripheral smear and diagnosed…

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FDA Approves Sale of Prescription Placebo

December 8, 2006
FDA Approves Sale of Prescription Placebo

Believe it or not…Have a great weekend.

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Outbreak: Toxic Tacos

December 7, 2006
Outbreak: Toxic Tacos

Update 12/12/06  Download new NY DOH Alert

Several Taco Bell restaurants in our area have been shut down recently due to an outbreak of E. Coli O157:H7.  At least 22 people are infected, and most are under age 18.  Interestingly, at least 2 Taco Bell employees have been found to carry the bacteria but are asymptomatic.

The vector is usually undercooked infected meat.  Symptoms usually present within 3-4 days of ingestion. The department of health has issued a warning to physicians to consider this diagnosis if…

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How do you approach a patient with asymptomatic primary hyperparathyroidism?

December 6, 2006
How do you approach a patient with asymptomatic primary hyperparathyroidism?

56 year old  Hispanic female with a history of hypertension, type 2 diabetes on oral medications, hyperlipidemia  and normal renal function. Over the past 2 years she has been noted to have mild hypercalcemia (11.0-11.5) on several basic metabolic panels. On her last visit, intact PTH was checked and was elevated at 66 (normal range 7-57). In patients such as this, with apparent asymptomatic primary hyperparathyroidism, what further diagnostic tests should be done and in whom is surgery indicated?…

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As Power Shifts in Washington…

December 5, 2006
As Power Shifts in Washington…

In the summer of 2002, I worked in DC for the Pharmaceutical Researchers and Manufacturers of America (PHRMA), which is an umbrella organization that represents the largest pharmaceutical companies.  It was the height of Republican power and PHRMA lobbyists were at the forefront of influencing the policy debate.   One of the crowning achievements of the Bush’s domestic policy was the Medicare prescription drug benefit.  Passed in 2003 at an initial cost of…

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Pfizer Shutting Lights on ILLUMINATE Study

December 4, 2006
Pfizer Shutting Lights on ILLUMINATE Study

Low HDL is a well known independent risk factor for atherosclerotic disease.  As a result, there have been several attempts to develop medications to raise HDL.  Specific targets include the inhibition of cholesteryl ester transfer protein, which plays an essential role in HDL metabolism by facilitating the transfer of cholesterol esters from HDL cholesterol to apolipoprotein B-containing lipoproteins.

Pfizer created just that drug.  Known as Torcetrapib, it was seen as a promising therapeutic to increase HDL and potentially…

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