Morning Report: How Do You Approach a Patient With Bronchiectasis

January 16, 2007
Morning Report: How Do You Approach a Patient With Bronchiectasis

Chief complaint: 85 year old female presents with worsening shortness of breath for one day.

History of present illness:

The patient’s history of present illness begins at the age of 60 when she was diagnosed with asthma, for which she had been treated with inhaled anticholinergics, beta agonists and intermittent oral steroids.  Twelve years prior to admission, the patient was diagnosed with diabetes, which was managed with oral medications.  Two years prior to admission, the patient was diagnosed with Mycobacterium avium complex (MAC) at an…

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A Debate: Should Smokers be Denied Surgery?

January 12, 2007
A Debate: Should Smokers be Denied Surgery?

In last week’s issue of the British Medical Journal, two physicians argue about the merits of refusing to perform elective surgeries on smokers. The debate has been spurred by a primary care group in the UK who announced last year that it would take smokers off waiting lists for surgery in an attempt to contain costs. The proponent, Matthew Peters, argues that, for elective procedures such as plastic, reconstructive, and orthopedic surgeries, the rates of complications in smokers are so high that the increased costs…

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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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Why Are Breast Cancer Rates Trending Down?

January 9, 2007
Why Are Breast Cancer Rates Trending Down?

The recent finding of decreasing breast cancer rates made headlines throughout the media; including a NY Times article entitled, Reversing Trend, Big Drop is seen in Breast Cancer on December 15, 2006.

Striking epidemiological facts tells us that breast cancer is the most common cancer in women in the U.S., and only second to lung cancer as the most common cause of cancer deaths. It is estimated that approximately 212,920 American women will be diagnosed with breast cancer in the year…

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A Bad Break for the Purple Pill…

January 8, 2007
A Bad Break for the Purple Pill…

Commentary By Josh Remick, PGY-2

In the December 27th 2006 issue of JAMA, Yang et al. reported the results of a nested case-control study of United Kingdom patients entitled “Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture.” Using the General Practice Research Database (GPRD), a computerized medical record system used by several of the general medical practices in the UK, new hip fracture cases were found in patients at least 50 years old (n=13,556) and matched them with…

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Links: Dermis.net-An Online Dermatology Atlas

January 5, 2007
Links: Dermis.net-An Online Dermatology Atlas

The best online dermatology atlas I have come across is dermIS.net.  The site originates from Germany and includes an excellent, easily searchable database with terrific pictures and clinical information. The most useful feature of the site however is the differential diagnosis list which appears next to the pictures that are displayed.  So if you have an educated guess what the rash you're looking at is, then you can easily review similar rashes and quickly compare and contrast them to your original diagnosis. Then you can make the fancy diagnosis, sound smart…

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Do Statins Get Along With Hepatitis C?

January 4, 2007
Do Statins Get Along With Hepatitis C?

A 53 year old male with chronic hepatitis C and type 2 diabetes is found to have a moderately elevated cholesterol.

1. Is it safe to start a statin?

2. Do statins have any effect on viral replication?

Comentary By Ed Bini, M.D. Associate Professor/Director Gastroenterology and Hepatology Research

The many benefits of statins far outweigh the risks associated with this class of medications. However, statins are known to have the potential to cause hepatotoxicity. The most common form of statin-induced hepatotoxicity is elevations in…

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Does the Existence of Community Acquired MRSA Change Empiric Therapy for Skin and Soft Tissue Infections?

January 3, 2007
Does the Existence of Community Acquired MRSA Change Empiric Therapy for Skin and Soft Tissue Infections?

A 58 year old man with type 2 diabetes and chronic venous insufficiency/recurrent lower extremity cellulitis presents with fever and a left lower extrmity ulcer with purulent drainage. He’s been successfully treated in the past with both Unasyn/Augmentin or Levaquin.  In the face of community acquired methicillin resistant staph aureus (CA-MRSA),  have guidelines for skin and soft tissue infections changed?

Commentary By Howard Leaf, M.D. Assistant Professor, Division of Infectious Diseases and Immunology

 

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